- Email: [email protected]
Intraventricular vancomycin in the treatment of ventriculitis associated with cerebrospinal fluid shunting and drainage
INTERNATIONAL ABSTRACTS ration, and its use in this manner is recommended.--George Holcomb, Jr Multicystic Dysplastic Kidney: Natural History From In Utero Diagnosis and Postnatal Follow-up. E.F. Avni, T. Lalmand, F.
Didier, et al. J Urol 138:1420-1424, (December), 1987. Based on the experience with 13 in utero diagnoses, the authors report changes that may occur in the ultrasonic appearance of a multicystic dysplastic kidney. Macrocysts appear obvious only in the early third trimester of pregnancy. After reaching a maximum size, the cysts start to involute either in utero or after birth. This may lead to a small noncystic mass, the so-called aplastic kidney, or even to complete disappearance of the entire dysplastic kidney. The dysplastic kidney seems vulnerable to anoxia or infection, and necrosis may supervene. The multicystic dysplastic kidney is a progressive and changing disorder. If its radiologic appearance is typical, management may be conservative with ultrasonic monitoring. Nephrectomy should be done if there is any abnormal clinical or ultrasonic change.--George Holcomb, Jr MUSCULOSKELETAL SYSTEM The Natural History of Hip Dislocations in Ambulatory Myeolomeningocele. H.H. Shekr, J. Melchionne and R. Smith. Z Kinderchir
42 (suppl 1): 48-49, (December), 1987. The authors studied 22 myelomeningocele patients with strong quadriceps and good ambulatory capability who had a dislocated hip. These patients did not have hip pain, had good to excellent hip motion, and could sit without difficulty. All but one were good to excellent community ambulators with crutches and orthoses. Twenty-five percent had limb length inequality requiring shoe lifts, but this combination did not impair functional capability. None owned wheelchairs. Seven had associated musculoskeletal deformities that required treatment. It was concluded that the hip dislocation in these patients was not significant. A similar series of 11 patients was evaluated who had open reduction of a dislocated hip an average of 18 months previously. Two patients were slightly improved and five patients were significantly worse after the open reductions. Serious complications related to surgery ensued in half of the cases. The cost of surgery and treatment of the complications in these 11 patients was $400,000. It is concluded that surgical treatment of paralytic hip dislocations in ambulatory myelomeningocele patients offers no distinct benefit.-- Thomas A. Angerpointne r The Evolution of Surgical Treatment of Spinal Deformity in My-
elomeningocele. J.V. Banta. Z Kinderchir 42 (suppl 1):10-12, (December), 1987. Although modern anterior and posterior fusion techniques can provide excellent correction of dysraphic spinal deformities, the surgery can be formidable. Newer surgical techniques utilizing segmental spinal fixation of implants has afforded both a greater degree of three-dimensional correction of spinal deformity and more rigid control of the fusion mass. However, due to the inherent loss of posterior elements and the associated high level of paralysis, the use of bivalved total contact spinal orthoses is essential to achieve a high fusion rate with a minimum number of complications.-- Thomas A. Angerpointner NERVOUS SYSTEM Do Cerebral Arteriovenous Malformations Increase in Size? A.D.
Mendelow, A. Erfurth, K. Grossant, et al. J Neurol Neurosurg Psychiatry 50:980-987, (August), 1987. Six patients with cerebral arteriovenous malformations were reviewed over 4 to 20 years. The researchers conclude that these
879
vascular lesions may be expected to increase in size by 0% to 3% per annum and that this rate of enlargement should be considered with regard to timing of surgery or other forms of treatment.--R.J. Brereton A Reappraisal of the Relationship Between Arachnoid Cysts of the Middle Fossa and Chronic Subdural Haematoma. A. Page, R.M.
Paxton, and D. Mohan. J Neurol Neurosurg Psychiatry 50:10011007, (August), 1987. It has been increasingly recognized that infants with arachnoid cysts of the middle fossa are susceptible to the development of subdural hematomas. The authors describe seven such patients, mainly teenagers. Primary arachnoid cysts are thought to occur prenatally as a result of multiple local developmental abnormalities, whereas secondary arachnoid cysts may follow trauma or infection. The mechanism whereby they predispose to subdural hematoma formation is open to speculation.--R.J. Brereton Intraventricular Vancomycin in the Treatment of Ventriculitis Associated With Cerebrospinal Fluid Shunting and Drainage. R.
Bayston, C.A. Hart, and M. Barnicoat. J Neurol Neurosurg Psychiatry 50:1419-1423, (November), 1987. The authors report the results of treatment of 50 patients with ventriculitis associated with the presence of a cerebrospinal fluid shunt or external ventricular drain. In those treated with intraventricular vanocomycin, and overall cure rate was 66%. Those having the shunt removed did better than those treated leaving the shunt in situ. Despite relatively high concentrations of vancomycin in the CSF, no toxicity was seen.--R.J. Brereton Eosinophilic Meningitis and Radiculomyelitis in Thailand Caused by CNS Invasion of Gnathostoma Spinigerum and Angiostrongylus
Cantonesis. E. Schmutzhard, P. Boongird, and A. Vejjajiva. J Neurol Neurosurg Psychiatry 51:80-87, (January), 1988. Increasingly, young people are traveling to Asia to imitate the local eating habits of villagers and thus are at risk of acquiring local parasites, eg, 100,000 German tourists visited Thailand in 1985. Eosinophilic meningitis may be caused by tuberculous, syphilis, viral or fungal organisms, drug allergies, neoplasms, leukemia, Hodgkin's disease, multiple sclerosis, and parasitic infections. In Southeast Asia parasites are the most common cause, especially Cysticerous cellulosae, Angiostrongytus cantonensis, and Gnathostoma spinigerum. The first is a tape worm of world wide distribution, but the latter two nematodes are exclusively found in Southeast Asia. They are acquired by eating undercooked fish, fowl, or snails. Various neurologic problems may ensue, including death from invasion of vital centres. Even in survivors there is a high risk of permanent neurologic damage, and there is no specific treatment.--R.J. Brereton Selective Indications for the Use of Praziquantel in the Treatment of Brain Cysticercosis. D. Vasconcelos, I-1. Cruz-Segura, 1-I.
Mateos-Gomez, et al. J Neurol Neurosurg Psychiatry 50:383-388, (April), 1987. Over a period of 2 years, the authors treated 40 patients with brain cysticercosis confirmed by CT scan. The use of praziquantel in neurocysticercosis was described in 1980, and many patients were subsequently treated with the drug in an uncontrolled manner. As a result, poor results were obtained. The authors set out to delineate the criteria for selection of patients for treatment with this drug in a dose of 50 mg/kg/d in three divided doses. CT scan demonstrated changes in the cysts within 1 week of starting treatment, and even large cysts vanished within 8 weeks. In none of the scans at 4 months
Didier, et al. J Urol 138:1420-1424, (December), 1987. Based on the experience with 13 in utero diagnoses, the authors report changes that may occur in the ultrasonic appearance of a multicystic dysplastic kidney. Macrocysts appear obvious only in the early third trimester of pregnancy. After reaching a maximum size, the cysts start to involute either in utero or after birth. This may lead to a small noncystic mass, the so-called aplastic kidney, or even to complete disappearance of the entire dysplastic kidney. The dysplastic kidney seems vulnerable to anoxia or infection, and necrosis may supervene. The multicystic dysplastic kidney is a progressive and changing disorder. If its radiologic appearance is typical, management may be conservative with ultrasonic monitoring. Nephrectomy should be done if there is any abnormal clinical or ultrasonic change.--George Holcomb, Jr MUSCULOSKELETAL SYSTEM The Natural History of Hip Dislocations in Ambulatory Myeolomeningocele. H.H. Shekr, J. Melchionne and R. Smith. Z Kinderchir
42 (suppl 1): 48-49, (December), 1987. The authors studied 22 myelomeningocele patients with strong quadriceps and good ambulatory capability who had a dislocated hip. These patients did not have hip pain, had good to excellent hip motion, and could sit without difficulty. All but one were good to excellent community ambulators with crutches and orthoses. Twenty-five percent had limb length inequality requiring shoe lifts, but this combination did not impair functional capability. None owned wheelchairs. Seven had associated musculoskeletal deformities that required treatment. It was concluded that the hip dislocation in these patients was not significant. A similar series of 11 patients was evaluated who had open reduction of a dislocated hip an average of 18 months previously. Two patients were slightly improved and five patients were significantly worse after the open reductions. Serious complications related to surgery ensued in half of the cases. The cost of surgery and treatment of the complications in these 11 patients was $400,000. It is concluded that surgical treatment of paralytic hip dislocations in ambulatory myelomeningocele patients offers no distinct benefit.-- Thomas A. Angerpointne r The Evolution of Surgical Treatment of Spinal Deformity in My-
elomeningocele. J.V. Banta. Z Kinderchir 42 (suppl 1):10-12, (December), 1987. Although modern anterior and posterior fusion techniques can provide excellent correction of dysraphic spinal deformities, the surgery can be formidable. Newer surgical techniques utilizing segmental spinal fixation of implants has afforded both a greater degree of three-dimensional correction of spinal deformity and more rigid control of the fusion mass. However, due to the inherent loss of posterior elements and the associated high level of paralysis, the use of bivalved total contact spinal orthoses is essential to achieve a high fusion rate with a minimum number of complications.-- Thomas A. Angerpointner NERVOUS SYSTEM Do Cerebral Arteriovenous Malformations Increase in Size? A.D.
Mendelow, A. Erfurth, K. Grossant, et al. J Neurol Neurosurg Psychiatry 50:980-987, (August), 1987. Six patients with cerebral arteriovenous malformations were reviewed over 4 to 20 years. The researchers conclude that these
879
vascular lesions may be expected to increase in size by 0% to 3% per annum and that this rate of enlargement should be considered with regard to timing of surgery or other forms of treatment.--R.J. Brereton A Reappraisal of the Relationship Between Arachnoid Cysts of the Middle Fossa and Chronic Subdural Haematoma. A. Page, R.M.
Paxton, and D. Mohan. J Neurol Neurosurg Psychiatry 50:10011007, (August), 1987. It has been increasingly recognized that infants with arachnoid cysts of the middle fossa are susceptible to the development of subdural hematomas. The authors describe seven such patients, mainly teenagers. Primary arachnoid cysts are thought to occur prenatally as a result of multiple local developmental abnormalities, whereas secondary arachnoid cysts may follow trauma or infection. The mechanism whereby they predispose to subdural hematoma formation is open to speculation.--R.J. Brereton Intraventricular Vancomycin in the Treatment of Ventriculitis Associated With Cerebrospinal Fluid Shunting and Drainage. R.
Bayston, C.A. Hart, and M. Barnicoat. J Neurol Neurosurg Psychiatry 50:1419-1423, (November), 1987. The authors report the results of treatment of 50 patients with ventriculitis associated with the presence of a cerebrospinal fluid shunt or external ventricular drain. In those treated with intraventricular vanocomycin, and overall cure rate was 66%. Those having the shunt removed did better than those treated leaving the shunt in situ. Despite relatively high concentrations of vancomycin in the CSF, no toxicity was seen.--R.J. Brereton Eosinophilic Meningitis and Radiculomyelitis in Thailand Caused by CNS Invasion of Gnathostoma Spinigerum and Angiostrongylus
Cantonesis. E. Schmutzhard, P. Boongird, and A. Vejjajiva. J Neurol Neurosurg Psychiatry 51:80-87, (January), 1988. Increasingly, young people are traveling to Asia to imitate the local eating habits of villagers and thus are at risk of acquiring local parasites, eg, 100,000 German tourists visited Thailand in 1985. Eosinophilic meningitis may be caused by tuberculous, syphilis, viral or fungal organisms, drug allergies, neoplasms, leukemia, Hodgkin's disease, multiple sclerosis, and parasitic infections. In Southeast Asia parasites are the most common cause, especially Cysticerous cellulosae, Angiostrongytus cantonensis, and Gnathostoma spinigerum. The first is a tape worm of world wide distribution, but the latter two nematodes are exclusively found in Southeast Asia. They are acquired by eating undercooked fish, fowl, or snails. Various neurologic problems may ensue, including death from invasion of vital centres. Even in survivors there is a high risk of permanent neurologic damage, and there is no specific treatment.--R.J. Brereton Selective Indications for the Use of Praziquantel in the Treatment of Brain Cysticercosis. D. Vasconcelos, I-1. Cruz-Segura, 1-I.
Mateos-Gomez, et al. J Neurol Neurosurg Psychiatry 50:383-388, (April), 1987. Over a period of 2 years, the authors treated 40 patients with brain cysticercosis confirmed by CT scan. The use of praziquantel in neurocysticercosis was described in 1980, and many patients were subsequently treated with the drug in an uncontrolled manner. As a result, poor results were obtained. The authors set out to delineate the criteria for selection of patients for treatment with this drug in a dose of 50 mg/kg/d in three divided doses. CT scan demonstrated changes in the cysts within 1 week of starting treatment, and even large cysts vanished within 8 weeks. In none of the scans at 4 months