- Email: [email protected]
The employment of adults with spina bifida
92
INTERNATIONAL ABSTRACTS
prognosis group over the poor prognosis groups regardless of the treatment received in the poor prognosis group. Of the patients in the good prognosis group 78% have normal cognitive development, 76% arc ambulatory, and 96% are residing in the natural home. Of the survivors in the poor prognosis group who received supportive care only, 40% have normal cognitive development, 20% are ambulatory, 50% are residing in the natural home, and 60% have kyphoscoliosis. Of those survivors with the poor prognosis who had early surgery, 62% have normal cognitive development, 18% are ambulatory, 79% reside in the natural home, and 54% have kyphoscoliosis. These differences in the poor prognosis groups were not statistically significant, however. The authors feel that improved initial stabilization of newborns, better technical options for management, and social change have influenced the better outcome in children with myelodysplasia. The prognostic criteria remained reliable predictors of the outcome of survivors and should not be confused with the prediction of death among infants assigned to supportive care. The authors recommend early surgical care for most newborns with myelodysplasia after the parents have been fully informed about the infants' prognosis, possible complications, available treatments, and educational and social options.--Eugene S. Wiener A Review of the Management Policy for Newborn Spina Bifida Children at Our Lady's Hospital for Sick Children, Crumlin, 1973 to 1983. E.J. Guiney, R.J. Fitzgerald and C. Goldberg. Z Kinderchir
39 Suppl ll:114-116, (December), 1984.
Employment
of Adults With
Spina Bifida. A.P. Lonton,
A.M. Loughlin and A.M. O'Sullivan. 11:132-134, (December), 1984.
113, (Decem-
Ten cases of shunt-associated ventriculitis treated with intraventricular vancomycin are presented. Eight were cured of their infection, one of these without shunt removal, though this failed in another instance. There were no toxic or untoward effects except in one case, where intravenous administration of vancomycin produced a histamin-like reaction. Intraventricular vancomycin, preferably combined with oral rifampicin, should be considered in cases of intractable or problematic shunt-associated ventriculitis due to grampositive organisms. Thomas A. Angerpointner Comparison of Two Methods of Prophylaxis Against CSF Shunt Infection. M. Lambert, A.E. MacKinnon and A. Vaishnav.
Z Kinderchir 39 Suppl II:109 110, (December), 1984. In a series of 68 operations for insertions or revision of C S F shunts, the incidence of infection was reduced from 20% in controls to 4.2% when systemic and intrathecal or intrashunt gentamycin prophylaxis was employed. The only infection occurring in the latter group was due to an organism resistant to gentamycin. No reduction in infection rate was noted when povidone iodine was instilled into the wounds. Thomas A. Angerpointner An Operative Technique to Reduce Valve Colonisation. R. Fitzger-
ald and B. Conolly. Z Kinderchir 39 Suppl II: 107-108, (December),
The management policy at Our Lady's Hospital for Sick Children, Crumlin for newborn spina bifida infants consists of immediate operation for those considered likely to benefit and full nursery care for those who do not have early surgery. In the 11 years since this policy was first implemented, there have been 493 infants admitted with open myelomeningocele. Two hundred sixty (52.7%) were managed nonoperatively. The mortality for all infants so managed was 78% at one year. Of this group, 171 (66%) died without further intervention. Eighty-nine (34%) survived long enough for some form of treatment to be instituted. Of these, 41 children are still alive, and it is felt that their handicaps have not been increased by their early management. It is argued that an approach to management that considers the needs and interests of the individual infant is more acceptable than one that seeks to enforce total care, regardless of circumstances, or the impersonal assignment by criteria into "Treatment" and "Nontreatment" groups.--Thomas A. Angerpointner The
R.E. Cudmore, et al. Z Kinderchir 39 Suppl I I : l l l ber), 1984.
Z Kinderchir 39 Suppl
Information on employment was obtained from 157 adults with spina bifida aged 18 to 26 years. Ninety were given an additional interview. Forty-three percent had been employed at some time, but only 19% currently. They mainly did routine, nonmanual work for average working hours but below average pay. They enjoyed their jobs, principally for social contact, and were well accepted by employees and workmates. Unfortunately, job retention was poor. The 81% who were unemployed largely hoped to find jobs, but suitable ones were not available. They considered that they should have more help to find jobs. Their days were mainly spent at home or at day centers. They had no doubts that being unemployed had many disadvantages, of which the principal one was lack of social contact. Financial hardship was also mentioned.--Thomas A. Angerpointner The Use of Intraventricular Vancomycin in the Treatment of CSF Shunt Associated Ventriculitis. R. Bayston, M. Barnicoat,
1984. Using a multiple skin preparation technique, drape edges soaked in chlorhexidine and valves primed with gentamycin solution, CSF shunt colonisation rate was reduced to 2.4% of 82 operations. --Thomas A. Angerpointner The Tethered Spinal Cord Syndrome. S.tt. Bakker-Niezen, H.A.D.
Walder and J.L. Merx. Z Kinderchir 39 Suppl II: 100-103, (December), 1984. The results of surgical treatment of the tethered spinal cord syndrome in 25 children in the age range 6 weeks to 19 years are reported. After a description of symptomatology, the importance of neuroradiologic investigations, including myelography and CT-scanning, as well as urodynamic studies are explained. The operative techniques are described in cases of tight ilium terminale, diastematomyelia, lipomyelomeningocele, and meningocele. Early operation is essential to avoid neurological damage that results from awaiting the onset of symptoms. The aim of operation is to free the conus medullaris and cauda equina before mechanical traction or compression damages function in the lumbosacral cord.-- Thomas A. Angerpointner A Case of Spinal Subdural Hematoma in an Immature Neonate After Lumbar Puncture. N. Takeda, T. Shimojo, K. Nakajima, et
al. J Pediatr Surg 17:522 526, 1985. A 10-day-old baby girl with spinal subdural hematoma following multiple lumbar punctures is presented. She was born following 37 weeks gestation and normal delivery. Birth weight was 2040 g. Multiple lumbar punctures were performed because of vertical nystagmus and apnea at age 7 days. She gradually lost movement of both lower extremities and by the age of 10 days was completely paraplegic. Myelography showed a complete block at the level of T10. Emergency laminotomies between TI and L3 revealed a subdural hematoma and low conus medullaris. The hematoma was successfully removed. The postoperative course was eventful with slow but steady improvement from paraplegia. The authors empha-
INTERNATIONAL ABSTRACTS
prognosis group over the poor prognosis groups regardless of the treatment received in the poor prognosis group. Of the patients in the good prognosis group 78% have normal cognitive development, 76% arc ambulatory, and 96% are residing in the natural home. Of the survivors in the poor prognosis group who received supportive care only, 40% have normal cognitive development, 20% are ambulatory, 50% are residing in the natural home, and 60% have kyphoscoliosis. Of those survivors with the poor prognosis who had early surgery, 62% have normal cognitive development, 18% are ambulatory, 79% reside in the natural home, and 54% have kyphoscoliosis. These differences in the poor prognosis groups were not statistically significant, however. The authors feel that improved initial stabilization of newborns, better technical options for management, and social change have influenced the better outcome in children with myelodysplasia. The prognostic criteria remained reliable predictors of the outcome of survivors and should not be confused with the prediction of death among infants assigned to supportive care. The authors recommend early surgical care for most newborns with myelodysplasia after the parents have been fully informed about the infants' prognosis, possible complications, available treatments, and educational and social options.--Eugene S. Wiener A Review of the Management Policy for Newborn Spina Bifida Children at Our Lady's Hospital for Sick Children, Crumlin, 1973 to 1983. E.J. Guiney, R.J. Fitzgerald and C. Goldberg. Z Kinderchir
39 Suppl ll:114-116, (December), 1984.
Employment
of Adults With
Spina Bifida. A.P. Lonton,
A.M. Loughlin and A.M. O'Sullivan. 11:132-134, (December), 1984.
113, (Decem-
Ten cases of shunt-associated ventriculitis treated with intraventricular vancomycin are presented. Eight were cured of their infection, one of these without shunt removal, though this failed in another instance. There were no toxic or untoward effects except in one case, where intravenous administration of vancomycin produced a histamin-like reaction. Intraventricular vancomycin, preferably combined with oral rifampicin, should be considered in cases of intractable or problematic shunt-associated ventriculitis due to grampositive organisms. Thomas A. Angerpointner Comparison of Two Methods of Prophylaxis Against CSF Shunt Infection. M. Lambert, A.E. MacKinnon and A. Vaishnav.
Z Kinderchir 39 Suppl II:109 110, (December), 1984. In a series of 68 operations for insertions or revision of C S F shunts, the incidence of infection was reduced from 20% in controls to 4.2% when systemic and intrathecal or intrashunt gentamycin prophylaxis was employed. The only infection occurring in the latter group was due to an organism resistant to gentamycin. No reduction in infection rate was noted when povidone iodine was instilled into the wounds. Thomas A. Angerpointner An Operative Technique to Reduce Valve Colonisation. R. Fitzger-
ald and B. Conolly. Z Kinderchir 39 Suppl II: 107-108, (December),
The management policy at Our Lady's Hospital for Sick Children, Crumlin for newborn spina bifida infants consists of immediate operation for those considered likely to benefit and full nursery care for those who do not have early surgery. In the 11 years since this policy was first implemented, there have been 493 infants admitted with open myelomeningocele. Two hundred sixty (52.7%) were managed nonoperatively. The mortality for all infants so managed was 78% at one year. Of this group, 171 (66%) died without further intervention. Eighty-nine (34%) survived long enough for some form of treatment to be instituted. Of these, 41 children are still alive, and it is felt that their handicaps have not been increased by their early management. It is argued that an approach to management that considers the needs and interests of the individual infant is more acceptable than one that seeks to enforce total care, regardless of circumstances, or the impersonal assignment by criteria into "Treatment" and "Nontreatment" groups.--Thomas A. Angerpointner The
R.E. Cudmore, et al. Z Kinderchir 39 Suppl I I : l l l ber), 1984.
Z Kinderchir 39 Suppl
Information on employment was obtained from 157 adults with spina bifida aged 18 to 26 years. Ninety were given an additional interview. Forty-three percent had been employed at some time, but only 19% currently. They mainly did routine, nonmanual work for average working hours but below average pay. They enjoyed their jobs, principally for social contact, and were well accepted by employees and workmates. Unfortunately, job retention was poor. The 81% who were unemployed largely hoped to find jobs, but suitable ones were not available. They considered that they should have more help to find jobs. Their days were mainly spent at home or at day centers. They had no doubts that being unemployed had many disadvantages, of which the principal one was lack of social contact. Financial hardship was also mentioned.--Thomas A. Angerpointner The Use of Intraventricular Vancomycin in the Treatment of CSF Shunt Associated Ventriculitis. R. Bayston, M. Barnicoat,
1984. Using a multiple skin preparation technique, drape edges soaked in chlorhexidine and valves primed with gentamycin solution, CSF shunt colonisation rate was reduced to 2.4% of 82 operations. --Thomas A. Angerpointner The Tethered Spinal Cord Syndrome. S.tt. Bakker-Niezen, H.A.D.
Walder and J.L. Merx. Z Kinderchir 39 Suppl II: 100-103, (December), 1984. The results of surgical treatment of the tethered spinal cord syndrome in 25 children in the age range 6 weeks to 19 years are reported. After a description of symptomatology, the importance of neuroradiologic investigations, including myelography and CT-scanning, as well as urodynamic studies are explained. The operative techniques are described in cases of tight ilium terminale, diastematomyelia, lipomyelomeningocele, and meningocele. Early operation is essential to avoid neurological damage that results from awaiting the onset of symptoms. The aim of operation is to free the conus medullaris and cauda equina before mechanical traction or compression damages function in the lumbosacral cord.-- Thomas A. Angerpointner A Case of Spinal Subdural Hematoma in an Immature Neonate After Lumbar Puncture. N. Takeda, T. Shimojo, K. Nakajima, et
al. J Pediatr Surg 17:522 526, 1985. A 10-day-old baby girl with spinal subdural hematoma following multiple lumbar punctures is presented. She was born following 37 weeks gestation and normal delivery. Birth weight was 2040 g. Multiple lumbar punctures were performed because of vertical nystagmus and apnea at age 7 days. She gradually lost movement of both lower extremities and by the age of 10 days was completely paraplegic. Myelography showed a complete block at the level of T10. Emergency laminotomies between TI and L3 revealed a subdural hematoma and low conus medullaris. The hematoma was successfully removed. The postoperative course was eventful with slow but steady improvement from paraplegia. The authors empha-