bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Citrullus colocynthis Schard on Testosterone-Induced Benign Prostatic Hyperplasia
Authors: Dhanotiya Renuka , Chauhan Nagendra Singh , Saraf Dinesh K , Dixit V. K.
Published: September 2009

The petroleum ether extract of Citrullus colocynthis Schrad (Cucurbitaceae) fruits and a steroidal compound isolated from this extract were tested in Wistar rats for their effect on Prostatic Hyperplasia (PH) induced by testosterone. The PH was induced in rats by daily subcutaneous injection of testosterone for 10 days. Rats of the test group were administered 100 mg/kg of petroleum ether extract of Citrullus colocynthis fruit along with testosterone. Graded doses i.e, 1, 2.5, and 5 mg/kg dose of isolated steroidal fraction were also tested in three groups of rats. Finasteride was used as positive control. Treatment with C. colocynthis extract reduced prostatic weights of the treated animals considerably. The isolated steroidal fraction also diminished the weight of prostate in dose dependent fashion. Histological examination of prostate revealed that the extract as well as isolate brought a significant change in histo-architecture. The epithelial cells of the treated groups were less involuated and reduction in connective tissue was observed. The petroleum ether extract as well as the isolate exhibited inhibition of 5-alpha reductase activity in in vitro studies. The histological studies, as well as in vitro enzyme inhibitory activity, clearly establish petroleum ether extract and isolate as a potential candidate in management of androgen dependent conditions like benign prostate hyperplasia.
Spontaneous resolution of a 13-mm Chiari malformation Type I in relation to differential growth of the posterior fossa volume
Authors: Waldau Ben , Domeshek Leahthan F. , Leigh Fawn A. , Lum Kristian C. , Fuchs Herbert E. , Marcus Jeffrey R. , Mukundan Srinivasan , Grant Gerald A.
Published: September 2009

The case of a 3-year-old patient with tuberous sclerosis and a 13-mm Chiari malformation Type I that spontaneously disappeared over the course of 4 years is presented. Using morphometric measurements of the posterior fossa and cerebellum in this patient, the authors show that the volume of the posterior fossa at the time of initial evaluation was consistent with that reported as normal in the literature (180.24 cm3; normal volume 132–198 cm3). Moreover, the patient showed a normal rate of growth of his posterior fossa over the period of observation (201.05 cm3; normal range 153–230 cm3). Cerebellar volumes were found to increase only minimally during this time period, which is compatible with observations in healthy controls. The posterior fossa volume, on the other hand, was shown to increase significantly more than that of the cerebellum (p = 0.0185). This differential growth may permit the tonsils to ascend back up into the posterior fossa. Therefore, pediatric patients with normal posterior fossa volumes and normal development may have a spontaneous resolution of their asymptomatic Chiari malformation Type I.
Pleomorphic xanthoastrocytoma presenting with life-threatening hemorrhage in a child
Authors: Wind Joshua J. , Kerr P. Benjamin , Sweet Jennifer A. , Deshmukh Vivek R.
Published: September 2009

Pleomorphic xanthoastrocytomas are glial-based tumors that arise most frequently in young patients and usually follow a more benign and indolent clinical course than their other glial-based tumor counterparts. These tumors most frequently present with seizures, and only 3 previous case reports exist of hemorrhagic tumor as the clinical presentation. The authors present the first case of life-threatening intracerebral hemorrhage from pleomorphic xanthoastrocytoma in a child.
Intracranial kaposiform hemangioendothelioma: proposal of a new malignant variant
Authors: Cho Won-Sang , Kim Seung-Ki , Park Sung-Hye , Cho Byung-Kyu
Published: September 2009

Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of infancy and early childhood that occurs mainly in soft tissue and the retroperitoneum. The pathological characteristics of a KHE are fascicles of spindleshaped endothelial cells and slitlike vascular channels with irregular tumor margins. In spite of benign features such as rare mitoses and a low MIB-1 labeling index, a KHE is categorized as an intermediate malignancy because of local invasiveness into adjacent lymph nodes or organs. Resection is the treatment of choice for this type of tumor and adjuvant medical therapy is prepared for the tumor remnants and the associated Kasabach-Merritt syndrome. In this paper the authors report a case of a KHE without Kasabach-Merritt syndrome arising from the right tentorium cerebelli in a 13-month-old male child. The biological behavior of the tumor, including its pathological traits and clinical course, was malignant in nature. This case may be not only the first intracranial extraaxial KHE, but also the first truly malignant variant. Kaposiform hemangioendothelioma should be considered in the differential diagnosis of intracranial and extraaxial tumors.
Periinsular hemispherotomy in children with stroke-induced refractory epilepsy
Authors: Scavarda Didier , Major Philippe , Lortie Anne , Mercier Claude , Carmant Lionel
Published: September 2009

Object

Ischemic cerebral vascular accidents (CVAs) in children result in epilepsy in 25% of patients, which is refractory in 7% of cases. Repeated seizures worsen the global and cognitive prognosis of these patients. To evaluate the prognosis of epilepsy and cognitive development in children with refractory seizures following a CVA, the authors retrospectively studied the effectiveness of periinsular hemispherotomy in the treatment of these patients.

Methods

Between March 1995 and November 2007, 8 children who suffered from stroke-induced refractory epilepsy underwent a periinsular hemispherotomy. All patients' charts were reviewed in a retrospective manner. Age at the time of the CVA, imaging studies, cause of the ischemic event, onset of the first seizure, patient's handedness, the extent of the parenchymal damage, electroencephalography findings, type of epileptic seizures, number of seizures per day, number of antiepileptic medications, preoperative neuropsychological evaluation, and surgical outcome with regard to the patient's seizure activity were analyzed.

Results

There were 7 boys and 1 girl in this study. The mean age at stroke was 23 months (range birth–5 years). The mean age at onset of epilepsy was 22 months (range 0–60 months). The mean age at the time of the hemispherotomy was 7 years (range 54–130 months). The average delay prior to the hemispherotomy was 5 years and 3 months (range 23–115 months). Prior to surgery, the average number of seizures per day was 35 (range 5–100). The average number of antiepileptic medications introduced before the hemispherotomy was 8 (range 6–12). Six patients required only 1 surgical intervention and 2 necessitated 2 separate operations:1 underwent a 2-staged hemispherotomy and the other underwent a prior callosotomy. There were no reported surgical complications in this series. Seven children are seizure free. However, the remaining child, after a 3.5-year disease-free interval, has recently started having seizures. No child demonstrated an improvement in neuropsychological evaluation.

Conclusions

The periinsular hemispherotomy must be considered an alternative in the therapeutic approach to stroke-induced pediatric refractory epilepsy. It is effective in controlling seizure activity. The authors believe the delay before hemispherotomy must be shortened in children with post-CVA refractory epilepsy.
Boost radiosurgery as a strategy after failure of initial management of pediatric primitive neuroectodermal tumors
Authors: Flannery Thomas , Kano Hideyuki , Martin Juan J. , Niranjan Ajay , Flickinger John C. , Lunsford L. Dade , Kondziolka Douglas
Published: September 2009

Object

The aim in this study was to determine the outcomes of boost stereotactic radiosurgery, specifically Gamma Knife surgery (GKS), for recurrent primitive neuroectodermal tumors (PNETs) in children in whom initial multimodality management had failed.

Methods

The authors performed a retrospective analysis of 7 patients who underwent a total of 15 GKS procedures for locally recurrent or metastatic PNETs. Nine procedures were directed at the primary site, whereas 6 were directed at distant brain sites. All patients received multimodality therapy, including resection, fractionated radiotherapy, and chemotherapy. The mean interval from diagnosis to first stereotactic radiosurgery was 25.8 months (range 11–35 months). The mean tumor volume was 3.9 cm3 (range 1.1–13.1 cm3), and an average marginal dose of 14.5 Gy (range 9–20 Gy) was administered.

Results

Following salvage GKS, 2 patients had early disease progression (median survival of 5 months after GKS). Five patients had late disease progression (complete response in 3, partial response in 1, and stable disease in 1) and a median survival of 30 months after GKS. Four of the 5 patients who had late progression underwent repeat GKS for marginal recurrence. No adverse radiation effects were observed in these 7 patients.

Conclusions

The GKS modality was a well-tolerated and useful boost strategy in pediatric patients with PNET and a poor prognosis in whom initial multimodality management had failed. However, local or distant disease progression or diffuse leptomeningeal spread ultimately proved fatal to these patients.
Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience
Authors: Willis Brian , Javalkar Vijayakumar , Vannemreddy Prasad , Caldito Gloria , Matsuyama Junko , Guthikonda Bharat , Bollam Papireddy , Nanda Anil
Published: September 2009

Object

The aim of the study was to analyze the outcome of surgical treatment for posthemorrhagic hydrocephalus in premature infants.

Methods

From 1990 to 2006, 32 premature infants underwent surgical treatment for posthemorrhagic hydrocephalus, and their charts were retrospectively reviewed to analyze the complications and outcome with respect to shunt revisions. Multivariate analysis and time series were used to identify factors that influence the outcome in terms of shunt revisions.

Results

The mean gestational age was 27 ± 3.3 weeks, and mean birth weight was 1192 ± 660 g. Temporary reservoir placement was performed in 15 patients, while 17 underwent permanent CSF diversion with a ventriculoperitoneal (VP) shunt. In 2 patients, reservoir tapping alone was sufficient to halt the progression of hydrocephalus; 29 patients received VP shunts. The mean follow-up period was 37.3 months. The neonates who received VP shunts first were significantly older (p = 0.02) and heavier (p = 0.04) than those who initially underwent reservoir placement. Shunts were revised in 14 patients; 42% of patients in the reservoir group had their shunts revised, while 53% of infants who had initially received a VP shunt required a revision. The revision rate per patient in the reservoir group was half that in the direct VP shunt group (p = 0.027). No patient in the reservoir group had > 2 revisions. Shunt infections developed in 3 patients (10.3%), and 2 patients in the reservoir group died of nonneurological issues related to prematurity.

Conclusions

Birth weight and age are useful parameters in decision making. Preterm neonates with low birth weights benefit from initial CSF drainage procedures followed by permanent CSF diversion with respect to the number of shunt revisions.
Angiocentric glioma: a case series
Authors: Shakur Sophia F. , McGirt Matthew J. , Johnson Michael W. , Burger Peter C. , Ahn Edward , Carson Benjamin S. , Jallo George I.
Published: September 2009

Object

Angiocentric glioma was recently recognized as a distinct clinicopathological entity in the 2007 World Health Organization Classification of Tumours of the Central Nervous System. The authors present the first 3 pediatric cases of angiocentric glioma encountered at their institution and review the literature of reported cases to elucidate the characteristics and outcomes of pediatric patients with this novel tumor.

Methods

The children in the 3 cases of angiocentric glioma were 10, 10, and 13 years old. Two presented with intractable seizures and 1 with worsening headache and several months of decreasing visual acuity. Twenty-five cases, including the 3 first described in the present paper, were culled from the literature.

Results

In all 3 cases, MR imaging demonstrated a superficial, nonenhancing, T2-hyperintense lesion in the left temporal lobe. Histologically, the tumors were composed of monomorphous cells with a strikingly perivascular orientation that were variably reactive for glial fibrillary acidic protein and epithelial membrane antigen. Surgical treatment resulted in gross-total resection in all 3 cases. By 24, 9, and 6 months after surgery, all 3 patients remained seizure free without focal neurological deficits.

Conclusions

Among 25 cases of angiocentric glioma, seizure was the most common symptom at presentation. Magnetic resonance imaging demonstrated supratentorial, nonenhancing, T1-hypointense, T2-hyperintense lesions. Gross-total resection of this lesion yields excellent results.
Human fetal medial striate artery or artery of Heubner
Authors: Vasović Ljiljana , Ugrenović Sladjana , Jovanović Ivan
Published: September 2009

Object

The authors describe some of the features of the medial striate branch or recurrent artery of Heubner (RAH). This structure has indisputable functional, neurological, and neurosurgical significance, and originates from the A1 and/or A2 segments of the anterior cerebral artery.

Methods

Microdissection of 94 human fetal specimens was performed. The RAH was observed in 97.3% (single in 71.6%, double in 25.1%, and triple in 3.3%) of the cases. Its origin was from A2 in 42.3% of specimens, from the A1–A2 junction in 25.7%, and from A1 in 20%.

Results

Five types and 14 subtypes of the RAH were identified, determined based on vessel origin and number. In its course, the RAH gave 1–12 branches, and the terminal part most frequently penetrated into the brain through the anterior perforated substance at the level of the sphenoid segment of the middle cerebral artery. The specimens with a single RAH fenestration, abnormal double RAH anastomosis, and unusual RAH origin and relationship to the surrounding vessels represented new data.

Conclusions

The authors' observations of common anatomical variations in the number and origin of the RAH, as well as its abnormalities, may assist neuroradiologists in the interpretation of diagnostic test results and neurosurgeons in performing procedures in the anterior cerebral circulation.
Dysembryoplastic neuroepithelial tumor located in pericallosal and intraventricular area in a child
Authors: Cataltepe Oguz , Marshall Paul , Smith Thomas W.
Published: September 2009

Dysembryoplastic neuroepithelial tumors (DNETs) are frequently seen in children and young adults with intractable epilepsy, and are typically located in the temporal cortex. Extracortical location of DNET is a very rare occurrence. The authors report on a child with a unique extracortical location of DNET with an extensive involvement to the supracallosal cistern and callosum, septum pellucidum, and lateral ventricle ependyma. The authors discuss the radiological and pathological characteristics of the lesion and reiterate the difficulty in differentiating the histological characteristics of central neurocytoma and DNET in extracortical locations and its significance for further management planning.
Nonaccidental head injury in children
Authors: Al-Holou Wajd N. , O'Hara Edward A. , Cohen-Gadol Aaron A. , Maher Cormac O.
Published: September 2009

Our current understanding of nonaccidental head injury in children is the result of decades of effort and the tireless work of numerous physicians. In 1860 Auguste Ambroise Tardieu, a French forensics expert, recognized important patterns of injury in children and identified nonaccidental trauma as the cause of these injuries. His work was ignored. In the years that followed, physicians continued to report these patterns of injury but were unable to identify the etiology. A fundamental misunderstanding of the usual cause of subdural hematoma (SDH) contributed to the confusion at that time. Early in the 20th century, neurosurgeons such as Wilfred Trotter recognized that SDHs were traumatic in origin. However, even Trotter's efforts to expose faults in the theories that SDHs primarily resulted from inflammatory or infectious processes were not accepted immediately. Eventually, the pattern of injuries in children was again recognized both by neurosurgeons, who began to identify an association between trauma-induced SDHs and retinal hemorrhages, and by radiologists, who began to note SDHs in conjunction with osseous lesions. Not until the 1950s and 1960s, however, did physicians begin to routinely identify nonaccidental trauma as the cause of these injuries. Following the recognition of child abuse, a pattern of injuries in conjunction with shaking was identified and is currently known as shaken baby syndrome. Since its identification, our understanding of this syndrome has been modified as a result of new medical research, legal challenges, and popular media forces.
Agitation and/or aggression after traumatic brain injury in the pediatric population treated with ziprasidone
Authors: Scott L. Keith , Green Rebecca , McCarthy Paul J. , Conrad Steven A.
Published: September 2009

Object

Agitation and aggression are common after traumatic brain injury (TBI) and can hamper recovery and rehabilitative efforts. To date, there is no consensus on pharmaceutical intervention for these conditions after TBI. Ziprasidone has been reported efficacious in this population but the evidence is limited. The authors report their experience of using ziprasidone to treat posttraumatic brain injury agitation in 20 consecutive pediatric patients. A secondary objective of this case series was to attempt to establish an age-specific dosage and identify possible side effects of this medication.

Methods

This case series study was performed at a university hospital and pediatric trauma center. Over an 18-month period, all patients who presented to the pediatric intensive care unit with TBI and later developed agitation and/or aggression were treated with ziprasidone as the sole intervention. Pre- and posttreatment scores on the Riker Sedation-Agitation Scale (SAS) were recorded along with demographic data.

Results

Twenty children received ziprasidone for agitation and/or aggression during the immediate recovery period from TBI. The median patient age was 8 years (range 9 months–17 years). Children were stratified into 4 age groups: < 2 years old (Group 1), 2–6 years old (Group 2), 7–12 years old (Group 3), and ≥ 13 years old (Group 4). The SAS score, before and 24 hours after the initiation of ziprasidone, demonstrated a significant reduction after initiation of the medication (p < 0.001). The initial dose for Groups 1–4 was 1.7, 0.9, 0.7, and 0.6 mg/kg, respectively, with final doses of 1.8, 1.5, 1.7, and 0.07 mg/kg, respectively. The duration of therapy for Groups 1–4 was 5, 8, 6, and 3 days, respectively. All patients received continuous cardiac and blood-pressure monitoring. No adverse events were reported in any of the age groups.

Conclusions

Based on this limited patient series, ziprasidone appears to be safe and effective in pediatric patients with closed head injuries who develop agitation and/or aggression in the immediate postinjury period. Ziprasidone consistently lowered SAS scores and did so in all age groups. There were minimal dose adjustments and the duration of therapy was relatively brief. No adverse events were reported. A prospective trial of ziprasidone in this population appears warranted.
Paraspinal arteriovenous malformations in children
Authors: Kitagawa Ryan S. , Mawad Michel E. , Whitehead William E. , Curry Daniel J. , Luersen Thomas G. , Jea Andrew
Published: September 2009

Arteriovenous malformations (AVMs) within the spinal canal and in the paraspinal region are unusual. Spinal cord and dural AVMs or arteriovenous fistulas have been the subject of numerous reports, but paraspinal malformations causing venous congestion or hemorrhage in the spinal canal are rare and present special diagnosis and management challenges. The authors review previously published reports on 16 children with paraspinal AVMs. They also describe the 17th case of a child with a paraspinal AVM who presented with a spontaneous spinal epidural hematoma. To the best of the authors' knowledge, there has been no other case of a spinal epidural hematoma associated with a paraspinal AVM. In each of the 17 cases, the vascular lesion was successfully obliterated using endovascular therapy. Embolization with permanent occlusive agents is an effective treatment for these rare but potentially debilitating lesions.
Combined surgical/endovascular treatment of a complex dural arteriovenous fistula in 21-month-old
Authors: Crowley R. Webster , Evans Avery J. , Jensen Mary E. , Kassell Neal F. , Dumont Aaron S.
Published: September 2009

The treatment of intracranial dural arteriovenous fistulas (AVF) has progressed considerably over the past few decades. With the introduction of new embolic materials and refinement of endovascular techniques, lesions that in the past may have required extensive surgery, or were considered untreatable, have increasingly become curable. Despite improvements in technology, not every condition is amenable to an endovascular treatment, including those patients with preexisting vascular abnormalities that preclude an endovascular approach. In these cases, the patient may be left with suboptimal treatment options with higher associated risks. The authors here report on the treatment of a dural AVF in a pediatric patient in whom prior procedures rendered his cerebrovascular anatomy unnavigable using traditional endovascular techniques. To circumvent these vascular abnormalities the patient underwent combined surgical/endovascular treatment that included surgical exposure and cannulation of the cervical carotid artery, as well as simultaneous femoral artery access, with subsequent successful transarterial embolization of the dural AVF.
Endoscopic disconnection of hypothalamic astrocytoma causing gelastic epilepsy
Authors: Park Young Seok , Lee Yun Ho , Shim Kyu-Won , Kim Dong-Seok , Lee Joon Soo , Kim Heung Dong
Published: September 2009

The authors report on a case of juvenile pilocytic astrocytoma (JPA) and concomitant hypothalamic hamartoma (HH) with gelastic epilepsy that was successfully treated with endoscopic disconnection. This 6-year-old girl presented with prolonged, medically intractable gelastic seizures that were often followed by generalized tonic seizures. An enhancing, low-grade hypothalamic tumor was identified on MR images obtained when she was 11 months old, but no surgical intervention was attempted at that time apart from bur hole drainage of a chronic subdural hemorrhage. In the first surgery, performed when she was 6 years of age, the authors attempted disconnection and tumor sampling; the lesion was revealed to be a JPA. A second endoscopic disconnection was performed 1 year later to improve seizure control and obtain a pathological specimen from the nonenhancing contralateral side. The pathological results after the second surgery revealed that the enhancing mass was a spontaneously regressing JPA and the contralateral nonenhancing mass was an HH. The HH was found as latent tumor and the JPA was the mass causing gelastic epilepsy. To the authors' knowledge, this is the first report of a patient with a spontaneously regressing JPA and concomitant HH, both of which were treated by endoscopic disconnection.
Hemiparkinsonism due to a pontomesencephalic cavernoma: improvement after resection
Authors: Ghaemi Kazem , Krauss Joachim K. , Nakamura Makoto
Published: September 2009

Cavernous angiomas of the upper brainstem causing hemiparkinsonism are very rare. Due to their difficult-to-reach localization, brainstem cavernomas, in particular those in anterior locations, continue to present a therapeutic challenge.

The authors report on a 16-year-old boy with a pontomesencephalic cavernoma who developed hemiparkinsonism and hemiparesis after hemorrhage. After complete surgical removal of the pontomesencephalic cavernoma via a pterional transsylvian approach, his symptoms resolved.

Although pontomesencephalic cavernomas occupying the ventral portion of the brainstem are regarded as problematic for resection, the pterional transsylvian approach provides an excellent route for removal of cavernomas that are in contact with the ventral surface of the midbrain in the interpeduncular cistern. Surgical removal of this type of lesion is recommended because resolution of clinical symptoms, including hemiparkinsonism, can be achieved.
Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States
Authors: Simon Tamara D. , Hall Matthew , Riva-Cambrin Jay , Albert J. Elaine , Jeffries Howard E. , LaFleur Bonnie , Dean J. Michael , Kestle John R. W. , _ _
Published: September 2009

Object

Reported rates of CSF shunt infection vary widely across studies. The study objective was to determine the CSF shunt infection rates after initial shunt placement at multiple US pediatric hospitals. The authors hypothesized that infection rates between hospitals would vary widely even after adjustment for patient, hospital, and surgeon factors.

Methods

This retrospective cohort study included children 0–18 years of age with uncomplicated initial CSF shunt placement performed between January 1, 2001, and December 31, 2005, and recorded in the Pediatric Health Information System (PHIS) longitudinal administrative database from 41 children's hospitals. For each child with 24 months of follow-up, subsequent CSF shunt infections and procedures were determined.

Results

The PHIS database included 7071 children with uncomplicated initial CSF shunt placement during this time period. During the 24 months of follow-up, these patients had a total of 825 shunt infections and 4434 subsequent shunt procedures. Overall unadjusted 24-month CSF shunt infection rates were 11.7% per patient and 7.2% per procedure. Unadjusted 24-month cumulative incidence rates for each hospital ranged from 4.1 to 20.5% per patient and 2.5–12.3% per procedure. Factors significantly associated with infection (p < 0.05) included young age, female sex, African-American race, public insurance, etiology of intraventricular hemorrhage, respiratory complex chronic condition, subsequent revision procedures, hospital volume, and surgeon case volume. Malignant lesions and trauma as etiologies were protective. Infection rates for each hospital adjusted for these factors decreased to 8.8–12.8% per patient and 1.4–5.3% per procedure.

Conclusions

Infections developed in > 11% of children who underwent uncomplicated initial CSF shunt placements within 24 months. Patient, hospital, and surgeon factors contributed somewhat to the wide variation in CSF shunt infection rates across hospitals. Additional factors may contribute to variation in CSF shunt infection rates between centers, but further study is needed. Benchmarking and future prospective multicenter studies of CSF shunt infection will need to incorporate these and other patient, hospital, and surgeon factors.
Minimally invasive decompression of a suboccipital osseous prominence causing rotational vertebral artery occlusion
Authors: Lu Daniel C. , Gupta Nalin , Mummaneni Praveen V.
Published: September 2009

Surgical decompression of the vertebral artery (VA) between the suboccipital area and C-1 is typically performed via a large midline incision or a far-lateral approach. Such traditional open approaches are often associated with significant muscle dissection and blood loss. In this case, a 12-year-old boy suffered a stroke related to a VA rotational occlusion (bow hunter syndrome) and dissection due to a prominent suboccipital bone mass. Successful decompression of the VA was performed via a minimally invasive 22-mm tubular retractor. This is the first reported case report of a minimally invasive decompression of the VA between the skull base and C-1.
Mixed germ cell tumor of the midbrain
Authors: Koh Eun Jung , Phi Ji Hoon , Park Sung-Hye , Kim In-One , Cheon Jung-Eun , Wang Kyu-Chang , Cho Byung-Kyu , Kim Seung-Ki
Published: September 2009

This 14-year-old boy presented with left hemiparesis, gait disturbance, and multiple cranial nerve palsies. Magnetic resonance imaging revealed a multicystic mass with hemorrhagic fluid–fluid levels in the right midbrain, suggesting the presence of a cavernous malformation. Diffusion tensor imaging showed the mass to be close to the right corticospinal tract and ipsilateral medial lemniscus. Subtotal removal of the mass was performed via a right subtemporal approach. The histopathological diagnosis was of a mixed germ cell tumor (GCT) comprising mature teratoma and germinoma cells with syncytiotrophoblastic giant cells. The patient underwent postoperative chemotherapy and radiotherapy, and no tumor progression was found during 1 year of follow-up.

Intracranial GCTs arise mainly in the pineal and the suprasellar area. Germ cell tumors in the brainstem are rare, with only 12 reported cases. Among these, 4 were in the midbrain and histologically were pure germinomas. To the authors' knowledge, this is the first reported case of a mixed GCT in the midbrain combining mature teratoma and germinoma cells.
Longitudinal diffusion-weighted imaging in infants with hydrocephalus: decrease in tissue water diffusion after cerebrospinal fluid diversion
Authors: Leliefeld Paul H. , Gooskens Rob H. J. M. , Braun Kees P. J. , Ramos Lino M. P. , Uiterwaal Cuno S. P. M. , Regli Luca P. E. , Tulleken Cees A. F. , Kappelle L. Jaap , Hanlo Patrick W.
Published: September 2009

Object

Progressive hydrocephalus may lead to edema of the periventricular white matter and to damage of the brain parenchyma because of compression, stretching, and ischemia. The aim of the present study was to investigate whether cerebral edema can be quantified using diffusion-weighted imaging in infants with hydrocephalus and whether CSF diversion could decrease cerebral edema.

Methods

Diffusion-weighted MR imaging was performed in 24 infants with progressive hydrocephalus before and after CSF diversion. Parametric images of the trace apparent diffusion coefficients (ADCs) were obtained. The ADCs of 5 different cortical and subcortical regions of interest were calculated pre- and postoperatively in each patient. The ADC values were compared with age-related normal values. Mean arterial blood pressure and anterior fontanel pressure were measured immediately after each MR imaging study.

Results

After CSF diversion, the mean ADC decreased from a preoperative value of 1209 ± 116 × 10−6 mm2/second to a postoperative value of 928 ± 64 × 10−6 mm2/second (p < 0.005). Differences between pre- and postoperative ADC values were most prominent in the periventricular white matter, supporting the existence of preoperative periventricular edema. Compared with age-related normal values, the preoperative ADC values were higher and the postoperative ADC values were lower, although within normal range. The decrease in ADC after CSF drainage was more rapid than the more gradual physiological decrease that is related to age.

The preoperative ICP was elevated in all patients. After CSF diversion the ICP decreased significantly to within the normal range. A linear correlation between ADC values and ICP was found (correlation coefficient 0.496, p < 0.001). In all patients the mean arterial blood pressure was within physiological limits both pre- and postoperatively.

Conclusions

This study shows a rapid and more extensive decrease in ADC values after CSF diversion than is to be expected from physiological ADC decrease solely due to increasing patient age. The preoperative ADC increase can be explained by interstitial edema caused by transependymal CSF leakage or by vasogenic edema caused by capillary compression and stretching of the brain parenchyma. This study population of infants with (early recognized) hydrocephalus did not suffer from cytotoxic edema. These findings may help to detect patients at risk for cerebral damage by differentiating between progressive and compensated hydrocephalus.
Evolution in the frequency of nonsyndromic craniosynostosis
Authors: Di Rocco Federico , Arnaud Eric , Renier Dominique
Published: September 2009

Object

The prevalence of the different subtypes of craniosynostosis varies greatly. The aim of this study was to analyze the prevalences of the different subtypes of craniosynostosis at a single major craniofacial center and their changes during a 20-year period.

Methods

The medical charts of 2808 children hospitalized between 1988 and 2007 for a true craniosynostosis were retrospectively reviewed. Patients were divided according to their subtype of craniosynostosis (sagittal, plagiocephaly, brachycephaly, metopic, oxycephaly, syndromic cases, or unclassifiable).

Results

The total number of patients according to their craniosynostosis subtype were as follows: 1224 cases of scaphocephaly, 315 cases of plagiocephaly, 598 cases of trigonocephaly, 105 cases of brachycephaly, 69 cases of oxycephaly, 396 syndromic cases, and 101 unclassifiable cases. The prevalences of these craniosynostoses evolved differently over time. The number of children hospitalized each year increased over time from 106 to 181 cases, but this increase varied according to the subtype of craniosynostosis. Cases of scaphocephaly, plagiocephaly, brachycephaly, and syndromic cases increased similarly (170% increase on average), whereas trigonocephalies dramatically increased (420% increase).

Conclusions

The evolution observed in the prevalence of craniosynostosis might result from several factors. An increased recruitment of patients at the center and an improvement in the diagnosis of craniosynostosis might explain the overall increase. However, other mechanisms should be examined to explain the great increase in the number of cases of trigonocephaly (environmental or pharmacological).
Recovery of sensorineural hearing loss following operative management of a posterior fossa arachnoid cyst
Authors: Jayarao Mayur , Devaiah Anand K. , Chin Lawrence S.
Published: September 2009

Arachnoid cysts are benign, intraarachnoid cysts filled with cerebrospinal fluid that are usually encountered in the middle cranial fossa. If present in the posterior fossa, they usually produce nonspecific signs and symptoms such as headaches, dizziness and vertigo. We report the rare presentation of a young girl with right-sided sensorineural hearing loss and tinnitus secondary to a right cerebellopontomedullary arachnoid cyst. The patient underwent a suboccipital retrosigmoid (retromastoid) craniectomy with fenestration of the arachnoid cyst. Subsequently, the patient experienced improvement in hearing with near-complete resolution of sensorineural hearing loss. To the authors' knowledge, postoperative near-complete resolution of hearing loss secondary to posterior fossa arachnoid cysts in a pediatric patient has not been previously reported. The authors also review the literature with respect to posterior fossa arachnoid cysts and discuss their clinical features, diagnosis, and management.
Isolated cerebellar Rosai-Dorfman granuloma mimicking Lhermitte-Duclos disease
Authors: Johnston James M. , Limbrick David D. , Ray Wilson Z. , Brown Stephanie , Shimony Joshua , Park Tae Sung
Published: September 2009

Rosai-Dorfman disease (RDD) is an idiopathic histioproliferative disorder that rarely involves the CNS. Rosai-Dorfman disease is exceedingly rare in the pediatric population and has never been observed in the cerebellum of a child. The authors present the case of a 14-year-old male with a cerebellar lesion having radiographic characteristics of Lhermitte-Duclos disease. After a period of observation with a presumptive diagnosis of Lhermitte-Duclos disease, the child underwent suboccipital craniotomy and resection of the lesion due to continuous suboccipital headaches. Histological examination of the tissue demonstrated RDD. The published literature on RDD is reviewed with an emphasis on differential diagnosis.
Neuroleptic malignant syndrome from central nervous system insult: 4 cases and a novel treatment strategy
Authors: Wait Scott D. , Ponce Francisco A. , Killory Brendan D. , Wallace Donna , Rekate Harold L.
Published: September 2009

Neuroleptic malignant syndrome (NMS) is a potentially life-threatening entity characterized by hyperthermia, autonomic deregulation, decreased mental status, increased muscle tone, and, frequently, by renal failure due to rhabdomyolysis. Classically, it follows administration of antipsychotic medication.

The authors report on 4 patients (2 children and 2 adults) in whom NMS was diagnosed after a CNS insult. No patient was receiving antipsychotic medication. The patients' hospital and clinic charts, radiographic data, and follow-up telephone conversations were reviewed retrospectively.

All 4 patients met diagnostic criteria for NMS. Three patients presented with shunt failure, and 1 patient had undergone a functional hemispherectomy 2 days earlier. One patient with shunt failure received the diagnosis retrospectively. An endoscopic third ventriculostomy alleviated his shunt failure and he remains free of NMS. The other 2 patients underwent treatment for shunt failure, but NMS remained. These 2 patients and the one who had undergone hemispherectomy underwent a trial of intrathecal baclofen, and the NMS resolved. Subsequently, an intrathecal baclofen infusion device was placed in all 3 patients, and the NMS resolved. The 2 patients in shunt failure had a lumbar intrathecal baclofen infusion device. The patient who had undergone hemispherectomy had an intracranial baclofen catheter.

Neuroleptic malignant syndrome is a rare, life-threatening disorder that can occur without the administration of neuroleptic medications. Alleviation of any CNS insult is the first order of treatment. Some patients with persistent symptoms of NMS may benefit from intrathecal delivery of baclofen.
Urological outcome following multiple repeat spinal cord untethering operations
Authors: Maher Cormac O. , Bauer Stuart B. , Goumnerova Liliana , Proctor Mark R. , Madsen Joseph R. , Scott R. Michael
Published: September 2009

Object

Patients who have undergone myelomeningocele or lipomyelomeningocele repair may present with symptomatic retethering of the spinal cord. The authors describe the results as well as the utility of urological testing in pediatric patients undergoing multiple repeat untethering operations.

Methods

The authors reviewed the records of 13 patients with lipomyelomeningocele or myelomeningocele who underwent at least 2 untethering procedures after their initial repair and who had urodynamic testing within 6 months prior to and 6 months following each untethering operation. In each case, urological testing included a slow-fill cystometrogram and an external urethral sphincter electromyogram using a concentric needle electrode to analyze individual motor unit action potentials at rest, in response to sacral reflexes, and during bladder filling and emptying.

Results

New urinary symptoms were identified in 7 of 13 cases prior to surgery. Postoperative subjective improvement in urinary symptoms was noted in 5 of these 7 cases. Improvement in bladder function on urodynamic testing correlated with symptomatic improvement. Sphincter electromyography findings did not correlate with changes in preoperative symptoms or postoperative improvement.

Conclusions

In patients undergoing multiple repeat spinal cord untethering operations, measuring bladder function is more useful than sphincter electromyographty when selecting candidates for surgery and for measuring surgical outcomes.
Temporal and spatial variations in spectral reflectance and characteristics of surface dust on Gulkana Glacier, Alaska Range
Authors: Takeuchi Nozomu
Published: September 2009

Spectral reflectances in the visible to near-infrared wavelength range (350–1050 nm) were measured on the surface of Gulkana Glacier, Alaska Range, Alaska, USA, at six different elevations from May to September 2001. The measurements showed variable spectral reflectances on the glacier surface, and the spectra changed over time and elevation. The spectra in May were those of a typical wet snow surface: the reflectance ranged approximately from 0.4 to 0.8, and generally decreased as the wavelength increased. As snowmelt proceeded, the reflectance gradually fell, and specific absorptions appeared in the spectrum at wavelength ranges of 400–600 and 670–680 nm, corresponding to a red snow surface due to snow algal bloom. As the ice surface was exposed, the spectrum finally shifted to a lower (0.1–0.4) and flat reflectance curve, typical of an ice surface contaminated with dust. Analyses of the dust on the glacier surface showed that its quantity and characteristics changed spatially and seasonally and were correlated with spectral albedo. The results showed that the temporal and spatial variations in spectral reflectance on this glacier are due not only to physical properties of the glacier surface, but also to biogenic materials on the surface (e.g red-colored snow algal cells and cryoconite).
The impact of accumulation rate on anisotropy and air permeability of polar firn at a high-accumulation site
Authors: Hörhold Maria W. , Albert Mary R. , Freitag Johannes
Published: September 2009

The first three-dimensional properties of polar firn obtained by X-ray microtomography are used to study the microstructure of snow on a 15 m deep firn core from West Antarctica. The snow is found to undergo coarsening down to approximately 2.5 m depth before grain growth and densification become the prevalent mechanisms of microstructure change. In contrast to previous assumptions, distinct anisotropy of the ice and pore geometry is observed throughout the profile, with a maximum at 2.5 m depth. The air permeability and the degree of anisotropy vary with depth and can be linked to short-term changes in accumulation rate via the residence time for which a certain snow layer stays in the uppermost 2.5 m. Patterns of the degree of anisotropy and air permeability of buried polar firn are relative indicators of past accumulation rates.
Multiplication Symmetric Convolution Property for Discrete Trigonometric Transforms
Authors: Kim Do Nyeon , Rao K. R.
Published: September 2009

The symmetric-convolution multiplication (SCM) property of discrete trigonometric transforms (DTTs) based on unitary transform matrices is developed. Then as the reciprocity of this property, the novel multiplication symmetric-convolution (MSC) property of discrete trigonometric transforms, is developed.
Theoretical Study on Exciton Dynamics in Dendritic Systems: Exciton Recurrence and Migration
Authors: Nakano Masayoshi , Kishi Ryohei , Minami Takuya , Yoneda Kyohei
Published: September 2009

The optical functionalities such as exciton recurrence and migration for dendritic systems, e.g., dendrimers, are investigated using the quantum master equation (QME) approach based on the ab initio molecular orbital configuration interaction (MOCI) method, which can treat both the coherent and incoherent exciton dynamics at the first principle level. Two types of phenylacetylene dendrimers, Cayley-tree dendrimer and nanostar dendrimer with anthracene core, are examined to elucidate the features of excion recurrence and migration motions in relation to their structural dependences. It is found that the nanostar dendrimer exhibits faster exciton migration from the periphery to the core than Cayley-tree dendrimer, which alternatively exhibits exciton recurrence motion among dendron parts in case of small relaxation parameters. Such strong structural dependence of exciton dynamics demonstrates the advantage of dendritic molecular systems for future applications in nano-optical and light-harvesting devices.
Medical Home 2009: What It Is, Where We Were, and Where We Are Today
Authors: Homer Charles J. , Cooley W. Carl , Strickland Bonnie
Published: September 2009

CME Educational Objectives

1.

Delineate the changing epidemiology of disease states in children and describe model systems for chronic illness care and prevention.

2.

Identify some of the controversies surrounding the medical home model and the critical components necessary for successful transformation to the medical home model.

3.

Explain how state and federal policy must change in order for the medical home model to flourish and succeed in the near future.
Instruments for Measuring Fall Risk in Older Adults Living in Long-Term Care Facilities: An Integrative Review
Authors: Kehinde Julius Oluwole
Published: September 2009

Lack of consistency in the literature regarding the use of fall risk assessment in long-term care settings and the uniqueness of the environment demand a critical analysis of fall risk instruments specific to older adults living in long-term care facilities. This integrative review of the existing literature on instruments used to measure fall risk in residents living in long-term care facilities revealed a total of 16 fall risk assessment tools from 13 studies. Of the 13 studies, only 8 reported sensitivity, specificity, and interrater reliability values of the tools. Only the Morse Fall Scale and Mobility Fall Chart demonstrated high predictive values in their initial developmental studies. This review can help clinicians make informed choices about tools to predict falls in their settings and establish appropriate preventive interventions.
Scanning Electron Microscopy Analysis of a Sputnik-Like Intraocular Lens 28 Years After Implantation
Authors: Ferrer Consuelo , Abu-Mustafa Sabat K. , Alió Jorge L.
Published: September 2009

Purpose:

To report a pupil-supported, iris-clip intraocular lens (IOL) that was explanted more than 28 years after implantation.

Methods:

A pupil-supported, iris-clip, Sputnik-like IOL was implanted in the left eye of a 33-year-old man to correct aphakia after extracapsular cataract extraction due to trauma.

Results:

Twenty-eight years after implantation, the patient was referred to our center with loss of vision. Clinical examination showed dislocation of the IOL, which was subsequently explanted. Scanning electron microscopic examination showed a transparent, polymethylmethacrylate (PMMA), pupil-supported, iris-clip IOL with melanosomes and cell deposits (foreign-body reaction) on its surface.

Conclusions:

This case demonstrates the inertness of PMMA material and reports that a foreign body reaction can be induced following IOL dislocation 28 years after implantation. [
J Refract Surg.
2009;25:788–791.]
Traumatic Corneal Flap Dehiscence 6 Years After LASIK
Authors: Iskeleli Güzin , Ozkok Ahmet , Cicik Erdogan
Published: September 2009

Purpose:

To report a case of LASIK flap dehiscence caused by blunt trauma 6 years after uneventful refractive surgery.

Methods:

A 32-year-old man presented 3 hours after being struck by a carton edge in his left cornea, causing dehiscence of the LASIK flap.

Results:

At initial examination, uncorrected visual acuity (UCVA) was 20/200 in the left eye. Minimal flap dehiscence was seen on the inferior corneal quadrant. A therapeutic bandage soft contact lens was placed and topical medical therapy was administered. Ten days after trauma, UCVA was 20/50 and best spectacle-corrected visual acuity was 20/30 in the left eye. At 7-month follow-up, the patient's clinical status did not change.

Conclusions:

Blunt corneal trauma occurring several years after uneventful LASIK may cause corneal flap dehiscence. Appropriate and prompt treatment usually is successful. [
J Refract Surg
. 2009;25:787–788.]