bluuebunny/crossref_metadata_2025 huggingface dataset:
Publication Patterns of the American Society of Pediatric Neurosurgeons
Authors: Dias Mark S.
Published: April 2003

The American Society of Pediatric Neurosurgeons (ASPN) has expressed a commitment to have all of its members’ qualifying research efforts published in peer-reviewed pediatric neurosurgical journals such as Pediatric Neurosurgery. To test this commitment, citations from January 1985 through December 1994 were analyzed for all 76 current members of the ASPN. The citations were divided into those of general or adult neurosurgical interest, and those of pediatric neurosurgical interest based upon title, key words, and/or abstract. Each pediatric neurosurgical citation was further classified by topic, and by the type of journal in which it appeared (pediatric neurosurgical, general or adult neurosurgical, and other pediatric or adult journal, subspecialty journal, or basic science journal). A total of 1,887 individual author citations were identified during the study period; of these, 1,586 citations (84%) were classified as pediatric neurosurgical citations. These included 1,391 citations from peer-reviewed publications and 195 citations from Concepts in Pediatric Neurosurgery. As a society, the ASPN published only one third of its citations in peer-reviewed pediatric neurosurgery journals; the remainder were cited in general neurosurgical or other journals. Even when only citations from neurosurgical journals (in which pediatric neurosurgeons were more likely to be primary authors and therefore to have more control over the journal of publication) were analyzed, less than 50% of citations appeared in peer-reviewed pediatric neurosurgery journals. Nearly three quarters of ASPN members failed to provide even a modest commitment – publishing 51% or more of their pediatric citations in peer-reviewed pediatric neurosurgical journals. When the analysis was again limited to only those citations published in neurosurgery journals, over half of the members failed this ‘51% rule’. These results suggest the need for a firmer commitment from ASPN members to publish in peer-reviewed pediatric neurosurgery journals.
The Internet as a Pediatric Neurosurgery Information Resource
Authors: Maugans Todd A. , McComb J. Gordon , Levy Michael L.
Published: April 2003

The Internet is evolving as a powerful source of medical information for patients, family members, and health care providers; however, critical analyses of this information are generally lacking. This investigation was carried out to ascertain the sources, nature, and accuracy of information acquired via searches on the Internet for ten common pediatric neurosurgical topics. Thirteen source types and nine categories of information were characterized and examined. With few notable exceptions, the educational information was highly accurate. It is concluded that the Internet represents an important new pediatric neurosurgery educational resource for the layman and health care providers. Guidelines are offered to assist in the use of this new medium.
Untethered Filum terminale Presenting as Cauda equina Lesion
Authors: Mace J. Charles , Cure Joel , Bailey Byron N. , Storrs Bruce B.
Published: April 2003

We report the case of a young girl with recurrent bladder dysfunction. Magnetic resonance imaging performed for evaluation of initial urologic symptoms revealed a low-lying conus medullaris. She underwent an L5 laminectomy and cord untethering by sectioning of the filum terminale. After initial improvement of bladder function, her symptoms returned 4 years later. Repeat magnetic resonance imaging demonstrated a new intradural lesion at L2. At surgery she was found to have an untethered, thickened, coiled filum terminale at L2.
Headache and Chiari I Malformation in the Pediatric Population
Authors: Weinberg Jeffrey S. , Freed Diana L. , Sadock James , Handler Michael , Wisoff Jeffrey H. , Epstein Fred J.
Published: April 2003

There has been disagreement regarding surgical intervention in treating pediatric patients with Chiari I malformation with headache as sole complaint. Therefore, we retrospectively reviewed our experience over a 6-year period, with patients less than 5 years of age (mean = 34.8 months) with radiographically confirmed Chiari I malformation. We identified 7 patients who presented with headaches as their only complaint. The headaches varied in location and severity. All patients were treated with posterior fossa decompression and syringosubarachnoid shunt when indicated. At follow-up, all patients were noted to have rapid clinical improvement (mean = 11.6 weeks) and remain asymptomatic. Our data suggest that patients less than 5 years of age with Chiari I malformation benefit from surgical decompression when presenting with a chief complaint of headache.
Shunt Revision by Coagulation with Retention of the Ventricular Catheter
Authors: Hudgins Roger J. , Boydston William R.
Published: April 2003

Intraluminal coagulation of a ventricular catheter followed by its removal and replacement is a technique used for proximal shunt revision. The authors describe experience leaving the original catheter in place when flow of CSF is established by the coagulation. Advantages of this modification include maintenance of ventricular access when the ventricles are small and the possibility of reducing the incidence of subsequent shunt obstruction by mitigating intraventricular hemorrhage caused by catheter removal.
Upper Extremity Performance and Self-Care Skill Changes in Children with Spastic Cerebral Palsy following Selective Posterior Rhizotomy
Authors: Loewen Patricia , Steinbok Paul , Holsti Liisa , MacKay Margot
Published: April 2003

Changes in upper extremity and self-care performance following selective posterior rhizotomy (SPR) are reported frequently, but rarely quantified. In this study, 36 children with spastic cerebral palsy were assessed preoperatively and 1 year following SPR using the Quality of Upper Extremity Skills Test (QUEST). Twenty-six children were assessed at similar intervals using the Functional Independence Measure for Children (WeeFIM) as a measure of self-care performance. Wilcoxon matched-pair signed-rank tests were used to compare the QUEST total scores and the WeeFIM motor, cognitive, and total scores before and after SPR. One year after SPR, the total QUEST scores were significantly better (median improvement = 3.2%, p < 0.0001), as were the WeeFIM motor (median improvement = 9.5, p < 0.0001), cognitive (median improvement = 1.0, p < 0.008), and total (median improvement = 11.0, p < 0.0001) scores. The results indicate quantifiable improvements in upper extremity function, and motor and cognitive self-care skills in children 1 year after SPR.
Hypothalamic Hamartoma Associated with Multiple Congenital Abnormalities
Authors: Tsugu Hitoshi , Fukushima Takeo , Nagashima Tomonari , Utsunomiya Hidetsuna , Tomonaga Masamichi , Mitsudome Akihisa
Published: April 2003

We report 2 patients with hypothalamic hamartoma associated with multiple congenital abnormalities and analyze 42 (including our own) reported cases, including our 2 cases, of hypothalamic hamartoma or hypothalamic hamartoblastoma with multiple congenital abnormalities, to understand the timing of their occurrence and clarify the prognosis. To this end, we classified them into lethal and nonlethal cases. We found poly- and syndactyly, cleft or high-arched palate and nose abnormalities to be important manifestations of this syndrome. Major organ abnormalities and CNS and endocrine abnormalities occurred frequently among the lethal cases, very likely indicative of a disturbance of embryogenesis between gestational days 34–37 and thus implicated in a negative prognosis.
A Case of Cerebrospinal Fluid Eosinophilia Associated with Shunt Malfunction
Authors: Tanaka Toshihide Tanaka , Ikeuchi Satoshi , Yoshino Kaoru , Isoshima Akira , Abe Toshiaki
Published: April 2003

A 3-month-old female patient presented with a meningomyelocele at the lumber region associated with congenital hydrocephalus. She underwent ventriculoperitoneal (V-P) shunt surgery using the Sophy system. The shunt system was replaced due to a malformation. Following replacement, the patient presented with cerebrospinal fluid (CSF) eosinophilia at the age of 8 months. The eosinophilic granulocytosis of the CSF improved dramatically following systemic prednisolone administration. CSF eosinophilia without accompanying inflammation or pyrexia in the present case may have resulted from an allergic response to a foreign material such as the silicone tube pressure valve of the Sophy system or the sutures rather than bacterial or fungal infection. Based on our results, we believe that some patients may experience CSF eosinophilia following postoperative V-P shunt due to an allergic reaction to the shunt equipment. Prompt steroid treatment can produce spontaneous regression in such cases.
Interventional Magnetic Resonance Imaging Guided Aspiration and Biopsy of a Cystic Midbrain Tumor
Authors: Lancon John A. , Killough Kevin R. , Dhillon Gurmeet , Parent Andrew D.
Published: April 2003

Interventional magnetic resonance imaging defines the intraoperative application of magnetic resonance imaging technology, permitting the surgeon to work in an open magnetic field. The application of this technology to pediatric neurosurgery allows precise intraoperative localization of pathology, real-time assessment of the anatomical consequences of surgical and anesthetic interventions, accountability of brain shifts, confirmation of the exact site of biopsy or completeness of lesion removal, and immediate identification of some intraoperative and early postoperative complications. We present the case of a young boy with a cystic left midbrain tumor who underwent interventional magnetic resonance imaging guided aspiration and biopsy to illustrate the surgical advantages of this technology.
Segmental Costovertebral Malformations: Association with Neural Tube Defects
Authors: Duru Soner , Ceylan Süreyya , Güvenç B. Haluk , Ceylan Savaş
Published: April 2003

Patients with spondylocostal dysostosis (SCD) have vertebral abnormalities and numerical or structural rib anomalies that produce thoracic asymmetry. Rib anomalies and dysmorphism are the typical features that differentiate this syndrome from spondylothoracic dysostosis (STD). Jarcho-Levin syndrome is a severe form with involvement of the whole vertebral column. Other associated findings such as congenital heart defects, abdominal wall malformations, genitourinary malformations and upper limb anomalies may be found; in addition, neural tube defects (NTDs) have been associated with this malformation. SCD is transmitted both in a recessive form and as a dominant defect. We report on 3 children with SCD; 2 also had NTDs. All of them were studied with X-rays and spinal magnetic resonance (MR), and over the same period they underwent multidisciplinary clinical functional evaluation. One of our cases with NTD also presented polythelia, which has not previously been described in patients with SCD. The common association of segmental costovertebral malformations with NTDs could be related to an early gastrulation genomic defect, or one after gastrulation, when there are two independent somitic columns. The latter sometimes progresses and then involves primary and secondary neurulation. Also, the association of SCD with NTDs could be related to the interaction of different genes, resulting in this complex phenotype. Therefore, additional genetical and embryological studies are necessary to provide evidence of an etiological link between SCD and NTD.
Malignant Ectomesenchymoma
Authors: Freitas Alexandre Bruno Raul , Aguiar Paulo Henrique , Miura Flávio Kei , Yasuda Alexandre , Soglia Jean , Soglia Fernanda , Aguiar Claudia H. , Vinko Filadelfo , Silva Najla Saba
Published: April 2003

Malignant ectomesenchymoma is an uncommon neoplasm composed of neuroectodermal elements and one or more mesenchymal neoplastic elements. It is believed to arise from remnants of migratory neural crest cells (ectomesenchyme). The authors report the clinical and pathological findings of a 3-year-old girl with malignant ectomesenchymoma of the CNS. Embryogenesis of this tumor is discussed, and a review of the literature with 39 other cases is done.
Ventricular Anatomy and Shunt Catheters
Authors: Kaufman Bruce A. , Park T.S.
Published: April 2003

A functioning shunt must have a patent proximal catheter within the cerebrospinal fluid space. Occlusion with choroid plexus or ependymal tissue might be expected if these tissues are in contact with the proximal inlets. This study was undertaken to define the intraventricular distances available for a standard-placement shunt cather and to compare the available distances with actual ventricular catheter inlets. In 52 normal subjects (age range from 1 month to 20 years; median 7.7 years) magnetic resonance imaging was used to measure the dimensions of the anterior horn in planes typically used for cather placement. For anterior placements, the intraventricular length (ventricle entry to the foramen of Monro) was measured for a standardized catheter route ('As') and for a route yielding a maximum lenght ('Amax'). For posterior placements, the length (ventricle tip to foramen of Monro) was obtained for a standardized catheter placement to the ipsilateral ('Pi') and the contralateral ventricle ('Pc') as well as measuring a maximum length in a curved trajectory ('Pmax'). The average length (and range) in centimeters for the various trajectories was: As = 1.5 (1.1-1.9), Amax = 1.7 (1.2-2.2), Pi = 1.6 (1.2-2.1), Pc = 2.0 (1.4-2.9), and Pmax = 2.8/3.1 (2.1-3.6). Minor variations from a standard shunt insertion site did not affect the length of catheter within the ventricle. Current ventricular catheters have proximal inlets extending 1.6-2.4 cm from the catheter tip. Variations in standard ventricular catheter placement should have no measurable effect on how much ventricle is available for the proximal catheter. It may not be possible to place a standard ventricular catheter and keep the inlets within the ventricle and placed consistently away from choroid plexus and ependyma, regardless of approach. This may contribute to the similar proximal occlusion rates reported for the differing placements. Subsequent studies of shunt placement should correlate proximal occlusion rates with ventricular size. To prevent ventricular size from directly affecting proximal conclusion, consideration should be given to altering the design of ventricular catheters by placing inlets over a shorter distance (1.0 cm) from the tip.
Achondroplasia and Cervicomedullary Compression: Prospective Evaluation and Surgical Treatment
Authors: Keiper Jr. Glenn L. , Koch Bernadette , Crone Kerry R.
Published: April 2003

The association between sudden death and cervicomedullary compression in infants with achondroplasia has been well described. Prospective clinical and imaging evaluations have been recommended to identify those infants with achondroplasia who are at risk of dying suddenly from respiratory arrest secondary to unrecognized cervicomedullary compression. Since 1988, we have prospectively evaluated 11 infants (average age 13 weeks) with achondroplasia who were asymptomatic for cervicomedullary compression on initial clinical evaluation. Craniocervical magnetic resonance imaging (MRI) findings included narrowing of the foramen magnum, effacement of the subarachnoid spaces at the cervicomedullary junction, abnormal intrinsic cord signal intensity and mild to moderate ventriculomegaly. Two patients with severe cord compression underwent immediate decompression. Two patients developed opisthotonic posturing within 3 months of evaluation and underwent foramen magnum decompression, including suboccipital craniectomy and atlantal laminectomy. Surgery in all cases revealed forward extension of the squamous portion of the occipital bone, thickened posterior rim of the foramen magnum and a dense fibrotic epidural band. There were no complications from surgery. Seven patients did not require surgery and were followed closely. All 11 patients remain asymptomatic at follow-up (mean 4.6 years; range 16 months to 7.3 years), and no patient has required a diversionary shunt procedure. The results of this prospective study confirm that early clinical and MRI evaluations are necessary to determine whether infants with achondroplasia have cervicomedullary compression. With early recognition, an immediate decompression can be performed safely to avoid serious complications associated with cervicomedullary compression, including sudden death.
An Alternate Technique to Close Neurosurgical Incisions Using Octylcyanoacrylate Tissue Adhesive
Authors: Lee Kuk-Wha , Sherwin Thomas , Won Daniel J.
Published: April 2003

The present authors have applied the use of tissue adhesive octylcyanoacrylate, recently approved by the FDA, in the closure of routine neurosurgical cases. The authors find this to be an excellent substitute for nylon, staples, vicryl or steristrip final layer closure of the surgical incision. This is especially useful in the pediatric neurosurgical practice where young children can be emotionally traumatized by the experience of suture or staple removal. We recommend octylcyanoacrylate closure as a safe, simple, quick, cost-effective method of skin closure that has superior applications in pediatric neurosurgical wound closure when used with proper technique.
A Case Report of Caudal Regression Syndrome Associated with an Intraspinal Arachnoid Cyst
Authors: Tsugu Hitoshi , Fukushima Takeo , Oshiro Shinya , Tomonaga Masamichi , Utsunomiya Hidetsuna , Oshima Kazuhiro , Ohjimi Hiroyuki
Published: April 2003

We report here a rare case of caudal regression syndrome associated with an intraspinal arachnoid cyst. The patient was a 6-month-old baby girl with multicomplex congenital abnormalities: sacrococcygeal dysgenesis and ventral curvature, large terminal cyst (myelocystocele), spinal arachnoid cyst, cerebellar hypertrophy (suspected), high imperforate anus, partial dysgenesis of the large intestine, omphalocele, atresia of the vagina, bilateral incomplete ureter duplication, incomplete pseudoduplicated bladder and bilateral talipes equinovarus. We performed plastic repair of the myelocystocele and perineal lesion for caudal regression syndrome and partial removal of the cyst wall for the intraspinal arachnoid cyst. She has been well for 3 years postoperatively, and her mental development is normal.
Cranial Bone Fixation in Infants and Children
Authors: Winston Ken R. , Wang Marjorie C.
Published: April 2003

A technique is described for fixing cranial bone flaps with absorbable sutures and bone shims. This technique is a cost-efficient method of rapidly achieving rigid structural stability with excellent cosmetic results. The kerf created by the craniotome is bridged at multiple sites by bone chips harvested from the inner edge of the bone flap. Solid bony union is documented on histopathological analysis. The technique requires no special tools and avoids the problems associated with the use of plates, screws and wire.
Skull Base Growth in Childhood
Authors: Sgouros S. , Natarajan K. , Hockley A.D. , Goldin J.H. , Wake M.
Published: April 2003

While studying skull base changes in craniosynostosis, it became apparent that there is a lack of reference studies quantifying the changes of three-dimensional (3D) parameters of the normal skull base throughout childhood. Using advanced 3D visualisation techniques, 34 points of the skull base were identified on MRI scans of 66 normal children, aged 1 month to 15 years. Several distances and angles between the various landmarks were measured in an attempt to quantify the growth of skull fossae with age. Two main growth periods were observed: before and after the first 5 years of life. Most change occurred in the first period. Anatomical regional differences were identified between the two sexes. During the first 5 years of life, the anterior fossa showed rapid growth rate with respect to its anterior projection in males, whereas in the females there was a more concentric growth pattern. The body of the sphenoid bone and the middle fossa showed a rapid growth rate in both sexes which was greater in the females. The posterior fossa showed a concentric pattern of growth in both sexes with a greater growth rate in the females. These findings provide new insight into the pattern of growth of the various parts of the skull base and can be used for comparative study of deformities that affect such growth.
Approach via the Floor of the Fourth Ventricle for Hydatid Cyst of the Pons
Authors: Yilmazlar Selcuk , Aksoy Kaya
Published: April 2003

A very rare case of a pontine hydatid cyst is reported. It was diagnosed preoperatively on the basis of magnetic resonance imaging findings. The patient was operated on in the sitting position. Total excision of the cyst using the Dowling technique and gravity effect was performed through the floor of the fourth ventricle. The patient was discharged without extra neurological sequel. The significance of an accurate preoperative diagnosis, surgical approaches and technique in the management of this pathology is discussed.
Pediatric Low-Grade and Ependymal Spinal Cord Tumors
Authors: Merchant Thomas E. , Kiehna Erin N. , Thompson Stephen J. , Heideman Richard L. , Sanford Robert A. , Kun Larry E.
Published: April 2003

Our institutional experience with pediatric spinal cord tumors includes 25 patients with the diagnosis of ependymoma (EP; n = 4), myxopapillary ependymoma (MPEP; n = 4), juvenile pilocytic astrocytoma (JPA; n = 5), nonpilocytic astrocytoma (WHO grade I or II, n = 6), and other nonastrocytic spinal cord tumors (n = 6) treated during the period 1974–1999. Nineteen patients required radiation therapy (RT). The median progression-free survival following RT was 65 months (range 1–206 months). Seven patients recurred at an average of 22 months. The EP patients recurred at an average of 8.5 months, while the patients with low-grade astrocytoma recurred at an average of 42 months. Including the 6 nonsurviving patients, the median overall survival was 96 months. Two EP patients died with a progression-free survival of 9 months. One patient with MPEP died of other causes at 7 months. The treatment of pediatric spinal cord tumors should be individualized based on the histologic type. Radical surgery is indicated for nonmyxopapillary EP and low-grade astrocytic tumors. The need for adjuvant therapy most often depends on the extent of resection as well as the tumor type. Patients with disseminated EP, MPEP, JPA and nonpilocytic astrocytoma may achieve long-term progression-free survival with craniospinal irradiation.
Use of a Portable CT Scanner during Resection of Subcortical Supratentorial Astrocytomas of Childhood
Authors: Gwinn Ryder , Cleary Kevin , Medlock Michael
Published: April 2003

The development of intraoperative imaging has made it possible to visualize shifting brain structures during surgery, and may allow greater intraoperative discrimination of normal and abnormal tissue. This may provide greater confidence to the neurosurgeon to proceed with a more extensive resection while decreasing postoperative morbidity. We investigated the intraoperative use of a portable CT scanner in the resection of 4 cases of supratentorial, subcortical astrocytomas of childhood to assess its usefulness in determining the endpoint of the dissection. We operated on 4 patients, ages 3–17, with astrocytomas. Three were thalamic, and 1 was based primarily in the caudate nucleus. The approach to the basal ganglia was transcallosal in 3 and transtemporal in 1. Specific observations on the intraoperative use of the portable CT scanner included its overall facility, any additional operative time required, the overall quality of the images, intraoperative decisions made based on the images and problems associated with its use. These observations are presented with a review of intraoperative imaging as it pertains to deep pediatric brain tumors. The CT scanner was helpful in limiting the dissection of the hypothalamic and midbrain regions and in localizing remaining abnormal tissue. The scans allowed informed decisions about leaving margins of the tumor which were adjacent to vital structures, but dit not prove to be a decisive factor in providing a complete resection. The following observations are worth noting: (1) average imaging time was 20 min per scan; (2) the extent and location of residual enhancing tumor was easily identified despite other materials in the surgical bed; (3) air/tissue interfaces limit resolution; (4) tumors retain contrast long enough to obtain multiple scans without additional dye, and (5) the cost profile of a mobile CT scanner is superior to that of a fixed intraoperative CT scanner.
Stroke Associated with Marijuana Abuse
Authors: White Daniel , Martin David , Geller Thomas , Pittman Thomas
Published: April 2003

We present the case of a 15-year-old with a cerebellar infarct that involved multiple arterial territories. It was temporally related to, and probably caused by, heavy marijuana use. While the mechanism of marijuana-associated stroke is unclear, the drug is known to cause hypotension and to impair peripheral vasomotor reflexes. We suspect that the child had diminished cerebral autoregulatory capacity and developed the stroke during a period of hypotension.
Fetal MRI in the Evaluation of Intrauterine Myelomeningocele
Authors: Mangels Kyle J. , Tulipan Noel , Tsao Leland Y. , Alarcon John , Bruner Joseph P.
Published: April 2003

Background: Accurate fetal imaging is essential to the practice of maternal-fetal medicine. While ultrasonography has been the traditional mainstay of fetal imaging, its ability to resolve critical features of central nervous system (CNS) anatomy remains limited. As interest in intrauterine therapy for myelomeningocele has increased, so has the need for more accurate, noninvasive imaging of the CNS. Fetal magnetic resonance imaging (MRI) promises to fill the gap left by ultrasound. Methods: Thirty-seven MRI scans of fetuses previously diagnosed with myelomeningocele were reviewed by 2 neuroradiologists. The ability of fetal MRI to resolve the commonest CNS stigmata of spina bifida, and the incidence and extent of interobserver error, was assessed. In 4 cases, postnatal MRIs were also available. These were compared to the corresponding fetal studies. Results: The imaging quality with the technique used in this study was excellent, even without the use of maternal or fetal sedation. There were no complications, and the imaging times were minimal. Interobserver error was minimal with respect to the evaluation of ventricular dilatation and hindbrain herniation, but moderate in the description and location of the spinal lesion. As had previously been documented with ultrasonography, a reduction was seen in hindbrain herniation when comparing pre- and postnatal MRIs. Conclusion: It is concluded that fetal MRI is an effective, noninvasive means of assessing fetal CNS anatomy. Its ability to resolve posterior fossa anatomy is superior to ultrasonography while, with respect to the evaluation of hydrocephalus and the level and nature of the spinal lesion, it may be equivalent to inferior. Inclusion of the fetal MRI into the standard diagnostic armamentarium will probably await the next major advance in speed and resolution. It is conceivable that, with further advances, MRI might supplant ultrasonography as the diagnostic tool of choice for evaluation of fetal anomalies including myelomeningocele.
Fibrous Dysplasia of the Orbit in an Infant
Authors: Joseph Elizabeth , Kachhara R. , Bhattacharya R.N. , Radhakrishnan V.V. , Balachandran Krishna
Published: April 2003

Fibrous dysplasia is an idiopathic fibro-osseous lesion of the skeletal bones. These uncommon osseous lesions usually manifest within the first two decades of life. Its occurrence during infancy is extremely uncommon, and we describe here a case of fibrous dysplasia involving the orbit in a 9-month-old male child.
Chemotherapy: Low-Grade Gliomas of the Hypothalamus and Thalamus
Authors: Packer Roger J.
Published: April 2003

Chemotherapy is an increasing component of the management of diencephalic gliomas. It can result in tumor shrinkage and significant disease control in some patients. However, decisions concerning the institution of treatment should be based on the goals of treatment. Factors include: (1) age of the patient; (2) whether the child has neurofibromatosis type 1; (3) tumor size and location; (4) the potential sequelae of radiotherapy, and (5) the acute and long-term toxicity of the chemotherapeutic approach utilized. The erratic natural history of diencephalic tumors confounds evaluation of efficacy of the regimen chosen.
Thalamic and Hypothalamic Tumors of Childhood: Endocrine Late Effects
Authors: Oberfield Sharon E. , Garvin Jr James H.
Published: April 2003

Children who have received chemotherapy and radiation therapy for treatment of thalamic/hypothalamic tumors are at risk for late effects, specifically endocrine dysfunction. Evaluation of growth and pubertal development, thyroid function and integrity of the hypothalamic-pituittary-adrenal axis should be undertaken in a prospective manner. Issues of metabolic disturbances such as obesity, altered body composition/bone density as well as ultimate fertility also need to be addressed by ongoing prospective evaluations.
Hippocampal Sclerosis in a Two-Year-Old with Temporal Lobe Epilepsy: Case Report with Pathological Confirmation
Authors: Kanos Charles C. , Davies Keith G. , O’Brien Thomas , Dohan Jr. F. Curtis
Published: April 2003

The case of a 2-year-old girl who underwent anterior temporal lobectomy for intractable epilepsy is described. Hippocampal sclerosis (HS) was present on histopathological examination. We believe this to be one of the youngest reported patients with pathologically confirmed HS. This has implications for the possible etiology of HS.
Safety and Efficacy of Remifentanil in Craniosynostosis Repair in Children Less than 1 Year Old
Authors: Chiaretti Antonio , Pietrini Domenico , Piastra Marco , Polidori Giancarlo , Savioli Alessandra , Velardi Francesco , Ciano Francesca , Di Rocco Concezio
Published: April 2003

Few studies on analgesia with remifentanil (Rf) in children are available, and there are no data on the use of this drug in pediatric neurosurgery. Rf is a new μ-receptor opioid agonist, acting through the activation of pain inhibitory mechanisms. We conducted a prospective trial on the analgesic effects of Rf in 20 children less than 1 year of age undergoing a neurosurgical procedure for craniosynostosis repair. Rf was administered at doses of 0.25 μg/kg/min, by continuous infusion, 1 h after admission to the pediatric intensive care unit (PICU). The treatment was prolonged for 12 h after the operation. The postoperative pain was evaluated in our PICU, comparing the changing of behavioral (AFS and CHEOPS score) and hemodynamic (heart rate, respiratory rate, systolic and diastolic blood pressure, oxygen saturation, O2 and CO2 partial pressure) parameters, before and after treatment with Rf. This drug showed a satisfactory pain control in all the children treated. No significant side effects were noticed, except for one episode of urinary retention. In conclusion, Rf appears to be safe and effective for the treatment of acute pain in the very young child submitted to craniosynostosis repair.
Metabolic and Clinical Markers of Prognosis in the Era of CT Imaging in Children with Acute Epidural Hematomas
Authors: Ben Abraham Ron , Lahat Eli , Sheinman Guy , Feldman Zeev , Barzilai Asher , Harel Ran , Barzilay Zohar , Paret Gideon
Published: April 2003

Acute epidural hematoma (AEH), a relatively common complication of head injury in children, persists in bearing high morbidity and mortality. Early establishment of prognosis could guide optimal patient allocation, and early identification of predictive signs could assist in choosing appropriate therapeutic interventions. This study aimed to delineate expeditiously obtainable prognostic markers for determining outcome in a subset of children with AEH. We reviewed our 11-year experience with 61 consecutive children <16 years old with head trauma and isolated AEH. Treatment followed a standard advanced trauma life support protocol. A medical history was obtained, and all patients underwent neurosurgical and physical evaluations. CT scans were performed, as were laboratory tests which included arterial blood gases, glucose, electrolytes (K+, Na+), hemoglobin and coagulation studies. Evaluation of the data collected on cause of injury, interval between trauma occurrence and presentation, clinical symptoms, Glasgow Coma Scale (GCS) scores, vital signs, laboratory test results, physical findings and surgical versus conservative management revealed that the best single predictors of outcome following AEH were the GCS and focal neurological deficits. Of all laboratory data obtained on admission, the blood potassium, pH and glucose test results correlated significantly with prognosis. Prognosis can be adequately and expeditiously estimated by selected markers within a comprehensive evaluation of children with AEH.
Prepontine Lesions with Chiari II Malformation
Authors: Ojemann Jeffrey G. , Park T.S. , Moran Christopher J. , Godken Murat , Kaufman Bruce A.
Published: April 2003

In 2 cases of infants with the Chiari II malformation, a prepontine cyst presented in association with the hindbrain abnormalities characteristic of the Chiari II syndrome. Both infants presented with bulbar dysfunction and had poor outcome despite decompression of the cerebellar tonsillar herniation and drainage of the prepontine cysts. No such association between prepontine lesions and Chiari II has been described previously.
Remission and Residual Symptomatology in Major Depression
Authors: Paykel E.S.
Published: April 2003

This paper reports the course of remission of 64 major depressives, predominantly inpatients, whose course was followed longitudinally with repeated assessment. Remission was comparatively rapid for many of the subjects so that 70% had remitted by 6 months. Only 6% failed to remit by 15 months. Slower remission occurred in those subjects who were initially more severely ill and had longer episodes. Detailed examination at the time of remission revealed that residual symptoms reaching 8 or more on the Hamilton Depression Scale were present in 32% of subjects who remitted below major depression. The pattern was of mild typical depressive symptoms without major biological symptoms. Residual symptoms were more common in subjects with more severe initial depression, but were unrelated to other predictors including longer prior illness, dysthymia or lower dose of drug treatment during the index episode. There were weak associations with passive dependent personality traits, which might however have been reflections of persisting symptom presence. Neither remission nor residual symptoms were related to life stress. Residual symptoms were strong predictors of subsequent relapse. Residual symptoms comprise an important adverse outcome in depression which is common and has received comparatively little attention in the past.
Treated versus Untreated Major Depressive Episodes
Authors: Angst Jules
Published: April 2003

It is a plausible hypothesis that among treated cases of major depressive episodes (MDE) in the community, females will be overrepresented, episodes will be more severe, the course of the disorder will be more frequently chronic and the consequences in the depression more serious. This hypothesis was tested on the subjects of the Zürich cohort study, an enriched population sample (n = 591), which was examined 5 times between the ages of 20 and 35. We found a longitudinal prevalence rate for MDE of 20.2% (13.5% for males and 26.7% for females). 173 subjects met DSM-IV criteria for MDE and of those 66 (38%) had been treated for depression in the preceding 12-month period. 82% of the treated cases were females; in untreated subjects the sex ratio F/M was 1.2:1. Treated cases were found to be more severely depressed, they spent more days in depression over 1 year, experienced greater suffering and suffered more work and social impairment. However, in terms of family history of depression and age of onset, treated and untreated cases did not differ. Surprisingly, there was a trend to a more favorable course among treated subjects than in the untreated group. Compared with controls, untreated subjects demonstrated normal coping skills. The treated cases differed from both untreated subjects and controls in their aggression and neuroticism scores.
Frequency and Phenomenology of Persisting Alterations in Affective, Schizoaffective and Schizophrenic Disorders: A Comparison
Authors: Marneros Andreas , Rohde Anke , Deister Arno
Published: April 2003

Investigating the long-term outcome of affective, schizoaffective and schizophrenic disorders, a model that integrated the operationally gathered findings with the ‘interactional atmosphere’ experienced by the clinician was applied. Eight different types of phenomenological constellations of persisting alterations were delineated (depletion syndrome, apathetic-paranoid (respectively apathetic-hallucinatory) syndrome, adynamic deficiency syndrome, chronic psychosis, structural deformation, slight asthenic insufficiency syndrome, chronic subdepressive syndrome, chronic hyperthymic syndrome. Former assumptions that cross-sectionally the persisting alterations in affective disorders are usually indistinguishable from those in schizophrenia could not be confirmed.
Transcultural Study of Schizophrenic Delusions
Authors: Tateyama Masato , Asai Masahiro , Hashimoto Motohide , Bartels Mathias , Kasper Siegfried
Published: April 2003

Schizophrenic delusions of 324 inpatients in Tokyo, 101 in Vienna, and 150 in Tübingen (Germany) were compared according to the same classifications. Among the three areas, about 80% of the patients had equally ‘negative’ delusions (injury and/or belittlement), and about one-fourth had ‘positive’ delusions of grandeur. Transcultural influences were found in the detailed contents of the ‘negative’ delusions; specific and direct themes of persecutory delusion, i.e., delusions of poisoning, and religious themes of guilt/sin were conspicuous in Europe, while amorphous delusions of reference such as ‘being slandered’ were predominant in Japan. The latter may derive from the group-oriented self in Japanese ‘shame culture’.
Identifying Misidentifications:A Phenomenol ogical Study
Authors: Mojtabai Ramin
Published: April 2003

This study assessed how well the current classification system of the delusional misidentification syndromes (DMSs) represents the full range of misidentification phenomena encountered in self-descriptions of psychotic patients. To this end, a sample of 58 self-descriptions of ex-patients who had suffered from an episode of psychosis were reviewed. Misidentifications fitting the definition of one of the DMSs were identified in only 3 cases, whereas those fitting a general and broad definition were identified in 16 cases. It is argued that the restrictive nature of the currently dominant DMSs classification may have led to the neglect of a wide range of misidentification phenomena which do not fit the descriptions of any one of the classic DMSs. Proper identification, description and classification of these non-DMS misidentification phenomena is needed.
Genital Retraction Syndrome in a Korean Woman
Authors: Kovács, Attila , Osváth Péter
Published: April 2003

Koro is a culture-specific psychiatric disorder occurring primarily in Southeast Asian cultures. It is manifested by acute anxiety associated with the fear of genital retraction, accompanied by fear of death induced by the thought that complete disappearance of the genital organ will result in death. Koro has been described in non-Asian patients as well, leading to a debate concerning the culture-specific nature of the syndrome. Giving a psychopathological, nosological definition of this peculiar syndrome is also problematic. In this paper, we report a case of koro in a young, Korean female patient. We briefly present the etiological factors related to the development of the syndrome and the most significant psychopathological characteristics.
Pathological Fear of Cot Death
Authors: Weightman Helen , Dalal Brian M. , Brockington I.F.
Published: April 2003

Cot death (sudden infant death syndrome) is one of the most common causes of death in the first year of life. Four cases with a pathological fear of cot death are presented. All the patients were depressed and in 2 cases the fear of cot death had an obsessional quality. In all cases there were complications during pregnancy (miscarriage, threatened abortion, recurrent vomiting in last trimester). In 1 case, the patient knew 3 mothers who had suffered cot deaths; in another, the infant was gravely ill in the neonatal period. Pathological fear of cot death can be recognised by the presence of two central features – overvigilance and excessive nocturnal checking of the baby’s breathing. Therapeutic interventions are discussed.
Parapartum Mental Illness: A Long-Term Follow-Up Study
Authors: Bågedahl-Strindlund, Margaretha , Ruppert Sonja
Published: April 2003

All mothers (n = 79) in the county of Stockholm who gave birth to a child during 1976–77 and were also hospitalised for the first time in a psychiatric clinic were followed up after a mean interval of 15 years. The sample was classified according to the Research Diagnostic Criteria. Comparisons were made with matched obstetric controls. Five patients had died. The recurrence rate was 51% and 7.3% relapsed after a subsequent childbirth. No difference was found between psychotic and non-psychotic mothers regarding mean sick-leave days per year. The majority of the women with a depressive disorder at index admission suffered from a minor depressive disorder. The women in the group with an unspecified functional psychosis showed a less severe course of illness than the women in the schizophrenia group.
Affective Disorders, Hospital Admissions, and Seasonal Variation of Mania in a Subtropical Area, Southern Hemisphere
Authors: Kerr-Corrêa F. , Souza L.B. , Calil H.M.
Published: April 2003

Hospital admissions (n = 15,450) to a state psychiatric hospital in Botucatu, São Paulo State, Brazil, over a 10-year period (1982–1991) were reviewed. 157 (1%) patients received a probable diagnosis of affective disorder according to DSM-III-R criteria. Among them, 46% had been diagnosed by the staff psychiatrists, and their diagnoses were sustained by the researchers, whereas 54% were diagnosed only by one of the researchers (F.K.C.). These last patients had previously received a diagnosis of paranoid schizophrenia or unspecified psychosis (ICD-9). Most of the patients with affective disorders were bipolar: 72 and 8%, respectively, presented manic and depressive episodes. Thus, only 20% received a diagnosis of major depression. A seasonal pattern in hospital admission was observed only for mania in women, their episodes occurring more often (p < 0.02) in spring and summer. No significant seasonal pattern in hospital admission for depression was found.
Gender Differences and Age of Onset in the Catatonic Subtypes of Schizophrenia
Authors: Stöber Gerald , Franzek Ernst , Haubitz Imme , Pfuhlmann Bruno , Beckmann Helmut
Published: April 2003

In a family study involving 139 probands with chronic DSM-III-R schizophrenia, catatonic type, 83 probands met the criteria for periodic catatonia and 56 probands those for systematic catatonia according to Leonhard. In the systematic catatonias, we found a low morbidity risk of 4.6% in first-degree relatives, an early age at first hospitalization and a high prevalence of affected males. In the light of our recent report of an association between maternal gestational infection and systematic schizophrenia, male fetuses exposed to midgestational infection seem to be particularly at risk of developing systematic catatonia. Periodic catatonia with a family morbidity risk of 26.9% affected both genders with equal frequency and showed no age-at-onset differences between the genders. We found a moderate inverse relationship between early-onset probands and an increased risk in relatives of 24.1% compared to 17.8% in late-onset probands. Our findings substantiate the hypothesis that periodic catatonia is a clinically homogenous disorder with a major gene effect and an age at onset which is to a large extent genetically determined.
The Hysterical Personality Disorder:A Phenomenological Approach
Authors: Sigmund, Dieter , Barnett, Winfried , Mundt Christoph
Published: April 2003

The background of the present study is a general uncertainty as to what comprises the essence of hysterical (histrionic) personality disorder. Using phenomenological methodology, phenomena observable in the ‘classic’ hysterical personality are analysed, described, named, and classified according to the basic functions of human experience and behaviour. The resulting psychopathological picture of the hysterical personality facilitates a differential diagnosis that is often decidedly difficult. The phenomenon of dissociation of the mental processes is demonstrated for the various basic functions. A specific feature of the disorder is shown which generates a dissociation of contents of the personality along a conscious-preconscious-unconscious continuum. It is concluded that dissocation is, in the final analysis, the prerequisite for a compromised and partial acting out of prohibited non-integrated elements, e.g. aggression, as a coping strategy.
Shared Psychotic Disorder in Delusional Parasitosis
Authors: Trabert Wolfgang
Published: April 2003

Delusional parasitosis (DP) is associated in 5–15% with shared psychotic disorder (SPD). Little systematic information is available about this particular aspect of the syndrome. A thorough review of all published cases with DP was carried out. 68 case histories of SPD were identified (5.67%). The data of these patients were compared with those of their inducers (n = 44) and with the data of DP patients, who did not transfer their delusional beliefs to others (n = 1,155). Approximately 30% of the psychotic dyads were reported from public health departments. The sex ratio was balanced in the SPD group, but showed a clear preponderance of females in the other two groups. SPD patients and their inducers reported more frequently visual illusions or hallucinations and located the animals correspondingly upon the surface of the skin. No diagnostic differences were found between the inducers and those who had DP but did not induce SPD in others. Albeit 50% of the SPD patients did not receive any treatment except separation from the inducer, the remission rate in this group was 93%.
A Case of Asperger’s Syndrome First Diagnosed in Adulthood
Authors: Bankier Bettina , Lenz Gerhard , Gutierrez Karin , Bach Michael , Katschnig Heinz
Published: April 2003

A 25-year-old white male patient was admitted to the Department of Psychiatry, Division of Social Psychiatry, of the University of Vienna, Austria, for severe social withdrawal, selective mutism and outbursts of violence with attacks on his mother. Careful examination revealed the presence of all the typical symptoms of Asperger’s syndrome. The diagnosis had never been made before, although the patient had a history of a difficult childhood with several admissions to a child psychiatric inpatient unit for ‘obsessional neurosis’ and an institutional career. It is stressed that, in view of the availability of treatments and the deleterious effect of the untreated condition in the sensitive years of personality development, early recognition and diagnosis of Asperger’s syndrome are of utmost importance.