bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scaphoid Fracture in a Patient After a Fall
Authors: Buscema Christopher J. 
Published: June 2012

The patient was a 27-year-old man who was referred to a physical therapist because of persistent right wrist pain after a fall on an outstretched hand in a remote setting 3 months prior. Immediately after the injury, the patient was seen by a physician's assistant in a remote medical clinic, where right wrist radiographs were completed and interpreted as normal. Based on the history and physical exam, a potential scaphoid fracture was suspected. Therefore, the physical therapist ordered radiographs of the right wrist, which revealed a fracture through the waist of the right scaphoid with a band-like lucency. J Orthop Sports Phys Ther 2012;42(6):568. doi:10.2519/jospt.2012.0410
Ultrasound Assessment of an Acute Biceps Brachii Injury
Authors: Krause David A. , Smith Jay 
Published: June 2012

The patient was a 24-year-old woman who was evaluated by a physical therapist in a direct-access sports medicine clinic for a chief complaint of right anterior arm pain and swelling. Given the unusual mechanism and location of the injury, significant pain and weakness, and questionable tissue defect, diagnostic ultrasound was ordered. The ultrasound examination findings revealed a strain of the right short head of the biceps brachii with a partial tear more distally. J Orthop Sports Phys Ther 2012;42(6):569. doi:10.2519/jospt.2012.0411
Safety and Feasibility of an Early Mobilization Program for Patients With Aneurysmal Subarachnoid Hemorrhage
Authors: Olkowski Brian F. , Devine Mary Ann , Slotnick Laurie E. , Veznedaroglu Erol , Liebman Kenneth M. , Arcaro Melissa L. , Binning Mandy Jo 
Published: June 2012

BackgroundSurvivors of aneurysmal subarachnoid hemorrhage (SAH) are faced with a complicated recovery, which typically includes surgery, prolonged monitoring in the intensive care unit, and treatment focusing on the prevention of complications.ObjectiveThe purpose of this study was to determine the safety and feasibility of an early mobilization program for patients with aneurysmal SAH.DesignThis study was a retrospective analysis.MethodsTwenty-five patients received early mobilization by a physical therapist or an occupational therapist, or both, which focused on functional training and therapeutic exercise in more progressively upright positions. Participation criteria focused on neurologic and physiologic stability prior to the initiation of early mobilization program sessions.ResultsPatients met the criteria for participation in 86.1% of the early mobilization program sessions attempted. Patients did not meet criteria for the following reasons: Lindegaard ratio &gt;3.0 or middle cerebral artery (MCA) mean flow velocity (MFV) &gt;120 cm/s (8.1%), mean arterial pressure (MAP) &lt;80 mm Hg (1.8%), intracranial pressure (ICP) &gt;15 mm Hg (1.8%), unable to open eyes in response to voice (0.9%), respiratory rate &gt;40 breaths/min (0.6%), MAP &gt;110 mm Hg (0.3%), and heart rate &lt;40 bpm (0.3%). Adverse events occurred in 5.9% of early mobilization program sessions for the following reasons: MAP &lt;70 mm Hg (3.1%) or &gt;120 mm Hg (2.4%) and heart rate &gt;130 bpm (0.3%). The 30-day mortality rate for all patients was 0%. Participation in the early mobilization program began a mean of 3.2 days (SD=1.3) after aneurysmal SAH, and patients received an average of 11.4 sessions (SD=4.3). Patients required a mean of 5.4 days (SD=4.2) to participate in out-of-bed activity and a mean of 10.7 days (SD=6.2) to walk ≥15.24 m (50 ft).ConclusionsThe results of this study suggest that an early mobilization program for patients with aneurysmal SAH is safe and feasible.
Targeted delivery of nerve growth factor via encapsulated cell biodelivery in Alzheimer disease: a technology platform for restorative neurosurgery
Authors: Wahlberg Lars U. , Lind Göran , Almqvist Per M. , Kusk Philip , Tornøe Jens , Juliusson Bengt , Söderman Michael , Selldén Eva , Seiger Åke , Eriksdotter-Jönhagen Maria , Linderoth Bengt 
Published: June 2012

Object
The authors describe the first clinical trial with encapsulated cell biodelivery (ECB) implants that deliver nerve growth factor (NGF) to the cholinergic basal forebrain with the intention of halting the degeneration of cholinergic neurons and the associated cognitive decline in patients with Alzheimer disease (AD). The NsG0202 implant (NsGene A/S) consists of an NGF-producing, genetically engineered human cell line encapsulated behind a semipermeable hollow fiber membrane that allows the influx of nutrients and the efflux of NGF. The centimeter-long capsule is attached to an inert polymer tether that is used to guide the capsule to the target via stereotactic techniques and is anchored to the skull at the bur hole.

Methods
Six patients with mild to moderate AD were included in this Phase Ib open-label safety study and were divided into 2 dose cohorts. The first cohort of 3 patients received single implants targeting the basal nucleus of Meynert (Ch4 region) bilaterally (2 implants per patient), and after a safety evaluation, a second cohort of 3 patients received bilateral implants (a total of 4 implants per patient) targeting both the Ch4 region and the vertical limb of the diagonal band of Broca (Ch2 region). Stereotactic implantation of the devices was successfully accomplished in all patients. Despite extensive brain atrophy, all targets could be reached without traversing sulci, the insula, or lateral ventricles.

Results
Postoperative CT scans allowed visualization of the barium-impregnated tethers, and fusion of the scans with stereotactic MR images scan was used to verify the intended positions of the implants. Follow-up MRI at 3 and 12 months postimplantation showed no evidence of inflammation or device displacement. At 12 months, implants were successfully retrieved, and low but persistent NGF secretion was detected in half of the patients.

Conclusions
With refinement, the ECB technology is positioned to become an important therapeutic platform in restorative neurosurgery and, in combination with other therapeutic factors, may be relevant for the treatment of a variety of neurological disorders. Clinical trial registration no.: NCT01163825.
The use of abdominal binders to treat over-shunting headaches
Authors: Sklar Frederick H. , Nagy Laszlo , Robertson Brian D. 
Published: June 2012

Object
Headaches are common in children with shunts. Headaches associated with over-shunting are typically intermittent and tend to occur later in the day. Lying down frequently makes the headaches better. This paper examines the efficacy of using abdominal binders to treat over-shunting headaches.

Methods
Over an 18-year period, the senior author monitored 1027 children with shunts. Office charts of 483 active patients were retrospectively reviewed to identify those children with headaches and, in particular, those children who were thought to have headaches as a result of over-shunting. Abdominal binders were frequently used to treat children with presumed over-shunting headaches, and these data were analyzed.

Results
Of the 483 patients undergoing chart review, 258 (53.4%) had headache. A clinical diagnosis of over-shunting was made in 103 patients (21.3% overall; 39.9% of patients with headache). In 14 patients, the headaches were very mild (1–2 on a 5-point scale) and infrequent (1 or 2 per month), and treatment with an abdominal binder was not thought indicated. Eighty-nine patients were treated with a binder, but 19 were excluded from this retrospective study for noncompliance, interruption of the binder trial, or lack of follow-up.
The remaining 70 pediatric patients, who were diagnosed with over-shunting headaches and were treated with abdominal binders, were the subjects of a more detailed retrospective study. Significant headache improvement was observed in 85.8% of patients. On average, the patients wore the binders for approximately 1 month, and headache relief usually persisted even after the binders were discontinued. However, the headaches eventually did recur in many of the patients more than a year later. In these patients, reuse of the abdominal binder was successful in relieving headaches in 78.9%.

Conclusions
The abdominal binder is an effective, noninvasive therapy to control over-shunting headaches in most children. This treatment should be tried before any surgery is considered. It is suggested that the abdominal binder may modulate abnormally increased intracranial pulse pressures associated with over-shunting. Interactions with the cerebrovascular bed are suspected to account for persistent headache relief after the binder is discontinued.
Sacroiliac joint pain in the pediatric population
Authors: Stoev Ivan , Powers Alexander K. , Puglisi Joan A. , Munro Rebecca , Leonard Jeffrey R. 
Published: June 2012

Object
The sacroiliac (SI) joint can be a pain generator in 13%–27% of cases of back pain in adults. These numbers are largely unknown for the pediatric population. In children and especially girls, development of the pelvic girdle makes the SI joint prone to misalignment. Young athletes sustain repeated stress on their SI joints, and sometimes even minor trauma can result in lasting pain that mimics radiculopathy. The authors present a series of 48 pediatric patients who were evaluated for low-back pain and were found to have SI joint misalignment as the cause of their symptoms. They were treated with a simple maneuver described in this paper that realigned their SI joint and provided significant improvement of symptoms.

Methods
A retrospective review of the electronic records identified 48 patients who were referred with primary complaints of low-back pain and were determined to have SI joint misalignment during bedside examination maneuvers described here. Three patients did not have a record of their response to treatment and were excluded. Patients were evaluated by a physical therapist and had the realignment procedure performed on the day of initial consultation. The authors collected data regarding the immediate effect of the procedure, as well as the duration of pain relief at follow-up visits.

Results
Eighty percent of patients experienced dramatic improvement in symptoms that had a lasting effect after the initial treatment. The majority of them were given a home exercise program, and only 2 of the 36 patients who experienced significant relief had to be treated again. Fifty-three percent of all patients had immediate and complete resolution of symptoms. Three of the 48 patients had missing data from the medical records and were excluded from computations.

Conclusions
Back pain is multifactorial, and the authors' data demonstrate the potential importance of SI joint pathology. Although the technique described here for treatment of misaligned SI joints in the pediatric patients is not effective in all, the authors have observed significant improvement in 80% of cases. Often it is difficult to determine the exact cause of back pain, but when the SI joint is suspected as the primary pathology, the authors have described a simple and effective bedside treatment that should be attempted prior to the initiation of further testing and surgery.
Spinal cord ependymomas and myxopapillary ependymomas in the first 2 decades of life: a clinicopathological and immunohistochemical characterization of 19 cases
Authors: Stephen James H. , Sievert Angela J. , Madsen Peter J. , Judkins Alexander R. , Resnick Adam C. , Storm Phillip B. , Rushing Elisabeth J. , Santi Mariarita 
Published: June 2012

Object
Primary spinal cord ependymomas (EPNs) are rare in children, comprising classical WHO Grade II and III tumors and Grade I myxopapillary ependymomas (MEPNs). Despite their benign histology, recurrences and neural-axis dissemination have been reported in up to 33% MEPNs in the pediatric population. Treatment options beyond resection are limited, and little is known about their tumorigenesis. The purpose of this study was to explore the tumor biology and outcomes in a consecutive series of pediatric patients treated at a single institution.

Methods
The authors performed a retrospective clinicopathological review of 19 patients at a tertiary referral children's hospital for resection of a spinal cord ependymoma. The population included 8 patients with a pathological diagnosis of MEPN and 11 patients with a pathological diagnosis of spinal EPN (10 cases were Grade II and 1 case was Grade III). The upregulation of the following genes HOXB13, NEFL, PDGFRα, EGFR, EPHB3, AQP1, and JAGGED 1 was studied by immunohistochemistry from archived paraffin-embedded tumor samples of the entire cohort to compare the expression in MEPN versus EPN.

Results
Gross-total resection was achieved in 75% of patients presenting with MEPNs and in 100% of those with EPNs. The average follow-up period was 79 months for the MEPN subset and 53 months for Grade II/III EPNs. Overall survival for both subsets was 100%. However, event-free survival was only 50% for patients with MEPNs. Of note, in all cases involving MEPNs that recurred, the patients had undergone gross-total resection on initial surgery. In contrast, there were no tumor recurrences in patients with EPNs. Immunohistochemistry revealed no significant differences in protein expression between the two tumor types with the exception of EPHB3, which demonstrates a tendency to be positive in MEPNs (6 reactive tumors of 9) rather than in EPN (2 reactive tumors of 10).

Conclusions
The authors' experience shows that, following a gross-total resection, MEPNs are more likely to recur than their higher-grade counterpart, EPNs. This supports the recommendation for close long-term radiological follow-up of pediatric patients with MEPNs to monitor for recurrence, despite the tumor's low-grade histological feature. No significant difference in the protein expression of HOXB13, NEFL, PDGFRα, EGFR, EPHB3, AQP1, and JAGGED 1 was present in this selected cohort of pediatric patients.
Complex pediatric cervical spine surgery using smaller nonspinal screws and plates and intraoperative computed tomography
Authors: Karandikar Mahesh , Mirza Sohail K. , Song Kit , Yang Tong , Krengel Walter F. , Spratt Kevin F. , Avellino Anthony M. 
Published: June 2012

Object
The treatment of craniocervical instability in children is often challenging due to their small spine bones, complex anatomy, and unique syndromes. The authors discuss their surgical experience with 33 cases in the treatment of 31 children (≤17 years of age) with craniocervical spine instability using smaller nontraditional titanium screws and plates, as well as intraoperative CT.

Methods
All craniocervical fusion procedures were performed using intraoperative fluoroscopic imaging and electrophysiological monitoring. Nontraditional spine hardware included smaller screw sizes (2.4 and 2.7 mm) from the orthopedic hand/foot set and mandibular plates. Twenty-three of the 33 surgical procedures were performed with intraoperative CT, which was used to confirm adequate position of the spine hardware and alignment of the spine.

Results
The mean patient age was 9.5 years (range 2–17 years). Eleven children underwent a posterior C1–2 transarticular screw fusion, 17 had an occipitocervical fusion, and 3 had a posterior subaxial cervical fusion. The follow-up duration ranged from 9 to 72 months (mean 53 months). All children demonstrated successful fusion at their 3-month follow-up visit, except 1 patient whose unilateral C1–2 transarticular screw fusion required a repeat surgery before proper fusion was achieved. Of the 47 C1–2 transarticular screws that were placed, 13 were 2.4 mm, 15 were 2.7 mm, 7 were 3.5 mm, and 12 were 4.0 mm. Eighteen of the 47 C1–2 transarticular screws were suboptimally placed. Eleven of these misplaced screws were removed and redirected within the same operation because these surgeries benefitted from the use of intraoperative CT; 6 of the 7 remaining suboptimally placed screws were left in place because a second surgery for screw replacement was not warranted. The other suboptimally placed C1–2 screw was replaced during a repeat operation due to failure of fusion. Use of intraoperative CT was invaluable because it enabled the authors to reposition suboptimal C1–2 transarticular screws without necessitating a second operation.

Conclusions
Successful craniocervical fusion procedures were achieved using smaller nontraditional titanium screws and plates. Intraoperative CT was a helpful adjunct for confirming and readjusting the trajectory of the screws prior to leaving the operating room, which decreases overall treatment costs and reduces complications.
Clinical evaluation and surveillance imaging in children with spina bifida aperta and shunt-treated hydrocephalus
Authors: Chern Joshua J. , Muhleman Mitchel , Tubbs R. Shane , Miller Joseph H. , Johnston James M. , Wellons John C. , Blount Jeffrey P. , Oakes W. Jerry , Rozzelle Curtis J. 
Published: June 2012

Object
Most children with spina bifida aperta have implanted CSF shunts. However, the efficacy of adding surveillance imaging to clinical evaluation during routine follow-up as a means to minimize the hazard of shunt failure has not been thoroughly studied.

Methods
A total of 396 clinic visits were made by patients with spina bifida aperta and shunt-treated hydrocephalus in a spina bifida specialty clinic during the calendar years 2008 and 2009 (initial clinic visit). All visits were preceded by a 6-month period during which no shunt evaluation of any kind was performed and were followed by a subsequent visit in the same clinic. At the initial clinic visit, 230 patients were evaluated by a neurosurgeon (clinical evaluation group), and 166 patients underwent previously scheduled surveillance CT scans in addition to clinical evaluation (surveillance imaging group). Subsequent unexpected events, defined as emergency department (ED) visits and caregiver-requested clinic visits, were reviewed. The time to an unexpected event and the likelihood of event occurrence in each of the 2 groups were compared using Cox proportional hazards survival analysis. The outcome and complications of shunt surgeries were also reviewed.

Results
The clinical characteristics of the 2 groups were similar. In the clinical evaluation group, 2 patients underwent shunt revision based on clinical findings in the initial visit. In the subsequent follow-up period, there were 27 visits to the ED and 25 requested clinic visits that resulted in 12 shunt revisions. In the surveillance imaging group, 11 patients underwent shunt revision based on clinical and imaging findings in the initial visit. In the subsequent follow-up period, there were 15 visits to the ED and 9 requested clinic visits that resulted in 8 shunt revisions. Patients who underwent surveillance imaging on the day of initial clinic visit were less likely to have an unexpected event in the subsequent follow-up period (relative risk 0.579, p = 0.026). The likelihood of needing shunt revision and the morbidity of shunt malfunction was not significantly different between the 2 groups.

Conclusions
Surveillance imaging in children with spina bifida aperta and shunted hydrocephalus decreases the likelihood of ED visits and caregiver-requested clinic visits in the follow-up period, but based on this study, its effect on mortality and morbidity related to shunt malfunction was less clear.
First preoperative functional mapping via navigated transcranial magnetic stimulation in a 3-year-old boy
Authors: Coburger Jan , Karhu Jari , Bittl Markus , Hopf Nikolai J. 
Published: June 2012

Preoperative functional mapping in children younger than 5 years old remains a challenge. Awake functional MRI (fMRI) is usually not an option for these patients. Except for a description of passive fMRI in sedated patients and magnetoencephalography, no other noninvasive mapping method has been reported as a preoperative diagnostic tool in children. Therefore, invasive intraoperative direct cortical stimulation remains the method of choice. To the authors' knowledge, this is the first case of a young child undergoing preoperative functional motor cortex mapping with the aid of navigated transcranial magnetic stimulation (nTMS).
In this 3-year-old boy with a rolandic ganglioglioma, awake preoperative mapping was performed using nTMS. A precise location of Broca area 4 could be established. The surgical approach was planned according to the preoperative findings. Intraoperative direct cortical stimulation verified the location of the nTMS hotspots, and complete resection of the precentral tumor was achieved.
Navigated TMS is a precise tool for preoperative motor cortex mapping and is feasible even in very young pediatric patients. In children for whom performing the fMRI motor paradigm is challenging, nTMS is the only available option for functional mapping.
Complications of occipital screw placement for occipitocervical fusion in children
Authors: Hwang Steven W. , Gressot Loyola V. , Chern Joshua J. , Relyea Katherine , Jea Andrew 
Published: June 2012

Object
Occipitocervical stabilization in the pediatric age group remains a challenge because of the regional anatomy, poor occipital bone purchase, and, in some instances, significant thinning of the occipital bone. Multiple bicortical fixation points to the occipital bone may be required to increase construct rigidity. The authors evaluated the complications of bicortical occipital screw placement in children with occipital fusion constructs.

Methods
The records of 20 consecutive pediatric patients who had undergone occipitocervical fusion between September 1, 2007, and November 30, 2010, at Texas Children's Hospital were reviewed.

Results
The patients consisted of 10 girls and 10 boys, ranging in age from 10 months to 16 years (mean ± SD, 7.7 ± 5.1 years). Two patients were lost to follow-up, 2 died for reasons unrelated to the surgery, and the remaining patients had at least 3 months of follow-up (mean 14 ± 11.8 months) with evaluation via dynamic radiography and CT. Four patients experienced 8 complications: 2 CSF leaks, 2 vigorous venous bleedings, worsening of quadriparesis, wound infection, radiographic pseudarthrosis, and transient dysphagia. Among 114 screws, there were 2 cases of intraoperative dural venous sinus injury and 2 cases of intraoperative CSF leakage, without clinical sequelae from these complications. Only 1 case of radiographic pseudarthrosis was identified in a patient with skeletal dysplasia and a prior failed C1–2 posterior arthrodesis. There were no difficulties with wound healing because of prominent occipital instrumentation, and there was only 1 wound infection.

Conclusions
Data in this report confirm that including bicortical occipital screw placement in occipitocervical constructs in children may result in a high fusion rate but at the cost of a notable complication rate.
Split cord malformation Type II with twin dorsal lipomas
Authors: Salunke Pravin , Futane Sameer S. , Aggarwal Ashish 
Published: June 2012

Although uncommon, variations in split cord malformation (SCM) have been described. However, a combination of SCM Type II and dorsal lipomas has not been reported.
The authors describe the case of a 6-year-old girl who presented with a 1-year history of spastic paraparesis associated with a lipomatous swelling on her lower back. Radiology revealed a Type II SCM with a dorsal lipoma at that level. Intraoperatively, the authors observed a dorsal lipoma for each hemicord; these were excised, and the septum causing the split was cut.
Premature separation of the cutaneous and neural ectoderm is predetermined for each neural fold, and a split at this level would give rise to SCM with twin dorsal lipomas, one for each hemicord.