bluuebunny/crossref_metadata_2025_split huggingface dataset:
C2/3 Instability in a Child with Down’s Syndrome
Authors: Citow Jonathan Stuart , Munshi Ilyas , Chang-Stroman T. , Sullivan Christopher , Frim David M. 
Published: April 2003

Down’s syndrome patients are prone to cervical ligamentous laxity, the vast majority of which is at the C1/2 level. We describe the case of a 2-year-old girl with Down’s syndrome who was found to have cervical instability at the C2/3 level on screening cervical spine radiographs with 9 mm of anterolisthesis of C2 on C3. She was without clinically evident neurological deficit from this condition; however, T<sub>2</sub>-weighted magnetic resonance imaging of her cervical spine revealed high intensity signal changes within the spinal cord at and above that level. She underwent posterior fusion that was complicated by poor tolerance of her Minerva-type cervical brace. She eventually developed a stable fusion with 5 mm of anterolisthesis at the C2/3 level. This is the only Down’s syndrome patient with instability at the C2/3 level that we have found reported. Our experience suggests that Down’s syndrome patients can have instability at C2/3 that can be successfully treated with posterior fusion.
Management of Uncomplicated Skull Fractures in Children:Is Hospital Admission Necessary?
Authors: Vogelbaum M.A. , Kaufman B.A. , Park T.S. , Winthrop A.L. 
Published: April 2003

<b>Objective: </b>This study was undertaken to determine the necessity for routine hospital admission of children with skull fractures, a normal neurological exam, a normal head CT, and no other injuries (‘uncomplicated skull fracture’). <b>Methods: </b>A prospective study of closed-head injuries in children was done over a 2-year period at St. Louis Children’s Hospital. All patients with closed head injuries underwent skull radiographs and a head CT scan. From this cohort, children with uncomplicated skull fractures were identified and studied. For comparison, a retrospective analysis was also performed of the hospital admission records of children admitted over a 5-year period (1990–1994) with the diagnosis of epidural hematoma (EDH) to identify the typical time intervals between injury and documentation of the lesion in these cases. <b>Results: </b>Forty-four patients with uncomplicated skull fractures were identified; all had been admitted for observation. Mean age was 1.8 years. Average time between injury and hospital admission was 6.35 h with half of this time being spent in the emergency room. Average LOS was 35 h, but 50% of patients were hospitalized less than 24 h. No patient in this study group suffered a complication related to their inury. Twenty-three patients with EDH had been admitted during the 5-year review period. Slightly more than one-half of patients had their EDH detected within 6 h of injury. The others were diagnosed more than 6 h after injury due to a delay in medical evaluation or a delay in obtaining a computed tomographic (CT) scan after an initial medical evaluation. <b>Conclusions: </b>Patients with uncomplicated skull fractures, in the absence of recurrent emesis and/or evidence of child abuse, can be considered for discharge home. The definition of an uncomplicated skull fracture requires that a head CT be performed on these patients.
Predictors of Posttraumatic Convulsions in Head-Injured Children
Authors: Ratan Simmi K. , Kulshreshtha Rajiv , Pandey Ravindra M. 
Published: April 2003

The purpose of this study was to determine predictors of posttraumatic convulsions in children. Study subjects included children under 12 years of age, who were admitted to the Safdarjang Hospital, New Delhi, during the year 1997 (January to December) after suffering head trauma. The occurrence of first convulsion after head injury was taken as the outcome variable in the study. Medical records were reviewed for data about clinical, radiological and epidemiological features of such children. The study revealed that children younger than 2 years of age (odds ratio, OR 2.96; 95% confidence interval, CI 1.42–6.21), those suffering severe head injuries, i.e. with low Glasgow Coma Score (OR 3.07; 95% CI 1.40–6.77), and those with longer period of unconsciousness after head trauma, especially longer than 12 h (OR 1.71; 95% CI 0.69–4.19) have higher likelihood of suffering convulsions after head injury. However, none of the radiological findings were found to be significantly associated with posttraumatic convulsions.
Preclinical Evaluation of Benzoporphyrin Derivative Combined with a Light-Emitting Diode Array for Photodynamic Therapy of Brain Tumors
Authors: Schmidt Meic H. , Reichert II Kenneth W. , Ozker Kutlan , Meyer Glenn A. , Donohoe Debra L. , Bajic Dawn M. , Whelan Noel T. , Whelan Harry T. 
Published: April 2003

<i>Objective:</i> The aim of this study was to investigate the second-generation photosensitizer benzoporphyrin derivative (BPD) and a novel light source applicator based on light-emitting diode (LED) technology for photodynamic therapy (PDT) of brain tumors. <i>Methods:</i> We used a canine model to investigate normal brain stem toxicity. Twenty-one canines underwent posterior fossa craniectomies followed by PDT with BPD. These animals were compared to light only and BPD control. In addition, we investigated the ability of BPD and LED to cause inhibition of cell growth in canine glioma and human glioma cell lines, in vitro. The biodistribution of BPD labeled with <sup>111</sup>In-BPD in mice with subcutaneous and intracerebral gliomas and canines with brain tumors was studied. <i>Results:</i> The in vivo canine study resulted in a maximal tolerated dose of 0.75 mg/kg of BPD and 100 J/cm<sup>2</sup> of LED light for normal brain tissue. The in vitro study demonstrated 50% growth inhibition for canine and human glioma cell lines of 10 and 4 ng/ml, respectively. The mucine study using <sup>111</sup>In-BPD showed a tumor to normal tissue ratio of 12:1 for intracerebral tumors and 3.3:1 for subcutaneous tumors. Nuclear scans of canines with brain tumors showed uptake into tumors to be maximal from 3 to 5 h. <i>Conclusion:</i> Our study supports that BPD and LED light sources when used at appropriate drug and light doses limit normal brain tissue toxicity at doses that can cause significant glioma cell toxicity in vitro. In addition, there is higher BPD uptake in brain tumors as compared to normal brain in a mouse glioma model. These findings make BPD a potential new-generation photosensitizer for the treatment of childhood posterior fossa tumors as well as other malignant cerebral pathology.
Tandem Spinal Cord Injurieswithout Radiographic Abnormalities in a Young Child
Authors: Pollina John , Li Veetai 
Published: April 2003

Anatomic features unique to the pediatric spine render this population susceptible to spinal cord injuries without radiographic abnormalities (SCIWORA). To date, published descriptions of SCIWORA have been limited to a single region of the spinal column. We describe a case of a 3-year-old boy in whom, after a motor vehicle accident, tandem SCIWORA lesions involving the lower cervical spinal cord and thoracolumbar junction resulted in severe quadraparesis. The child was initially treated with 24 h of methylprednisolone followed by 3 months of external orthoses of both the cervical and thoracic spine. We include in this article a brief review of the literature and treatment guidelines for SCIWORA and postulate the mechanism of these tandem spinal cord injuries.
Stereotactic Radiation in Primary Brain Tumors in Children and Adolescents
Authors: Benk Véronique , Clark Brenda G. , Souhami Luis , Algan Ozer , Bahary Jean-Paul , Podgorsak Ervin B. , Freeman Carolyn R. 
Published: April 2003

To evaluate treatment outcome and morbidity of stereotactic external-beam irradiation (SEBI) in pediatric patients, we reviewed 14 children treated with SEBI, using a 10-MV isocentric linear accelerator at McGill University between 1988 and 1994. The median follow-up was 46 months (range 6–82 months). The median age was 14 years. There were 8 low-grade astrocytomas, 3 neuromas and 4 other histologies. Twelve patients received fractionated treatments. The median collimator diameter was 2.5 cm (range 1–5 cm). The median biological effective dose delivered to the entire tumor volume was 57 Gy for astrocytomas and 43 Gy for the other histologies. The overall actuarial survival rate and disease-free survival rate at 5 years were 83 and 62%, respectively. For the patients with low-grade astrocytomas, the 5-year survival and disease-free survival rates were 100 and 60%, respectively. Four children had recurrence at a median of 37 months. Four patients developed treatment-related complications: 1 had edema alone, 2 had necrosis and 1 had edema associated with necrosis. Neither the physical nor radiobiological parameters were predictive of the treatment outcome or the treatment complications. Stereotactic irradiation is a valid option for progressive nonresectable tumors in children.
Management of Chiari I Malformations with Holocord Syringohydromyelia
Authors: Feldstein Neil A. , Choudhri Tanvir F. 
Published: April 2003

The management of patients with Type I Chiari malformations (CM 1) with or without syringohydromyelia (SHM) has remained quite controversial, and many different surgical procedures have been advocated. Over the past several years, the authors have treated 7 children presenting with CM 1 and holocord syringohydromyelia with suboccipital decompression and duraplasty alone without intradural procedures. All children received MRI imaging at 2–4 months and 1 year postoperatively. On the early postoperative MRI examination, marked reduction in the syringohydromyelia was seen in 6 children, with minimal change in syrinx size in 1 child who was clinically improving after the operation. At 1 year, all children with early collapse remained collapsed, and the child with minimal early collapse demonstrated an approximately 50% reduction in syrinx size. Clinical follow-up (mean 30 months, range 21–50 months) showed good results in all patients: none of the children have required further neurosurgical intervention, and all have shown improvement in their preoperative function. One child with a 46° scoliosis had a complete collapse of her SHM, but ultimately required spinal fusion. The presenting clinical findings, operative technique, MRI imaging and clinical outcomes will be discussed. The results from these 7 patients with CM 1 and holocord syringomyelia suggest that posterior fossa decompression alone (without intradural procedures) can provide excellent radiographic and clinical outcome.
Late Shunt Infections
Authors: Baird Clinton , O’Connor Dennis , Pittman Thomas 
Published: April 2003

We reviewed the records of the 957 shunt-related operations performed at Cardinal Glennon Children’s Hospital over a 10-year period. During that time, 94 shunt infections were recognized. Eight of the infections occurred more than 9 months postoperatively. These differed from early infections in two ways: (1) <i>Staphylococcus aureus</i> was not found to be a pathogen in any late infection. (2) Abdominal pseudocysts were much more frequently found in patients with late-developing infections. In addition, the pathogens involved and the temporal distribution of cases suggest most infections that occur more than 9 months postoperatively are more likely caused by secondary bacterial seeding than by bacterial inoculation at the time of operation.
Cranial Vault Expansion: A Comparison of Magnetic Coupled Distraction to Traditional Surgical Repositioning
Authors: Baird Clinton , Fewings Paul , Manepalli Anantha , Pittman Thomas , Rinehart Gregory 
Published: April 2003

We compared the effectiveness of transcutaneously activated magnetic distraction of an osteotomized cranial bone flap to surgical repositioning of the flap with immediate, rigid internal fixation. Thirty immature rabbits were studied. All 30 rabbits underwent complete circumferential osteotomies of both parietal bones and postoperatively all were fitted with head frames. The rabbits were divided into 4 groups. The experimental magnetic distraction group consisted of 10 animals (group 1). In these rabbits magnets were secured to both parietal bones and magnets of opposite polarity were placed in the headframes. Each morning, the magnets in the head-frames were moved 0.25 mm farther away from the skull; this continued for 20 days for a total setback of 5 mm. Five animals served as the magnetic distraction controls; in these animals magnets were placed on the parietal bones but none were attached to the headframes (group 2). The experimental surgical repositioning group consisted of 10 rabbits (group 3). In each the parietal bones were elevated and fixed 5 mm above the rest of the skull using vitallium mesh and screws. Five rabbits made up the surgical respositioning control group (group 4). In these animals, parietal osteotomies were performed but the bones were secured to the skull in their original positions using hardware identical to that used in the experimental group. Six weeks later all of the animals were sacrificed. Two significant differences were identified between the experimental groups: (1) the cranial contours of the animals in the magnetic distraction group were rounded while those of the surgically repositioned group were acutely angled; (2) the osteotomies in rabbits in the magnetic distraction group were essentially completely ossified while in rabbits in the surgically repositioned group there were obvious gaps at the osteotomy sites that were filled with fibrous tissue. These conclusions support the potential utility of magnetically activated distraction as an alternative to current methods of cranial vault remodeling.
Age-Related Differences in Acute Physiologic Response to Focal Traumatic Brain Injury in Piglets
Authors: Durham Susan R. , Raghupathi Ramesh , Helfaer Mark A. , Marwaha Sunil , Duhaime Ann-Christine 
Published: April 2003

<i>Introduction:</i> The goal of the present study was to determine whether age-related differences in the acute physiologic response to scaled cortical impact injury contribute to differences in vulnerability to traumatic brain injury (TBI). <i>Methods:</i> Heart rate (HR), mean arterial pressure (MAP), brain temperature (BrT) and cerebral blood flow (CBF) were measured in 22 piglets (7 of age 5 days, 8 of age 1 month, 7 of age 4 months) at baseline and for 3 h following scaled cortical impact injury. <i>Results:</i> There were no age-dependent variations from baseline in HR, MAP or BrT following injury. CBF increased in the 5-day-old animals following injury while CBF in the 1- and 4-month-old animals decreased following injury (p = 0.0049). <i>Conclusion:</i> CBF was shown to have a significant age-dependent response to TBI with the youngest animals exhibiting increased CBF following injury.
Indices of Respiratory Muscle Endurance in Healthy Subjects
Authors: Fiz José Antonio , Romero Pilar , Gomez Roser , Hernandez M.C. , Ruiz Juan , Izquierdo José , Coll Ramon , Morera José 
Published: April 2003

<b>Background:</b> The evaluation of respiratory muscle performance can be described in terms of strength and endurance, the latter usually being measured by means of resistive or threshold inspiratory loads, using devices that are also used for respiratory muscle training. Few authors, however, have published endurance reference values for healthy subjects. To that end, we studied two indices of respiratory muscle endurance in a population of 99 healthy volunteers (50 men, 49 women) divided into five age groups (20–70 years old) applying a modification of the methods of Martyn et al. and Nickerson and Keens. Inspiratory muscle endurance (T<sub>lim</sub>) was defined as the time the subject was able to sustain breathing against an inspiratory pressure load equivalent to 80% of the maximum tolerated load (C<sub>max</sub>). C<sub>max</sub> was calculated using a 2-min incremental threshold load. <b>Results:</b> We found that the heaviest inspiratory threshold load tolerated for 2 min and the time a load equivalent to 80% of C<sub>max</sub> (T<sub>lim</sub>) could be sustained were not significantly different for male and female subjects. T<sub>lim</sub> correlated with C<sub>max</sub>, age, height, and maximum respiratory pressures.
Slow Compartment Features and Gas Exchange Impairment in Mild Asthma: Effects of Beta Agonist Inhalation
Authors: Valente Salvatore , De Rosa Marino , Corbo Giuseppe M. , Carlucci Annalisa , Fumagalli Giorgio , Ciappi Giuliano 
Published: April 2003

Static and dynamic lung volumes, arterial blood gases, alveolar ventilation and ventilation-perfusion (&#118;&#775;<sub>A</sub>/q&#775;) relationships were studied in 14 mild asthmatic patients and in 7 normal subjects (as controls) before and after fenoterol inhalation. Multiple nitrogen washout curves were analyzed by a bicompartmental distribution model, in order to assess the distribution of ventilation and &#118;&#775;<sub>A</sub>/q&#775; mismatch. At baseline, asthmatics showed mild airway obstruction and gas exchange impairment [forced expiratory volume in 1 s (FEV<sub>1</sub>) = 79% pred; PaO<sub>2</sub> = 87.4; alveolar-arterial oxygen tension gradient (AaPO<sub>2</sub>) = 22.9 mm Hg]. By analysing nitrogen washout curves, an alveolar slow space representing 45.1% of total lung volume (vs. 36.8% in normals; p = 0.044) was identified; its alveolar ventilation per minute per unit lung volume (&#118;&#775;<sub>A2</sub>/L<sub>2</sub>) was lower than in normals (p = 0.01). β-Agonist inhalation by the asthmatics, which reversed airway obstruction (FEV<sub>1</sub> = 98% pred.; p < 0.001) and improved gas exchange (PaO<sub>2</sub> = 92.6 mm Hg, p < 0.001; AaPO<sub>2</sub> = 16.8 mm Hg, p = 0.003), led to a highly significant increase in &#118;&#775;<sub>A2</sub>/L<sub>2</sub> (p = 0.001). The improvement in PaO<sub>2</sub> was associated with the increase in &#118;&#775;<sub>A2</sub>/L<sub>2</sub> (r<sup>2</sup> = 0.39; p = 0.017), but not with the increase in FEV<sub>1</sub>. Lastly, the changes in FEV<sub>1</sub> and &#118;&#775;<sub>A2</sub>/L<sub>2</sub> were not correlated with each other. We conclude that even in mild stable asthma there is substantial unevenness of ventilation, detectable by bicompartmental analysis of nitrogen washout curves, which is responsible for gas exchange impairment and is not related to common spirometric parameters. In addition, the improvement in gas exchange is probably due to the effect of fenoterol on the tributary airways of the alveolar slow compartment. This effect can be assessed by this simple method, which can be used in clinical pharmacology studies and in the follow-up of asthmatic patients.
Surfactant Function in Neonates with Respiratory Distress Syndrome
Authors: Griese Matthias , Westerburg Bettina 
Published: April 2003

The function of pulmonary surfactant of a group of 14 preterm neonates (birth weight 907 ± 60 g) who suffered from severe respiratory distress syndrome (RDS) and who had received exogenous bovine lipid extracted surfactant on the first day of life was compared to that in a second group of 8 neonates (birth weight 940 ± 110 g) with mild RDS who had not received surfactant treatment. Mechanical respiratory support from day 2 on was the same in both groups. The minimal surface tension (γ<sub>min</sub>) improved steadily, falling from about 30 mN/m initially to less than 20 mN/m before extubation. A consistent but loose correlation was found between γ<sub>min</sub> and mechanical respiratory support necessary, as quantitated by the oxygenation index. Total protein was about 0.8 ± 0.2 mg/mg of phospholipids and did not change during the first week of life. There were no correlations between total protein and γ<sub>min</sub> or the oxygenation index. The data suggest that inhibition of surfactant function by proteins leaked into the airspaces does not play a major role during recovery from RDS. Instead, endogenous remodelling of surfactant might be of greater relevance.
Salmeterol Enhances the Inhibitory Activity of Dexamethasone on Allergen-Induced Blood Mononuclear Cell Activation
Authors: Oddera S. , Silvestri M. , Testi R. , Rossi G.A. 
Published: April 2003

The possibility that salmeterol could interfere with the inhibitory effect of glucocorticosteroids on allergen-induced activation of leukocytes was assessed in cultures of human blood mononuclear cells (BMCs). BMCs, recovered from 27 patients (21 ± 4 years of age) sensitized to <i>Dermatophagoides pteronyssinus </i><i>(Der p)</i>, were incubated with a purified <i>Der p</i> extract (10 µg/ml) for 7 days in the presence of salmeterol (10<sup>–8</sup> and 10<sup>–7</sup> <i>M</i>) and/or dexamethasone (10<sup>–10</sup> and 10<sup>–9</sup> <i>M</i>). BMC proliferation and cytokine release were respectively tested by [<sup>3</sup>H]thymidine incorporation and EASIA. Stimulation with <i>Der p</i> extract induced a significant BMC proliferation (<i>Der p</i> 18.7 ± 1.9 cpm × 10<sup>3</sup>, control 1.8 ± 0.3 cpm × 10<sup>3</sup>, p < 0.01) which was significantly inhibited both by salmeterol and dexamethasone (p < 0.05, each comparison). The inhibition of BMC proliferation induced by dexamethasone (10<sup>–9</sup> <i>M</i>) was significantly enhanced by salmeterol 10<sup>–7</sup> <i>M</i> (p < 0.05). Evaluation of cytokine levels in BMC supernatants showed that <i>Der p</i> extract significantly increased the release of granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-2 (p < 0.001, each comparison). Salmeterol (10<sup>–7</sup> <i>M</i>) or dexamethasone (10<sup>–9</sup> <i>M</i>) induced a similar, statistically significant, downregulation of GM-CSF release (p < 0.05, each comparison) and induced a slight, not significant, decrease in the production of IFN-γ, TNF-α, IL-1β and IL-2 (p > 0.05, each comparison). Interestingly, salmeterol (10<sup>–7</sup> <i>M</i>) significantly enhanced the inhibitory activity of dexamethasone (10<sup>–9</sup> <i>M</i>) on the release of GM-CSF, TNF-α, IL-1β and IL-2 (p < 0.05, each comparison) but not of IFN-γ (p > 0.05). Thus β<sub>2</sub>-adrenoceptors may enhance the inhibitory activity of low doses of corticosteroids on allergen-induced BMC activation.
Diabetes mellitus Induces a Thickening of the Pulmonary Basal Lamina
Authors: Weynand B. , Jonckheere A. , Frans A. , Rahier J. 
Published: April 2003

Long-term diabetes mellitus (DM) is characterized by widespread alterations of basal lamina (BL). The purpose of the present work was to verify whether the lung is also a target organ damaged in DM. Electron microscopy was performed on lung and kidney samples (autopsic material) from 6 diabetics and 6 control subjects studying the thickening of BL of different structures (alveolar epithelial BL, endothelial capillary BL, both fused BL, BL of the glomerular capillary endothelium and BL of the renal tubules). The results were as follows: (1) alveolar epithelial BL (mean ± SD) = 121 ± 11 nm in controls and 176 ± 27 nm in diabetics (p < 0.01), (2) endothelial capillary BL = 164 ± 14 nm in controls and 223 ± 27 nm in diabetics (p < 0.001), (3) both BL fused = 222 ± 23 nm in controls and 316 ± 62 nm in diabetics (p < 0.01), (4) BL of the glomerular capillary endothelium = 374 ± 44 nm in controls and 626 ± 249 in diabetics (p < 0.05) and (5) BL of the renal tubules = 602 ± 94 nm in controls and 1,083 ± 376 nm in diabetics (p < 0.05). All parts of the lung are equally affected by DM. The thickening of BL is of the same magnitude in lung and kidney. There is no relationship between the thickening of the lung BL and the known duration and type of DM.