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Purpose: The aim of this study was to evaluate the outcomes and complications for individual surgeons at British Columbia Children's Hospital for the treatment of Chiari I Malformation (CMI) in children. Methods: This was a retrospective review of patients with CMI who had surgery from 1986 to 2015. We assessed the Chicago Chiari Outcome Scores (CCOS) and complication rates by surgeon. Results: Seventy patients, 38 males and 32 females, underwent posterior fossa decompression including 14 extradural and 56 intradural approaches. Syringomyelia was present in 74.3%. Most syringomyelia improved with no difference between intradural and extradural surgeries. After initial surgery, 13 patients (18.6%) had complications including 2/14 (14.3%) of extradural and 11/56 (19.6%) of intradural surgeries. Two patients required surgical intervention for complications whereas 11 had transient complications. The complication rate by surgeon ranged from 11 to 20% for extradural (2 surgeons only) and 10.5 to 40% for intradural surgeries (4 surgeons). The CCOS ranged from 12 to 15 for extradural and 6 to 16 for intradural. The CCOS ranges for surgeons 1 and 2 were 12–15 and 13–15 respectively for extradural. The CCOS ranges for surgeons 1, 2, 3, and 4 were 12–16, 6–15, 12–16, and 12–16 respectively for intradural. Thirteen patients had a second surgery for CMI. The final CCOS was good in 86% and moderate in 14%. Conclusion: There was variability in surgeries performed at BCCH by different surgeons, with variations in CCOS and complication rates. This information is important during decision making, consent process, and for quality improvement. [ABSTRACT FROM AUTHOR]

Introduction: Many patients with lumbosacral lipoma are asymptomatic; however, a significant proportion will have neurological deficits present at birth. Implication of these deficits with respect to natural history and management are not well understood. Methods: A retrospective review of all infants with lumbosacral lipoma seen at BCCH between 1997 and 2013 was carried out. The study population was stratified on the presence of a congenital, non-progressive deficit and subdivided on treatment approach. The subsequent developments of deficits resulting in untethering procedures were recorded. Results: Of the 44 infants in this study, 24 patients had no neurologic deficit while 20 patients had a fixed, non-progressive deficit evident at birth. Ten of 24 patients without a neurological deficit at birth underwent a prophylactic untethering with 3 eventually requiring repeat untethering after, on average, 62.7 months. Eleven of 14 asymptomatic, monitored patients required untethering for clinical deterioration. Two required a second untethering procedure after 48.7 months. Ten of 20 infants with congenital deficits present at birth underwent prophylactic untethering, and 4 required further surgery after 124 months. Ten patients underwent observation with 8 eventually requiring surgery. Two required repeat untethered after 154 months. The complication rates and operative burden for patients are similar whether prophylactic or delayed surgery is performed. Conclusion: The presence of congenital neurologic deficit does not affect the likelihood of deterioration in patients managed expectantly; prophylactic detethering of these patients did not prevent delayed neurologic deterioration. Comparing the need for repeat surgery in prophylactically untethered patients with initial untethering of patients operated upon at the time of deterioration, prophylactic untethering may confer a benefit with respect to subsequent symptomatic tethering if complication rates are low. However, in a setting with multidisciplinary follow-up, a period of observation for patients and intervention when patients become symptomatic is an acceptable approach for patients with or without congenital deficits. [ABSTRACT FROM AUTHOR]

Introduction: Our center previously reported low transfusion rates for craniosynostosis surgery by two experienced neurosurgeons using standard intraoperative techniques and acceptance of low hemoglobin levels. This study evaluated whether low rates were maintained over the last 10 years and if a less experienced neurosurgeon, trained in and practicing in the same environment, could achieve similar outcomes. Methods: All craniosynostosis operations performed in children between 2004 and 2015 were reviewed retrospectively. Transfusion rates were calculated. Analyses examined the relationship of transfusion to craniosynostosis type, surgical procedure, redo operation, surgeon, and perioperative hemoglobin levels. Results: Two hundred eighteen patients were included: 71 open sagittal, 28 endoscopic-assisted sagittal, 32 unicoronal, 14 bicoronal, 42 metopic, and 31 multisuture. Median age at operation was 9.1 months. Overall transfusion rate was 24 %: 17 % open sagittal, 7 % endoscopic-assisted sagittal, 6 % unicoronal, 21 % bicoronal, 45 % metopic, and 45 % multisuture. The timing of transfusions were 75, 21, and 4 % for intraoperative, postoperative, and both, respectively. Patients not receiving transfusion had a mean lowest hemoglobin of 87 g/l (range 61-111) intraoperatively and 83 g/l (range 58-115) postoperatively. Mean lowest hemoglobin values were significantly lower in those necessitating intraoperative (75 g/l, range 54-102) or postoperative (59 g/l, range 51-71) transfusions. There was no significant difference in transfusion rate between less and more experienced surgeons. There were no cardiovascular complications or mortalities. Conclusion: In craniosynostosis surgery, reproducible, long-term low blood transfusion rates were able to be maintained at a single center by careful intraoperative technique and acceptance of low intraoperative and postoperative hemoglobin levels in hemodynamically stable patients. Furthermore, low rates were also achieved by an inexperienced neurosurgeon in the group. This suggests that these results may be achievable by other neurosurgeons, who follow a similar protocol. [ABSTRACT FROM AUTHOR]

Purpose: Intraoperative ultrasound (iUS) is a valuable tool-inexpensive, adds minimal surgical time, and involves minimal risk. The diagnostic predictive value of iUS is not fully characterized in Pediatric Neurosurgery. Our objective is to determine if surgeon-completed iUS has good concordance with post-operative MRI in estimating extent of surgical resection (EOR) of pediatric brain tumors. Methods: We reviewed charts of all pediatric brain tumor resections (single institution 2006-2013). Those with iUS and postoperative imaging (<1 week) were included. The surgeon's estimation of the EOR based on iUS and the post-operative neuroimaging results (gold standard) were collected, as well as information about the patients/tumors. Results: Two hundred two resections were reviewed and 58 cases were included. Twenty-six of the excluded cases utilized iUS but did not have EOR indicated. The concordance of interpretation between iUS and post-operative MRI was 98.3 %. Of 43 cases where iUS suggested gross total resection, 42 were confirmed on MRI (negative predictive value (NPV), 98 %). All 15 cases where iUS suggested subtotal resection were confirmed on MRI (positive predictive value (PPV), 100 %). Agreement between iUS and post-operative imaging had an overall Kappa score of 0.956, signifying almost perfect agreement. Conclusion: The results from this study suggest that iUS is reliable with both residual tumor (PPV-100 %) and when it suggests no residual (NPV-98 %) in tumors that are easily identifiable on iUS. However, tumors that were difficult to visualize on iUS were potentially excluded, and therefore, these results should not be extrapolated for all brain tumor types. [ABSTRACT FROM AUTHOR]

The article offers information related to the launch of pediatric neurosurgical service in British Columbia (BC) with the opening of British Columbia's Children's Hospital (BCCH) as a full service pediatric tertiary care center. Topics discussed include various developments and accomplishments of pediatric neurosurgical service in the BCCH, association of well-educated pediatricians and general practitioners in the community and various forms of spinal dysraphism treated in the the hospital.

Purpose: About 5 % of pediatric intracranial germ cell tumors and 20 % of non-germinomatous germ cell tumors (NGGCT) progress to growing teratoma syndrome (GTS) following chemoradiotherapy. The growing teratoma is thought to arise from the chemotherapy-resistant, teratomatous portion of a germ cell tumor and is commonly benign but may undergo malignant transformation. Methods: Two pediatric patients whose intracranial NGGCTs progressed to growing teratomas during chemotherapy and later transformed to secondary malignant tumors after partial resection and radiation therapy (RT). Results: Both tumors were diagnosed by MRI scans and elevated serum and CSF markers. Following normalization of tumor markers with chemotherapy and initial decrease in tumor volume, subsequent imaging showed regrowth during chemotherapy with pathology revealing benign teratoma. RT was administered. Several years following this treatment, further growth was seen with pathology indicating malignant carcinoma in one patient and malignant rhabdomyosarcoma in the other. The patient with carcinoma received palliative care while the patient with the sarcoma received further resection, intensive chemotherapy, and an autologous stem cell transplant and is currently in remission, 36 months since malignant transformation. Conclusion: Malignant transformation of presumed residual teratoma has been seldom reported. Treatment of NGGCT involves platinum-based chemotherapy with craniospinal RT and boost to the primary site, with cure rates of around 80 %. Teratomas are characteristically chemotherapy and RT resistant and are treated surgically. In the event that residual or growing teratoma is suspected, a complete resection should be considered early in the management as there is a risk of malignant transformation of residual teratoma. [ABSTRACT FROM AUTHOR]

The article presents a case study of four of the seven patients who were of Spanish/Mexican/Puerto Rican ancestry. The patients had several features in common including an abnormal head shape, variable developmental delay, and short stature. The article discusses the methods and results of a retrospective chart review at a single institution.

Introduction: Serial change in ventricular size is recognized as an imperfect indicator of ongoing hydrocephalus in children. Potentially, other radiographic features may be useful in determining the success of hydrocephalus interventions. In this study, optic nerve sheath diameter (ONSD), optic nerve tortuosity, and optic disk bulging were assessed as indicators of hydrocephalus control in children who underwent endoscopic third ventriculostomy (ETV) or posterior fossa tumor resection. Methods: Sixteen children underwent ETV or tumor resection for treatment of hydrocephalus. T2-weighted axial magnetic resonance images of the orbit were obtained, and the ONSD was measured posterior to the optic globe, pre- and post-intervention. Evidence of optic disk bulging and optic nerve tortuosity was also assessed. Ventricular size was estimated using the frontal and occipital horn ratio (FOR). Results: There was a significant reduction in the ONSD post-ETV ( n = 9) and after tumor resection ( n = 7). Average preoperative ONSD was 6.21 versus 5.71 mm postoperatively ( p = 0.0017).There was also an 88 % ( p = 0.011) and 60 % ( p = 0.23) reduction in optic disk bulging and tortuosity, respectively. The FOR normalized in the tumor resection group but not the ETV group. After intervention, all patients showed improvement in signs and symptoms of hydrocephalus. Conclusion: In our study population, ONSD decreased in response to measures to reduce hydrocephalus. Optic disk bulging also appears to resolve. Serial reduction in ONSD, and optic disk bulging may be indicators of improved hydrocephalus following pediatric neurosurgical interventions. [ABSTRACT FROM AUTHOR]

Introduction: Cavum velum interpositum (CVI) is commonly an incidental asymptomatic finding on imaging studies. Encystment can occur and, in most situations, is also asymptomatic. Clinical symptoms occurring in patients with CVI cysts have been reported infrequently with the result that the relationship of these symptoms and the cyst are usually unclear. This report contributes to the knowledge base of symptoms that can occur in patients with CVI and the response of symptoms to effective treatment. Patients and methods: We report the clinical outcomes of a 3-year-old male patient and a 13-year-old female patient with symptoms and CVI cysts on imaging who were treated successfully with endoscopic fenestration. Results: The developmental delay and occasional headache present in the 3-year-old male patient resolved after endoscopic fenestration; however, the 13-year-old patient who had neuropsychiatric symptoms did not improve. Conclusions: Our cases add to the literature describing the response to cyst treatment in symptomatic patients harboring CVI cysts. Symptoms due to CSF pathway obstruction may respond to cyst fenestration, while the response of symptoms in patents who do not have clear CSF circulation disorders is less predictable. [ABSTRACT FROM AUTHOR]

Introduction: Some investigators have suggested that medulloblastomas can be distinguished from other cerebellar neoplasms by demonstrating 'restricted diffusion' on the Apparent Diffusion Coefficient (ADC) map obtained from diffusion-weighted imaging (DWI) sequences on magnetic resonance imaging. Previous authors have postulated that this observed restricted diffusion is a reflection of very high cell density. There has been a tendency to assert that pediatric medulloblastoma uniformly demonstrates restricted diffusion on DWI. However, our clinical observation has been that there are pediatric medulloblastomas that exhibit normal or even increased diffusion on DWI. The current study was undertaken primarily to determine whether restricted diffusion is uniformly present in pediatric medulloblastoma and secondly to look for pathological features that might distinguish medulloblastomas with and without restricted diffusion. Methods: The DWI characteristics of pathologically confirmed medulloblastomas diagnosed at our institution were retrospectively reviewed. The ADC was obtained in two non-overlapping, solid, non-hemorrhagic, non-necrotic regions of tumor and averaged. An ADC below 1 × 10 mm/s was considered to represent restricted diffusion. A detailed pathologic review of each tumor was conducted. Results: Ten cases of medulloblastoma were reviewed, of which two demonstrated average ADCs above 1 × 10 mm/s (1.223 and 1.169 × 10 mm/s, respectively), indicating no restricted diffusion. Pathologic review revealed that both of these non-restricting cases displayed a lack of reticulin deposition by light microscopy. Conclusion: DWI does not appear to be an entirely reliable means of distinguishing medulloblastomas from other cerebellar neoplasms. Histologically, restricted diffusion in medulloblastomas may be related to reticulin deposition. [ABSTRACT FROM AUTHOR]

Purpose: A possible benefit of endoscopic third ventriculostomy (ETV) is that families might harbor less concern and anxiety compared to shunt. This has not yet been demonstrated, however. Our goal was to compare parental concern in a large sample of children with hydrocephalus treated with ETV or shunt, using our previously developed measure of parental concern, the Hydrocephalus Concerns Questionnaire for Parents (HCQ-P). Methods: The parents of children 5-18 years old with previously treated hydrocephalus at three Canadian pediatric neurosurgery centers completed the HCQ-P. HCQ-P scores were compared between those who were initially treated with ETV and those initially treated with shunt. A multivariable linear regression analysis was used to adjust for center, current age, age at initial hydrocephalus surgery, seizures, etiology, hydrocephalus complications, and quality of life. Results: Six hundred three families participated (58 ETV [9.6%], 545 shunt [90.4%]). In unadjusted comparison, ETV parents had lower overall concern (HCQ-P = 0.41 versus 0.51, p = 0.02). After adjustment for multiple patient factors, ETV parents still had lower concern ( p = 0.03) but the only questions for which there was a still a statistically significant difference were those related to concerns about shunt/ETV complications. Conclusions: Parents of children who have had ETV experience less concern than those who have had shunt and this is due almost exclusively to less concern about hydrocephalus treatment complications. While this could be interpreted as a beneficial aspect of ETV treatment, it remains important for neurosurgeons to ensure that parents are not being overly complacent about the possibility of ETV failure requiring urgent treatment. [ABSTRACT FROM AUTHOR]

Surgical resection is generally recommended for cervicomedullary tumors, but morbidity of resection may be significant. This study sought to identify MRI characteristics that might predict morbidity and extent of resection. A retrospective review was performed of MRI findings, histopathology, extent, and morbidity of resection in cervicomedullary gliomas undergoing resection during 1985–2008. Of 78 brainstem tumors, nine cervicomedullary tumors undergoing resection were identified: two pilocytic astrocytomas, two gangliogliomas, and five grade II astrocytomas. Mean age was 6.3 years (range 1.7–11.2 years). Initial treatment was surgery in seven: biopsy (1), <25% resection (4), and 25–50% resections (2). Bulbar worsening occurred in five of six patients with interposed areas of non-enhancement versus one of three patients without interposed non-enhancing tissue ( P = 0.014). Additionally, bulbar worsening occurred in five of five patients with a poorly defined tumor/brainstem interface and abnormal low T1 signal extending beyond obvious tumor into the brainstem versus one of four with a well-defined tumor margin ( P = 0.008). Following chemo- or radiotherapy, the definition of the brainstem/tumor interface improved. In four patients undergoing surgery after chemo/radiotherapy, more extensive resections were achieved without neurologic worsening: >80% in three and 30% in one. A less aggressive initial surgical approach, supplemented by postoperative chemotherapy, designed to preserve brainstem function, is proposed for patients with interposed non-enhancing tissue continuous with normal cervical cord or medulla and/or a poorly defined ventral tumor/brainstem interface with abnormal low T1 signal extending beyond obvious tumor into the brainstem. [ABSTRACT FROM AUTHOR]

The main purpose of the present study was to examine the effects of acute whole body vibration (WBV) on recovery following a 3 km time trial (3 km TT) and high-intensity interval training (HIIT) (8 x 400 m). Post-HIIT measures included 3 km time-trial performance, exercise metabolism and markers of muscle damage (creatine kinase, CK) and inflammation (c-reactive protein, CRP). A second purpose was to determine the effects of a 3 km TT and HIIT on performance and metabolism the following day. Nine well-trained, middle-aged, male runners [(mean +/- SD) age 45 +/- 6 years, body mass 75 +/- 7 kg, VO2peak 58 +/- 5 ml kg(-1 )min(-1)] performed a constant pace run at 60 and 80% velocity at VO2peak (v VO2peak) followed by a 3-km TT and a 8 x 400-m HIIT session on two occasions. Following one occasion, the athletes performed 2 x 15 min of low frequency (12 Hz) WBV, whilst the other occasion was a non-WBV control. Twenty-four hours after each HIIT session (day 2) participants performed the constant pace run (60 and 80% v VO2peak) and 3 km TT again. There was a significant decrease in 3 km TT performance (~10 s) 24 h after the HIIT session (P < 0.05); however, there were no differences between conditions (control vs. vibration, P > 0.05). Creatine kinase was significantly elevated on day 2, though there were no differences between conditions (P > 0.05). VO2peak and blood lactate were lower on day 2 (P < 0.05), again with no differences between conditions (P > 0.05). These results show no benefit of WBV on running performance recovery following a HIIT session. However, we have shown that there may be acute alterations in metabolism 24 h following such a running session in well-trained, middle-aged runners. [ABSTRACT FROM AUTHOR]

This study compared the rate of muscle temperature (Tm) increase during acute whole-body vibration (WBV), to that of stationary cycling and passive warm-up. Additionally we wanted to determine if the purported increase in counter-movement jump and peak power cycling from acute WBV could be explained by changes in muscle temperature. Eight active participants volunteered for the study, which involved a rest period of 30 min to collect baseline measures of muscle, core, skin temperature, heart rate (HR), and thermal leg sensation (TLS), which was followed by three vertical jumps and 5 s maximal cycle performance test. A second rest period of 40 min was enforced followed by the intervention and performance tests. The change in Tm elicited during cycling was matched in the hot bath and WBV interventions. Therefore cycling was performed first, proceeded by, in a random order of hot bath and acute WBV. The rate of Tm was significantly greater (P < 0.001) during acute WBV (0.30 degree C min(-1)) compared to cycle (0.15 degree C min(-1)) and hot bath (0.09 degree C min(-1)) however there was no difference between the cycle and hot bath, and the metabolic rate was the same in cycling and WBV (19 mL kg(-1) min(-1)). All three interventions showed a significant (P < 0.001) increase in countermovement jump peak power and height. For the 5 s maximal cycle test (MIC) there were no significant differences in peak power between the three interventions. In conclusion, acute WBV elevates Tm more quickly than traditional forms of cycling and passive warm-up. Given that all three warm-up methods yielded the same increase in peak power output, we propose that the main effect is caused by the increase in Tm. [ABSTRACT FROM AUTHOR]

Aims and Objectives The significance of beaten copper appearance (BCA) on skull radiographs in children following surgery for isolated sagittal craniosynostosis has not been studied. This study was designed to look for any correlation between BCA and symptoms suggestive of intracranial hypertension in this group of patients. Materials and Methods Forty-eight consecutive children, who were operated for isolated sagittal synostosis from1987 to 2000 and had postoperative skull radiographs, were included. Patients were divided into: (a) BCA group (n=20), consisting of children who had beaten copper appearance on skull radiographs at last follow up, and (b) Non-BCA group (n=28), consisting of children who did not have this finding. Records were reviewed to look for symptoms suggestive of intracranial hypertension, such as headache, head banging, and irritability. Results Median age at surgery was 4.8 months for BCA group and 4 months for the non-BCA group. Follow up ranged from 4 to 156 months with a mean of 36.2 months. Total of 28.6% (n=6) of the children with follow up radiographs done at ?18 months of age had BCA. The incidence of BCA increased to 83.3% in children with skull radiographs performed after 48 months of age. In 18 (90%) children, the BCA was 'diffuse' with 5 (25%) children having the maximum possible score of 8. In the BCA group, 45% (n=9) had symptoms compared to 10.7% (n=3) in the control group (p=0.0068). Conclusions This study suggests a significant number of children with BCA on radiographs develop symptoms suggestive of raised ICP following surgical treatment in infancy and prolonged follow up may be warranted in this group of patients. [ABSTRACT FROM AUTHOR]

We present a new quantitative prostate-specific antigen (PSA) assay using a portable, point-of-care test (PSAwatch) and reader system (BioScan) for measuring PSA concentrations in the range from 0.5 to 25 μg/l. Blood samples from patients (n=199) were submitted for laboratory PSA and also evaluated using PSAwatch and the BioScan system. PSA concentrations in 188 men were 25 μg/l and studied. Correlation between the two methods was good (R2=0.88) with a standard error of 1.588. The regression line had a bias of −0.02 at the concentration of 4.00 μg/l. This is the first report of a quantitative, portable, point-of-care PSA test and reader system. PSAwatch may reduce the number of hospital visits for patients with prostate disease.Prostate Cancer and Prostatic Diseases (2007) 10, 270–273; doi:10.1038/sj.pcan.4500962; published online 13 March 2007 [ABSTRACT FROM AUTHOR]

Objective To explore opportunities for workforce development in NHS general dental services (GDS) in Shropshire and Staffordshire.Method Secondary data sources were supplemented with a primary survey of GDS practices to build up a profile of the existing GDS workforce and its current capacity. Attitudes and perceptions on current workforce issues and potential solutions were gathered using a second survey and explored further through other qualitative techniques including interviews and a focus group discussion.Results The results confirm that there is a shortage of dentists in the area, fuelled by multiple factors including the move from NHS to private work, the decision to retire early and a growing disillusionment with NHS policies and remuneration. Modelling of alternate approaches to future dental clinical needs highlighted the opportunity for meeting the consequent workforce demands through increased involvement of hygienists and therapists.Conclusions This study has provided local evidence to inform dental service development in Shropshire and Staffordshire. It has provided a starting point for exploring new ways of working and will contribute towards a more effective implementation of new and evolving service strategies. [ABSTRACT FROM AUTHOR]

Pretreatment of isolated mast cells with analogs of neurotensin 8-13 (NT), in which the amino acids Leu or Ile are replaced with an aspartic acid (Asp-NT or Asp-NT), inhibits the secretion of histamine in response to NT. A 10 min pretreatment with either analog (10 μ M) inhibited NT-induced histamine release by 90% (Asp-NT) or by 98% (Asp-NT). At concentrations that are inhibitory, Asp-NT and Asp-NT alone elicit very little release (<5% at 10 μ M). In the continued presence of the analogs, the inhibitory effect lasts for more than 45 min; removal of the analogs resulted in restoration of sensitivity to NT within 10 min. Pretreatment with analog Asp-NT resulted in a 39% inhibition of stimulation by substance P and a 52% inhibition of stimulation by histaminereleasing peptide (HRP). In contrast, pretreatment with analog Asp-NT gave no inhibition of release by SP or HRP. Neither analog inhibited histamine release in response to bradykinin (BK), NT, compound 48/80 (48/80), the calcium ionophore A23187, or anti-IgE stimulation of passively sensitized mast cells. Although Asp-NT and Asp-NT differ slightly in regard to the peptides they inhibit, both probably act at a step early in the stimulus-secretion coupling sequence; most likely before the rise in the level of free intracellular calcium that has been shown to accompany secretion in mast cells. It is suggested that these analogs exert their inhibitory effect on NT by competing with NT for a binding site on the mast cell membrane. The limited number of peptides inhibited by these analogs suggest that not all basic peptides act at the same site to stimulate secretion. [ABSTRACT FROM AUTHOR]

Selective functional posterior rhizotomy (SFPR) is a popular operation for the treatment of spasticity in children with cerebral palsy, but the physiologic basis of the procedure is poorly understood. As part of SFPR operations in 60 consecutive children, the responses to electrical stimulation of posterior lumbosacral roots and rootlets, and the corresponding anterior roots were studied. In addition, similar electrical stimulation of posterior roots was performed in four nonspastic 'control' children. Sustained responses to 50 Hz stimulation, one of the criteria used to signify abnormality in the spastic children, was found frequently in the 'control' children. Contralateral spreal to the lower limb muscles and suprasegmental spread to the upper limbs, face, and neck were determined to be the most valid criteria which differentiated abnormal from normal responses. Stimulation of anterior nerve roots at 50 Hz caused sustained responses and ipsilateral lower limb spread, at a low threshold compared to that of corresponding posterior roots. The results of this study bring into question the validity of some of the criteria that are used to select abnormal posterior rootlets in the SFPR procedure, and suggest criteria that may be more valid based on findings in nonspastic children. [ABSTRACT FROM AUTHOR]

The long-term functional outcome of 101 children born with meningomyelocele between 1971 and 1981 was assessed, by a combination of retrospective chart review and follow-up assessments. The children had been managed at birth using a process ofnonstandardized selection. Eighty-three of the 101 patients survived after a minimum follow-up of 8.6 years, for a mortality rate of 18%. Forty-four of 83 children (53%) were community ambulators, and this correlated well with the presence of intact quadriceps function. Forty-eight children (58%) attended normal school and were grade-appropriate. Sixty-two of 83 patients (75%) were socially continent of urine, and 71/83 (86%) were socially continent of stool. Hydrocephalus was present in 93 of the 101 children in the study, and 85 children were shunted. Half of the shunted children required a shunt revision in the first year of life, and thereafter the rate of revision decreased, so that after 2 years the risk of revision was approximately 10% per year. [ABSTRACT FROM AUTHOR]

Two hundred and eight patients with meningomyeloceles were reviewed to assess the role of birth trauma in the pathogenesis of their neurological deficit. Vaginal breech-delivered patients appeared to have poorer neurological function in the newborn period. The factors responsible include: (1) a mid or upper lumbar level, that by sparing hip flexors and knee extensors, predisposes to breech presentation; (2) limb posturing due to residual neurological function and intrauterine positioning that limits the accurate neurological assessment of the newborn; (3) nervous system or soft tissue injury due to labor and delivery. Regardless of the mechanism, vaginal breech-delivered patients showed improvement in function, and eventually exhibited ambulatory function comparable to those infants born by cesarian section or vaginally after vertex presentation and labor. In our patient population, elective cesarian section did not offer a spinal cord or ambulatory advantage over vaginal delivery for those pregnancies presenting in a vertex fashion. Thus, it should be reserved for fetuses who are presenting breech or who have other obstetrical indications for operative delivery. [ABSTRACT FROM AUTHOR]

Enhanced and non-enhanced computed tomography (CT) brain scans were performed within 72 h of surgery on 21 children in whom brain tumors had been resected totally or subtotally, and scans were repeated at varying intervals thereafter. Biopsies of the resection margins were performed in 12 patients at the end of the surgical procedure. The immediate CT scan showed enhancement in the resection margin in 13 of the 21 patients and in 9 of the 13, the enhancement disappeared on follow-up scans. There was discordance between the results of immediate CT scan examination and the biopsies of the resection margins in 7 of the 12 cases. The advantages and disadvantages of an immediate postoperative scan versus a more delayed CT scan are discussed. [ABSTRACT FROM AUTHOR]

Mast cells depleted of cellular calcium (Ca) by a 3 hr exposure to Ca-free conditions and then bathed in Ca-free Locke failed to release histamine when stimulated by compound 48/80 or peptides. The cellular Ca required for histamine release could be replenished by a 5 sec exposure to extracellular Ca at 37°C. To inhibit this replenished cellular Ca dependent histamine secretion required an additional 3 hr exposure to Ca-free conditions. When cellular Ca was replenished at 4°C, an additional 2 min incubation at 37°C was required to restore stimulated secretion to a maximum. During this 2 min incubation period the replenished cellular Ca is suggested to be 'processed' so that it can be used for secretion. Manganese (Mn) or cobalt added during (but not after) this 2 min incubation period prevented the restoration of histamine release. Preincubation of cellular Ca depleted mast cells in Mn (0.1-1 m M) blocked the effect of subsequent Ca replenishment at 37°C while coblat and barium were less inhibitory. Neither magnesium nor strontium were inhibitory. Extracellular sodium (Na) was required for the restoration of cellular Ca dependent histamine secretion. Lithium could substitute for Na but rubidium and potassium were ineffective. [ABSTRACT FROM AUTHOR]

Non-immunologic and immunologic stimulation of mast cells have been compared. Non-immunologic stimulation relys heavily on cellular Ca, is unaffected by neuraminidase treatment, shows a rapid inactivation, and elicits no increase in the incorporation ofH-methyl groups into the lipid fraction. In contrast, stimulation by immunologic agents relys primarily on extracellular Ca, is inhibited by neuraminidase treatment, shows a comparatively slow rate of inactivation, and causes a significant increase in the incorporation ofH-methyl groups into the lipid fraction. We found no evidence of crossinactivation or desensitization between immunologic and non-immunologic agents. However, pretreatment of mast cells with neurotensin desensitized them to subsequent stimulation by compound 48/80. Our results support the hypothesis that immunologic and non-immunologic agents activate exocytotic mast cell secretion via separate mechanisms. [ABSTRACT FROM AUTHOR]

Objective and Design: The ability of neurotensin (NT) at nmolar levels to stimulate exocytosis of the mast cell suggested that it could play a role in neuro-immune-endocrine interactions. The inhibition by a specific receptor antagonist of NT’s mast cell stimulation suggested the presence of a specific mast cell NT receptor. We have here employed several probes to determine if a specific neurotensin receptor was present on rat serosal mast cells.¶ Material: Serosal mast cells were isolated from the peritoneal and pleural cavities of male Sprague-Dawley rats.¶ Methods: Immunocytochemistry with an antibody raised against the C-terminal peptide of the neurotensin receptor was utilized. The same antibody was employed in immunoblotting following SDS gel electrophoresis of mast cell extracts. An RNA probe for ribonuclease protection assays (RPA) was prepared using the rat brain neurotensin receptor cDNA and polymerase chain reaction was carried out using primers based on the rat brain neurotensin receptor sequence.¶ Results: Mast cells showed specific staining with the anti-neurotensin receptor antibody and this same antibody revealed a protein on SDS gels migrating as a 70 kDa species. Ribonuclease protection assays revealed the predicted protected fragment at approximately 450 bp while PCR amplification gave a major product at 843 bp.¶ Conclusions: These results indicate that a specific neurotensin receptor is present on the rat mast cell. [ABSTRACT FROM AUTHOR]

A biography of Paul Steinbok, 2012 President of the International Society of Pediatric Neurosurgery (ISPN) is presented. He was born in Barbados, West Indies and was the eldest of the seven children. He was awarded with a Barbados scholarship after he graduated in high school at the Harrison College. He then went to study medicine at the University of the West Indies (UWI) and was the president of the Camera Club of the university. He is distinguished for his excellence in clinical neurosurgery.

The use of a ventriculosubgaleal shunt for temporary treatment of hydrocephalus in a child with multiple recurrent shunt infections related to eczema in the neck is described. Further shunt infection was avoided, the eczema cleared, and a permanent ventriculoperitoneal shunt was inserted successfully after 2 months. [ABSTRACT FROM AUTHOR]

In order to restore spinal integrity following posterior exposures of the spinal canal in children, we describe modifications of Raimondi's laminotomy technique. The use of a pneumatic dissecting tool with footplate to create a hinged osteoplastic laminotomy is described, as are techniques for secruing the laminotomy flap in place at the end of the procedure. [ABSTRACT FROM AUTHOR]

The article discusses various factors leading to the ischemia of spinal cord taking place during the operation conducted in the prone position.