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Biomedical subjects

A M Flannery

Publications and source records attributed to A M Flannery.

13 recordsLinked to original sources
PubMed2000

Pump-regulated cerebrospinal fluid drainage.

The drainage of cerebrospinal fluid (CSF) from the lumbar subarachnoid space is an effective technique for the treatment of CSF fistula and control of intracranial pressure in children and adults. The use of the lumbar drain poses unique challenges, however, in the pediatric population. We present a safe and effective method of pump-controlled lumbar subarachnoid drainage. This technique allows accurate titration of CSF removal while providing a closed system which is not sensitive to position changes or patient activity. Four case histories are reviewed.

Brain Diseases↗
PubMed1998

Pediatric neurosurgery work force: a pilot study.

The physician work force of tomorrow is influenced by the number of physicians and specialists trained today. Little information exists about the need for pediatric neurosurgeons in the next 10 years or about the activity of pediatric neurosurgeons currently in practice. The objective of this study was to obtain preliminary data about pediatric neurosurgeons and current work loads. A questionnaire was distributed to physicians attending the Pediatric Section Meeting of the American Association of Neurological Surgeons, 1997, 93 questionnaires were returned. A majority of the respondents were between 35 and 55 years of age. The largest group geographically was from the northeast. Fifty-five respondents described their practice as academic and of that group, 48% reported that their practice was either exclusively or at least 95% pediatric neurosurgery. Self-described work load varied with geographic location. In the northeast, only 26% of practitioners felt they were not busy enough, whereas in the southwest, 60% reported not being busy enough. Academic practitioners were more likely than other respondents to describe their practice as too busy or appropriately busy. Thirty-six respondents indicated plans to either expand their practice or retire within the next 10 years. This pilot study demonstrates the potential for future growth in pediatric neurosurgery as well as providing information about the current self-reported work load and its distribution over practice types and geographic locations. This study provides guidance for development of future studies to improve the sensitivity and usefulness of acquired data.

Adult↗
PubMed1996

Lymphangiolipoma of the thoracic spine in a pediatric patient with Proteus syndrome.

Proteus syndrome is a rare hamartomatous disorder involving macrodactyly, hemihypertrophy, and subcutaneous lymphangiomas; fewer than 25 cases have been reported worldwide. We report a case of a thoracic epidural lymphangiolipoma in a 5-year-old boy with Proteus syndrome. Computerized axial tomography (CT) of the thoracic spine revealed a left posterior mediastinal mass that extended into the spinal canal through adjacent neural foramina. No sign of spinal cord compression was observed despite the extensive volume of tumor within the spinal canal. Surgical debulking utilizing a T3-10 laminectomy resulted in gross total resection of the tumor. Microscopic examination of the surgical specimen revealed a lymphangiolipoma. No previous report of spinal cord involvement has been reported in this syndrome. A detailed discussion of the phenotypic features and probable mode of genetic transmission is included.

Child, Preschool↗
PubMed1990

Medulloblastomas in childhood: postsurgical evaluation with myelography and cerebrospinal fluid cytology.

Thirty-one children with medulloblastoma treated at the Children's Memorial Hospital have been evaluated with both postoperative myelography and cerebrospinal fluid (CSF) cytological studies. Computed tomography of the spine following myelography was used in an attempt to increase sensitivity. Each study was done 30 days after radical resection of the posterior fossa tumor, and just prior to the spinal irradiation. Only 3 (9.6%) showed positive results for spinal subarachnoid seeding by both myelography and CSF cytology. In 2 of these patients, preoperative head CT showed evidence of intracranial subarachnoid seedings. The incidence of positive myelographic finding in our series is lower than reported ones, and neoplastic cells are detected in the CSF only when the myelography shows visible disease.

Adolescent↗
PubMed1989

Transcranial Doppler: a noninvasive method to monitor hydrocephalus.

The ability to discriminate between ventriculomegaly and hydrocephalus often relies on clinical impression and parameters such as change in ventricular size and configuration, increasing head circumference, and evidence of developmental delay. In an effort to confirm clinical impressions, 24 children underwent transcranial doppler (TCD). All had ventriculomegaly confirmed by computerized cranial tomography (CT), magnetic resonance imaging (MRI), and/or cranial ultrasound (CS). Fifteen were infants and nine were older children with closed fontanelles. Three patient groups were established. Group 1 included those patients with ventriculomegaly but no clinical evidence of increased intracranial pressure. Group 2 included those children with hydrocephalus and evidence of increased intracranial pressure. The last group consisted of hydrocephalic children who had shunts placed for increased pressure. The Gosling pulsatility index (PI) as well as the peak systolic velocity (PS) as measured by the TCD were compared in all three groups. The PI was found to be a useful indicator of increased intracranial pressure and need for eventual shunt. Transcranial doppler sonography may therefore prove useful as a noninvasive, easily reproducible screening tool to evaluate children with hydrocephalus.

Adolescent↗
PubMed1989

Cervical spine fractures sustained by young children in forward-facing car seats.

Child passenger safety restraint laws have reduced the number of children killed or injured in motor vehicle accidents in the past few years. However, the increased used of child safety seats has brought with it an increase in the misuse of these devices. High cervical spine injuries sustained by five children less than 2 years of age while in forward-facing car seats are described. In the cases of three children, the care safety seat use was correct. Misuse of car seats and anatomic and biomechanical factors in the cervical spines of infants and young children appear to have contributed to the occurrence of these previously rare injuries. Like seat belts, car safety seats are now a factor in child passenger injury characteristics, and therefore, car safety seat design merits reevaluation. In light of this development, public and parent education by health care professionals concerning the correct use of car safety seats is necessary.

Accidents, Traffic↗
PubMed1988

Head injuries in children under 36 months of age. Demography and outcome.

Head injuries in children under the age of 3 years have not been extensively studied, due in part to the lack of an objective tool for neurological assessment. We have developed a Children's Coma Scale (CCS) by modifying the verbal response subscore of the Glasgow Coma Scale (GCS) to overcome this limitation. When applied prospectively to children under 3 years of age, we found the CCS to be useful in predicting outcome. During the 5-year study period from 1981 to 1985, there were 738 patients with head injuries (0-16 years) admitted to the Children's Memorial Hospital in Chicago, including 318 (43.1%) less than 3 years of age. Initial data demonstrated the following observations. The most common mechanism of injury was a fall (75.5%). Although a brief loss of consciousness (LOC) was reported in three-fourths of the patients, prolonged LOC of more than 6 h was uncommon (16/318, 5.0%). The classically described "lucid interval" was seen in only 7 children (2.2%) and was not a reliable indicator of epidural hematoma. Post-traumatic seizures developed more commonly in children under 2 years of age (15.7%) than in older children (11.6% under 3 years of age, 9.6%, entire group), (P less than 0.001). Oculovestibular reflex and bilateral fixed dilated pupils had the most reliable correlation with outcome. Other brain-stem reflexes were less useful.(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of Death↗
PubMed1988

Anorectal malformations: evaluation of associated spinal dysraphic syndromes.

The early recognition and treatment of correctable lesions of the terminal spinal cord in patients with anorectal malformations may preserve important neurologic function. Tethered cord and intraspinal masses are detectable with the use of high-resolution ultrasonography in the neonate. Fourteen infants and children with anorectal malformations and associated spinal dysraphism have been identified in our institution over the past 7 years. Six patients had cloacal exstrophy, and eight had imperforate anus (four high and four low lesions). The spinal lesions caused symptoms in only seven children; progressive neurologic deficit in five, and urinary incontinence or retention in two others. Five asymptomatic patients with cutaneous abnormalities on the back were studied and two were discovered during scoliosis evaluation. Imaging techniques included high-resolution ultrasonography, computed tomography with and without metrizamide myelography, and magnetic resonance imaging. Spinal sonography was highly accurate in the neonatal period. The application of ultrasonography can be of great advantage in early screening of patients with anorectal malformations and, in some cases, may eliminate the need for invasive imaging techniques.

Anus, Imperforate↗
PubMed1988

Choroid plexus papillomas of neonates, infants and children.

Case descriptions of 17 patients with choroid plexus papillomas of neonates, infants and children are presented. Fourteen (82%) were diagnosed and treated during the first 24 months of life (5 were in the neonatal period). Choroid plexus papillomas were located in the lateral ventricle in 11 (bilateral in 1), the third ventricle in 4, both the lateral and third ventricle in 1 and the fourth ventricle in 1. All patients were evaluated by computed tomography. All tumors were excised and histologically verified. There were no surgical or case mortalities. Ten patients needed permanent shunting postoperatively. Follow-up observations show that 13 patients exhibit normal neurological and psychomotor development. Three are retarded and have seizure disorders. One is hemiparetic but normal otherwise. Aggressive surgical resection and appropriate management of associated hydrocephalus should be performed for the patients with choroid plexus papillomas.

Brain Neoplasms↗
PubMed1988

Factors influencing posttraumatic seizures in children.

The ideal treatment of children with head trauma would include prevention of posttraumatic seizures. Ninety-two of 937 children with head injuries (9.8%) experienced posttraumatic seizures. In 94.5% of these patients (87 of 92), seizures developed within the first 24 hours after injury. Three children convulsed between 24 hours and 7 days, but only 2 children developed seizures after the 1st week. Factors found to influence the likelihood of seizures included severe head injury (GCS, 3 to 8), diffuse cerebral edema, and acute subdural hematoma (P less than 0.001). Seizures occurred in 35% of severely head-injured children compared to 5.1% with minor head injury (P less than 0.001). A less significant correlation (P less than 0.1) was noted between seizures and open, depressed skull fractures. We found no significant correlation between seizure occurrence and numerous other factors including age, sex, fracture location and type (other than open, depressed fractures), parenchymal injuries, fixed neurological deficits, and cranial operation. Based on our observations, we recommend the prophylactic use of anticonvulsants in children at higher risk for posttraumatic seizures: those with diffuse cerebral edema, acute subdural hematoma, open, depressed skull fracture with parenchymal damage, or severe head injury (GCS less than or equal to 8).

Adolescent↗
PubMed1982

Immunoregulatory cell function in peripheral blood leukocytes of patients with intracranial gliomas.

Levels of indomethacin-sensitive, glass-adherent, preculture-sensitive, and lymphocyte-mediated immunoregulatory activity were measured in peripheral blood mononuclear cells from 12 patients with intracranial astrocytomas. The levels of regulatory cell function were determined in assays of T cell immunocompetence as judged by phytohemagglutinin (PHA)-induced in vitro lymphocyte DNA synthesis. Of 6 patients studied before surgical exploration and diagnosis, 6 exhibited significantly depressed levels of PHA responsiveness in association with significantly increased levels of regulatory cell function by glass-adherent, preculture-sensitive and/or indomethacin-sensitive cells. Six patients were studied after diagnosis and treatment. Of those, 2 in remission had normal levels of immune function in association with normal levels of regulatory cell activity, whereas 2 of 4 patients who had recurrent disease had significantly depressed T cell function in association with increased glass-adherent, preculture-sensitive and/or indomethacin-sensitive regulatory cell activity. Although some alterations in lymphocyte-medicated suppressor cell activity were seen in 2 patients, those changes could not be correlated with impaired T cell function as measured in the PHA stimulation assay. The changes in regulatory cell function could not be correlated with levels of immune complexes in patient sera. These data suggest that increased levels of regulatory cell function by glass-adherent, preculture-sensitive and/or indomethacin-sensitive cells alone or in conjunction with lymphocyte and T cell depletion are a primary determinant of impaired immunocompetence in glioma patients.

Adult↗