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Biomedical subjects

A N Guthkelch

Publications and source records attributed to A N Guthkelch.

At least 37 records · Page 2Linked to original sources
PubMed1985

Diencephalic gliomas of children. A clinicopathologic study.

The authors reviewed the clinical information and pathology specimens from 29 children with diencephalic gliomas to determine whether any clinical or histopathologic feature correlated with prognosis. The median survival time for the entire group was 3.96 years. No symptom or sign at the time of diagnosis correlated with outcome. The tumors consisted of 25 astrocytomas or mixed gliomas and 4 malignant astrocytomas-mixed gliomas. Median survival time of the 25 children with astrocytomas-mixed gliomas was 4.8 years, compared with 0.5 years for the 4 children with malignant tumors. The tumor histology was relatively uniform: most tumors were moderately cellular astrocytomas with pleomorphism and hyperchromatism but without mitoses, hemorrhage, or necrosis. High cell density and the presence of mitoses were the two histologic features significantly associated with poor prognosis; no child with mitosis survived longer than 14 months.

Actuarial Analysis↗
PubMed1985

Early detection of brainstem glioma using brainstem auditory evoked potentials.

Brainstem tumor was suspected in an 11-year-old boy presenting with a painless lateral rectus palsy, on the basis of abnormal brainstem auditory evoked potentials (BAEP), despite normal computed tomographic studies, the diagnosis being confirmed by biopsy. The BAEP improved after radiation therapy, but their later deterioration heralded the onset of recurrence two weeks before any adverse clinical symptoms appeared. The value of BAEP studies in the early detection of brainstem lesions and in monitoring their progress, is discussed.

Astrocytoma↗
PubMed1984

Visual evoked potentials in hydrocephalus: relationship to head size, shunting, and mental development.

Flash-evoked visual cortical potentials were measured in 54 infants and children with symptomatic hydrocephalus; 54 shunted, asymptomatic infants and children; and 57 controls. All patients were evaluated for head size, mental development, and history of infection of the nervous system. Hydrocephalic infants up to 60 weeks of conceptional age showed significant changes in the maturation curve of the latency to the main positive peak P2 (P100), particularly when their hydrocephalus was associated with an enlarged head or with infection. Older children of normal mental development presenting with acute hydrocephalus of recent onset had normal latencies to P2. Some persistent ventriculomegaly after shunting was also compatible with normal visual evoked potentials (VEPs). After shunting, the latency to P2 became normal in most of the patients who showed normal mental development, whereas retarded hydrocephalic children of all ages continued to have abnormal VEPs.

Cerebrospinal Fluid Shunts↗
PubMed1983

Brain stem gliomas of children. A clinicopathological study.

To determine the risks and benefits of biopsying brain stem gliomas of children, the authors analyzed the clinical and histopathological features of 27 children with biopsied brain stem gliomas and compared them to 26 children with brain stem gliomas that were not biopsied. In both groups, cranial nerve palsies at the time of diagnosis were associated with increased mortality. There was no operative mortality and low operative morbidity associated with biopsies, and 35% of the biopsied children survived 5 years or longer. Children with exophytic tumors and those who received more than 4000 rad survived significantly longer. When the histologic features of pleomorphism, nuclear hyperchromatism, and mitoses were present, they occurred uniformly throughout each biopsy, regardless of the sample size. Mitoses in the biopsy specimen were associated with significantly increased mortality. The authors conclude that the risk of biopsying brain stem gliomas in children is low, and that the benefit is the identification of those children who should be treated more intensively because of their poor prognosis.

Adolescent↗
PubMed1982

Changes in the visual evoked potentials of hydrocephalic children.

The visual evoked potentials (VEPs) of a group of 84 hydrocephalic children, aged between 2 days and 15 years, were studied. The variables analyzed were age, ventriculomegaly, head size, and the presence or absence of a functioning shunt. In infants, an increase in the latency of the primary positive wave (P2) was confirmed, but this was present consistently only when ventriculomegaly was accompanied by increased head size. Improvement in the VEP was slow to follow shunting. No change in the latency of P2 was found during hydrocephalic episodes in older children.

Adolescent↗
PubMed1982

Malfunctioning ventriculoperitoneal shunts. Clinical and pathological features.

The authors report the clinical and pathological findings in 201 procedures to revise malfunctioning ventriculoperitoneal shunts in 114 patients. The revised shunts were predominantly Raimondi three-piece systems. Collection of fluid along the shunt track is emphasized as an early clinical feature of shunt malfunction. In some cases, there are few clinical signs of shunt infection, and the first indication of it may be shunt malfunction. Ventricular catheter obstruction was caused by tissue from the region in addition to choroid plexus. Inflammation was frequently found around both ventricular and peritoneal catheters. Foreign bodies (cotton fiber, hair, and talc) and granulomatous inflammation were often present at both ends. Tissues obstructing the peritoneal catheter included embolic neoplastic cells, choroid plexus, and leptomeninges. There was also more necrotic debris at the peritoneal end. To prevent shunt malfunction, attention should be directed to: 1) optimal placement of ventricular catheters inside the lateral ventricle; 2) prevention of infection; 3) avoidance of contamination by cotton fibers, hair, or talc; and 4) improvements in the biocompatibility of the implanted materials.

Adolescent↗
PubMed1981

Tethered spinal cord in association with diastematomyelia.

There is no good evidence that division of the filum terminale with simultaneous removal of the central spur in patients with diastematomyelia improves their eventual neurological status. We describe 5 patients in whom the filum was not divided and who were later reported upon because of lack of improvement or because of increasing neurological deficit. In 3 patients the division of a congenitally short filum terminale resulted in no improvement; in the other 2, symptoms were relieved following the division of adhesions at the site of previous surgery.

Child↗
PubMed1981

Influence of closure technique on results in myelomeningocele.

The results of the repair of myelomeningoceles by, respectively, reconstitution of the neural tube and simple replacement of the placode within the dural sheath are examined. It is concluded that neither offers any significant advantages over the other. When no neurologic function is present below the upper level of the lesion, no method of repair is likely to result in improvement, while the mere preservation of reflex activity in the distal segment of cord may be counterproductive. It is suggested, therefore, that there is a place for immediate excision of the lesion in properly selected cases.

Brain↗
PubMed1980

Posttraumatic amnesia, post-concussional symptoms and accident neurosis.

This communication surveys 398 consecutive head injury patients who were in regular full-time employment at the time of injury and who were examined in connection with a claim for compensation. In uncomplicated cases there was a close correlation between the duration of posttraumatic amnesia and the length of time off work. Some common causes of prolonged organic disability are mentioned. The recovery rate of patients suffering from posttraumatic emotional disorders, such as depression or anxiety, was proportional to the initial severity of injury, whereas the indefinite invalidism associated with so-called 'accident neurosis' was found to be rare in severely injured patients. 'Accident neurosis' also was more common in manual workers sustaining accidents at work than in the same occupation group after road accidents, or in non-manual workers. It is concluded that posttraumatic emotional disorder and 'accident neurosis' are not the extremes of a spectrum but separate and distinguishable conditions.

Accidents↗
PubMed1979

Detection of dilated cerebral ventricles in infants: a correlative study between ultrasound and computed tomography.

Cross-sectional ultrasonic (US) and computed tomographic (CT) scans were obtained to compare their relative accuracies in determining cerebral ventricular size in 20 infants less than one year of age. The goal was to determine whether ultrasound imaging techniques could replace CT in the serial evaluation of the lateral ventricles, particularly in patients with ventricular shunts. The US images were obtained with a servo-controlled real-time sector and trapezoid scanner of the authors' own design. In 85% of the infants, biventricular width by US and CT differed by less than 0.5 cm, and in 95% by less than 1 cm.

Brain Diseases↗
PubMed1975

Expansion of central arachnoid pouches.

Three case of central arachnoid pouches or cysts which are freely in communication with the subarachnoid space and cause hydrocephalus are reported. One case died; the second recovered following transtentorial opening of a huge cystic cavity located between the tentorium and the cerebellum, which opened into the cisterna magna. The patient was well although mentally retarded 6 years later. The third case was treated with a ventriculoatrial shunt and has fully recovered. In these cases, the shape and situation of the pouches are consistent with a processes of upward movement of CSF. In the CSF waves, originating from constant variations of venous pressure, there is an obvious aetiological factor. Even if the hydrocephalus were primary and the pouch secondary, the pouch might contribute to the progression of the former by occasional compression of the aqueduct. This can be another example of the way hydrocephalus leads to its own exacerbation.

Arachnoid↗