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Biomedical subjects

D B Shurtleff

Publications and source records attributed to D B Shurtleff.

At least 37 records · Page 2Linked to original sources
PubMed1991

Cognitive abilities and achievement status of children with myelomeningocele: a contemporary sample.

Designed study as a conceptual replication of Shaffer, Friedrich, Shurtleff, and Wolf (1985). Intelligence, school achievement, and perceptual motor skill data from 73 children with uncomplicated myelomeningocele were examined to determine their deviation from test norms. The respective impact of shunting and functional motor level was also assessed. The sample as a whole functioned below WISC-R and VMI norms. On the WRAT, deviation from the norms was evident only for the Arithmetic subtest. Partial replication of the Shunt X Motor level interaction reported by Shaffer et al. (1985) was obtained. Limitations of small-sample studies are discussed.

Adolescent↗
PubMed1991

Modifications to the traditional description of neurosegmental innervation in myelomeningocele.

The consistency between patterns of lower-limb muscle strengths in children with myelomeningocele and Sharrard's classic description of segmental innervation was examined in 291 patients. Although it has been assumed that medial hamstring innervation was from a similar neurosegmental level as gluteus medius, and gluteus maximus was from a similar level as gastrocnemius-soleus, the authors found that medial hamstring strength more frequently correlated with iliopsoas and quadriceps, and glutei with anterior tibialis. It is proposed that children with myelomeningocele be grouped according to specific muscle strength rather than by neurosegmental level.

Adolescent↗
PubMed1991

Ambulatory outcome of children with myelomeningocele: effect of lower-extremity muscle strength.

The relationship between patterns of strength and mobility was studied in 291 children with myelomeningocele, graded as community ambulators, partial (household) ambulators and nonambulators. Iliopsoas strength was found to be the best predictor of ambulation, with the quadriceps, anterior tibialis and glutei also contributing significantly. Grade 0 to 3 iliopsoas strength was always associated with partial or complete reliance on a wheelchair. No patient with grade 4 to 5 iliopsoas and quadriceps function relied completely on wheelchairs and the majority were community ambulators. Grade 4 to 5 gluteal and anterior tibialis function was associated with community ambulation, without aids or braces. Deterioration in mobility was most common in those with strong iliopsoas/quadriceps and grade 0 to 3 gluteus medius, and was not age-related.

Adolescent↗
PubMed1987

The outcome of pregnancies diagnosed as having a fetus with meningomyelocele.

Forty-nine cases of meningomyelocele diagnosed in utero and another 10 cases delivered by prelabor cesarean section (N = 59) are compared to all other cases of meningomyelocele (N = 98) born following labor and seen during the same period. Prenatal diagnosis was established for 19 cases before and 30 cases after 24 weeks gestational age. Ten cases were delivered by prelabor cesarean section for maternal indications. Eight of 12 cases diagnosed before 24 weeks and given a guarded prognosis and one given a poor prognosis, elected cesarean section. One of the 8 was stillborn. Four of the 12 given a guarded prognosis and 6 an extremely poor prognoses elected termination of the pregnancy. Nineteen of the 30 cases diagnosed after 24 weeks were delivered by prelabor cesarean section and two by cesarean section after inadvertent labor. Of the 35 cases born by prelabor cesarean section, 48% have sacral levels or no loss of motor function compared to 14% of the 98 born after labor (P = 0.0001). We recommend prelabor cesarean section before onset of labor to preserve neural function of a baby with meningomyelocele and leg movement in utero when parents refuse termination or have a diagnosis made after 24 weeks gestational age.

Cesarean Section↗
PubMed1986

Meningomyelocele: a new or a vanishing disease?

I believe meningomyelocele is not vanishing, but is a new and diminishing disorder. Prenatal diagnosis will be accepted only by a portion of most communities if abortion is the only alternative to the delivery of an impaired child. I believe participation in neural tube screening programmes can be increased by offering improved pregnancy outcome with concomitant prelabor caesarean section in addition to termination. Regardless, the prevalence at birth of children with myelomeningocele will decrease both in total numbers and in the severity of the expressed lesion. The resultant rarity will require collaboration between centers to evaluate treatment. The developing International Myelodysplasia Study Group using a Patient Data Management System and computer-assisted analysis is a model of successful collaboration that allows better exploration of the multiple variables that contribute to the well-being of children with open neural tube defects of the spine.

Abortion, Induced↗
PubMed1986

Assessment of muscle strength in children with meningomyelocele: accuracy and stability of measurements over time.

The strength of lower limb musculature, as determined by clinical muscle testing, influences assigned lesion levels, prognosis, and the subsequent orthopedic and rehabilitative management of children with meningomyelocele. The purpose of this study was to determine the accuracy of muscle testing at various ages based on clinical impressions of therapists; and to determine how the stability of measurements over time varies with age and muscle tested. A total of 3,084 examinations were performed on 825 children with meningomyelocele. Therapists coded the degree of accuracy of the last 1,282 examinations. Of these patients 177 with six or more serial examinations were studied by generating Spearman rank order correlation coefficients for comparison of strength measurements at given ages with median strengths during five-year follow-up periods. The percentages of patients who had examinations at a given age equal to, and within one grade of individual best estimates of ultimate muscle strength were also calculated. It was concluded that: therapists are markedly more confident about assessments in children five years and older; stability of muscle testing measurements over time generally increases from birth to age five or six when peak stability is approached; the probability that a single muscle test precisely predicts future muscle strength varies with age and muscle tested; and the probability that a muscle test will predict future strength to within one grade is not strongly influenced by age or muscle tested.

Child↗
PubMed1985

Influence of prognosis on decisions regarding the care of newborns with myelodysplasia.

Treatment of newborns with myelodysplasia (meningomyelocele and related disorders) continues to be a controversial subject. We have used a consistent plan of care and have employed the same prognostic criteria over the period from 1965 to 1982 to address the needs of 212 affected newborns. A good prognosis and early surgical care were given to 42 per cent of 53 newborns during the period 1965 to 1970, to 58 per cent of 65 newborns from 1971 to 1976, and to 71 per cent of 94 newborns from 1977 to 1982. Of the newborns with an initially poor prognosis, 19 per cent of 31 received early surgery between 1965 and 1970, as compared with 33 per cent of 27 between 1971 and 1976 and 52 per cent of 27 between 1977 and 1982. Life-table analyses of survival in the three periods revealed significant improvement over time in the survival of newborns receiving early surgical care, regardless of the initial prognosis (log-rank statistic = 8.240, P = 0.016) and in comparison to recipients of supportive care alone (log-rank statistic = 5.975, P = 0.05). We conclude that early surgery permits the survival of an increasing percentage of patients with myelodysplasia.

Decision Making↗
PubMed1985

Hip flexion contractures: a comparison of measurement methods.

Rater reliability characteristics of four positioning techniques used to measure hip extension (prone hip extension, Thomas, Mundale, and pelvifemoral angle) were compared. Two raters examined 45 children (90 hips), including patients with spastic diplegia and with meningomyelocele, who are prone to developing hip flexion contractures, and healthy subjects. Retests were performed on 21 children. The least reliable readings in the cerebral palsy group were found from tests using the Thomas technique, and in the meningomyelocele group using the Mundale technique. The pelvifemoral angle is more time consuming, and no more accurate than other methods. Considering the ease of measurement, reliability and reproducibility, we recommend use of the prone hip extension test for patients with cerebral palsy and for those with meningomyelocele, and recommend the Thomas test as an alternative for nonspastic patients.

Adolescent↗
PubMed1984

Toileting skills in children with myelomeningocele: rates of learning.

Rates at which 173 children with myelomeningocele learned 20 different toileting skills were studied in an attempt to describe their acquisition of control over chronic urinary and stool incontinence. All had clinical or urodynamic evidence of neurogenic bowel and bladder dysfunction. Seventy-five other children were excluded because of intelligence quotients less than or equal to 70 points, uncontrolled hydrocephalus, spastic extremities, or other major disabilities. Inadequate follow-up or parent cooperation eliminated 27 other cases. Using a home inventory, parents recorded their child's accomplishments. An investigator contacted parents regularly to minimize inaccurate reporting and to screen data against preestablished criteria. The observation period lasted 2.5 years, but earlier achievements that met criteria were included in the cumulative data pool. Each child was categorized into one of four groups of motor paralysis (L2 and above, L3-4, L4-5, S1 and below), and calculations were made when 20%, 50%, and 80% of the children had attained each toileting skill. Intergroup and intragroup variances were often striking. Possible explanations for these variances include physical and psychosocial readiness as well as home and community support systems. For the child who meets the selection criteria, these specific learning rates can be used in evaluating treatment, describing current levels of bladder or bowel control, and setting realistic goals.

Adolescent↗
PubMed1983

Survival after acute mercury vapor poisoning.

An 8-month-old girl with acute mercury vapor intoxication experienced pneumonitis with respiratory failure, bilateral pneumothorax, pneumomediastinum, acute renal failure, hepatocellular dysfunction, and seizures. Treatment centered on intensive supportive care; her survival is exceptional among infants with severe mercury intoxication.

Acute Kidney Injury↗
PubMed1983

Developmental guidelines for children with myelodysplasia.

A new inventory of 166 milestones and developmental tasks was designed and given to parents of 173 children with myelodysplasia to use over a 2 1/2-year period to record their children's development. The inventory included items in the categories of self-help (including independent toileting), personal-social development, and gross motor development. The children were placed in one of four subgroups according to their level of paralysis. For each motor-level group, the percentage of those performing each item at various ages was calculated. The ages of routine performance of selected self-help and personal-social items are reported for 20, 50, and 80 percent achievement for the children for whom the data were known. There was a tendency for the less paralyzed children to learn skills more quickly than their more paralyzed peers. However, the wide age ranges within groups for learning individual skills indicate that factors other than the level of paralysis affect the rate of development, and these factors need to be identified. The data provided represent a reasonable estimate of when children with varying degrees of paralysis can first be expected to perform developmental tasks. The tables can be used to establish learning objectives and programs so that more children with myelodysplasia can learn independence at an earlier age.

Activities of Daily Living↗
PubMed1983

A longitudinal study of shunt function in 360 patients with hydrocephalus.

Data from an eight-year clinical study of shunt-treated hydrocephalus indicated continued shunt dependency in 289 of 360 patients. 919 combined pressure-radionuclide clearance studies were performed. In 307 studies in which the shunt was identified as nonfunctional, 208 patients were symptomatic for increased intracranial pressure and had the shunt revised. Of the other 99 patients, 71 have remained asymptomatic for three to 60 months (mean 27 months) and 28 subsequently required shunt revision after one to 67 months (mean 24 months). Five other clinical patterns are described. Various methods of monitoring shunt function are recommended.

Adolescent↗
PubMed1983

Skin breakdown in patients with myelomeningocele.

An attempt was made to quantify longitudinal morbidity and identify risk factors associated with high rates of skin breakdown in patients with myelomeningocele. Based on annual evaluations, 227 of 524 patients accounted for 468 positive observations including classic decubiti, abrasions, burns, and ammoniacal dermatitis. Forty-two percent (196) of skin breakdown was attributed to excessive pressure; 57% (267) to other causes; and 1% (5) to unknown causes. Prevalence curve revealed a steady rise from infancy to age 10 years, at which point rates varied between 20-25%. Longitudinal morbidity curves of first skin breakdown showed a tendency of lesions over the perineum or gibbus to appear more frequently in the presence of higher paraplegia (generalized Savage or Mantel-Cox, p = 0.05). However, mildly paraplegic and partially insensate patients exhibited relatively higher rates of breakdown over the lower extremities compared to more paraplegic patients. Higher rates of breakdown were associated with other characteristics such as mental retardation, large head size, kyphoscoliosis, and chronic soiling. Data confirm the high prevalence of skin breakdown in patients with myelomeningocele and reflect an overall influence of growth and development.

Casts, Surgical↗
PubMed1981

Vesicoureteral reflux in children with uremia. Prognostic indicators for treatment and survival.

To define factors related to renal prognosis in children with vesicoureteral reflux and renal insufficiency, we reviewed 908 children with vesicoureteral reflux. Twenty-five patients were found who had initial creatinine clearances of less than 60 mL/min/sq m and had five-year follow-up examinations. All had severely dilated ureters. Renal function improved in eight, remained stable in ten, and deteriorated in seven. Probability of deterioration of renal function in these children was related to factors measurable at clinical presentation: (1) a corrected creatinine clearance of less than 25 mL/min/sq m; (2) 2r greater reaction for protein on urinalysis that disclosed no infection; and (3) being in less than the fifth percentile of body length. The total number of the three factors present in each patient was more significantly related to prognosis than any one factor.

Child↗