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Biomedical subjects

E B Hendrick

Publications and source records attributed to E B Hendrick.

At least 55 records · Page 3Linked to original sources
PubMed1984

Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome.

A retrospective study of the management of patients with infected cerebrospinal fluid (CSF) shunts was undertaken, covering the 20 years from 1960 to 1979, inclusive, and involving 222 patients with 267 infections. The data were analyzed with emphasis on influences surrounding treatment choice and subsequent outcome. Treatment was classified into three major categories: medical management (antibiotics alone), surgical management (antibiotics plus operative removal of the infected shunt), and no treatment (ranging from admission and observation only to shunt revision), the diagnosis of shunt infection having been missed. Results showed surgical treatment to be more efficacious than medical or no treatment, with a higher rate of initial cure, and lower morbidity and mortality rates. Also examined were the relationships among clinical presentation, infection rate, and results of specimens sent for culture, and initial treatment. The definitive nature of initial treatment was revealed to be directly proportional to the aggressiveness of microbiological investigation. This latter aspect was related to clinical presentation, with shunt malfunction being the least recognized symptom of shunt infection. Patients presenting with blocked shunts were less likely to receive therapy appropriate for infection than any other group, leading to the conclusion that shunt malfunction may be more specific to infection than heretofore believed.

Anti-Bacterial Agents↗
PubMed1984

Lambdoid synostosis. Part 2: Review of cases managed at The Hospital for Sick Children, 1972-1982.

Seventy-four patients with premature union of the lambdoid suture were treated at The Hospital for Sick Children during the years 1972 through 1982. Lambdoid synostosis is considered to be a rare form of craniosynostosis, but this is more likely due to lack of recognition rather than to infrequent occurrence. The skull deformity resulting from lambdoid synostosis is often mistakenly attributed to positional molding rather than to actual synostosis. When the lambdoid suture closes, the occiput on the involved side is flat, the forehead on the same side tends to bulge forward, and the ear on this side adopts a low and forward position. Skull x-ray films may demonstrate obliteration of the lambdoid suture, but more frequently one sees sclerosis along one edge of the closing suture. Radionuclide bone scanning will show increased activity during the active phase of union and decreased or absent activity once union has occurred. Craniectomy performed during the neonatal period will correct the deformity and provide for normal cranial growth. Delay in surgery beyond 6 months will frequently necessitate a more extensive cranial repair.

Cranial Sutures↗
PubMed1984

Thalamic tumors in children. Long-term follow-up and treatment guidelines.

The authors review the cases of 60 children (aged 5 months to 18 years) with thalamic tumors who were seen at The Hospital for Sick Children between 1951 and 1983. The diagnosis of thalamic tumor was based on neuroradiological studies; 33 children were first seen in the pre-computerized tomography (CT) era and 27 since the advent of CT scanning. Histological diagnosis was obtained in 37 patients at the time of operation. A further four tumors were verified histologically at autopsy. Thirty-six patients required cerebrospinal fluid shunt placement. Sixteen patients had no surgery on their tumor, three underwent needle biopsy, 20 underwent open biopsy, and 21 had partial resection. Forty-four patients were irradiated. All 20 patients with malignant tumors died, with a mean survival time of 1.1 years. Of 19 patients with benign tumors, 11 died, with a mean survival time of 5.3 years, and eight are still alive after a mean period of 7.2 years since diagnosis. Based on this series, the authors recommend open biopsy of thalamic tumors (and resection if deemed safe), followed by radiation in selected cases.

Adolescent↗
PubMed1983

Experience with ventriculo-pleural shunts.

Ventriculo-pleural shunting for the management of hydrocephalus was initially introduced by Ransohoff in 1954. However, because of the reported cases of pleural effusion with this procedure, the operation has not achieved popularity in the management of hydrocephalus. In the course of a review of 1,500 patients with hydrocephalus treated at the Hospital for Sick Children over the years 1960-1981, we encountered 59 patients who had been treated with a ventriculo-pleural shunt during the years 1971-1981. The commonest reason for insertion of the ventriculo-pleural shunt was a preexisting infected ventriculo-peritoneal shunt. 12 of the 59 patients developed pleural effusions, and 6 of these 12 patients were under 11 months of age. The incorporation of an antisiphon device in the shunting system seemed to decrease the possibility of a pleural effusion. 23 of the 59 patients continue to function on their inserted ventriculo-pleural shunt, and in 9 of these the shunts have been functioning for over 5 years. Ventriculo-pleural shunting seems to be a safe and simple form of diversionary CSF bypass. The risk of pleural effusion seems to be highest in the infant, but can occur at any age. However, even in the infant the ventriculo-pleural shunt provides a good temporary site for diversion of CSF when the peritoneal cavity is contaminated or hazardous to shunt function. Ventriculo-pleural shunting provides a valuable alternative for the management of hydrocephalus in those patients where the heart or the peritoneal cavity are unsuitable sites.

Adolescent↗
PubMed1983

Experience with surgical decompression of the Arnold-Chiari malformation in young infants with myelomeningocele.

Forty-five infants with myelomeningocele in whom hydrocephalus was absent or adequately controlled developed signs and symptoms of the Arnold-Chiari malformation before the age of 3 months. All of them underwent laminectomy and opening of the dura mater for hindbrain decompression. The clinical presentation included swallowing difficulty, apneic episodes, stridor, bronchial aspiration, arm weakness, and opisthotonos. Within 2 weeks of the initial clinical presentation, the neurological status of 14 patients (31%) deteriorated dramatically and culminated in irreversible neurological deficits. In all patients, compression of the brain stem occurred in the spinal canal. A transverse dural band constricting the dural sac at the C-1 level was noted in 41% of the patients, and a mild degree of arachnoidal adhesion was noted in 23%. The lowermost level of the cerebellar tongue or medullary kink was located at C-1 to C-4 in 28 cases and at C-5 to T-1 in 17 cases. Twenty-eight (62%) of the patients were alive and 17 (38%) had died at the last follow-up assessment. All survivors showed improvement of their overall neurological function. Twenty-four made a complete recovery. The majority of deaths were attributed to respiratory failure. Early recognition of symptoms and prompt decompressive laminectomy are essential for successful management of the Arnold-Chiari malformation in infants.

Arnold-Chiari Malformation↗
PubMed1983

Subdural empyema and epidural abscess in children.

From January 1, 1954, through December 31, 1981, 31 children were treated at The Hospital for Sick Children in Toronto, Ontario, for subdural empyema (22 cases), epidural abscess (6 cases), and infected nidi at both subdural and epidural sites (3 cases). All but four of the children with subdural empyema were from 6 months to 2 years of age or from 12 years to 16 years of age; all children with epidural abscess fitted into the older age group. The subdural empyemas developed from varied sources, but the paranasal sinuses, the ears, and the mastoids processes were predominantly affected. Five subdural empyemas developed following craniotomy or shunt procedures. The epidural abscesses developed mostly from infections in the paranasal sinuses and the middle ears. Two of the combined infections developed from the paranasal sinuses; the third followed craniotomy. The infecting bacteria varied, but were usually Streptococci and were common to both the subdural and epidural sites. The subdural empyemas presented as focal seizures in the older group, and that group of patients was more seriously ill and had greater focal deficit; the mortality rate was 13%. Epidural abscesses only rarely presented with focal deficit, and diagnosis was delayed in most instances; no deaths occurred in this group. Two cases are reported in detail to illustrate the principles and pitfalls of surgical management of these intracranial infections in the pediatric age group.

Adolescent↗
PubMed1983

Medulloblastoma: clinical presentation and management. Experience at the hospital for sick children, toronto, 1950-1980.

The authors review the cases of 144 children with medulloblastoma treated between 1950 and 1980. Duration of time between onset of symptoms and initial treatment was less than 1 1/2 months in 51% of cases, and less than 3 months in 76%. The tumor was located in the cerebellar vermis in 93% of patients. Brainstem infiltration was noted in 32%. Classical medulloblastomas comprised 82% of the total number reviewed, and desmoplastic medulloblastomas 15%. The majority of desmoplastic medulloblastomas were found in the midline of the cerebellum and in patients under 10 years of age. The prognosis for patients with desmoplastic medulloblastomas was worse than that for children with classical medulloblastomas. Spontaneous hemorrhage associated with primary or recurrent medulloblastoma occurred in 5.6% of the patients. Supratentorial metastases were found in 14.6% of cases, spinal cord metastases in 12.5%, and systemic metastases in 9%. The overall 5-year survival rate was 47%, and the 10-year survival rate 42%. Extent of surgical excision proved to be a statistically significant prognostic factor. Two patients developed recurrence after the "period of risk" as defined by Collins' rule. Delayed complications of radiotherapy were found to be substantial. Intelligence quotient (IQ) testing on 16 survivors revealed verbal IQ, performance IQ, and full-scale IQ to be within the normal range in 11, seven, and nine cases, respectively. Two were retarded on all scores.

Adolescent↗
PubMed1982

Dermoid cysts of the anterior fontanelle.

A review of the medical records at The Hospital for Sick Children in Toronto, Ontario, from 1967 through 1980 showed that, of the 94 cases of dermoid cyst of the skull treated at this institution by the neurosurgical staff, 25 were located over the anterior fontanelle. This is the largest single group of cases reported to date. The children were 2 months to 13 years of age, but two-thirds were treated before their 1st birthday. Females outnumbered males 2:1, and all of the patients presented with a nontender swelling over the anterior fontanelle, which had been present from birth. The lesions were treated by a variety of surgical approaches, all of which were curative. None of the lesions has recurred. The most interesting finding was that all but 2 of the children were white, in contrast to all previously published series. This confirms our belief that the racial incidence of dermoid cysts of the anterior fontanelle is a reflection of the general population. A review of previously published cases and the pathology and embryology of the lesion is included.

Adolescent↗
PubMed1981

The intelligence of hydrocephalic children.

In a group of 78 children with hydrocephalus in the first months of life, the level and pattern of intelligence were considered in relation to various parameters and symptoms of their condition. These included demography (age, sex, handedness); early developmental status; symptoms (visual, motor, and seizure); formative pathology; type of hydrocephalus; site of CSF obstruction; extent and configuration of cortical thinning; and shunt treatment. The common outcome of early hydrocephalus is an uneven growth of intelligence during childhood, with nonverbal intelligence developing less well than verbal intelligence. The origin of this selective cognitive deficit is in neither the hydrocephalic condition itself nor its treatment, but rather in the developmental brain anomalies and symptoms to which the hydrocephalic child is prone: In children with aqueduct blocks and intraventricular hydrocephalus, a selectively thin vertex and occipital lobe; in any hydrocephalic child, ocular abnormalities, motor deficits, and seizures.

Age Factors↗
PubMed1979

Subtemporal decompression for the slit-ventricle syndrome after shunting in hydrocephalic children.

During the past 2 years, we have performed subtemporal decompression to deal with recurrent shunt obstruction in 22 hydrocephalic patients with the slit-ventricle syndrome. 13 patients have been followed-up for more than 1 year and 2 others for more than 2 years. The frequency of hospitalization for shunt-revision has been greatly reduced. These results confirm that subtemporal craniectomy is useful in the treatment of patients in whom this syndrome develops.

Adolescent↗
PubMed1979

Hemispherectomy for Sturge-Weber syndrome.

Patients with Sturge-Weber disease who have the onset of seizures in infancy invariably face a progressively downhill course which leaves them severely hemiplegic, demented and usually institutionalized because of uncontrolled seizures. During the past 12 years, we have carried out 6 hemispherectomies in infants under 1 year of age who presented with seizures and Sturge-Weber disease. The results have been gratifying. Seizures have stopped, hemipareses have been minimal and intellectual development has been good.

Angiomatosis↗
PubMed1979

Radiopharmaceutical bone scanning in pediatric neurosurgery.

Radionuclide bone scanning is an extremely sensitive, safe and widely applicable investigative aid. In most circumstances it cannot be employed to the exclusion of plain radiography as the two procedures--one dynamic and the other static--complement each other. In children, bone imaging demonstrates physiologic characteristics of bone growth and early suture closure, delineates obscure tumors and infection, recent or old trauma not always visible on orthodox radiography and may solve the diagnostic dilemma of a child with heretofore undiagnosed head, neck or back pain.

Back Pain↗