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Biomedical subjects

F H Sklar

Publications and source records attributed to F H Sklar.

At least 19 recordsLinked to original sources
PubMed1998

Surgical outcomes using bioabsorbable plating systems in pediatric craniofacial surgery.

The purpose of this study was to evaluate the surgical outcomes of the 1.5-mm LactoSorb plating system (Walter Lorenz Surgical, Inc., Jacksonville, FL, U.S.A.) used to stabilize the osteotomized calvarial bone in pediatric patients who have undergone craniofacial surgery. The records of 33 consecutive pediatric patients who underwent craniofacial surgery from January 1997 through December 1997 were reviewed. There were 18 male and 15 female patients, and the age ranged from 4 months to 12 years. Patients were followed-up at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. For those patients reviewed, the following information is included: age, sex, diagnosis, surgical procedures, number and size of LactoSorb plates and screws used in each patient, operative difficulty of the screws and the heat pack, and postoperative complications, including wound healing, palpability, and infection. The LactoSorb plating system was used to stabilize the osteotomized calvarial bones in 33 patients who were diagnosed with: 1) craniosynostosis, 2) hydrocephalus, 3) fibrous dysplasia, or 4) cranial deformation. Orbital rim advancement and anterior cranial vault reshaping were performed in 17 patients. Posterior cranial vault reshaping, orbital rim advancement, and anterior cranial vault reshaping were performed in eight patients. Posterior cranial vault reshaping only was performed in seven patients. Excision of fibrous dysplasia from temporal bone was performed in one patient. One patient had a postoperative wound infection, and LactoSorb plates were palpable postoperatively in four patients. The LactoSorb plating system provided adequate rigidity for stabilizing the osteotomized calvarial bone during surgery and maintained adequate rigidity after surgery during the bone healing period before absorption. This plating system showed satisfactory results in pediatric craniofacial surgery patients.

Absorbable Implants↗
PubMed1984

Adverse reactions to vancomycin used as prophylaxis for CSF shunt procedures.

From January to May 1982, 37 children undergoing CSF shunt procedures in two different countries were enrolled in a randomized, double-blind, controlled study to receive vancomycin hydrochloride (15 mg/kg/dose) or placebo (saline) one hour before surgery and again six hours later. Twenty patients received vancomycin, and 17 received placebo. In the 35 cases that could be evaluated, shunt-associated infections developed in three (17%) of 18 patients who received vancomycin and in four (23%) of the 17 placebo recipients. All infections were caused by Staphylococcus species susceptible to vancomycin. A histaminelike rash developed in seven (35%) of 20 patients during vancomycin infusion. It recurred with readministration in one patient and was accompanied by hypotension in another patient. The reactions were not related to too rapid infusion of vancomycin. Because of the adverse reactions to vancomycin, the study was discontinued.

Adolescent↗
PubMed1984

Effect of meningomyelocele closure on the intracranial pulse pressure.

Intracranial pressure (ICP) was monitored in a 12-year-old child before and after closure of a large, skin-covered meningomyelocele. Significant cerebrospinal fluid pulse pressure augmentation was observed over a spectrum of pressures following sac closure. Linear regression analysis was done to define pulse pressure-ICP relationships before and after surgery, and a significant increase in the regression slope was noted postoperatively. It is suggested that the unoperated meningomyelocele defect served as a shock absorber to dampen the intracranial pulse pressure. Meningomyelocele closure removes this shock absorber effect, resulting in pulse pressure augmentation.

Blood Pressure↗
PubMed1983

Subtemporal decompressions for shunt-dependent ventricles: mechanism of action.

The literature suggests that subtemporal decompression is an effective treatment for the syndrome of shunt-dependent ventricles because it allows the ventricle to enlarge around the shunt catheter tip. Pre- and post craniectomy ventricular areas were measured from computed tomography scans with a computer digitizing technique in three patients with this syndrome who had undergone four surgical procedures. All patients improved symptomatically following craniectomy. A significant decrease in total ventricular area was noted in all instances. The results suggest that subtemporal craniectomy causes the ventricles to become smaller, not larger. Other possible explanations for the effectiveness of the procedure are discussed.

Cerebrospinal Fluid Shunts↗
PubMed1982

Functional improvement after spinal surgery for the dysraphic malformations.

Spinal surgery for the various dysraphic malformations is generally indicated to arrest disease progression. The results of the present study suggest that certain clinical conditions and presentations are associated with an exceptionally good surgical prognosis. Sixty-nine procedures were done in 55 patients. The diagnoses included hydromyelia and tethered cord related to diastematomyelia, lipoma, lipomeningocele, previous operation, and thickened filum terminale. The operative results were evaluated for significant functional neurological and urological improvement, as well as for the relief of pain. Pain relief was achieved in 92% of patients with preoperative pain. Significant functional return was seen in 67% of hydromyelia patients. On the other hand, surgical treatment of tethered cord caused improvement in 24% (lipoma) to 46% (thickened filum and diastematomyelia). These results suggest that patients with hydromyelia and patients with a dysraphic malformation and pain have an excellent prognosis after operation. A re-evaluation of the indications for surgery for these patients may be necessary.

Adolescent↗
PubMed1981

Thermoregulatory disorders after removal of a craniopharyngioma from the third cerebral ventricle.

Aspiration and dissection of a cystic tumor from the third ventricle of a 3-year-old child resulted in several hypothalamic symptoms. One of the most persistent and troubling symptoms was marked hyperthermia which could not be traced to an infectious origin. The elevated temperature was not reduced by acetaminophen and there were abnormalities of circadian temperature cycles. In thermal stimulation tests the high body temperature was defended against induced cooling but the body temperature was raised above 40 degrees C without evoking physiological heat-loss responses and thermal discomfort. The unusual thermoregulatory status of this patient is similar to that seen in laboratory animals with hypothalamic lesions and to that observed with certain naturally occurring hypothalamic lesions in man. This dysthermia has been successfully treated with chlorpromazine.

Body Temperature↗
PubMed1981

Significance of the so-called absorptive reserve in communicating hydrocephalus: a preliminary report.

Twelve patients with communicating hydrocephalus were studied with a servocontrolled lumbar infusion technique to measure net cerebrospinal fluid (CSF) absorptive capacity and resting pressure. Each patient showed a significant absorptive reserve; the rate of CSF absorption exceeded the rate of formation over a physiological range of pressure. The size of the ventricles did not correlate with either the absorptive capacity or the resting pressure parameter, or both. The data suggest that communicating hydrocephalus does not reflect a simple imbalance between the rates of CSF formation and absorption. Other factors must be of etiological importance and are considered in the discussion.

Absorption↗
PubMed1981

Significance of postshunt ventricular asymmetries.

Ventricular asymmetries after shunt surgery were studied. Right and left ventricular areas from pre-and postoperative computerized tomography scans were measured with a computer digitizing technique, and the respective areas were expressed as a ratio. Measurements were made from the scans of 15 hydrocephalic children selected at random. Ages at surgery ranged from 1 to 101 weeks. The results indicate a significantly greater decrease in ventricular size on the side of the ventricular shunt catheter. Multiple regression analysis showed no relationship between the magnitude of change in ventricular size and either the patients' age orn the time intervals between surgery and follow-up scans. Possible mechanisms for these postshunt ventricular asymmetries are discussed.

Brain Diseases↗
PubMed1980

Effects of pressure on cerebrospinal fluid formation: nonsteady-state measurements in dogs.

Effects of pressure on cerebrospinal fluid (CSF) formation were studied in dogs with a recirculatory spinal perfusion tracer clearance technique that does not require steady-state conditions. The data permit statistical analysis of the relationship between the rate of CSF formation and pressure for individual animals. Most animals showed no statistical relationship between CSF formation and intracranial pressure (ICP) and/or cerebral perfusion pressure (CPP). In this study, a disturbance of cerebral blood flow (CBF) autoregulation may have been present in five animals on the basis of CPP reductions, and four of this latter group showed formation to decrease with increasing ICP. It is suggested that CSF formation is normally pressure insensitive. With impaired autoregulation of CBF, formation may follow CBF and CPP passively.

Animals↗
PubMed1980

Servo-controlled lumbar infusions in children. A quantitative approach to the problem of arrested hydrocephalus.

Servo-controlled variable-rate lumbar infusions were performed in 11 children with presumed cerebrospinal fluid (CSF) absorptive defects. The CSF dynamics were determined as a function of intracranial pressure in terms of CSF absorptive capacity and resting pressure. These physiological measurements showed poor correlation with traditional clinical signs. On the basis of the CSF measurements there were four children with arrested hydrocephalus, one with compensated hydrocephalus, three with active hydrocephalus, and three with brain atrophy. Retrospective management decisions based on the clinical presentations, physical findings, and traditional diagnostic tests disagreed with management as indicated by the CSF measurements in eight of 11 cases. It is suggested that this technique may be a useful diagnostic tool for difficult clinical problems.

Atrophy↗
PubMed1980

Physiological features of the pressure-volume function of brain elasticity in man.

The intracranial pressure-volume relationship of brain elasticity was examined in 20 patients with suspected disorders of the cerebrospinal fluid (CSF) system. Elasticity measurements were made as the patients were studied with a servo-controlled lumbar infusion technique to measure CSF absorptive capacity. The data were evaluated to determine the relationship between intracranial pressure (ICP) and volume, and between ICP variability and the level of ICP. The results confirm the exponential nature of the pressure-volume elasticity function in patients who are not critically ill. Eight of the 20 patients were shown to have normal CSF absorptive capacities, and there was no difference between their elasticity measurements and those of patients with absorptive defects. In addition, ICP variability was shown to be linearly related to the actual level of ICP. The physiological features of the pressure-volume elasticity function are reviewed. Based on these considerations, the clinical value and significance of elasticity measurements is questioned.

Adolescent↗
PubMed1980

Brain elasticity changes with ventriculomegaly.

The pressure-volume relationship of brain elasticity was determined in 32 patients during servo-controlled variable-rate lumbar infusions to measure net cerebrospinal fluid (CSF) absorptive capacity. Several indices were used to estimate ventricular size from computerized tomography scans. The results show a linear relationship between ventricular size and the elasticity slope which relates the natural logarithm of pressure to volume. It follows that a hydrocephalic patient should show a greater intracranial pulse amplitude at a given pressure than does a patient with normal-sized ventricles. Although these elasticity changes may simply be the result of the ventriculomegaly, it seems possible that the pressure-volume elasticity relationship may be of etiological importance in disorders of the CSF system.

Adolescent↗
PubMed1979

Visual evoked potentials: a noninvasive technique to monitor patients with shunted hydrocephalus.

Visual evoked potentials (VEPs) to repetitive flash stimuli were abnormal in 10 patients with documented hydrocephalus. Abnormalities included latency delays, fatigability, and asymmetries. Both latency and wave form disturbances improved in the postshunt period. Clinical progression of the hydrocephalus occurred in several patients, and this correlated well with worsening of the VEPs. We suggest that this noninvasive technique may be valuable in following patients with cerebrospinal fluid shunts, patients with presumed "arrested" hydrocephalus, and patients who are being weaned from their shunts.

Adult↗
PubMed1979

Cerebrospinal fluid dynamics in patients with pseudotumor cerebri.

CSF dynamics were determined as a function of intracranial pressure in patients with pseudotumor cerebri. Servocontrolled variable rate lumbar infusions were used to determine net CSF-absorptive capacities and resting pressures in 10 patients; serial studies were done in 5 of the patients. Nearly all of the patients had abnormally low CSF-absorptive capacities. On the other hand, marked elevations in resting pressure were not a constant feature of the disease. Concurrent changes in the cerebrovascular bed could introduce errors into this manometric determination of CSF dynamics; the significance of this potential artifact is examined. The results of this study suggest that the CSF compartment may be of etiological importance in the pathophysiology of pseudotumor cerebri.

Adolescent↗
PubMed1979

Halo immobilization of cervical spine fractures. Indications and results.

Thirty-three patients with a spectrum of cervical spine fractures or subluxations were treated with immobilization by a halo apparatus. All spines were assumed to be unstable because of the nature of the fracture or because of a subluxation noted on spine films. Treatment consisted of immobilization and fracture reduction followed by application of a halo plaster cast or molded halo plastic vest. Patient acceptance was high. Complications were few and minor. No patient experienced neurological deterioration during treatment. Reduction was well maintained during an average halo immobilization period of over 3 months. Use of the halo resulted in healing of bone and ligament and restoration of stability in 85% of the patients. Halo immobilization was efficacious in the treatment of odontoid and hangman's fractures as well as complex fractures involving multiple areas of a single vertebra. It was also used successfully as an adjunct to posterior cervical fusion. Although several patients with subluxations or angulation without bone injury were treated successfully, two of the four therapy failures occurred in this group of patients, and the halo must be used with caution in this clinical setting. Contraindications to the use of the halo include complete cervical spinal cord injury with anesthetic skin, tomographic and/or myelographic evidence of disc or bone within the spinal canal, and unsatisfactorily reduced subluxations. The halo has provided more effective and reliable immobilization than other orthoses. It is an acceptable alternative to cervical fusion for the achievement of stability in a wide variety of cervical spine fractures and dislocations avoiding both the short-term and perhaps long-term complications of spinal fusion.

Adolescent↗