PubMed Health⌕ Search

Biomedical subjects

J C Peter

Publications and source records attributed to J C Peter.

At least 19 recordsLinked to original sources
PubMed2001

Advantages of delayed VP shunting in post-haemorrhagic hydrocephalus seen in low-birth-weight infants.

The optimal timing of ventriculo-peritoneal (VP) shunt insertion in a neonate with post-haemorrhagic hydrocephalus (PHH) is uncertain. During the 8-year period from January 1989 to December 1996, 41 patients had VP shunts inserted for PHH at Red Cross War Memorial Children's Hospital. Data on 36 patients were sufficient for review in order to determine whether the timing of surgery in any way influenced the complication incidence of this intervention. Nine of the 36 patients had a serious complication, either infection or mechanical shunt obstruction, during their initial hospital admission (early period). Nineteen patients had surgery performed before day 35 after birth and all those with early complications were in this group. Seventeen patients had surgery delayed until after day 35, and none of these patients had an early complication. In this study a higher complication incidence was noted when a VP shunt was inserted prior to day 35 (Chi-square test P < 0.01). This most probably correlates with a high concentration of blood breakdown products in the cerebrospinal fluid during the first month after intra-ventricular haemorrhage.

Age Factors↗
PubMed1999

The Department of Neurosurgery of the University of Cape Town: a brief historical overview.

Neurosurgery as an independent discipline at Groote Schuur Hospital in Cape Town commenced with the return of Hermann de Villiers Hammann from Munich in 1946. He developed the unit with Alex Gonski, J.P. Van Niekerk, P. Keet, and A.P. Rose-Innes. Jacquez (Kay) C. de Villiers followed in 1966, becoming the first Helen and Morris Mauerberger Professor and chairman of neurosurgery at Groote Schuur Hospital, the Red Cross War Memorial Children's Hospital, and Conradie Hospital. During that period, many contemporary South African neurosurgeons received their training, and the unit developed and expanded its reputation as a center of excellence in Africa. Since 1994, Jonathan C. Peter has been the Helen and Morris Mauerberger Professor and chairman of the department, which now consists of six full-time neurosurgeons, six part-time consultants, seven registrars, and two interns. Two to three thousand outpatients are treated each year, and approximately 1000 surgical procedures are performed. Sociopolitical changes in South Africa have resulted in a reduction in funding of tertiary academic health services, and this presents major challenges for the future.

History, 20th Century↗
PubMed1998

Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity.

OBJECT: Selective dorsal rhizotomy is a neurosurgical procedure performed for the relief of spasticity in children with cerebral palsy, but its long-term functional efficacy is still unknown. The authors sought to address this issue by means of an objective, prospective study in which quantitative gait analysis was used. METHODS: Eleven children with spastic diplegia (mean age at initial surgery 7.8 years) were evaluated preoperatively in 1985 and then at 1, 3, and at least 10 years after surgery. For comparison, 12 age-matched healthy individuals were also studied. Retroreflective targets were placed over the hip, knee, and ankle joints, and each individual's gait was videotaped. The video data were subsequently entered into a computer for extraction and analysis of the gait parameters. An analysis of variance yielded a significant time effect (p < 0.05), and post hoc comparisons revealed differences before and after surgery and with respect to the healthy volunteers. The knee and hip ranges of motion (59 degrees and 44 degrees, respectively, for healthy volunteers) were significantly restricted in children with spastic diplegia prior to surgery (41 degrees and 41 degrees, respectively), but were within normal limits after 10 years (52 degrees and 45 degrees, respectively). The knee and hip midrange values (31 degrees and 3 degrees, respectively, for healthy volunteers), indicative of posture, were significantly elevated preoperatively (42 degrees and 15 degrees) and increased sharply at 1 year (56 degrees and 18 degrees), but by 10 years they had decreased to within normal limits (36 degrees and 9 degrees). Step length and velocity improved postoperatively but were not within the normal range after 10 years. Ten years after surgery these patients not only had increased ranges of motion, but also used that movement at approximately a normal midrange point. CONCLUSIONS: Selective dorsal rhizotomy is an effective method for alleviating spasticity. Furthermore, the authors provide evidence to show that lasting functional benefits, as measured by improved gait, can also be obtained.

Adolescent↗
PubMed1998

Severe head injury in children--a preventable but forgotten epidemic.

OBJECTIVE: To determine the outcome of seriously head-injured children and to analyse the factors that affect their prognosis. DESIGN: A retrospective analysis of all severely head-injured children treated between 1990 and 1993. SETTING: Red Cross War Memorial Children's Hospital's trauma unit and neurosurgery service. PATIENTS: One hundred and two children under the age of 14 years with admission Glasgow Coma Scores (GCSs) of below 8. RESULTS: There were 57 boys and 45 girls. The average time of assessment after injury was 2.8 hours. Eighty-three injuries were caused by pedestrian motor vehicle accidents. Thirty-seven were associated with other serious organ system injuries. Fifty-eight children died and only 36 made a good recovery. All children with a GCS of 3-4 died. Factors that were particularly associated with a poor prognosis were: (i) age less than 3 years; (ii) associated extracranial injury; (iii) GCS 3-4 following resuscitation; and (iv) diffuse cerebral swelling on computed tomography. CONCLUSION: Pedestrian motor vehicle accidents are the most common cause of serious paediatric head injury in the Cape Town area. Children with a presenting coma score of less than 8 have an extremely high mortality and morbidity rate, despite modern intensive care. Preventive strategies are essential.

Accidents, Traffic↗
PubMed1997

Patients with retained transcranial knife blades: a high-risk group.

Sixty-six patients with transcranial stab wounds presenting to Groote Schuur Hospital over a 2-year period are reviewed. Two groups were identified, those with retained knife blades at presentation (Group A, 13 patients) and those without (Group B, 53 patients). An increased incidence of vascular complications was observed in Group A, (eight of 13 patients) compared with 11 of 53 patients in Group B (p < 0.01, chi-square test). The mortality rate was also higher in Group A, with deaths in three of 13 patients compared with four of 53 in Group B. Increased mortality was a result of vascular injury, and in two patients neurological deterioration occurred only after knife blade removal. Possible reasons for these findings are that retained blades tend to be deeply penetrating with a potential for more cerebral and vascular injury, and there is a higher incidence of petrous bone penetration that results in carotid artery injury.

Aneurysm, False↗
PubMed1996

Carotid and vertebral artery occlusion after blunt cervical injury: the role of MR angiography in early diagnosis.

The early diagnosis of cervical vascular trauma is critical in the prevention of cerebral ischemia. Traumatic blunt carotid or vertebral artery dissection is rare and frequently associated with other injuries. Diagnosis is often delayed, limiting treatment options and contributing to a poor outcome. The clinical findings and investigation of 14 patients are presented with special reference to the last three who had magnetic resonance imaging angiography. Treatment options are discussed and it is suggested that with modern methods of investigation and management, the prognosis of this condition may be improved.

Adolescent↗
PubMed1995

Extradural haematomas in children.

OBJECTIVE: To determine the cause, clinical presentation, radiological and computed tomography (CT) findings, anatomical position and post-surgical outcome of traumatic intracranial, extradural haemorrhage in children. DESIGN: Retrospective study, 1979-1994. SETTING: Neurosurgical referrals from the Trauma Unit at Red Cross War Memorial Children's Hospital, Cape Town. PARTICIPANTS: Forty-four children below the age of 12 years who had extradural haematomas surgically removed. RESULTS: Twenty-one extradural haematomas resulted from falls, 12 from motor vehicle accidents, and 6 from assaults; 1 was of unknown cause. Nineteen patients presented with persistent drowsiness (14/15 on the Glasgow Coma Scale), 17 had headache and vomiting, and 13 gave a history of initial loss of consciousness. Seventeen pre-operative neurological examinations were normal, 11 showed anisocoria, 10 hemiplegia, 4 ataxia, 1 nystagmus and 1 a full fontanelle. Cases of posterior fossa haematoma presented with headache and ataxia. Skull fractures were visible on radiographs in 26; computed tomographic diagnosis was made in all but 1. The site of extradural haematoma was parieto-occipital in 24, posterior fossa in 11, frontal in 6, and temporal in 3. Subdural haematomas occurred in 4 cases. Surgical treatment consisted of 41 craniotomies/craniectomies and 3 burr-holes. Postoperatively 36 patients were neurologically normal, 6 had neurological deficits, and 2 died. CONCLUSION: Intracranial extradural haemorrhage in children presents in an atypical manner when compared with adults. An initial loss of consciousness followed by a lucid interval and a progressive deteriorating level of consciousness is the exception rather than the rule. Timeous neurosurgical treatment resulted in an excellent outcome in 36 of the 44 children.

Child↗
PubMed1994

Hydatid infestation of the brain: difficulties with computed tomography diagnosis and surgical treatment.

The radiological, surgical and pharmacological management of 11 children with cerebral hydatid disease is presented with special emphasis on the varying CT and MRI appearances and the surgical difficulties we have encountered. All but 2 had enhanced CT scanning and 2 had an MRI. The typical CT appearance of a large non-enhancing cyst of CSF density with minimal oedema was only seen in 3 children. Atypical appearances included irregularity of the cyst wall contour (2), enhancement of the surrounding rim (3), isodensity or heterogeneity of the cyst content (4), surrounding oedema (4) and globular as opposed to curvilinear calcification (2). Complete intact cyst removal was achieved in 3 patients. The reasons for puncturing the cysts or rupturing them at operation were failure to make a definitive pre-operative diagnosis (5), dense adhesions to the skull, dura or falx (3) and the misdiagnosis of an arachnoid cyst and the subsequent placement of a cystoperitoneal shunt (1). Pathological examination suggests that the degree of the inflammatory response to the ectocyst may determine the enhancement characteristics and the ease of surgical removal. There was 1 recurrence which responded well to four 28-day treatment cycles of albendazole.

Brain↗
PubMed1994

Low-velocity penetrating craniocerebral injury in childhood.

Fifty-four children with low-velocity penetrating injury of the skull and brain are described. The incidence of septic complications was 43%, which is significantly higher than that seen in adults. Nine percent of children developed vascular complications. Due to the high septic complication rate, a more aggressive management protocol consisting of craniectomy and dural repair under antibiotic cover is suggested.

Adolescent↗
PubMed1994

Selective posterior lumbosacral rhizotomy in teenagers and young adults with spastic cerebral palsy.

The outcome of 30 teenagers and young adults who have had selective posterior lumbosacral rhizotomy for cerebral palsy spasticity was analysed. This age group was selected because the full benefits of physiotherapy and maturation of the central nervous system would be likely to have accrued prior to rhizotomy and the post-operative function could be related more directly to the surgery per se. All 30 patients had satisfactory long-term tone reduction, sitting and standing were improved in 21 and 17, respectively, and walking patterns of the 25 of 26 spastic diplegic patients were improved. Five patients had dysaesthetic sensations in their legs and feet, and seven had patchy inconsistent areas of pin-prick loss which persisted for more than 2 years post-operatively. Touch was preserved in all cases and there were no patients with incontinence. Twenty-three patients were unequivocally positive about the benefits of this procedure.

Adolescent↗
PubMed1994

Rhinogenic subdural empyema in older children and teenagers.

Forty-five patients under the age of 20 years with rhinogenic subdural empyema were treated at Groote Schuur Hospital and Red Cross War Memorial Children's Hospital between 1979 and 1991. Thirty-two were male and 13 female. The majority were between 13 and 19 years of age. Headache was the predominant symptom in 41 patients. Vomiting occurred in 15 and 21 presented with seizures, 2 in status epilepticus. Thirty had swinging pyrexias and 26 neck stiffness while only 14 had focal neurological signs. Swelling of the face or orbit was seen in 24. Twenty-two had depressed levels of consciousness and 7 had Glasgow Coma Scale (GCS) values below 11/15. White cell counts and erythrocyte sedimentation rates were raised in all cases. Twenty-three patients underwent lumbar punctures despite the inherent danger in this procedure. Cerebrospinal fluid analysis showed a pleocytosis in all cases; no organisms were cultured in any of the specimens. The diagnosis in all cases was made by contrast-enhanced computed tomography. Twenty-five patients underwent multiple burrholes, 9 small craniectomies and 11 craniotomies. Thirty-four patients made an excellent recovery. All of the 6 patients who died had GCS values below 11 at the time of their surgery.

Adolescent↗
PubMed1994

Brain abscess in childhood. A 25-year experience.

The presentation, treatment and outcome of 98 children with brain abscesses at Red Cross War Memorial Children's Hospital, Cape Town, is reviewed. Middle ear disease and trauma were the commonest sources of infection in 60% of patients. The usual presentation was that of meningitis and it is recommended that computed tomography be performed before lumbar puncture in those patients with associated middle ear disease, trauma or sinusitis. With early treatment of both the abscess and the underlying source of infection, the mortality rate was 16%.

Adolescent↗