Biomedical subjects

James M Drake

Publications and source records attributed to James M Drake.

26 records · Page 2Linked to original sources

PubMed2004

An instrument to measure the health status in children with hydrocephalus: the Hydrocephalus Outcome Questionnaire.

OBJECT: In the measurement of clinical outcome in pediatric patients with hydrocephalus the condition's effects on a child's physical, emotional, cognitive, and social health are frequently ignored. The authors developed a quantitative health status measure, the Hydrocephalus Outcome Questionnaire (HOQ), designed specifically for children with hydrocephalus, which can be completed by the children's parents. METHODS: The standardized steps in the development of a health status measure were followed. Item generation required involvement of health professionals and focus groups with parents of children with hydrocephalus. A comprehensive list of 165 unique health status items was thus generated. To streamline the list, questionnaires were sent to 69 sets of parents to solicit their opinions regarding the most important of these health issues, and the 51 most significant items were then selected to represent the following health domains: physical, social-emotional, and cognitive. In another cohort of 90 sets of parents, the 51-item questionnaire was then tested for reliability and construct validity against the following independent measures of specific components of health: Health Utilities Index, Wide Range Achievement Reading Test, Strengths and Difficulties Questionnaires, and Functional Independence Measure for Children. The HOQ took approximately 10 to 15 minutes for the parents to complete and demonstrated excellent test-retest reliability (0.93, 95% confidence interval [CI] 0.88-0.96), interrater reliability (0.88, 95% CI 0.79-0.93), and internal consistency (Cronbach alpha 0.94). Pearson correlation testing demonstrated very good construct validity between domain scores and their respective independent measures. CONCLUSIONS: The HOQ for children with hydrocephalus demonstrated excellent reliability and validity properties. This tool will be valuable for a wide range of clinical research projects in pediatric hydrocephalus.

Adolescent↗

PubMed2004

Measuring the health status of children with hydrocephalus by using a new outcome measure.

OBJECT: In the preceding article, the authors described the Hydrocephalus Outcome Questionnaire (HOQ), a simple, reliable, and valid measure of health status in children with hydrocephalus. In the present study, they present their initial experience in using the HOQ to quantify the health status in a typical cohort of children with hydrocephalus. METHODS: The mothers of children with hydrocephalus completed the HOQ and, with the child's attending surgeon, provided a global rating of their children's health. An exploratory analysis was performed using a multivariate analysis of variance (ANOVA) to determine which variables might be associated with worse health status. The mothers of 80 children, ranging in age from 5 to 17 years, participated in the study. The mean HOQ Overall Health score was 0.68, a value estimated to be equivalent to a mean health utility score of 0.77. The global health ratings provided by the mothers and the surgeons were moderately correlated with the HOQ scores (Pearson correlations 0.58 and 0.57, respectively). Results of the multivariate ANOVA indicated that the presence of epilepsy was strongly associated with a worse health status (p < 0.0001, F-test). CONCLUSIONS: The health status of a typical sample of children with hydrocephalus was measured using the HOQ. The only consistently significant association with health status found was the presence of epilepsy.

Adolescent↗

PubMed2003

A systematic review of brachial plexus surgery for birth-related brachial plexus injury.

OBJECTIVE: Brachial plexus injury complicates 0.6-2.6 per 1,000 live births. Surgery is sometimes advocated for patients who fail to improve with conservative management. We reviewed the available literature on birth-related brachial plexus palsy in order to provide recommendations for surgical management, using evidence-based criteria. METHODS: Studies were identified by searching Medline (1966-2002) and the Cochrane Library using the terms brachial plexus, neonate or infant, surgery and natural history. The reference lists of relevant articles were also reviewed. The search was restricted to articles published in English. Each article was classified according to its methodology. Management recommendations were suggested based on the results of the studies identified and the degree of certainty of the available literature. RESULTS: Twenty-three papers were selected for detailed analysis. There are no randomized controlled trials that have investigated the role of brachial plexus surgery in the management of birth-related brachial plexus palsy. Two prospective studies of relevance were found, one describing the natural history of birth-related brachial plexus injury and one evaluating surgery for these patients. The remainder consisted of retrospective case series. Outcomes from surgical series are generally favorable (level III and V evidence). Direct comparison with the natural history could not be inferred from the series reviewed given the lack of controls. CONCLUSION: There is no conclusive evidence showing a benefit of surgery over conservative management approaches in the treatment of patients with birth-related brachial plexus injuries. Surgery remains a valid practice option given the level III and V evidence suggesting a possible benefit of surgery.

Birth Injuries↗

PubMed2003

Microfracture of a baclofen pump catheter with intermittent under- and overdose.

An 8-year-old boy with an implanted intrathecal baclofen pump presented with intermittent signs of baclofen under- and overdose. Pump interrogation, pump volumes, plain X-rays, catheter contrast fluoroscopy and CT of the intrathecal catheter tip were unremarkable. A microfracture of the extradural catheter was only seen at a magnification of x20 and confirmed by scanning electron microscopy. Symptoms resolved following replacement. Microfracture of the intrathecal catheter of baclofen pump systems may present puzzling symptomatology and be difficult to diagnose by conventional means.

Baclofen↗

PubMed2003

Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial.

OBJECT: Endoscopically assisted ventricular catheter placement has been reported to reduce shunt failure in uncontrolled series. The authors investigated the efficacy of this procedure in a prospective multicenter randomized trial. METHODS: Children younger than 18 years old who were scheduled for their first ventriculoperitoneal (VP) shunt placement were randomized to undergo endoscopic or nonendoscopic insertion of a ventricular catheter. Eligibility and primary outcome (shunt failure) were decided in a blinded fashion. An intention-to-treat analysis was performed. The sample size offered 80% power to detect a 10 to 15% absolute reduction in the 1-year shunt failure rate. The authors studied 393 patients from 16 pediatric neurosurgery centers between May 1996 and November 1999. Median patient age at shunt insertion was 89 days. The baseline characteristics of patients within each group were similar: 54% of patients treated with endoscopy were male and 55% of patients treated without endoscopy were male; 30% of patients treated with and 26% of those without endoscopy had myelomeningocele; a differential pressure valve was used in 51% of patients with and 49% of those treated without endoscopy; a Delta valve was inserted in 38% of patients in each group; and a Sigma valve was placed in 9% of patients treated with and 12% of those treated without endoscopy. Median surgical time lasted 40 minutes in the group treated with and 35 minutes in the group treated without endoscopy. Ventricular catheters, which during surgery were thought to be situated away from the choroid plexus, were demonstrated to be in it on postoperative imaging in 67% of patients who had undergone endoscopic insertion and 61% of those who had undergone nonendoscopic shunt placements. The incidence of shunt failure at 1 year was 42% in the endoscopic insertion group and 34% in the nonendoscopic group. The time to first shunt failure was not different between the two groups (log rank = 2.92, p = 0.09). CONCLUSIONS: Endoscopic insertion of the initial VP shunt in children suffering from hydrocephalus did not reduce the incidence of shunt failure.

Endoscopy↗

PubMed2003

Slow-flow spinal epidural AVF with venous ectasias: two pediatric case reports.

We report the clinical and imaging findings in the cases of two children who initially presented with back pain related to epidural AVF in the cervicothoracic spine. Both lesions were of particular interest because of their exclusive epidural and paraspinal venous drainage and the presence of the prominent venous pouches in the epidural space. Angiography revealed that one was multifocal and of relatively slow flow. We think that these unusual features have important implications for treatment.

Angiography↗

PubMed2002

Avulsion transverse ligament injuries in children: successful treatment with nonoperative management. Report of three cases.

Neck injuries in children most commonly affect the upper cervical spine. Injuries of the transverse ligament and its attachments may result in C1-2 instability, but the optimum form of treatment is unknown. Three patients, who ranged in age from 5 to 11 years, sustained transverse atlantal ligament injuries with unilateral avulsion fracture of the osseous tubercle of C-1. One child was injured in a fall and two were involved in motor vehicle accidents. Although all patients presented with neck pain, none exhibited neurological deficits. Plain radiography demonstrated no evidence of osseous injury, but an increased predental interval was noted in each case. Computerized tomography (CT) scanning demonstrated the avulsion fractures, and magnetic resonance imaging revealed evidence of soft-tissue injuries in the occipital-C2 ligamentous complex. All children were managed with external immobilization (halo vest in two and a Sterno-Occipito-Mandibular Immobilizer brace in one), for 6 to 12 weeks. Follow-up CT scanning demonstrated reattachment of the avulsed osseous tubercle, and dynamic cervical spine radiographs revealed the absence of C1-2 instability. The results of these cases suggest a role for external immobilization in the treatment of osseous avulsion injuries of the transverse atlantal ligament in children.

Cervical Vertebrae↗

PubMedDate not supplied

Orbital involvement by nasopharyngeal angiofibroma.

This article describes a rare cause of orbital apex syndrome in a child--juvenile nasopharyngeal angiofibroma. A high level of suspicion while treating an adolescent male with chronic nasal obstruction, epistaxis, and a nasal mass will promote early diagnosis. Multidisciplinary care is advisable, especially for advanced disease.

Angiofibroma↗