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Biomedical subjects

W B Cherny

Publications and source records attributed to W B Cherny.

12 recordsLinked to original sources

Neurologic injuries associated with all-terrain vehicles and recommendations for protective measures for the pediatric population.

OBJECTIVE: To present data and case studies illustrating the danger, especially in the pediatric population, of all-terrain vehicle (ATV) use, and to provide recommendations for pediatricians on how to educate parents concerning ATVs. DESIGN: Retrospective review of 33 patients with neurologic injuries sustained in ATV accidents presenting to one institution over a 40-month period. SETTING: Emergency department and neurosurgery service at Arkansas Children's Hospital and two other hospitals that make up the University of Arkansas for Medical Sciences. PATIENTS: All patients (n = 33) who presented between January 1993 and April 1996 at the emergency departments with neurologic injuries sustained in accidents involving either a three- or four-wheel ATV requiring hospitalization. INTERVENTIONS: Depending on the nature of the injury, various treatments, as described herein. MAIN OUTCOME MEASURES: Demographic measures, the mechanisms of injury, the types of injuries; the current data available regarding the number of injuries nationwide; and the precautionary measures parents should be advised to take. RESULTS: Ages ranged from four to 68 years (mean, 18; median, 14), 21 of the patients were < 16 years old. The predominant age range was 12 to 15 years; most common mechanisms of injury were being thrown to the ground, striking a tree, and flipping backward. Most injuries were cranial (21) or spinal (11). Nationwide, the proportionate number of injuries are decreasing, but the consequences remain severe. Using a helmet and restricting the use of these vehicles will reduce the number and magnitude of injuries. CONCLUSIONS: Although perceived as recreational toys, ATVs can be extremely unsafe, especially for children and adolescents; pediatricians should educate parents and patients on the dangers of riding these vehicles.

Accidents

Choroid plexus papilloma and cysts in the Aicardi syndrome: case reports.

Two female infants with callosal agenesis, infantile spasms, chorioretinal lacunae, optic disc colobomas and cortical heterotopias were diagnosed with Aicardi syndrome. A choroid plexus papilloma was found in one patient, and choroid plexus cysts were found in the other. Choroid plexus lesions are common findings in the Aicardi syndrome and are discussed in this paper.

Agenesis of Corpus Callosum

Controlled lumbar drainage in pediatric head injury.

A retrospective study of external lumbar subarachnoid drainage in 16 pediatric patients with severe head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or lower at 6 hours postinjury and were initially treated with ventriculostomy. Five patients required surgical evacuation of focal mass lesions. All patients manifested high intracranial pressures (ICPs) refractory to aggressive therapy, including hyperventilation, furosemide, mannitol, and in some cases, artificially induced barbiturate coma. After lumbar drainage was instituted, 14 patients had an abrupt and lasting decrease in ICP, obviating the need for continued medical management of ICP. In no patient did transtentorial or cerebellar herniation occur as a result of lumbar drainage. It was also noted retrospectively that the patients in this study had discernible basilar cisterns on computerized tomography scans. Fourteen patients survived; eight made good recoveries, three are functional with disability, and three have severe disabilities. Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. It is concluded that controlled external lumbar subarachnoid drainage is a useful treatment for pediatric patients with severe head injury when aggressive medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high ICP. Selected patients with elevated ICP, which may be a function of posttraumatic cerebrospinal fluid circulation disruption and/or white matter cerebral edema, can be treated with this modality, which accesses the cisternal spaces untapped by ventriculostomy.

Adolescent

Heterotopic pregnancy: report of four cases.

Four patients with heterotopic (combined) pregnancies were treated at one institution during the period of a year. The use of fertility agents, infertility surgery, and pelvic inflammatory disease may be risk factors predisposing to an increasing incidence of such pregnancies. Combined pregnancy may reasonably belong in the differential diagnosis in certain clinical settings.

Adult

Management of preterm premature rupture of membranes: assessing amniotic fluid in the vagina for phosphatidylglycerol.

This prospective study evaluates the clinical practicality of assessing free amniotic fluid in instances of premature rupture of the membranes (PROM) before term. The presence of phosphatidylglycerol (PG) provided evidence of fetal pulmonary maturity. Daily aspirations of vaginally pooled amniotic fluid were performed on 55 consecutive patients with preterm PROM and met with a success rate of 80% (79 of 99 attempts). Respiratory distress syndrome (RDS) occurred in none of 28 neonates in whom PG was present prior to delivery, and in four of 19 in whom PG was absent. Evidence of surfactant maturation at the time of initial sampling was noticed in 24% of fetuses at 28 to 34 weeks' gestation. Those who initially lacked PG showed an acceleration of its appearance in the aminotic fluid with time, and almost all required a minimum of 48 to 72 hours. Sampling free amniotic fluid for PG is reliable, noninvasive procedure which can be usefully applied to the management of preterm PROm.

Adult