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Biomedical subjects

W R Cheek

Publications and source records attributed to W R Cheek.

At least 19 recordsLinked to original sources
PubMed1994

Survival of split calvarial bone grafts in a dog model.

To gain a better understanding of the strength and long term viability of split calvarial bone graft, nine mongrel dogs each received four trephine craniotomies (1.5 mm diameter). The harvested bone plugs were split through the diploe and a partial-thickness plug was returned to each craniotomy site. The unused partial-thickness plugs underwent strength testing. After 90-150 days the dogs were sacrificed, bone scans and X-rays of the graft recipient sites performed, and the grafted plugs harvested for strength testing and histologic examination. Bone scanning showed increased osteoblastic activity within the grafts, strength testing showed a progressive loss in strength over the 150 days, and histologic examination demonstrated a creeping substitution. These results imply a similar evolution in strength and remodeling to that seen in long-bone grafts, whose remodeling typically spans 1 year.

Animals↗
PubMed1994

Effects of ventricular drainage and dural closure on cerebrospinal fluid leaks after posterior fossa tumor surgery.

In a retrospective study of 50 consecutive children with posterior fossa tumors treated at Texas Children's Hospital, Houston, Tex., in 1989-1992, we evaluated perioperative factors which might influence the development of postoperative cerebrospinal fluid leaks. Factors analyzed included the presence of preoperative hydrocephalus, the institution of cerebrospinal fluid diversion, and the method of dural closure. No statistically significant impact on subsequent cerebrospinal fluid leakage was demonstrated.

Adolescent↗
PubMed1990

Ventriculoatrial shunting via the azygos vein.

The treatment of hydrocephalus has evolved through many stages but the "cure" is still elusive. It is not unusual for the neurosurgeon to find that the commonly used routes for catheter placement or sites for drainage of cerebrospinal fluid (CSF) cannot be employed. The azygos vein was used to gain access to the right atrium when the CSF could not be drained into the peritoneal cavity, nor could the neck veins be used to place the catheter into the right atrium. The azygos vein is a convenient and safe route to reach the right atrium in selected patients.

Azygos Vein↗
PubMed1990

Tethered-cord syndrome after repair of meningomyelocele.

The occurrence of tethered-cord syndrome is one of the delayed consequences of the repair of meningo-myelocele. The existing neurological deficit worsens, or a new deficit is superimposed on the existing one. In addition, urological and orthopedic symptoms are also frequently encountered. Although radiological studies may be suggestive of tethering of the cord, not all children are symptomatic. Magnetic resonance imaging is the best radiologic study available. Ultrasonography, although economical and easy to perform, does not yield an optimal image. It appears that a careful periodic clinical evaluation is the best way to evaluate the patients for surgery.

Child↗
PubMed1990

Early surgical management of coronal synostosis.

Craniofacial surgery aims to allow proper expansion of the brain and the creation of an acceptable appearance. Early surgery represents an important means to attain these goals, with the choice of surgical technique being as critical as timing.

Age Factors↗
PubMed1989

Chiari type I malformation in children.

We reviewed the recent experience at Texas Children's Hospital by examining the records of 11 children who underwent suboccipital decompression for symptomatic Chiari type I malformation. Presenting complaints included neck pain (1 child), scoliosis (4 children), back pain (1 child), torticollis (1), motor dysfunction (1), and apnea (3 children). Neurologic findings were normal in 7 of the 11 children. The craniocervical junction and medulla were studied by magnetic resonance imaging, which revealed anatomy consistent with Chiari type I malformation in all cases. At surgery, all patients had tonsillar herniation to the first cervical vertebra or below. Three patients had syringomyelia. Postoperatively, either the patients were symptom free or, in the cases of scoliosis and torticollis, there was no progression. Our experience suggests that Chiari type I malformation may occur in childhood with varied and unusual clinical findings. Magnetic resonance imaging was essential to the diagnosis; the presence of tonsillar herniation was confirmed at surgery. The results of suboccipital decompression were favorable in this series.

Adolescent↗
PubMed1989

Penetration of cefuroxime into ventricular fluid in cerebrospinal fluid shunt infections.

The penetration of intravenously administered cefuroxime into ventricular fluid was assessed in five pediatric patients with ventriculoperitoneal shunt infections and in one with a ventriculostomy infection. Patients received a total dose of 200 to 230 mg of cefuroxime per kg of body weight per day administered at 8-h intervals. Levels of cefuroxime in ventricular fluid ranged from 1.6 to 22.5 micrograms/ml and were associated with cerebrospinal fluid bactericidal titers ranging from less than 1:2 to 1:16 against infecting staphylococcal isolates. Five infections were cured with cefuroxime monotherapy. On the basis of MIC data, one patient had vancomycin substituted for cefuroxime and the infection was cured.

Adolescent↗
PubMed1988

Epidural hibernoma as a complication of corticosteroid treatment. Case report.

Centripetal fat deposition is a well-recognized consequence of excessive use of corticosteroids, either endogenous or exogenous. Recently, several patients receiving large doses of corticosteroids have suffered compressive myelopathies due to excessive epidural fat collections, labeled "epidural lipomatosis." Two of these have been children, and a third child is reported here. This child was receiving chronic steroids for juvenile rheumatoid arthritis when he presented with such a myelopathy, which was confirmed by metrizamide computerized tomography myelography as well as by surgical exploration. Histological examination revealed that the epidural tissue was a brown-fat tumor or "hibernoma." An epidural hibernoma has not been described previously. The histological and endocrine features of fat in Cushing's syndrome are discussed, and the literature concerning hibernoma and epidural lipomatosis is reviewed.

Adipose Tissue, Brown↗
PubMed1986

A new staging method versus TNM staging in children with posterior fossa primitive neuroectodermal tumor (medulloblastoma).

Prognostic factors were evaluated in 30 children with primitive neuroectodermal tumors of the posterior fossa (classical medulloblastoma or differentiated medulloblastoma). The preoperative TNM (Tumor, Node, Metastasis) staging system has been applied to estimate prognosis of patients with central nervous system tumors, but this system was not applicable in assessing the postoperative status of the tumor. To fill this need, a postoperative staging system was developed known as MAPS (Metastasis, Age, Pathology, Surgery), and in this report its efficacy is compared with that of the TNM system. The predictive values of MAPS staging in these 30 children were better than those obtained using the TNM method (MAPS r2 = -0.90; TNM r2 = 0.73; P less than 0.05).

Age Factors↗
PubMed1983

Operative repair of lumbosacral myelomeningocele. Technical note.

A technique is described for closure of lumbosacral myelomeningoceles. The pathological anatomy of these lesions is examined, and the junction of the skin and dura is identified as the "junctional zone." This zone permits maximal preservation of the available dura for watertight closure after operative dissection. The junctional zone also serves as an anchor for traction sutures, permitting skin closure without tension. Seventy consecutive repairs have been completed by the authors without significant complications. There have been no instances of cerebrospinal fluid leaks, meningitis, or wound dehiscence. In all cases the repair was carried out rapidly and in a single stage.

Humans↗
PubMed1979

Device for extradural monitoring of intracranial pressure: technical note.

An ICP-monitoring device utilizing an extradural method is described. Clinical and laboratory use has shown it to be easily installed, safe, accurate, and reliable. It can be used with currently available transducers and monitoring equipment. It is hoped that this simple device will encourage the increased use of ICP monitoring.

Humans↗
PubMed1977

Growing skull fractures.

Four cases of growing skull fracture in children are presented and the reasons for poor surgical results are analyzed. The clinical presentation, causative factors, and operative findings are discussed.

Female↗