1/23. Detection of skin over cysts with Spina bifida may be useful not only for preventing neurological damage during labor but also for predicting fetal prognosis.Spina bifida is one of the most common open neural tube defects. There are two common types of spina bifida cystica, myelomeningocele and meningocele. Special attention to the thickness of the cystic sac (presence of intact skin and subcutaneous tissue) on magnetic resonance imaging is advantageous for determination of whether the child will profit from cesarean section in order to prevent neurological change (infection and drying of nerve tissue) and for management of spina bifida (most meningocele) during the perinatal period. Furthermore, skin detection may help to predict the prognosis of spina bifida after birth. meningocele, with intact skin over the cyst, has a better clinical course than myelomeningocele. Some myelomeningoceles with neural tube defects in a lower position, also frequently having an intact skin over the cyst, have almost the same clinical course as a meningocele. From this, we hypothesize that a baby with spina bifida who has intact skin over the cyst might have a good prognosis neurologically. In this report, we concentrate attention on the skin over cysts in 3 cases (1 meningocele and 2 myelomeningoceles).- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/23. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes.STUDY DESIGN: A retrospective case-control study evaluating risk factors for infection, causative organisms, and results of treatment in patients with cerebral palsy or myelomeningocele who underwent fusion for scoliosis was performed. OBJECTIVES: To identify risk factors for infection, and to characterize the infections in terms of infecting organisms and response to treatment. SUMMARY OF BACKGROUND DATA: No previous studies have analyzed risk factors or causative organisms, nor have they indicated results of treatment for infections in this group of patients. methods: After a 10-year retrospective review of 210 surgically treated patients, deep wound infections developed in 16 patients with myelomeningocele and 9 patients with cerebral palsy. These patients were studied extensively for possible risk factors, along with 50 uninfected patients matched for age, diagnosis, and year of surgery. Statistical testing was performed to identify risk factors. The courses of the infections were characterized in terms of organisms isolated and response to treatment. Treatment was performed in a stepwise fashion and classified in terms of the most successful step: debridement and closure, granulation over rods, or instrumentation removal. RESULTS: Of the 10 risk factors tested, 2 were found to be significant: degree of cognitive impairment and use of allograft. Findings showed that 52% of the infections were polymicrobial. Gram-negative organisms were isolated as commonly as gram-positive organisms. The most common organisms were coagulase-negative staphylococcus, enterobacter, enterococcus, and escherichia coli.- debridement and closure were successful in 11 of 25 patients with deep wound infection. Of the 14 patients with infection not resolved by serial debridements and closure, 2 were managed successfully by allowing the wound to granulate over rods, and 7 required rod removal for persistent wound drainage. There were three symptomatic pseudarthroses. Infections resulting from gram-positive organisms were most often managed successfully with debridement and closure (P = 0.012). CONCLUSIONS: patients with cerebral palsy or myelomeningocele who have severe cognitive impairment, and those who received allograft may be at increased risk for infection. Infections are more often polymicrobial and caused by gram-negative organisms than is typical for elective orthopedic procedures. This suggests an enteric source. Treatment with debridement and closure was not always successful. patients in whom infection develops are then at increased risk for pseudarthrosis.- - - - - - - - - - ranking = 1.0605925595901keywords = organ (Clic here for more details about this article) |
3/23. Oval-shaped cornea, lens duplication, and optic nerve hypoplasia associated with myelomeningocele.Oval-shaped cornea associated with true lens duplication and separate capsules is a rare anomaly. It can occur as an isolated finding(1,2) or be associated with other ocular and facial maldevelopments.(3-5) We report a novel association of an hourglass cornea, lens duplication, and optic nerve hypoplasia with myelomeningocele in a male infant.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
4/23. Intradural mesh: an unusual cause of spinal cord tethering: case report.A 13-year-old boy with a myelomeningocele experienced progressive foot deformity and lower-extremity pain while walking. magnetic resonance imaging demonstrated a low-lying spinal cord with scarring near the site of a previous repair. During surgery, the terminal nerve roots were found to have scarred and adhered to a piece of metal mesh lying in the intradural space. The mesh had originally been placed to bridge a sacral ossification defect that was present at the initial closure of the child's myelomeningocele.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
5/23. Serial neuropsychological assessment and evidence of shunt malfunction in spina bifida: a longitudinal case study.Myelomeningocele is often accompanied by hydrocephalus (MMH), making it a potentially unstable neurological condition requiring shunt placement and possible revisions. Serial neuropsychological assessment is an important tool in monitoring children with MMH, as cognitive changes can indicate shunt malfunction and hydrocephalus. We present the case of a girl with MMH who had five neuropsychological assessments (ages 5, 7, 11, 12, and 14). Despite a lack of overt neurological symptoms or report of behavioral decline, testing at age 11 revealed decline in multiple neurobehavioral domains, and imaging at that time showed increased hydrocephalus, requiring shunt revision. Subsequent neuropsychological assessment conducted after a 2-year period of medical stability showed improvement and/or a return to baseline levels in some skill areas (i.e., working memory, verbal memory, visuomotor integration, and sustained attention), yet more lasting impairments in others (i.e., Verbal IQ, processing speed, organization, and response inhibition). These lasting cognitive deficits potentially impact independent completion of complex medical self-care tasks. This pattern of recovery highlights vulnerability of brain systems supporting executive functions in children with hydrocephalus and shunt failure.- - - - - - - - - - ranking = 0.11784361773223keywords = organ (Clic here for more details about this article) |
6/23. Intraanal ultrasound: a new aid in the diagnosis of pelvic processes and their relation to the sphincter complex.Intraanal ultrasound provides a very accurate structural analysis of the continence organ. In addition it proved to give excellent pictures of solid or fluid intrapelvic, particularly retrorectal, structures. It is superior to computed tomography and magnetic resonance imaging (requiring anesthesia), because the scanner is very close to the structures in question. This allows high scanner frequencies with resolutions of 0.9 mm and better. It is a quick method, avoiding radiation, and can be safely repeated as often as necessary.- - - - - - - - - - ranking = 0.11784361773223keywords = organ (Clic here for more details about this article) |
7/23. The manchester-fothergill procedure as a fertility sparing alternative for pelvic organ prolapse in young women.Although reproductive organ prolapse typically affects older, parous women, a certain population of children and adolescents, primarily adolescents with congenital spinal defects, are also at risk. The Manchester-Fothergill procedure was first performed in 1888 by Dr. Archibald Donald of Manchester, england. Although this is a well-described procedure in historic texts, the practical application is not often employed, and modern surgical texts rarely describe how to perform this surgery. It is crucial to educate younger physicians about the technical aspects of this procedure so as not to lose this operation as an alternative surgical approach. We present a case of recurrent uterine prolapse after a prior laparoscopic uterine suspension procedure. In order to address recurrent prolapse, which was accompanied by cervical elongation, this young woman elected to have additional surgical management with the Manchester-Fothergill procedure. We describe the procedure in detail, accompanied by photographs taken during the operation to fully illustrate the extent of this patient's condition and to document the surgical technique. The Manchester Fothergill procedure is an additional fertility-sparing surgical approach to treatment of pelvic organ prolapse.- - - - - - - - - - ranking = 0.70706170639341keywords = organ (Clic here for more details about this article) |
8/23. Recurrent spinal cord tethering by sacral nerve root following lipomyelomeningocele surgery. Case report.A 21-year-old woman had recurrent progressive weakness/hypesthesia and pain in both lower extremities. At the age of 5 and 19 years, she had undergone surgical resection of a lipomyelomeningocele at L5-S1. Surgical exploration revealed that the cord was tethered and pulled over to the side by an excessively short right S-1 nerve root. The contralateral L-5 and S-1 nerve roots were markedly stretched. Division of the right S-1 nerve root resulted in prompt disappearance of pain in the lower extremities and improvement in neurological function.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
9/23. Neuroprostheses in the management of incontinence in myelomeningocele patients.A 16-year-old boy and a 17-year-old girl underwent successful closure of the meningomyelocele defect in childhood but they continued to suffer incontinence of stool and urine. After a 5-day trial with percutaneous electrostimulation of the pudendal nerve both patients received permanent neuroprosthetic implants. They became completely continent of stool and exhibited greater than 90% improvement in urinary control. These patients demonstrate that there is a small subset of meningomyelocele patients who, despite absence of spontaneous reflex tonus in the urinary and bowel sphincters, nevertheless have preserved motor capabilities.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/23. haemophilus influenzae B meningitis in a patient with a ventriculoperitoneal shunt and meningomyelocele.A child with an implanted ventriculoperitoneal (VP) shunt and meningomyelocele had an infection of his cerebrospinal fluid (CSF). The organism cultured from the VP shunt apparatus and the meningomyelocele repair site was haemophilus influenzae B (HIB), a very unusual pathogen in this setting. The patient was treated with the appropriate antibiotics, administered intravenously in accordance with accepted practice and available literature, with no improvement. The site of the persistent infection was finally determined to be within the meningomyelocele repair tissue. The patient's clinical status improved dramatically following the removal and replacement of the total shunt apparatus. The three-part apparatus tip was cultured according to the standard laboratory practice, but did not yield any organism. We conclude that the management of HIB meningitis in the presence of a VP shunt should include prompt removal of the apparatus. Recovery of the organism may be enhanced by separating the apparatus components and culture of the connections, instead of merely the indwelling tip.- - - - - - - - - - ranking = 0.3535308531967keywords = organ (Clic here for more details about this article) |
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