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Biomedical subjects

D H Reigel

Publications and source records attributed to D H Reigel.

At least 19 recordsLinked to original sources
PubMed1995

Adult stature and anthropomorphic measurements of patients with myelomeningocele.

UNLABELLED: Children with myelomeningocele are extremely short, yet little data exists on adult stature and anthropomorphic measurements. We measured the recumbent length, weight, arm length, sitting height and calculated body mass index of 54 adults with myelomeningocele. Mid parental height was also calculated. Measurements were compared with normative data. Patient charts were reviewed for history of hydrocephalus. The 27 males and 27 females had a mean age of 24.8 +/- 5.7 years. The mean length for adult females was 141.9 +/- 12 cm and was 152.1 +/- 13 cm for males. Patients with thoracic level of lesions were shorter than those with lumbar level who were, in turn, shorter than those with sacral levels. Recumbent length, sitting height, arm length and arm span were significantly smaller than expected values. Recumbent length was smaller than mid parental height. Those with ventriculoperitoneal shunts, required for hydrocephalus, were shorter than these without a shunt. CONCLUSION: Adults with myelomeningocele have significant short stature. Arm span is not an interchangeable measure with length for patients with myelomeningocele. Multiple factors are likely to be responsible for the observed short stature.

Adult↗
PubMed1995

The editors' labours: separating the wheat from the chaff.

From the author's standpoint, the editor is viewed as 'one who separates the wheat from the chaff and then prints the chaff'! Since its inception, Pediatric Neurosurgery has tried to provide the reader with the guarantee that only the 'wheat' is published. This paper will examine the policies of the journal's Editorial Board and in particular outline the review process for submitted manuscripts. In addition to certain operational items, the paper will consider how the 'peer' in 'peer review' is identified, the grading instruments for paper acceptance, the likelihood that the readers and peer reviewers agree on manuscript quality, and how authors should view failure. The Society is firmly committed to our journal. Our individual responsibilities begin with paper preparation and then its presentation at the annual meeting. Thereafter, it is important for the membership to appreciate that their participation, as either author and/or reviewer, is critical for the continued success of our journal.

Humans↗
PubMed1994

Change in spinal curvature following release of tethered spinal cord associated with spina bifida.

Changes in spinal curvature, scoliosis, kyphosis and lordosis are associated with the growth of patients with myelomeningocele. Previous investigators have stated that progressive developmental scoliosis is related to tethered spinal cord. In order to investigate the relationship of tethered spinal cord release to progression of spinal curvature, we surveyed the medical records of 262 patients with a history of one or more tethered spinal cord release. For 216 of these patients, a total of 2,369 serial spine x-rays, obtained over a 20-year period, were reviewed by the standard Cobb method for progression of scoliosis, thoracic kyphosis and lordosis. In addition, the serial spine x-rays of 74 patients without clinical findings of tethered spinal cord were collected and reviewed for comparison of progressive scoliosis and kyphosis. One hundred and sixty normal lumbar x-rays were evaluated to compare the progression of the lordotic curve in patients with tethered cord release with a normal population. Progression of scoliosis plateaued or declined following release of tethered cord in patients with lumbar and sacral level lesions, however, tether release did not halt the progression of scoliosis in the thoracic level group. Tethered cord release altered the course of lordosis in L1 through L3 level lesions, but had little affect on the normal progression of lordosis in patients with L4, L5 or sacral level lesions. Finally, tethered spinal cord release appears to be associated with a decrease in the incidence and magnitude of kyphosis.

Adolescent↗
PubMed1989

Cerebrospinal fluid shunt infections. Report of 41 cases and a critical review of the literature.

All shunt procedures performed at our institution from July 1982 to December 1987 were analyzed for factors possibly related to shunt infection. There were 41 infections detected in 31 patients for an overall rate of 6.9%. Only intraventricular hemorrhage (IVH) as an etiology of the hydrocephalus and internalization of an external ventricular drain (EVD) were found to correlate with septic risk. An extensive review of all the English language literature concerning shunt infections over the last 15 years was undertaken. Little consensus could be found among the 35 publications in regard to factors predisposing to shunt sepsis. Even the issue of antibiotic prophylaxis remains clouded as all papers examined exhibited methodologic flaws.

Age Factors↗
PubMed1983

CSF polyamines in childhood.

Specimens of CSF from 76 children without neurologic disease and from 191 children with neurosurgical conditions were assayed for polyamine content. Putrescine and spermidine concentrations decreased with age. In children with intracranial tumors, polyamine concentrations in lumbar CSF were comparable with those in ventricular CSF. Putrescine level was significantly increased in children with medulloblastomas. Spermidine level was increased in children with medulloblastomas, glioblastomas, and astrocytomas. Concentrations of putrescine and spermidine were significantly increased in infants with myelomeningocele and hydrocephalus. Spermidine concentrations were significantly increased in older children with myelomeningocele, encephalocele, and hydrocephalus. Polyamines thus seem to be increased by rapid cell proliferation and by disorders affecting myelination. Since putrescine and spermidine concentrations may be of use in monitoring tumor progression, the effects of childhood growth and of hydrocephalus must be considered for children whose brain tumors are associated with hydrocephalus.

Age Factors↗
PubMed1980

The value of myelography in the management of childhood medulloblastoma.

Sixteen children with newly diagnosed medulloblastomas underwent myelography prior to radiotherapy. None had clinical evidence suggesting spinal cord involvement. Seven patients (43%) were discovered to have unsuspected metastases involving the cord. Cerebrospinal fluid (CSF) cytology results were inaccurate in predicting spinal cord involvement. Additional radiation was administered to the demonstrated lesions. Thirteen children (81%) are alive and well 7-53 months (average 26) from completion of therapy. One of nine children with a normal myelogram initially, and two of seven with initial spinal cord involvement have relapsed.

Adolescent↗
PubMed1980

Detection of neonatal intraventricular hemorrhage using transcephalic impedance.

Transcephalic impedance (the resistance of the head to the flow of a 100 mu-amp alternating current) was measured serially during the first eight days of life in 93 neonates, ranging in gestational age from 26 to 43 weeks. Data compiled from the 70 clinically normal neonates showed an increase in mean trancephalic value with gestational age; this mean increase did not exceed 2.5 ohms during the first eight days of life within any four-week gestational age-group. Seven of the 23 clinically abnormal neonates showed evidence of clinical deterioration typical of intraventricular hemorrhage, and this diagnosis was confirmed at autopsy. Transcephalic impedance for these patients increased considerably with the onset of clinical deterioration, while the impedance for 11 clinically normal neonates, matched with these seven for gestational age, postnatal age and time of impedance measurement, rose only slightly. Transcephalic impedance is an uncomplicated, non-invasive, inexpensive test which has potential as a diagnostic aid in the detection of intraventricular hemorrhage.

Cerebral Hemorrhage↗
PubMed1979

Posterior lumbar apophyseal fractures.

The radiographic findings in 4 patients with fractures of the lumbar vertebral ring apophysis are reported. All patients had a bony ridge or fragment projecting into the spinal canal, usually from the lower border of L4; a defect in the postero-inferior aspect of the vertebral body; and either an anterior extradural impression or complete blockage on the myelogram. Computed tomography was performed on one patient and appears to be helpful in demonstrating bone within the spinal canal. Preoperative diagnosis can facilitate selection of the appropriate surgical approach.

Adolescent↗
PubMed1979

Tethered spinal cord following meningomyelocele repair.

Of 16 consecutive patients with tethered spinal cord studied, most had undergone repair of a meningomyelocele. All were evaluated using somatosensory evoked potentials at 6 to 12-month intervals. Other possibilities include tethered filum terminale, lipomeningocele, membrana reuniens, and miscellaneous conditions (diastematomyelia, neurenteric cysts, etc.). Metrizamide myelography with polytomography was superior to gas myelography in showing a low-lying cord, obtuse nerve root angles, and a thin subarachnoid space between the cord and the dorsal meninges cephalad to the tether. Surgery is generally helpful in these patients.

Child↗
PubMed1979

Biopsy of pediatric brain stem tumors.

26 patients, average age of 7.3 years, has biopsies of a brain stem tumor. 62% of the patients presented with hydrocephalus, and ventriculoperitoneal shunts were placed 7-10 days prior to biopsy. The midbrain was biopsied 13 times, the pons 3 and the medulla 12 times. Tissue for histopathologic examination was obtained at each operation and demonstrated astrocytoma in 13 patients, glioblastoma in 6, 'no tumor seen' in 5 and ependymoma in 2. Astrocytomas were usually located in the upper brain stem, and all of the glioblastomas were located in the medulla. The operative mortality was zero, and the morbidity was largely related to increased cranial nerve deficit. All the astrocytoma patients were treated with radiation only; whereas, 4 patients with glioblastoma were treated with vincristine, CCNU and methylprednisone in addition to radiation as described by the Children's Cancer Study Group (CCG-944). 3 patients with 'no tumor' were not treated and are alive and well 15-41 months following operation. 2 patients with no tumor were treated, one as a glioblastoma multiforme, subsequently verified at postmortem examination, and one as a midbrain astrocytoma. 1 patient with astrocytoma died 3 months following operation, all the remainder are living and well 4-51 months following operation. Irrespective of the treatment, all 7 patients with glioblastoma expired within 9 months of diagnosis. The prognosis for survival for patients with brain stem astrocytoma is superior to those with glioblastoma multiforme. Specific histopathologic correlation with clinical management may lead to improved and prolonged survival for patients with brain stem glioma.

Astrocytoma↗
PubMed1979

Arteriovenous malformations of the spinal cord in children.

Spinal arterivenous malformations occur in the pediatric age range more commonly than previously acknowledged. An analysis of 64 cases with onset under 18 years of age demonstrates pain to be the most common first symptom. A long delay to diagnosis permits development of significant paresis or plegia in the majority. Correctly performed myelography (with supine views) provided the diagnosis in 60%. A radical microsurgical excision appears to offer the best long-term results.

Adolescent↗
PubMed1978

Cricopharyngeal achalasia associated with Arnold-Chiari malformation in childhood.

Six patients with myelomeningocele and the Arnold-Chiari malformation developed cricopharyngeal achalasia and lower cranial nerve deficits. Diagnosis is established by cine-esophagram. Distortion of the brain stem or cranial nerves secondary to the Arnold-Chiari malformation may produce the autonomic imbalance necessary for cricopharyngeal achalasia. Treatment is supportive and includes verification of cerebral spinal fluid shunt function. Suboccipital craniectomy may reverse progressive lower cranial nerve deficits and reduce cricopharyngeus spasm. Cricopharyngeal myotomy may be considered when the cranial nerve deficits and cricopharyngeal achalasia are fixed, irreversible, and continue to cause disability.

Arnold-Chiari Malformation↗
PubMed1978

External drainage for ventricular infection following cerebrospinal fluid shunts.

57 children with shunt-related ventricular infection were treated with external ventricular drainage and a combination of systemic and intraventricular antibiotics. For persistent infection or inadequate drainage volume the external ventricular drain was promptly changed. Cerebrospinal fluid cultures of 54 (95%) of the children became sterile within an average of 5.1 days. As soon as three consecutive 48-hour cultures of the cerebrospinal fluid were negative, the external ventricular drainage was removed and a new ventriculoperitoneal shunt was inserted. Provided that three consecutive 48-hour cultures of the cerebrospinal fluid were negative at the time of reinstitution of ventriculoperitoneal shunting, low cerebrospinal fluid glucose readings were not associated with any greater risk of recurrent infection than following primary ventriculoperitoneal shunting.

Anti-Bacterial Agents↗
PubMed1977

Management of hydrocephalus secondary to posterior fossa tumors.

The records of children with hydrocephalus secondary to posterior fossa tumors were reviewed and the methods of treatment compared with their subsequent clinical course. Of 86 patients evaluated, 47 had no treatment for hydrocephalus prior to tumor removal., 12 had external ventricular drainage, and 27 had cerebrospinal fluid (CSF) shunts before suboccipital craniectomy. Children with CSF shunts before tumor removal had significantly better postoperative conditions than the children without shunts (p less than 0.01). Operative mortality of children without treatment of hydrocephalus before tumor surgery was 12.8%; it was 3.7% in the children with preexisting shunts. Treatment of hydrocephalus with a CSF shunt prior to suboccipital craniectomy was a safe procedure that significantly lowered the morbidity and mortality of subsequent tumor removal

Brain Neoplasms↗
PubMed1977

Intracranial pressure: monitoring and normalization therapy in children.

The clinical course of 42 children with intracranial pressure monitoring was reviewed. Intracranial hypertension was documented in a variety of diagnostic categories. Therapy was titrated to maintain a baseline intracranial pressure of less than 15 torr (mm Hg), and to decrease the frequency of spontaneous and reactive pressure waves. Ventricular drainage, controlled hyperventilation, intravenous glycerol osmotherapy, therapeutic hypothermia, and barbiturate loading were employed as needed to achieve those goals. Survival was significantly related to average and peak intracranial pressure levels and to the degree of serum hyperosmolality that developed during therapy.

Adolescent↗