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Biomedical subjects

D Pang

Publications and source records attributed to D Pang.

At least 91 records · Page 5Linked to original sources
PubMed1983

Regrowth of diastematomyelic bone spur after extradural resection. Case report.

Complete regrowth of a diastematomyelic bone septum producing progressive neurological deficits was found in a 15-year-old boy who had a previous extradural resection of a similar bone spur with the dural sleeve left untouched. This case and two similar cases in the literature documenting continued neurological deterioration after extradural removal of septum emphasize the need for resection of the dural sleeve along with the bone septum if adequate relief of tethering is expected. The capability of the septum to regenerate may be due to the persistence of residual mesenchymal cells associated with the embryogenesis of the midline septum.

Adolescent↗
PubMed1983

Nonsurgical management of extradural hematomas in children.

With the advent of computerized tomography (CT), an increasing number of patients with only minimal neurological symptoms and no signs of brain herniation are found to harbor subacute or chronic extradural hematomas (EH's). The authors present the cases of 11 symptomatic but neurologically normal children with medium to large EH's managed by close observation. These EH's were discovered 4 hours to 6 days after injury; three were in the posterior fossa, seven over the frontoparietal convexity, and one in the temporal fossa. These clots were followed by serial CT scans. Nine children recovered without surgery from 4 to 18 days after injury, and all had evidence on CT of spontaneous clot resorption. Of these nine EH's, five clots displayed volume expansion from 5 to 16 days after injury before final resorption occurred. Expansion correlated with persistence or increase in symptoms, whereas resorption correlated with improvement. Two patients showed gradual uncal herniation on Days 6 and 8, respectively, presumably during the "expansile phase" of their clots. Both had emergency craniotomy and recovered without morbidity. It is hypothesized that the resorption dynamics of the subacute or chronic EH are similar to that of the chronic subdural hematoma, with predictable volume changes, and the outcome of each lesion depends on the interplay between the patient's intracranial pressure buffering capacity and the rate of volume change. If subtle signs of brain dysfunction are adopted to signal the failure of conservative treatment and the need for craniotomy, these patients may be safely, and many successfully, managed without surgery. Factors that influence outcome of medical treatment include the size, location, configuration, and the rapidity of accumulation of the clot, the presence of associated intradural lesions, the extracranial decompression of blood through skull diastases, and the age of the patient. These factors, the criteria for patient selection, and the indications for immediate operative intervention are discussed.

Adolescent↗
PubMed1982

Symptomatic large parietal foramina.

A mother and her two children with large parietal foramina were studied with plain roentgenograms and computed tomography. The mother's comments convinced us that the bilateral defects in the children evolved from a single midline opening via median ossification. The children had recurrent bouts of unexplained headaches and vomiting. Gentle pressure over the defects and combining of the overlying hair produced local pain and violent headaches in all three patients. These characteristic symptoms as well as other clinical problems associated with this anomaly are discussed.

Adult↗
PubMed1982

Tethered cord syndrome in adults.

Patients with tethered cord syndrome (TCS) rarely have symptomatic onset in adulthood. Twenty-three adult patients with TCS were studied with respect to the clinical, radiological, and pathological features of this syndrome. Specific circumstances involving either additional tugging of the already tight conus, narrowing of the spinal canal, or direct trauma to the back or buttocks precipitated symptomatic onset in 60% of patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities as well as bladder and bowel dysfunction were also common findings; but, unlike TCS in children, progressive foot and spinal deformities were not seen. As in TCS with onset in childhood, the most common tethering lesions were thickened filum, intradural lipoma, and fibrous adhesions. The degree of cord traction, rather than the type or distribution of the tethering lesions, probably determines the age of symptom onset: less severe traction remains asymptomatic in childhood but results in neurological dysfunction in later life due to repeated tugging of the conus during natural head and neck flexion, or when abnormal tension is aggravated by trauma or spondylotic canal stenosis. Metrizamide myelography revealed the diagnosis of tethered conus in most cases, but the addition of computerized tomographic imaging provided valuable structural details concerning the tethering lesion. The surgical outcome was gratifying in relation to pain and motor weakness but disappointing in the resolution of bowel and bladder dysfunction. Early diagnosis and adequate release of the tethered conus are the keys to successful management.

Adolescent↗
PubMed1982

Spinal cord injury without radiographic abnormalities in children.

Spinal cord injury in children often occurs without evidence of fracture or dislocation. The mechanisms of neural damage in this syndrome of spinal cord injury without radiographic abnormality (SCIWORA) include flexion, hyperextension, longitudinal distraction, and ischemia. Inherent elasticity of the vertebral column in infants and young children, among other age-related anatomical peculiarities, render the pediatric spine exceedingly vulnerable to deforming forces. The neurological lesions encountered in this syndrome include a high incidence of complete and severe partial cord lesions. Children younger than 8 years old sustain more serious neurological damage and suffer a larger number of upper cervical cord lesions than children aged over 8 years. Of the children with SCIWORA, 52% have delayed onset of paralysis up to 4 days after injury, and most of these children recall transient paresthesia, numbness, or subjective paralysis. Management includes tomography and flexion-extension films to rule out incipient instability, and immobilization with a cervical collar. Delayed dynamic films are essential to exclude late instability, which, if present, should be managed with Halo fixation or surgical fusion. The long-term prognosis in cases of SCIWORA is grim. Most children with complete and severe lesions do not recover; only those with initially mild neural injuries make satisfactory neurological recovery.

Adolescent↗
PubMed1982

Extraneural metastasis of cerebellar glioblastoma multiforme.

The case of a 7-year-old girl with a cerebellar glioblastoma and extraneural metastases has been presented. The dura mater was left open at the time of tumor resection. Postoperative hydrocephalus caused prolonged bulging of the incision. We believe that an open dura mater facilitates continuous exposure of extrameningeal tissue to glioma cells that are capable of invading local lymphatics and extracerebral veins, enhancing the probability of widespread dissemination. We suggest that every effort should be made to close the posterior fossa dura mater after resection of a malignant tumor.

Bone Neoplasms↗
PubMed1981

Saccharomyces kluyveri mannoprotein mutants.

Saccharomyces kluyveri cells were mutagenized with ethylmethane sulfonate and, after the cells had grown a few divisions to express any altered cell-surface antigenic structure, the culture was treated with rabbit antiserum directed against the wild type cells in order to enrich for mutants that failed to precipitate with the serum. Several mutant clones were obtained that proved to be altered in the carbohydrate component of the cell-wall mannoprotein. Whereas the wild type strain produces mannoprotein with carbohydrate side chains up to 8 mannose units in length (Zhang, W.-J., and Ballou, C. E. (1981) J. Biol. Chem. 256, 10073-10079), one of the mutants (designated mnn1) has side chains no longer than 3 mannoses. From a comparison of the carbohydrate structures of the mutant and wild type mannoproteins by beta-elimination, acetolysis, and methylation, it appears that this mutant is unable to add mannose in alpha 1 leads to 3 linkage to the alpha 1 leads to 2-linked di- and trisaccharide side chains, thus preventing elongation and branching of the chains that occur in the wild type. Another mutant, designated mnn2, was unable to make the octasaccharide chain, whereas a third class made oligosaccharides of all sizes but did so in ratios that differed from the wild type. These three classes of mutants involve different loci because they complemented each other in the heterozygous diploids.

Carbohydrate Conformation↗
PubMed1981

External carotid-cavernous fistula in an infant.

A 7-week-old infant developed a nontraumatic fistula of the external carotid artery and the cavernous sinus. Therapeutic embolization produced an uncomplicated clinical and angiographic cure. Treatment was prompted by the availability of new methods of treatment and our hope of preventing irreversible anatomic and visual sequelae.

Arteriovenous Fistula↗
PubMed1981

Influence of closure technique on results in myelomeningocele.

The results of the repair of myelomeningoceles by, respectively, reconstitution of the neural tube and simple replacement of the placode within the dural sheath are examined. It is concluded that neither offers any significant advantages over the other. When no neurologic function is present below the upper level of the lesion, no method of repair is likely to result in improvement, while the mere preservation of reflex activity in the distal segment of cord may be counterproductive. It is suggested, therefore, that there is a place for immediate excision of the lesion in properly selected cases.

Brain↗
PubMed1981

External carotid-cavernous fistula in infancy: case report and review of the literature.

A case of external carotid-cavernous fistula in a 7-week-old infant is presented. Unlike post-traumatic internal carotid-cavernous fistulas, most of these dural fistulas are low flow, low pressure shunts with a benign and chronic clinical course sometimes ending in spontaneous closure. In adults and older children, meticulous follow-up of visual symptoms and signs may be adequate management. The only indications for aggressive therapy is progressive visual failure, which occurs rarely. In infants and visually immature children, however, persistent proptosis and intraocular hypertension can lead to anisometropic amblyopia, the prevention of which deserves urgent therapeutic intervention. In our patient, therapeutic embolization led to an uncomplicated clinical and angiographic cure. The vascular anatomy, the pathophysiology of associated visual failure, and the treatment modalities are reviewed.

Arteriovenous Fistula↗
PubMed1981

Metrizamide computed tomographic cisternography for the diagnosis of occult lesions of the hypothalamic-hypophyseal axis in children.

In children, hypothalamic-hypophyseal syndromes such as diabetes insipidus, precocious puberty, growth retardation, and panhypopituitarism can be due either to structural lesions or to functional disorders of the cerebral endocrine complex. When clinical and endocrinological parameters fail to distinguish between these etiologies, neuroradiographical diagnosis becomes extremely important. Although conventional intravenously enhanced computed tomography (IVCT) is satisfactory for the diagnosis of lesions larger than 1 cm, metrizamide CT cisternography (MCTC) greatly improves the diagnostic yield for smaller juxtapituitary masses in the suprasellar cistern, clearly defines their sizes and relationships with contiguous structures, and definitively confirms the diagnosis of empty sella syndrome. Six patients with endocrinopathies and normal or ambiguous IVCT findings are presented to illustrate how MCTC can influence their management and outcome without the patient discomfort and technical complexity associated with pneumoencephalography.

Adenoma↗
PubMed1981

Craniocerebral injuries from dog bite in an infant.

Animal bite is a common cause of craniofacial injuries in children. Whereas scalp lacerations from animal bites are often extensive and severe, only four instances of compound depressed skull fractures from animal bites have been reported. A case of a dog bite to the head of an infant is presented to point out the potential for such an insult to produce cranial perforation and underlying brain damage. The associated roentgenographic and computed tomographic features are shown.

Animals↗
PubMed1980

Sacral agenesis with progressive neurological deficit.

In the past, sacral agenesis was thought to be a form of bony malformation associated with static neurological deficits. The majority of therapeutic recommendations involved orthopedic correction of foot and leg deformities. Myelographic studies were seldom obtained, and surgical exploration was rarely attempted. We recently encountered two cases of sacral agenesis with progressive neurological deficits; both patients had myelographically demonstrable lesions and both responded favorably to surgical treatment. We believe that patients with caudal agenesis can be divided into two groups: one with static neurological deficits that probably would not improve after operation, and the other with progressive neurological findings probably associated with specific neuropathological lesions that would be amenable to operative therapy. We therefore endorse a more aggressive approach toward the management of patients in the second group. Upon the diagnosis of caudal agenesis, a detailed documentation of the base line neurological status, the bladder and bowel functions, and the degree of lower limb deformities should be obtained. A diligent follow-up program is essential to detect progression which, when present, should be followed promptly by myelography and surgical intervention. The etiology, classifications, and clinical features of sacral agenesis are discussed, and the associated neuropathological abnormalities are analyzed.

Adolescent↗
PubMed1980

Traumatic atlanto-occipital dislocation with survival: case report and review.

Traumatic atlanto-occipital (A-O) dislocation is a rare injury that is associated with a high mortality rate. We are presenting the case of a 5-year-old child with this entity to illustrate the mechanism of injury, the often-confusing clinical picture, and the use of diaphragmatic fluoroscopy to localize the neurological lesion. We suggest using plain lateral roentgenograms, anteroposterior tomograms, and a cervical computed tomographic scan to confirm the diagnosis of A-O dislocation. We strongly favor using the halo apparatus for immediate immobilization and posterior occipitoatlantoaxial fusion for long term stability. The various diagnostic radiographic criteria for A-O dislocation are compared and discussed.

Atlanto-Occipital Joint↗
PubMed1980

Upward migration of peritoneal tubing.

A case of upward migration of the peritoneal tubing of a subdural peritoneal shunt into a large craniotomy skin flap is presented. The probable mechanisms are discussed. Suggestions are made for how to avoid the occurrence of this rare complication.

Cerebrospinal Fluid Shunts↗