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Biomedical subjects

E Kosnik

Publications and source records attributed to E Kosnik.

12 recordsLinked to original sources
PubMed1999

Pediatric atlantoaxial instability: management with screw fixation.

Sixteen pediatric patients (age range 3-15 years; mean 9.4 years) with atlantoaxial instability underwent screw fixation at Columbus Children's Hospital between 1992 and 1998. Three patients with type II odontoid fractures underwent odontoid screw fixation. The remaining group of 13 patients had posterior C1-2 transarticular screw fixation and Sonntag C1-2 fusion. The group included 3 patients with rotatory C1-2 fixation, 4 patients with os odontoideum, 4 patients with congenital atlantoaxial instability and 2 patients with traumatic C1-2 instability. Postoperatively, all patients were placed in a Miami-J collar only. At 3 months follow-up, all patients achieved fusion. Bony fusion across the fracture line was clearly evident in patients with odontoid screws. The only complications in this series were a transient swallowing difficulty that resolved spontaneously in 2 weeks, and another patient's C1-2 fusion had extended to C2-3 at 9 months follow-up. This study demonstrates that children at 3 years of age and older, who sustain a type II odontoid fracture with an intact transverse ligament, can be safely managed with odontoid screws if the fracture is less than 4 weeks old. Posterior C1-2 transarticular screw fixation can be done safely and results in a high fusion rate in children older than 4 years of age. The technical difficulties of screw fixation in children are discussed.

Adolescent↗
PubMed1998

Lytic skull metastasis from a follicular thyroid carcinoma in a child.

We present a case of solitary lytic skull metastasis from a follicular thyroid carcinoma in a child. Salient clinical features, radiological findings, and histological distinctions of the metastatic skull tumor are described. Excision of the skull tumor followed by total thyroidectomy and (131)I-radioablation therapy has resulted in good short-term outcome. This is the first published report of a metastatic skull lesion from a follicular thyroid carcinoma in a child. Such a malignant lesion can radiologically mimic a benign skull tumor and should be considered in the differential diagnosis of a solitary lytic skull lesion with a sclerotic margin.

Adenocarcinoma, Follicular↗
PubMed1997

Cerebellar infarction from a traumatic vertebral artery dissection in a child.

Infarction due to vertebral dissection is a rarely reported event in children. We describe the clinical presentation, radiological findings and surgical treatment of a child with cerebellar infarction resulting from a traumatic vertebral artery dissection. Review of the literature on stroke due to a vertebral artery dissection in the pediatric population shows that trauma is a common preceding event. Although the most common site of traumatic vertebral artery dissection is at C1-2 level, our case illustrates that the vertebral artery dissection may also involve the lower cervical segment. We emphasize that vertebral artery dissection should be considered in a child with acute symptoms and signs of posterior circulation ischemia and that MRI and MR angiography may be helpful in the diagnosis of infarction and vertebral artery dissection.

Acute Disease↗
PubMed1995

Pediatric cervical-spine immobilization: achieving neutral position?

This study was designed to evaluate prospectively the ability of current spine-immobilization devices to achieve radiographic-neutral positioning of the cervical spine in pediatric trauma patients. All trauma patients who required spinal immobilization and a lateral cervical spine radiograph were included in the study. A lateral cervical spine radiograph was obtained while the child was immobilized. The Cobb angle (C2-C6) was measured using a handheld goniometer. The method of immobilization, age at injury, and Cobb angle were compared. One hundred and eighteen patients with an average age of 7.9 years were enrolled. The majority were males (71%). The most frequent mechanisms of injury included motor vehicle accidents (35%) and falls (32%). The average Glascow Coma Scale score was 14. Although 31% of the children complained of neck pain, 92% were without neurologic deficits. The Cobb angles ranged from 27 degree kyphosis to 27 degree lordosis, and only 12 of the patients presented in a neutral position (0 degrees). Greater than 5 degrees of kyphosis or lordosis was observed in 60% of the children. Thirty-seven percent of the patients had 10 degrees or greater angulation. The most frequent methods of immobilization included a collar, backboard, and towels (40%), and a collar, backboard, and blocks (20%), but these techniques provided < 5 degrees kyphosis or lordosis in only 45% and 26% of the children respectively. No single method or combination of methods of immobilization consistently placed the children in the neutral position.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

Successful treatment of disseminated central nervous system malignant rhabdoid tumor.

PURPOSE: Malignant rhabdoid tumor (MRT) of the central nervous system (CNS) is pathologically identical to MRT of the kidney. CNS MRTs have the clinicopathological behavior of a high-grade intracranial sarcoma, and the children have a very poor prognosis. We report on three cases of primary CNS MRT with a review and summary of the pediatric literature with respect to demographic features and multidisciplinary management. PATIENTS AND METHODS: The 18 cases reviewed had a male to female ratio of 1.0 and an extremely young median age of 32 months. Our three cases of CNS MRT were treated with surgery, chemotherapy, radiotherapy, and triple intrathecal (TIT) chemotherapy similar to the Intergroup Rhabdomyosarcoma Study III guidelines for parameningeal primary tumors with intracranial extension. RESULTS: The three patients described in this report are surviving with no evidence of disease at 5 years, 2 years, and 9 months from diagnosis. Before these three cases, only four of 16 reported patients were known to have survived. One unique case in our report involved disease in the cerebral cortex, sinuses, and orbit with metastases to the subarachnoid space. This metastatic MRT responded to treatment with TIT, multiagent chemotherapy and cranial-spinal radiation after partial resection of only the cortical portion of the MRT. CONCLUSIONS: Disseminated CNS MRTs can be treated using multidisciplinary management with an approach similar to that used to treat rhabdomyosarcoma.

Brain Neoplasms↗
PubMed1993

Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography?

STUDY OBJECTIVE: To assess clinical features that might reliably predict the need for computed tomography (CT) imaging in pediatric head trauma. DESIGN/SETTING/TYPE OF PARTICIPANT: Prospective cohort of 324 head CT scans performed on 322 consecutive trauma patients at an urban children's hospital. RESULTS: Sixty-two percent of patients were male. The mean age was 7.1 years (10 days to 20.6 years); half were less than 5 years of age. The two most frequent mechanisms of injury were falls (32%) and motor vehicle accidents (25%). Abnormalities were detected in 74 scans. Intracranial injuries were apparent in 39 patients (12%); 16 had a concomitant fracture. An isolated cranial abnormality was observed on 35 scans (11%). Loss of consciousness, amnesia for the event, a Glasgow Coma Scale (GCS) of less than 15, and the presence of a neurologic deficit were more common in children with intracranial injury (P < .05). Vomiting, seizures, and headache were not discriminating clinical features. No single characteristic consistently identified the children with an intracranial injury. Of the 195 children who were neurologically intact (GCS, 15) at the time of presentation, 11 (5%) had evidence of intracranial pathology on CT scan. CONCLUSION: This study demonstrates a poor correlation between the clinical symptoms of significant traumatic brain injury and findings on CT.

Adolescent↗
PubMed1990

Seizures in relation to shunt dysfunction in children with meningomyelocele.

To determine whether seizures are a reliable sign of increased intraventricular pressure in children with shunt-dependent hydrocephalus and meningomyelocele, we performed a retrospective chart review of 346 patients with meningomyelocele and shunt-dependent hydrocephalus. Fifty-one patients had seizures. Seizure episodes were investigated to determine whether they were temporally associated with shunt dysfunction. Episodes of actual or presumed shunt dysfunction were analyzed as to presenting symptoms, ventriculogram, computed tomography scan, and shunt film results. These 51 patients had 129 admissions for possible shunt dysfunction. One hundred one admissions were due to increased intraventricular pressure; nine (9%) of these, had a seizure as one of the presenting symptoms. All of the nine episodes had other common presenting symptoms of shunt dysfunction, such as headache, vomiting, lethargy, or respiratory compromise. We conclude that seizures alone are an inadequate predictor of shunt dysfunction in children with meningomyelocele, but can be seen as one of the presenting symptoms.

Cerebrospinal Fluid Shunts↗
PubMed1989

Intracranial trigeminal nerve rhabdomyoma/choristoma in a child: a case report and discussion of possible histogenesis.

Rhabdomyomas are rare tumors that usually arise within the heart, orocervical, or vulvovaginal regions. The cardiac tumors have a characteristic immature morphology, occur often in association with tuberous sclerosis, and are regarded as hamartomas rather than true neoplasms. The histogenesis of the extracardiac tumors and their true neoplastic nature are matters of controversy. We report the first case of a rhabdomyoma located inside the cranium. The intimate association with the mandibular division of the trigeminal nerve, the normal embryogenesis of the craniofacial muscles, and animal homograft and xenograft experiments provide a framework for considering this tumor, and possibly other rhabdomyomas, as a choristoma/hamartoma rather than a true neoplasm.

Child, Preschool↗
PubMed1981

The management of the Kleeblattschadel syndrome.

This paper describes the classic presentation of the Kleeblattschadel syndrome and the involvement of the ophthalmologist in preventing the loss of sight from exposure. It also described newer neurosurgical approaches for these patients and improvement in the outcome of this syndrome.

Craniosynostoses↗
PubMed1978

Interhemispheric subdural empyema: neuroradiological diagnosis.

A case of subdural empyema situated in the interhemispheric subdural space is described. CT scan is useful in the diagnosis and follow-up of intracranial inflammatory pathology. Selective angiography was helpful in the compartmental localization of the abscess in the interhemispheric subdural space, adjacent to the falx and tentorium by virtue of the hypertrophied tentorial meningeal arteries and vascular displacement. CT scans are also useful in follow-up of cerebral abscess after micropaque barium has been injected into the cavity as in this patient.

Brain Abscess↗
PubMed1976

Postictal blindness.

Transient loss of vision occasionally follows an epileptic seizure. This rare phenomenon is seen chiefly in children and may be related to the relative electrical instability of the occipital cerebral cortex. Occipital foci are more common in the juvenile electroencephalogram and, with maturity, tend to be seen more rostrally in the temporal areas. We have seen three cases of postictal blindness in children; all have cleared within 24 hours.

Adolescent↗