Biomedical subjects
Publications and source records attributed to E Paraicz.
Among 2493 patients undergoing cerebral angiography 43 children were found to have cerebrovascular occlusion. The diagnosis, aetiology, management and care of the condition is outlined. It is stressed that angiography is indispensable in diagnosis.
In a survey of 49 children idiopathic growth hormone deficiency, a sex ratio of 3 : 2 was found. Multiple pituitary hormone deficiency (MPHD) was seen in 31 and isolated growth hormone deficiency (IGHD) in 18 cases. The incidence of breech delivery was 32.5%; it occurred more frequently in MPHD than in IGHD. In one family there were two affected brothers whose birth weight was 4800 and 4900 g, respectively, and who were extremely retarded in growth. Screening of 594 children 1 to 9 years of age with cleft lip and palate was carried out; 1 child with growth hormone deficiency was detected. A study of the value of different thyroid hormones in the diagnosis of secondary and tertiary hypothyroidism showed that in spite of low free thyroxin concentrations the thyroxine and triiodothyronine levels are often normal. The discrepancy is probably due to a significantly higher plasma level of thyroxine-binding globulin demonstrated in children with hypopituitarism.
In a clinical study carried out in five infants with severe affections, provocation tests of different qualities were employed during the simultaneous recording of the intracranial blood volume (rICBV) and the intracranial pressure (ICP). The systematic use of a hydrostatic pressure test permits, among other things, to provide the theoretical basis for a statement of the volume/pressure response of the cerebrospinal fluid. Simultaneous measurements of rICBV and ICP enable a differenciated appraisal of the individually different critical points above which one must speak of a pathological ICP increase, with special importance being attached to the reactive hyperaemia and its prevention.
In five infants with severe neurologic-neurosurgical affections, correlations between the intracranial blood volume (rICBV) and the intracranial pressure (ICP) could be proved. For the ICP range from 0 to 250 mm H2O, an increase in the pulse amplitude of the rICBV was found with increasing ICP. On the other hand, there were distinct rICBV decreases with increasing ICP in the ICP range from 300 to 450 mm H2O. Subsequent, often only slight ICP decreases in this range resulted in a reactive hyperaemisation. More pronounced hyperaemisations could be associated with moderate ICP increases of the same duration. The results are discussed on the basis of a model.
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In infants with severe neurologic illnesses, rhythms found during continuous simultaneous recording of the rICBV and the ICP and their correlation with each other were described and supported by representations of the original curves. There were relations of the rICBV with the cardiac and respiratory rhythmus, with the so-called C- and B-waves, and clinical modes of behaviour. By using different electronic "frequency windows" and different recording speeds, a variety of relations with the clinical behaviour could be established. As a rule, several rhythms occurred at the same time. Problems and possibilities of the use of rhythmic processes for clinical diagnosis were discussed.
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In 18 cases of perinatal intraventricular haemorrhage, continuous ventricular drainage was applied. As a result, ICP hypertension was inhibited and thus brain damage prevented. The early intervention prevented the formation of hydrocephalus (evoidence of shunt dependence) and aspiration of the bleeding prevented DIC and maintained coagulation factors.
Intracranial hypertension of uncertain origin is a distinct form of cerebral pseudotumour. Eleven such cases have been treated between 1965 and 1977. All of them recovered without any residual symptom in response to symptomatic treatment (lumbar puncture, dehydration, etc.). No late relapse occurred. Steroid therapy is considered unwarranted, even harmful.
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Ventricular and subdural pressures have been monitored in 23 infants. Pressure waves which were influenced by respiratory and cardiac activity were noted. These were rather long lasting and were influenced more by respiration than by cardiac activity, when the intracranial pressure is low. Respiration and arterial pressure have similar effects when the intracranial pressure is normal, but when the intracanial pressure is increased the effects of respiratory activity are diminished.
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The development of hydrocephalic children who had been subjected to atrial shunt operation in infancy, has been studied at the age of 3 years. Psychological investigation was carried out in 24 of the 27 surviving cases. Mental development was normal in 14 children while 10 displayed mental retardation, of whom 8 are still suited for schooling. The grave aetiologic factors are considered primarily responsible for retardation. The functional development achievable by successful surgical treatment is discussed.
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