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Biomedical subjects

F J Epstein

Publications and source records attributed to F J Epstein.

85 records · Page 5Linked to original sources
PubMed1984

Pseudobulbar palsy after posterior fossa operation in children.

The authors describe their experience with an unusual postoperative syndrome of pseudobulbar palsy occurring a few days after the extirpation of large midline vermian/4th ventricular tumors in children. The patients had a delayed onset of supranuclear cranial nerve palsies associated with emotional incontinence and lability that resolved over several weeks to months. It is postulated that retraction pressure on the medial cerebellum and split vermis is the operative insult responsible for edema that subsequently tracked along fiber pathways in the middle and superior cerebellar peduncles into the upper pons and midbrain. Modifications of operative technique to eliminate the need for retraction are presented.

Adolescent↗
PubMed1983

The tethered spinal cord: diagnosis by high-resolution real-time ultrasound.

High-resolution real-time ultrasonography of the lumbosacral spine was performed in 10 control patients and in six patients with suspected spinal dysraphism. The spinal cord was readily visualized in both groups. Lack of ossification of the posterior arch of the spine in normal infants and the presence of a bony defect in patients with spina bifida permit sonographic investigation of the spinal canal and its contents. It is concluded that the diagnosis of spinal cord tethering can be established rapidly by high-resolution real-time ultrasonography, which may be used in screening patients with suspected occult spinal dysraphism.

Humans↗
PubMed1980

Early and late surgery in craniofacial dysostosis: a longitudinal cephalometric study.

Longitudinal clinical and cephalometric case studies are presented for two groups of patients with craniofacial dysostosis. The first sample includes two infants who underwent an extensive stripping procedure that was extended inferiorly to involve not only the coronal, but also the sphenozygomatic suture. The second sample includes two adolescents with midfacial hypoplasia who underwent a fronto-orbital-maxillary advancement. The extensive cranial stripping procedure had a favourable impact upon growth and development of the craniofacial structures, and longitudinal studies suggest the importance of promoting the growth potential of the bones contiguous to the affected sutures. Craniofacial surgery performed on adolescents results in a dramatic translocation of the skeletal and soft-tissue structures of the face. In contrast to early surgical intervention in infants in whom growth of the effected areas essential to the development of face and cranium was crucial, late surgery appeared to have little, if any, impact upon the development of the craniofacial skeletal structures that had been operated on.

Adolescent↗
PubMed1975

Avoidance of shunt dependency in hydrocephalus.

An approach to the treatment of neonatal hydrocephalus is proposed which is intended to reduce or eliminate shunt dependency by increasing the effectiveness of remaining pathways of absorption of cerebrospinal fluid. In suitable cases, intermittent cranial compression by means of an elastic bandage or a helmet with an inflatable inner-lining may be effective. Hydrocephalus was arrested in nine of 14 children treated with this method, eight of whom have developed normally. When cranial compression is contra-indicated or not successful, the preferred method of treatment is an 'on-off' type of valve which is used intermittently to drain a fixed volume of cerebrospinal fluid. Of 18 children who had such shunts inserted, 10 have become totally independent of their shunts and their hydrocephalus has become compensated. All are of normal intelligence. Subtemporal craniectomy was performed on seven shunt-dependent children with recurrent catheter obstruction. Four have been followed for six months and three for two years and in no case has there been further malfunction of the proximal catheter.

Cerebrospinal Fluid Shunts↗
PubMedDate not supplied

Aplasia cutis congenita of the scalp: issues in its management.

Two cases of aplasia cutis congenita with associated bony defects are presented to highlight the dangers of delayed coverage of exposed dura. Management of one case was complicated by repeated local and systemic sepsis and the other by repeated, life-threatening hemorrhage. Early, definitive coverage of these defects using full thickness skin flaps avoids the risks of hemorrhage and should, if the recipient bed is clean, lessen the incidence of complicating sepsis.

Focal Dermal Hypoplasia↗
PubMedDate not supplied

Intrinsic tumors of the medulla: surgical complications.

Intrinsic focal tumor of the medulla oblongata is an uncommon entity. Of the 51 cases presenting for treatment of a brainstem glioma between 1984 and 1990, only 7 were confined to the medulla. Radical excision was performed on each patient. Four of the first 5 patients who were extubated in the recovery room had CO2 retention, with associated respiratory arrest and hypoxia. Three suffered permanent cranial nerve deficits as a result. It is the purpose of this report to describe the serious complications of medullary surgery and to make recommendations as to how they may be avoided.

Adolescent↗
PubMedDate not supplied

Intramedullary spinal cord tumors in children: localization by intraoperative sonography.

Intraoperative sonography was performed in 20 children in order to localize intramedullary spinal cord tumors. It provided excellent visualization of the extent and consistency of the tumor before surgical opening of the dura mater. The sonographic findings were used in selecting the site and extent of myelotomy. Intraoperative sonography proved to be a valuable adjunct to spinal cord surgery.

Adolescent↗