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Biomedical subjects

J C Peter

Publications and source records attributed to J C Peter.

At least 19 recordsLinked to original sources
PubMed2006

Endoscopy for tuberculous hydrocephalus.

INTRODUCTION: The role of endoscopy in hydrocephalus due to infectious aetiology is unclear. Tuberculous hydrocephalus is a useful model to study because it presents particular challenges and the pathophysiology of the cerebrospinal fluid disturbance is well known. MATERIALS AND METHODS: We present the results of 24 endoscopic operations in tuberculous meningitis. RESULT: Endoscopic third ventriculostomy (ETV) was attempted in 17 patients: seven were successful, five failed, and five were not completed due to abnormal anatomy. There were five fenestration procedures, three of which were successful. Endoscopic biopsy of two tuberculomas failed to yield a bacteriological result. These operations were more difficult to perform than for hydrocephalus due to other aetiologies. CONCLUSION: Although ETV is technically possible in this situation, it is imperative that the patients are adequately selected for the procedure to ensure optimal treatment and that the surgeon has experience with difficult cases.

Biopsy↗
PubMed2006

Four decades of conjoined twins at Red Cross Children's Hospital--lessons learned.

Conjoined twins represent a rare but fascinating congenital condition, the aetiology of which remains obscure. Over the past four decades, the paediatric surgeons at Red Cross Children's Hospital have been involved in the management of 46 pairs of conjoined twins, of which 33 have been symmetrical and 12 asymmetrical. Seventeen symmetrical twins have undergone separation with 22 children (65%) surviving; all of the live asymmetrical twins survived separation. We describe the important features of this unique cohort, outline our approach to management and present the results of this approach. We consider some of the ethical and moral dilemmas we have confronted, and discuss the prenatal diagnosis, obstetric implications and postnatal care of these children, including the relevant investigations and anaesthetic and surgical management. Specific aspects related to the cardiovascular system, hepatobiliary and gastrointestinal tracts, urogenital tract, central nervous system and musculoskeletal system are highlighted.

Adolescent↗
PubMed2006

Surgical treatment for "brain compartment syndrome" in children with severe head injury.

OBJECTIVES: Traumatic brain injury accounts for a high percentage of deaths in children. Raised intracranial pressure (ICP) due to brain swelling within the closed compartment of the skull leads to death or severe neurological disability if not effectively treated. We report our experience with 12 children who presented with cerebral herniation due to traumatic brain swelling in whom decompressive craniectomy was used as an emergency. DESIGN: Prospective, observational. SETTING: Red Cross Children's Hospital. SUBJECTS: Children with severe traumatic brain injury and cerebral swelling. OUTCOME MEASURES: Computed tomography (CT) scanning, ICP control, clinical outcome. RESULTS: Despite the very poor clinical condition of these children preoperatively, aggressive management of the raised pressure resulted in unexpectedly good outcomes. CONCLUSION: Aggressive surgical measures to decrease ICP in the emergency situation can be of considerable benefit; the key concepts are selection of appropriate patients and early intervention.

Brain Edema↗
PubMed2005

Air encephalography for hydrocephalus in the era of neuroendoscopy.

INTRODUCTION: There is often uncertainty regarding the site of the cerebrospinal fluid (CSF) block in individual patients with hydrocephalus, leading to a significant failure rate for endoscopic third ventriculostomy (ETV) when performed for unconventional pathologies such as postmeningitic and posthaemorrhagic hydrocephalus. We describe the use of lumbar air encephalography (AEG) to refine the indications for ETV in such circumstances. METHODS: Data from AEG studies used to guide indications for ETV were collected prospectively. The technique and protocol for AEG have been modified from the historical description of the procedure in the interest of safety and to minimise discomfort. In a separate evaluation, the level of the CSF block was determined by one of the authors, who was blinded to the results of the AEG, based on conventional computerised tomographic criteria. These results are compared with those obtained from the AEG. RESULTS: Forty-five studies were performed over a 2-year period. Thirty-seven were preinterventional, the majority of which demonstrated communicating hydrocephalus. ETV performed in five cases of non-communicating hydrocephalus was successful in each. The prediction of the level of block based on CT criteria was poor. CONCLUSION: It is often difficult to determine whether hydrocephalus is communicating or not with conventional imaging in the absence of a clearly demonstrable lesional obstruction to the CSF pathways. We have found AEG helpful in excluding patients with communicating hydrocephalus from an inappropriate ETV. On the basis of our experience, we consider the modified procedure safe as long as a strict protocol is followed.

Analysis of Variance↗
PubMed2004

Intradural cervical lipomas with intracranial extension: a management strategy based on a case report and review of the literature.

Intradural cervical lipomas with intracranial extension are very rare. There have been 12 previously reported cases. We report an 18-year-old female who presented with quadraparesis and incontinence, and review the previously published literature. Intradural lipomas with intracranial extension occur in younger patients when compared with those without intracranial extension. Roughly half of high cervical lipomas have intracranial extension. This results in a more complicated course of surgical management and a worse prognosis. While the relatively older patients most commonly present with quadriplegia, in younger patients there may be a more variable presentation. Almost half the patients had symptoms ascribable to the intracranial component. In all patients, no more than subtotal resection and decompression was achieved using duroplasty if necessary. Only five patients showed functional recovery. We propose a management strategy for this condition.

Adolescent↗
PubMed2004

Inhuman shields--children caught in the crossfire of domestic violence.

BACKGROUND: Child abuse is a worldwide scourge. One of its most devastating manifestations is non-accidental head injury (NAHI). METHODS: This is a retrospective chart review of children presenting to the Red Cross Children's Hospital trauma unit with a diagnosis of NAHI over a 3-year period. RESULTS: Sixty-eight children were included in the study and 2 different groups were identified. Fifty-three per cent of the children were deliberately injured (median age 2 years), while 47% were allegedly not the intended target of the assailant (median age 9 months). The assailant was male in 65% of the intentional assaults and male in 100% of the unintentional assaults, with the intended adult victim female in 85% of the latter cases. Overall, 85% of the assaults were committed in the child's own home. CONCLUSIONS: The high proportion of cases in which a young child was injured unintentionally suggests that these infants effectively become shields in assaults committed by adults. In this context any attempts to deal with child abuse must also address the concurrent intimate partner violence.

Adult↗
PubMed2003

Early decompressive craniotomy in children with severe traumatic brain injury.

INTRODUCTION: Decompressive craniectomy remains a controversial procedure in the treatment of raised intracranial pressure (ICP) associated with post-traumatic brain swelling. Although there are a number of studies in adults published in the literature on this topic, most commonly as a salvage procedure in the treatment of refractory raised ICP, there are few that investigate it primarily in children with head injuries. AIM: Our aim was to report the experience with decompressive craniotomy in children with severe traumatic brain injury (TBI) at the Red Cross Children's' hospital. METHODS: This study reports five patients in whom decompressive craniectomy or craniotomy with duraplasty was used as an early, aggressive treatment of raised ICP causing secondary acute neurological deterioration after head injury. The rationale was to save the patient from acute cerebral herniation and to prevent exposure to a prolonged course of intracranial hypertension. RESULTS: All patients benefited from the procedure, demonstrating control of ICP, radiological improvement and neurological recovery. Long-term follow-up was available, with outcome assessed at a minimum of 14 months after injury. DISCUSSION: The early approach to the use of decompressive craniotomy in the treatment of severe traumatic brain injury (TBI) with secondary deterioration due to raised ICP is emphasised. A favourable outcome was achieved in all of the cases presented. The potential benefit of decompressive craniectomy/craniotomy in the management of children with severe TBI is discussed.

Brain Injuries↗
PubMed2003

Endoscopic third ventriculostomy in tuberculous meningitis.

INTRODUCTION: We report our preliminary experience with two cases of tuberculous meningitis (TBM) in which endoscopic third ventriculostomy (ETV) was performed to treat non-communicating hydrocephalus. For many years, the insertion of ventriculoperitoneal shunts has been the standard treatment for hydrocephalus in patients with TBM, although the indications for and timing of surgery are not uniformly accepted. Shunt insertion is associated with a high incidence of complications, particularly with long-term follow-up. An alternative treatment for hydrocephalus in this group of patients would clearly be of great benefit. The indications for ETV have increased in the last decade, and there are reports of some effectiveness of the procedure in patients with hydrocephalus due to bacterial meningitis. To our knowledge, ETV has not been described in the management of TBM. METHODS: We report the early results of our preliminary experience with ETV in two patients who presented with neurological compromise due to hydrocephalus and raised intracranial pressure. The clinical context and pre-operative investigation of these patients are presented. The emphasis is placed on the distinction between communicating and non-communicating pathologies as a guide to management options. We detail our surgical findings and the peculiar endoscopic challenges that the condition presented to us. Follow-up in these patients included clinical and investigational data suggesting early effectiveness of the procedure in converting non-communicating hydrocephalus into a communicating one, which can then be treated medically. DISCUSSION: Endoscopic third ventriculostomy is presented as a new application of a procedure accepted for other indications in the treatment of non-communicating hydrocephalus. There are particular aspects of the use of this procedure related to the unique pathology of TBM that are significantly different. We explain our rationale for endoscopy in these patients, and suggest a protocol in which endoscopy may play a role in the management of patients with raised intracranial pressure due to tuberculous hydrocephalus.

Child, Preschool↗
PubMed2001

Advantages of delayed VP shunting in post-haemorrhagic hydrocephalus seen in low-birth-weight infants.

The optimal timing of ventriculo-peritoneal (VP) shunt insertion in a neonate with post-haemorrhagic hydrocephalus (PHH) is uncertain. During the 8-year period from January 1989 to December 1996, 41 patients had VP shunts inserted for PHH at Red Cross War Memorial Children's Hospital. Data on 36 patients were sufficient for review in order to determine whether the timing of surgery in any way influenced the complication incidence of this intervention. Nine of the 36 patients had a serious complication, either infection or mechanical shunt obstruction, during their initial hospital admission (early period). Nineteen patients had surgery performed before day 35 after birth and all those with early complications were in this group. Seventeen patients had surgery delayed until after day 35, and none of these patients had an early complication. In this study a higher complication incidence was noted when a VP shunt was inserted prior to day 35 (Chi-square test P < 0.01). This most probably correlates with a high concentration of blood breakdown products in the cerebrospinal fluid during the first month after intra-ventricular haemorrhage.

Age Factors↗
PubMed1999

The Department of Neurosurgery of the University of Cape Town: a brief historical overview.

Neurosurgery as an independent discipline at Groote Schuur Hospital in Cape Town commenced with the return of Hermann de Villiers Hammann from Munich in 1946. He developed the unit with Alex Gonski, J.P. Van Niekerk, P. Keet, and A.P. Rose-Innes. Jacquez (Kay) C. de Villiers followed in 1966, becoming the first Helen and Morris Mauerberger Professor and chairman of neurosurgery at Groote Schuur Hospital, the Red Cross War Memorial Children's Hospital, and Conradie Hospital. During that period, many contemporary South African neurosurgeons received their training, and the unit developed and expanded its reputation as a center of excellence in Africa. Since 1994, Jonathan C. Peter has been the Helen and Morris Mauerberger Professor and chairman of the department, which now consists of six full-time neurosurgeons, six part-time consultants, seven registrars, and two interns. Two to three thousand outpatients are treated each year, and approximately 1000 surgical procedures are performed. Sociopolitical changes in South Africa have resulted in a reduction in funding of tertiary academic health services, and this presents major challenges for the future.

History, 20th Century↗
PubMed1998

Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity.

OBJECT: Selective dorsal rhizotomy is a neurosurgical procedure performed for the relief of spasticity in children with cerebral palsy, but its long-term functional efficacy is still unknown. The authors sought to address this issue by means of an objective, prospective study in which quantitative gait analysis was used. METHODS: Eleven children with spastic diplegia (mean age at initial surgery 7.8 years) were evaluated preoperatively in 1985 and then at 1, 3, and at least 10 years after surgery. For comparison, 12 age-matched healthy individuals were also studied. Retroreflective targets were placed over the hip, knee, and ankle joints, and each individual's gait was videotaped. The video data were subsequently entered into a computer for extraction and analysis of the gait parameters. An analysis of variance yielded a significant time effect (p < 0.05), and post hoc comparisons revealed differences before and after surgery and with respect to the healthy volunteers. The knee and hip ranges of motion (59 degrees and 44 degrees, respectively, for healthy volunteers) were significantly restricted in children with spastic diplegia prior to surgery (41 degrees and 41 degrees, respectively), but were within normal limits after 10 years (52 degrees and 45 degrees, respectively). The knee and hip midrange values (31 degrees and 3 degrees, respectively, for healthy volunteers), indicative of posture, were significantly elevated preoperatively (42 degrees and 15 degrees) and increased sharply at 1 year (56 degrees and 18 degrees), but by 10 years they had decreased to within normal limits (36 degrees and 9 degrees). Step length and velocity improved postoperatively but were not within the normal range after 10 years. Ten years after surgery these patients not only had increased ranges of motion, but also used that movement at approximately a normal midrange point. CONCLUSIONS: Selective dorsal rhizotomy is an effective method for alleviating spasticity. Furthermore, the authors provide evidence to show that lasting functional benefits, as measured by improved gait, can also be obtained.

Adolescent↗
PubMed1998

Severe head injury in children--a preventable but forgotten epidemic.

OBJECTIVE: To determine the outcome of seriously head-injured children and to analyse the factors that affect their prognosis. DESIGN: A retrospective analysis of all severely head-injured children treated between 1990 and 1993. SETTING: Red Cross War Memorial Children's Hospital's trauma unit and neurosurgery service. PATIENTS: One hundred and two children under the age of 14 years with admission Glasgow Coma Scores (GCSs) of below 8. RESULTS: There were 57 boys and 45 girls. The average time of assessment after injury was 2.8 hours. Eighty-three injuries were caused by pedestrian motor vehicle accidents. Thirty-seven were associated with other serious organ system injuries. Fifty-eight children died and only 36 made a good recovery. All children with a GCS of 3-4 died. Factors that were particularly associated with a poor prognosis were: (i) age less than 3 years; (ii) associated extracranial injury; (iii) GCS 3-4 following resuscitation; and (iv) diffuse cerebral swelling on computed tomography. CONCLUSION: Pedestrian motor vehicle accidents are the most common cause of serious paediatric head injury in the Cape Town area. Children with a presenting coma score of less than 8 have an extremely high mortality and morbidity rate, despite modern intensive care. Preventive strategies are essential.

Accidents, Traffic↗