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Biomedical subjects

J H Piatt

Publications and source records attributed to J H Piatt.

At least 55 records · Page 3Linked to original sources
PubMed1989

Cor pulmonale: a lethal complication of ventriculoatrial CSF diversion.

We report the case of a child with cor pulmonale due to chronic thromboembolism from a ventriculoatrial shunt. The patient's pulmonary hypertension and heart failure did not resolve after removal of the atrial catheter and conversion to a ventriculoperitoneal system, and death ensued 2 months later. The reasons for the historical ascendancy of ventriculoperitoneal over ventriculoatrial shunts must be recalled when circumstances make the peritoneal cavity an unsuitable receptacle for CSF diversion. Patients with ventriculoatrial shunts must be monitored for cardiopulmonary complications.

Cerebrospinal Fluid Shunts↗
PubMed1988

Preliminary experiences with brachial plexus exploration in children: birth injury and vehicular trauma.

The application of microsurgical techniques to the peripheral nervous system has made possible the reconstruction of the brachial plexus after vehicular and penetrating injuries. We now report our preliminary experiences utilizing these same techniques in the microsurgical management of brachial plexus birth injury. In contrast to other authors and in distinction from our own experiences with vehicular trauma in children, we did not find lesions requiring reconstruction by grafting or neurotization in any of seven plexus explorations for birth injury. The history of the surgical management of brachial plexus birth injury is reviewed, and the rationale for exploration is developed in the context of the natural history of the condition. Differences between our experiences and the existing literature are analyzed, with particular regard for timing of operation and technique of intraoperative assessment of nerve injury. All children with birth injuries of the brachial plexus require careful, repeated neurological evaluation during the first few months of life. Although the great majority make a rapid and satisfactory spontaneous recovery, the minority who do not recover are destined to suffer significant, life-long disability. Microsurgical brachial plexus exploration may benefit this select group of patients.

Accidents, Traffic↗
PubMed1985

Limitations of brain stem auditory evoked potentials for intraoperative monitoring during a posterior fossa operation: case report and technical note.

We have encountered an example of the insensitivity of brain stem auditory evoked potentials (BAEPs) for monitoring the brain stem during a posterior fossa operation. The addition of somatosensory evoked potential recording to conventional BAEP protocols is readily accomplished and is likely to improve the sensitivity of intraoperative electrophysiological assessment of brain stem function.

Brain Stem↗
PubMed1984

Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships.

A series of 152 posterior fossa explorations for tic douloureux and hemifacial spasm has been reviewed with assessment of outcome at the last follow-up examination. Among 103 cases of tic followed for an average of 48.3 months, 79 patients (77%) obtained good or excellent symptomatic relief, and there were 24 failures or recurrences (23%). Of 48 cases of hemifacial spasm followed for an average of 42.1 months, there were good or excellent results in 42 cases (87.5%); only 6 patients (12.5%) experienced failure or recurrence. Patients noted to have arterial contact at the 5th nerve entry zone responded significantly better to microvascular decompression than did patients with no arterial contact. Further, patients noted to have anatomical distortion of the 5th nerve by an artery or wedging of an artery into the crevice between the nerve and the pons had significantly better outcomes after microvascular decompression than did patients with other kinds of arterial contact. Partial sensory rhizotomy proved to be a highly effective alternative to microvascular decompression in cases of doubtful neurovascular compression. It was not possible to define similar neuroanatomical criteria predictive of response to microvascular decompression in patients with hemifacial spasm.

Adult↗
PubMed1983

Glioblastoma multiforme after radiotherapy for acromegaly.

A case of glioblastoma multiforme that occurred 14 years after radiotherapy for acromegaly is presented. The striking correspondence between the anatomy of the tumor and the geometry of the radiation ports is suggestive of a causal relationship. Previously reported cases of radiation-associated glioma are reviewed, and a brief appraisal of the evidence for induction of these lesions by radiation is presented. The differentiation of radiation-associated neoplasms from radionecrosis is also discussed.

Acromegaly↗
PubMedDate not supplied

Gait changes in children with spastic diplegia after selective dorsal rhizotomy.

Twenty-six ambulatory children underwent preoperative and 1-year postoperative assessments after selective dorsal rhizotomy. These included spasticity, passive range of motion, tone, three-dimensional motion analysis, and electromyography. Independent and dependent ambulators were evaluated separately. A decrease in spasticity was found in all lower extremity muscle groups. An increase in passive range of motion was found only at the hip for both independent and dependent ambulators. Gait changes included increases in velocity and stride length in the independent ambulators. An improvement in hip extension during stance was found in the dependent ambulators only; however, an increase in knee extension and dorsiflexion in stance were seen in both groups. Selective dorsal rhizotomy improves both passive and dynamic range of motion in children with spastic diplegia.

Cerebral Palsy↗
PubMedDate not supplied

Craniofacial conodysplasia.

A family with dominant inheritance of a previously unreported syndrome of craniofacial dysplasia and cone-shaped physes of the hands and feet is described. Hydrocephalus and spinal cord compression at the craniocervical junction causes neurological complications and mimics cerebral palsy. Early diagnosis and treatment may prevent progression of neurological changes.

Bone Diseases, Developmental↗
PubMedDate not supplied

Chronic focal encephalitis (Rasmussen syndrome): six cases.

Six of 81 (7.4%) patients with medically intractable epilepsy treated by selective cortical excision at The Hospital for Sick Children, Toronto, Canada, since 1974 were found to have inflammatory changes in the excised specimens of cerebral cortex. The clinical and histopathological findings in these cases resemble the chronic encephalitic syndrome described by Rasmussen. We confirm the unsatisfactory seizure control and the guarded neurological and intellectual prognosis that has been associated with Rasmussen syndrome.

Adolescent↗
PubMedDate not supplied

Reduction cranioplasty for craniocerebral disproportion in infancy: indications and technique.

Craniocerebral disproportion is a gross discrepancy between the volume of the brain and the volume of the cranial cavity that persists after initial treatment of the underlying condition, which in most cases is severe congenital hydrocephalus. The goals of treatment are control of intracranial pressure and arrest of the growth of the head. These goals can usually be accomplished by cerebrospinal fluid shunts supplemented as needed by shunting of extracerebral fluid collections. When conventional methods fail, or when in the setting of extreme degrees of craniocerebral disproportion they seem doomed to failure, reduction cranioplasty may simplify management. A surgical technique is described, three cases are presented, and indications are discussed.

Cephalometry↗
PubMedDate not supplied

Mechanical complications in shunts.

A retrospective study was conducted on 1,719 hydrocephalic patients, treated between 1974 and 1983 at the Hospital for Sick Children (Toronto) and l'Hôpital des Enfants Malades (Paris), in order to better understand shunt failure. The statistical analysis demonstrates the following: (1) A probability of occurrence of shunt malfunction of 81% at 12 years of follow-up. (2) A high prevalence of shunt obstruction (56.1% of all malfunction) and fracture or disconnection of the tubings (13.6%). (3) A higher risk of proximal occlusion with flanged ventricular catheter. (4) Less malfunction with proximal-non-slit valves as compared to distal-slit valves. (5) The importance of pressure-flow characteristics of the shunt; because of an indirect relation between overdrainage and proximal occlusion. (6) A correlation between connectors and migration or fracture of the shunt. (7) Less distal obstructions when an open-ended distal-catheter was used. These complications were of some clinical, psychological and economical consequences. Their rate could be lowed.

Cerebrospinal Fluid Shunts↗
PubMedDate not supplied

A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience.

All cerebrospinal fluid (CSF) shunt operations performed at Oregon Health Sciences University from 1976 through 1989 were reviewed retrospectively. There were 727 insertions or revisions of CSF shunts. Outcomes from these operations were studied using statistical techniques for analysis of survival data. There were 671 simple, linear shunts and 56 complex shunt systems incorporating 3-way connectors or consisting of multiple independent linear shunts. The overall estimated median survival of simple CSF shunts was 73 months, whereas the median survival of complex shunts was only 11 months (p = 0.0069). Only simple shunts were subjected to further analysis. The most important determinant of risk of obstruction was the age of the patient: children less than 2 years old were at higher risk than older patients (p < 0.00005). The risk of obstruction of a revised shunt was not different overall from the risk of failure of a new shunt, but revision of a shunt after an interval shorter than 6 months encountered a higher risk (p < 0.00005) of failure than either new shunts or shunts revised after a longer interval. The following factors had no significant influence on risk of obstruction: attending surgeon, etiology of hydrocephalus, duration of operation, time of day of operation, and whether the patient had epilepsy. Totally revised shunts lasted no longer than partially revised shunts. In children less than 2 years old, trends were observed favoring new shunts over revised shunts (p = 0.0355) and flat bottom valves over Hakim valves (p = 0.0255). The risk of shunt infection by 1 year was 8.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗