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Biomedical subjects

L Basauri

Publications and source records attributed to L Basauri.

At least 19 recordsLinked to original sources

Ethical issues in managed and rationed care for children with severe neurological disabilities: a questionnaire survey.

The attitudes of pediatric neurosurgeons to managed and rationed care for children with severe al neurological disabilities were surveyed as reflected in responses from International Society for Pediatric Neurosurgery (ISPN) members to a questionnaire. Of 399 ISPN members, 156 (39.1%) responded to the questionnaire. There were 15 questions, which were designed to explore what care is medically indicated, whether all medically indicated care should always be provided, and how this care should be managed or rationed. Most respondents agreed that these patients should receive the same level of medical care as a normally developing child. However, respondents felt that cardiopulmonary resuscitation (CPR) is not indicated if a child is not retrievable. Most respondents also felt that provision of care should be influenced by cost. The responses to the questions from ISPN members were compared with those from Child Neurology Society (CNS) members.

Adult↗

Intracranial arachnoidal cysts.

Twenty-eight cases of intracranial arachnoidal cysts diagnosed during the period 1978-1990 are analyzed. All cases were investigated with computed tomography (CT), 5 with magnetic resonance imaging (MRI) and 5 with ultrasonography (US). Seventeen were located in the middle cranial fossa, 3 in the quadrigeminal cistern, 2 were parasagittal, 3 suprasellar and 3 were located in the posterior fossa. Twenty-three of the 28 patients were treated surgically, craniotomy with fenestrations was used in 3 cases. Different varieties of shunts were inserted in 8 cases and in the last 15 patients the only surgical treatment was the insertion of cysto-peritoneal (CP) drainage (without a valve) with excellent results. MRI and/or CT follow-up revealed disappearance of the cyst in 13 out of 22 cases and 7 experienced a marked reduction. In 2 patients the cyst showed little change. There were no cases of infection and no deaths.

Adolescent↗

Technique for the replacement of a peritoneal catheter.

A simple method for the replacement of a peritoneal catheter is described. The old catheter is disconnected from the valve and exteriorized from the peritoneal cavity, using a straight connector. The new catheter is anchored to the cranial or peritoneal end of the old catheter. A gentle traction allows the new catheter to follow the previous subcutaneous tunnel.

Cerebrospinal Fluid Shunts↗

Electrolyte levels in the CSF of children with nontumoral hydrocephalus. Relation to clinical parameters.

The levels of calcium and magnesium (by atomic absorption spectrophotometry), sodium and potassium (by flame photometry), inorganic phosphate and proteins (by spectrophotometry) were measured in the CSF of 27 children with hydrocephalus and compared with the CSF data on 10 controls, so as to study the effect of the blood-brain and blood-CSF barrier alterations observed in hydrocephalus, on the CSF electrolytes. Ca (P less than 0.001), Mg (P less than 0.01) and phosphate (P less than 0.05) were found to be increased, K (P less than 0.01) decreased, and Na levels not significantly altered. Linear regression analysis of hydrocephalic patients showed a linear correlation (r = +0.62) between phosphate and proteins (P less than 0.01) and (r = +0.66) between phosphate and Ca (P less than 0.001). Comparison of control CSF electrolyte levels with those found in the CSF of hydrocephalic patients were grouped according to clinical variables: sex (F, M), age (less than or equal to 1.5 months, greater than 1.5 months), etiological variants (congenital, acquired), treated infection (no, yes), surgical treatment (no, yes), time of onset (less than or equal to 1 month, greater than 1 month), ventricular dilation (mild, severe) and intracranial hypertension (mild or severe). These comparisons showed specific increases of Mg for males (P less than 0.05), acquired hydrocephalus (P less than 0.05) and severe intracranial hypertension (ICH) (P less than 0.001), moderate decrease in the Na levels in acquired hydrocephalus (P less than 0.05) and mild ICH (P less than 0.05), specific increases of phosphate in females (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Cloverleaf skull syndrome.

4 cases of cloverleaf skull syndrome are reported and analyzed after a brief review of the literature is presented. It is noted that reported cases of surgical management of this entity are extraordinarily rare. The rather characteristic displacement of intracranial contents suggests early onset of craniosynostosis (in intrauterine life) and that hydrocephalus is not an invariable complication present at the time of birth. Rather, it appears that the hydrocephalus is secondary to obliteration of the cortical subarachnoid spaces and the presence of a cranial ring. Total craniectomy proved to be a satisfactory treatment, one which was responsible for the reversal of hydrocephalus. Early detection and treatment of this rather rare malformation results in acceptable cosmetic and neurologic improvement.

Craniosynostoses↗

Micro-abscesses and presumptive inflammatory nodules of the brain.

Sixteen cases of micro-abscesses and presumptive inflammatory nodules of the brain are analyzed. The increasing frequency of cortico-subcortical small nodular lesions diagnosed by CT scan, as well as the number of cases successfully treated with antibiotics, are stressed. In the authors opinion, initial antibiotic treatment with a high possibility of a cure is indicated in patients with a presumptive inflammatory cortico-subcortical nodular lesions diagnosed by CT scan.

Adolescent↗

Polyacrylamide gel electrophoresis of cerebrospinal fluid proteins in children with nontumoral hydrocephalus.

The changes occurring in the electrophoretic pattern of the cerebrospinal fluid (CSF) proteins in 37 children with nontumoral hydrocephalus, and the protein pattern of 12 children without organic neurological disease, were studied with polyacrylamide gel electrophoresis. In nontumoral hydrocephalus protein was frequently increased in lumbar and ventricular fluid, in this condition, in intraventricular obstruction, the protein fractions showed a decrease in the prealbumin and an increase in the gamma-globulin fractions, and in extraventricular obstruction, the protein fractions showed a decrease in the prealbumin and an increase in the gamma-globulin and alpha 2-globulin fractions. With CSF proteins within normal ranges we found that in intraventricular obstruction, the proteins of the ventricular-CSF showed an increase in the prealbumin and/or albumin fractions, and in extraventricular obstruction, the proteins of the ventricular CSF showed an increase in the prealbumin and beta-globulin fractions, and the proteins of the lumbar CSF showed an increase in the prealbumin fraction. The diagnostic implications of these findings are discussed.

Albumins↗

Occlusive arterial disease of the child and young adult. Clinical electroencephalographical analysis of 26 cases.

26 patients suffering from acute arterial disease, predominant in childhood and young adults, have been studied. Convulsive symptom and electroencephalographic (EEG) findings are especially analyzed. The series are grouped following the Hilal classification, based on angiographical aspects. The incidence and etiological facts as well as the clinical and the angiographical findings, are summarized. The EEG analysis shows the high incidence of localized or lateralized abnormalities (23 out of 26), closely related with the clinical signs. However, there is no close relationship between these findings and the conscious state of the stage of the disease. An attempt is made to correlate the added diffuse and/or paroxysmal activities with the brain damage suspected by the angiographical signs. Seizures are present in 10 cases, 9 of them as initial symptoms predominantly of the focal type. There seems to be no relationship between the incidence and type of fits and the angiographical findings. Follow-up study shows that seizures do not modify the immediate course of the disease nor the persistence of this sequela in 9 of the controlled patients. The histopathological findings of cerebral vessel involvement are reported.

Adolescent↗

The empty sella syndrome analysis of 10 cases.

Ten cases of the empty sella syndrome are presented. In four a pituitary adenoma had been treated by surgery with or without radiotherapy. In three women there was a close relation pregnancy, and two boys had congenital malformations. Five cases presented with appearances of pseudotomour, and the remainder had cerebrospinal fluid (CSF) fistula. Four fistulas were spontaneous, one was post-traumatic aggravated by the intrasellar implantation of YT-90. Two were occult CSF fistulas causing recurrent meningitis. Gamma cisternography and iodocisternography proved to be good diagnostic tests, both for the empty sella and for CSF fistulas. Nine cases were operated on. In four na intrasellar cyst was present. In the other five an empty sella with deficient or absent diaphragm was found. Treatment of most cases consisted of covering the floor of the sella with lyophilized dura, which was fixed in place with biological glue.

Adenoma↗

Gamma-encephalography in the diagnosis of subdural effusions in infancy and childhood.

The results of the use of gamma-encephalography (GEG) as a diagnostic tool in a group of 28 patients with subdural effusions and 46 membranes confirmed at surgery are presented. 27 patients were submitted to bilateral surgical expolorations and 1 was unilaterally explored. Positive GEG: membranes were present in 34, in 8 the test was nonconclusive and there were 4 false-negatives. Negative GEG: membranes were absent in 6, 1 case was nonconclusive and 2 were false-positive tests. Therefore, from 28 patients with 46 membranes the GEG was correct in two thirds of the cases, it was nonconclusive in 9 cases and the image did not confirm the surgical findings in 6 cases (false-positive or false-negative). The results suggest that the presence of a medium or thick membrane almost always results in a positive image, whereas the presence of a thin membrane leads to a nonconclusive result or in some cases a false-negative one. The general data from the literature correlates well with the present series.

Child, Preschool↗