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Biomedical subjects

S J Gaskill

Publications and source records attributed to S J Gaskill.

13 recordsLinked to original sources
PubMed1992

Vancomycin: its effect on intracranial pressure.

Vancomycin is a commonly used antibiotic in neurosurgical practice. It is, however, notorious for causing histamine release which has been associated experimentally with rises in intracranial pressure (ICP). The observation that patients receiving vancomycin had an elevation in ICP during vancomycin infusion over 1 h, and that this elevation persisted for the hour following infusion led to a more formal evaluation. Presented here are data obtained from 6 patients who received vancomycin while on external ventricular drainage for a variety of reasons. The mean ICP for the hour prior to, during and following vancomycin administration was 8 mm Hg (SD 5.6), 13.8 mm Hg (SD 4.9), and 12.6 mm Hg (SD 4.3), respectively. The data were analyzed using a repeated measures analysis of variance between the preadministration values, during-administration values and postadministration values. The p value was significant at < 0.0001. These observations led to experimentation in animals to further assess the effects of vancomycin on ICP. The mean ICP prior to, during and following vancomycin infusion was 1.95 mm Hg (SD 0.75), 8.4 mm Hg (SD 5.1) and 5.6 mm Hg (SD 2.5), respectively. The data were analyzed using a repeated measure analysis of variance for the preadministration, during-administration and postadministration values. The p value was significant at < 0.0001. Based on these data the use of vancomycin should be tempered in the setting of intracranial pathology.

Animals↗
PubMed1992

Giant bilateral xanthogranulomas in a child: case report.

Symptomatic xanthogranulomas are rare lesions that most commonly occur in adults. A case of giant bilateral xanthogranulomas in a 6-year-old boy, who remains without tumor recurrence 9 years after resection, is presented. The operative management of these unusually large lesions is discussed. The pathogenesis of xanthogranulomas is reviewed as it relates to the presentation of these lesions in the pediatric population.

Cerebral Ventricles↗
PubMed1992

Selective posterior rhizotomy to treat spasticity associated with cerebral palsy: a critical review.

Selective posterior rhizotomy for the treatment of spasticity has become a widely used procedure. The historical evolution of this procedure is reviewed with an emphasis on the physiological basis for the procedure. The proper screening and selection criteria, perioperative management, operative technique, and postoperative therapy are discussed. Results from a series of 25 patients are reviewed. Ten of these patients were operated on for a goal of improved ease in caretaking and this was achieved. In seven patients, the goal was to improve independent functioning (ambulation was not considered possible) and this was achieved. Eight patients underwent the procedure to improve ambulation and this was achieved.

Cerebral Palsy↗
PubMed1989

Pseudocysts of the abdomen associated with ventriculoperitoneal shunts: a report of twelve cases and a review of the literature.

Shunt complications are reported to occur at a rate of approximately 26%. One of the less frequent but important complications is that of the pseudocyst. Since Harsh's first mention of a periumbilical cyst associated with a shunt in 1954, 44 cases have been reported in the literature. These are reviewed in addition to 12 cases of our own. From the collected series several features about the etiology and management become apparent. The most common presentation is that of abdominal distension and/or pain rather than shunt malfunction. Diagnosis is then readily made with ultrasonography. Etiologically, it is evident that an inflammatory process is a frequent predisposing factor. In our series 16% had acute infection, 41.6% had a past history of CSF infection (6 months to 6.2 years), and 16% had CNS tumor although tumor cells were not isolated from the peritoneal cysts. Our management of the cyst itself was different from that reported in other series; it was found that the cyst reabsorbed spontaneously without excision or aspiration once the CSF was diverted. The peritoneal cavity could then be used for shunting once the cyst had reabsorbed. This sometimes required conversion to an atrial or pleural shunt before reutilization of the peritoneal cavity. There were no problems with cyst recurrence despite the conversion of 58% of the shunts to ventriculoperitoneal shunts with follow-up ranging from 3 months to 4 years. The mode of management of both the cyst and the hydrocephalus is reviewed.

Abdomen↗
PubMed1989

Neuroectodermal appendages: the human tail explained.

The human tail has been intermittently described in the literature since the early 1900s. These have typically been isolated cases presented primarily with intrigue and medical curiosity. Presented here is a series of 6 neuroectodermal appendages with a proposal for their etiological development. The material presented will support a theory of the superficial extension of a dermal sinus tract in the formation of neuroectodermal appendages. These are characterized by: a posterior localization in or near the midline, a tubular or 'tail-like' appearance, extension of the appendage into the spinal canal with attachment to neural elements, variable vertebral defects and occasionally an associated appendage which may appear as either a separate entity (probably due to breakage during development) or in connection with the posterior appendage. The appropriate evaluation and treatment of this entity will also be discussed.

Female↗
PubMed1988

Glioblastoma multiforme masquerading as a pleomorphic xanthoastrocytoma.

Since its first description by Kepes in 1979, pleomorphic xanthoastrocytoma (PXA) has been considered a tumor with a benign course. Two cases are presented here that support the concept that PXA may be more accurately considered part of a spectrum of astrocytomas that occasionally may act aggressively. These cases represent astrocytomas with PXA components and are characterized by meningeal proximity, a high number of mitoses, and subsequently aggressive clinical behavior. The importance of recognizing the potential of a "benign" PXA to transform into a malignant entity has obvious implications for the therapeutic management of these tumors.

Astrocytoma↗
PubMed1988

The subcutaneous ventricular reservoir: an effective treatment for posthemorrhagic hydrocephalus.

Use of the subcutaneous ventricular reservoir in the treatment of posthemorrhagic hydrocephalus was studied in a series of 38 patients. All of the patients were considered to be medically labile. Additionally, all had failed conservative modes of therapy consisting of lumbar punctures with or without furosemide or acetazolamide. Management of the hydrocephalus consisted of reservoir placement. Subsequently, taps were performed at various intervals and amounts, depending upon the degree of ventricular dilatation as determined by sonography and signs of increased intracranial pressure. The majority of reservoirs were left in place for 1-2 months. There were no reservoir infections. Once the patients were medically stable, the reservoir was removed and a shunt placed. Eight patients died before shunt placement and 2 patients died after shunting, reflecting a 29% mortality. In no case was a death related to the shunt, but rather reflected the medical lability of the patient population. Four patients (15% of surviving patients) did not require shunting. The total shunt infection rate was 6.9% (among survivors with a shunt in place, 7.7%). These results support the use of the reservoir as an easy and effective means of protecting the cortical mantle while decreasing morbidity related to future shunt placement.

Catheterization↗
PubMed1988

Diastematomyelia associated with ectopic renal tissue.

A case of diastematomyelia associated with ectopic renal tissue is presented. While findings of ectopic renal tissue and Wilms tumor in dysraphic conditions have been reported in the literature, there has been no incorporation of these findings into the theories of the development of neural tube defects. This case supports the hypothesis of neural tube defects secondary to rupture of a previously intact neural tube (secondary neural tube defect). A discussion and review of the literature regarding the hypotheses of primary and secondary neural tube defects is included.

Choristoma↗
PubMedDate not supplied

Custom fitted thermoplastic Minerva jackets in the treatment of cervical spine instability in preschool age children.

The options for cervical spine stabilization have traditionally been the Minerva jacket (MJ) or the halo brace. In the preschool age child both of these devices have significant drawbacks; the halo brace because of its erosion and difficulty providing adequate fixation due to the thin calvarium of the young child and the MJ because of its bulk and weight. With the advent of polyethylene plastics, MJs are a more viable option without the disadvantages noted above. Six cases of cervical spine instability in preschool age children treated with a custom-molded MJ are presented. All patients achieved cervical spine stability with minimal morbidity. This technique is recommended as an alternative to the halo brace, as it provides reliable and satisfactory treatment of these difficult problems in preschool children.

Casts, Surgical↗
PubMedDate not supplied

Development of carcinoma in the aging myelodysplastic population.

Presented here are 2 cases of carcinoma in young myelodysplastic patients. Even with current techniques of bowel and bladder management myelodysplastics remain at increased risk to develop carcinoma. Preventive measures must be introduced into this population. Counselling and yearly examinations to include visual inspection, cytological urinalyses and stool guaiacs should be performed.

Adenocarcinoma↗
PubMedDate not supplied

Continuous external drainage in the treatment of subdural hematomas of infancy.

A series of 16 patients with chronic or subacute subdural hematomas treated with continuous external drainage of the subdural space is reviewed. Of these only 44% went on to require subdural-peritoneal shunt placement. There were no complications in treatment and no clinical or laboratory evidence of infection in any case. The outcome, measured by neurological examination, was not different between the shunted and nonshunted groups. In conclusion, continuous external drainage of the subdural space in chronic and subacute hematomas of infancy frequently is an effective, definitive treatment. This approach should be considered as the initial procedure prior to subdural-peritoneal shunting.

Catheters, Indwelling↗
PubMedDate not supplied

Transient eye closure after posterior fossa tumor surgery in children.

Transient cerebellar eye closure following posterior fossa tumor surgery in children has recently been observed. This phenomenon is characterized by a transient inability to open the eyes postoperatively with complete resolution within 4-6 days. Presented are four cases of transient cerebellar eye closure after posterior fossa tumor surgery in children. Possible mechanisms are reviewed with regard to historical works of cerebellar stimulation in man, and anatomical structures and pathways which might be involved.

Adolescent↗