Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Comparative Study
Anti-epileptic therapy and behaviour disturbances in children.
In order to evaluate the effects on behaviour of some anti-epileptic drugs, we studied 300 children treated with phenobarbital and other drugs; their age ranged from 3.1 months to 15.9 years. The children were divided into two groups: group A: 197 (116 male and 81 female) children, mean age +/- SD 5.3 +/- 2.8 years, treated with phenobarbital; group B: 103 (66 male and 37 female) children, mean age 6.4 +/- 3.1 years, treated with anti-epileptic drugs other than phenobarbital. In all patients hyperactivity, irritability, disturbances of sleep, and drowsiness were investigated. ⋯ There was a significant difference between the two groups (P < 0.0001). The most frequent disorder was hyperactivity. The results of this study suggest that anti-epileptic drugs, in particular phenobarbital, can cause behaviour disturbances.
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Results of shunt tap were studied in 224 clinically or radiologically suspected instances of shunt malfunction. In 130 retrospectively studied patients the results of the tap had reported the opening pressure and ease of aspiration. In 94 prospectively studied instances the shunt tap parameters described were (i) the opening pressure, (ii) the drip interval, i.e., the interval between the drops of cerebrospinal fluid when the open end of the butterfly used for tapping was placed 5 cm below the level of the valve, and (iii) the closing pressure. ⋯ The opening pressure, closing pressure, and the drip interval recorded at surgery were not significantly different from the values obtained by shunt tap. The results suggested that shunt tap accurately provides information otherwise obtained at surgery and the drip interval is most useful for evaluating a proximal malfunction. The subjective impression of the distal flow may be more helpful in diagnosing distal malfunction rather than the absolute level of opening or closing pressures.
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We report three patients with arachnoid cysts treated by cyst-peritoneal shunting in whom intracranial hypertension occurred during episodes of shunt malfunction. In one case this was associated with re-expansion of the arachnoid cyst, whilst in the other two cases this did not occur. The similarities between these two cases and patients with pseudotumor cerebri suggest a common pathogenic mechanism--specifically, a disturbance of the cerebrospinal fluid circulation.
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In order to restore spinal integrity following posterior exposures of the spinal canal in children, we describe modifications of Raimondi's laminotomy technique. The use of a pneumatic dissecting tool with foot-plate to create a hinged osteoplastic laminotomy is described, as are techniques for securing the laminotomy flap in place at the end of the procedure.
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The aim of the present investigation is to determine whether or not hydrocephalus occurring in hydrocephalic Wistar-Imamichi strain rats (WIC-Hyd) is caused by functional and structural disorders of ependymal cilia. Ultrastructures and movement of cilia in the ependyma of the lateral, III and IV ventricles and aqueduct of Sylvius and in the trachea walls of the animals were examined by means of scanning electron microscopy (SEM), transmission electron microscopy (TEM), and light microscopy using a phase-contrast microscope equipped with a high-speed video recording system. SEM revealed that a marked decrease in the length and number of cilia in the ependymal and tracheal walls occurred in affected male WIC-Hyd. ⋯ The incidence of these ultrastructural abnormalities was found to be greater in affected male rats than in affected female rats. All cilia in affected male rats before and after development of hydrocephalus were immotile. A variety of movement disorders such as immobile, rotatory, and vibratory cilia were observed beside normally beating cilia (motile cilia) in affected female rats which never developed hydrocephalus as severe as that seen in affected male rats.(ABSTRACT TRUNCATED AT 250 WORDS)