The entire length of distal tubing from a ventriculoperitoneal shunt was found to have migrated into the subgaleal space, and resulted in a shunt obstruction. Upward migration of distal shunt catheters has rarely been reported, but probably involves patient motion that creates a "windlass" effect. Cephaled migration requires a potential space (subgaleal or ventricular) and no resistance to movement of the tubing. This complication can be prevented by securing the shunt near the site of motion.
Selective dorsal rhizotomy is increasingly used for management of spastic quadriplegic cerebral palsy but rates of hip stability following the operation have not been reported. Determining hip stability by radiographic measurement of lateral migration of the femoral head beyond a lateral edge of the acetabulum after dorsal rhizotomy allows an objective assessment of the outcome of the operation. This prospective study examined the effect of selective dorsal rhizotomy on lateral migration of the femoral head in 45 children with spastic quadriplegic cerebral palsy. The children ranged in age from 2 to 9 years (average 5 years 1 month) and were grouped according to their ages with 23 children in the 2- to 4-year-old group and 22 children in the 5- to 9-year-old group. Postoperative follow up ranged from 7 to 50 months (average 20 months). The Reimers migration percentage (MP), a measure of the lateral migration of the femoral head, was calculated from anteroposterior hip radiographs taken prior to the operation and at the last follow-up examination. Of the 90 hips involved, 9% improved, 80% remained unchanged, and 11% worsened, yielding a radiographic stability rate of 89%. The hips with postrhizotomy worsening of the MP had an average preoperative MP of 14% (range 9% to 38%) and an average postoperative increase in MP of 18% (range 11% to 37%). Of the 45 children, four subsequently underwent unilateral derotational femoral osteotomies for persistent or worsening hip subluxation. There was a significant tendency for the MP to worsen in patients with lower prerhizotomy MP values (chi 2 = 20.74, df = 4, p = 0.001), but the age of patients and their ambulatory status at the time of rhizotomy had no bearing on postoperative hip stability. The data indicate that selective dorsal rhizotomy prevents progressive lateral migration of the femoral head in the majority of children who undergo the operation for spastic quadriplegia.
Major limitations of adrenal medulla transplantation
in animal models of Parkinson's disease
have been the relatively small behavioral
effects and the poor or inconsistent graft survival.
Transplantation of fragments of sural nerve in
combination with adrenal medulla has been reported
to increase the survival of chromaffin cells
in adrenal medulla grafts in primates. In the
present study, the possibility was tested that peripheral
nerve co-grafts would increase the functional
effects of adrenal medulla grafts in a
6-hydroxydopamine-lesioned rat model. Animals
received unilateral substantia nigra lesions, and
subsequently received intraventricular grafts of
adrenal medulla, sciatic nerve, adrenal medulla
plus sciatic nerve, or sham grafts consisting of
medium only. Functional effects of the grafts
were tested using apomorphine-induced rotational
behavior. The sciatic nerve co-grafts did
not increase the survival of TH-immunoreactive
chromaffin cells. The co-grafting treatment also
did not augment the overall effect of adrenal medulla
grafts on rotational behavior. In the animals
with substantial numbers of surviving chromaffin
cells, however, the animals with sciatic
nerve co-grafts showed greater decreases in
rotational behavior as compared to the animals
with adrenal medulla grafts alone, even though
the number of surviving cells was not increased.
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