Metastasis stage, adjuvant treatment, and residual tumor are prognostic factors for medulloblastoma in children: conclusions from the Children's Cancer Group 921 randomized phase III study.

Purpose: From 1986 to 1992, "eight-drugs-in-one-day" (8-in-1) chemotherapy both before and after radiation therapy (XRT) (54 Gy tumor/36 Gy neuraxis) was compared with vincristine, lomustine (CCNU), and prednisone (VCP) after XRT in children with untreated, high-stage medulloblastoma (MB).

Patients And Methods: Two hundred three eligible patients with an institutional diagnosis of MB were stratified by local invasion and metastatic stage (Chang T/M) and randomized to therapy. Median time at risk from study entry was 7.

Recurrent tethering: a common long-term problem after lipomyelomeningocele repair.

The authors reviewed the records of 94 patients who underwent initial repair of a lipomyelomeningocele between 1982 and July 1996 at the Children's Hospital of Pittsburgh to determine the incidence and time course of symptomatic retethering. In each of these patients, the initial operative goals were to microsurgically debulk as much of the lipoma as possible to allow the conus to move freely within the spinal canal, to divide any tethering arachnoidal adhesions, to close the pia if possible and to reconstitute a capacious thecal sac, using a dural graft if necessary. With a median follow-up of 58 months, 19 of these patients (20.

Microglia express CCR5, CXCR4, and CCR3, but of these, CCR5 is the principal coreceptor for human immunodeficiency virus type 1 dementia isolates.

Microglia are the main human immunodeficiency virus (HIV) reservoir in the central nervous system and most likely play a major role in the development of HIV dementia (HIVD). To characterize human adult microglial chemokine receptors, we analyzed the expression and calcium signaling of CCR5, CCR3, and CXCR4 and their roles in HIV entry. Microglia expressed higher levels of CCR5 than of either CCR3 or CXCR4.

The effect of human herpesvirus-6 (HHV-6) on cultured human neural cells: oligodendrocytes and microglia.

Human herpesvirus-6 (HHV-6) is a betaherpesvirus that has been frequently associated with pediatric encephalitis. In 1995 Challoner et al reported that HHV-6 variant B (HHV-6B) was linked to multiple sclerosis (MS) due to the presence of viral DNA and antigen in the oligodendrocytes surrounding MS plaques. These findings led us to examine HHV-6B's in vitro tropism for primary neural cells.

Current management of pediatric atlantoaxial rotatory subluxation.

Study Design: A retrospective clinical review of 20 children seen during a 7-year period who had atlantoaxial rotatory subluxation.

Objective: To define the effectiveness of imaging and treatment measures and to identify risk factors for recurrence, the series was reviewed to analyze cause, management, and outcome.

Summary Of Background Data: Rotatory subluxation of the atlantoaxial complex remains a poorly understood entity.

Intraoperative hypothermia and ventricular shunt infections.

Several recent studies have demonstrated a relationship between intraoperative hypothermia and postoperative infection. A study was therefore conducted to evaluate the relationship between intraoperative hypothermia and ventricular shunt infections. Sixty-eight children who underwent ventricular shunt placement, including revisions, over a six year period subsequently developed a shunt infection (overall shunt infection rate of 5%).

Propionibacterium [correction of Proprionibacterium] acnes infections of cerebrospinal fluid shunts.

Ventricular cerebrospinal fluid shunt infections with Propionibacterium acnes are generally low-grade, indolent infections. Typical presentations include gradual shunt malfunction, nausea, headache, malaise, and infrequently, fever. In all, 489 shunt procedures performed between January 1992 and December 1995, and in 15 of these cases P.

Interaction of the human immunodeficiency virus type 1 Vpr protein with the nuclear pore complex.

The Vpr protein of human immunodeficiency virus type 1 (HIV-1) performs a number of functions that are associated with the nucleus. Vpr enhances the nuclear import of postentry viral nucleoprotein complexes, arrests proliferating cells in the G2 phase of the cell cycle, and acts as a modest transcriptional activator. For this paper, we have investigated the nuclear import of Vpr.

Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy.

Unlabelled: Intrathecal baclofen infusion (IBI) is an effective treatment for spasticity secondary to cerebral palsy (CP).

Object: To assess the need for orthopedic surgery of the lower extremities in such cases, the authors retrospectively reviewed the outcome in 48 patients with spastic CP who were treated with IBI.

Methods: Pumps were placed in 40 patients (84%) suffering from spastic quadriplegia and eight patients (16%) with spastic diplegia.

Follow-up of children with shunted hydrocephalus.

In order to determine if routine yearly evaluations of children with shunted hydrocephalus were likely to diagnose shunt malfunction, we reviewed the medical records of the last 100 children who had such routine evaluations. Only 4 children had symptoms that were potentially referable to malfunction; none were subsequently found to have malfunction and no child had signs of malfunction. We also reviewed the medical records of the last 100 children who had shunt revisions to determine if any of them were diagnosed during routine follow-up examinations.

Chemokine receptor utilization by human immunodeficiency virus type 1 isolates that replicate in microglia.

The role of human immunodeficiency virus (HIV) strain variability remains a key unanswered question in HIV dementia, a condition affecting around 20% of infected individuals. Several groups have shown that viruses within the central nervous system (CNS) of infected patients constitute an independently evolving subset of HIV strains. A potential explanation for the replication and sequestration of viruses within the CNS is the preferential use of certain chemokine receptors present in microglia.

Survival and prognostic factors following radiation therapy and chemotherapy for ependymomas in children: a report of the Children's Cancer Group.

Object: Ependymomas in children continue to generate controversy regarding their histological diagnosis and grading. optimal management, and possible prognostic factors. To increase our knowledge of these tumors the authors addressed these issues in a cohort of children with prospectively staged ependymomas treated with radiotherapy and chemotherapy.

Medulloblastoma and glioblastoma multiforme in a patient with Turcot syndrome: a case report.

Background: Turcot syndrome (TS) or the glioma-polyposis syndrome, is a rare, heritable disorder thought by some authors to be a variant of familial adenomatous polyposis (FAP). It is characterized by central nervous system (CNS) neoplasms and gastrointestinal polyposis.

Methods: We present a case report of a patient who developed a medulloblastoma at age 5 years.

Infusion of intrathecal baclofen for generalized dystonia in cerebral palsy.

Unlabelled: Generalized dystonia occurs in 15 to 25% of persons with cerebral palsy (CP) and responds poorly to medical and surgical treatments.

Object: After the authors observed a woman whose dystonic CP was dramatically improved by continuous infusion of intrathecal baclofen, they designed this pilot study to evaluate the effect of this treatment on a group of patients with dystonic CP.

Methods: The authors assessed the short-term response to intrathecal baclofen infusion in 12 patients with dystonic CP.

Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report.

Objective And Importance: This case illustrates that although endoscopic third ventriculostomy for patients with aqueductal stenosis is successful and minimally invasive, it can have severe, life-threatening complications.

Clinical Presentation: A 3-year-old girl presented with hydrocephalus and aqueductal stenosis. She underwent endoscopic third ventriculostomy with laser fenestration of the third ventricular floor.

Upper cervical spine fusion in the pediatric population.

The outcomes of 25 pediatric patients who underwent upper cervical or occipitocervical fusion at the authors' institution since 1983 were reviewed. At a mean age of 9 years, the patients presented with spinal instability that was associated with os odontoideum in 11 cases, rotatory subluxation in five cases, odontoid fracture in two cases, atlantooccipital dislocation in two cases, and congenital atlantoaxial instability in five patients, four of whom had Down's syndrome (trisomy 21). Ten children had abnormal findings on neurological examination preoperatively; however, nine experienced improvement or resolution of deficits as of their latest follow-up evaluation (mean 17 months).

Effect on ambulation of continuous intrathecal baclofen infusion.

Intrathecal baclofen (ITB) infusion has been shown to be an effective treatment for spasticity secondary to both cerebral palsy and spinal cord injury. Its effect on the ambulatory status of individuals with cerebral spasticity, however, has not previously been addressed. We reviewed the effect of ITB on functional ambulation in 24 patients who were ambulatory to some extent, either with or without assistive devices.

Spinal cord astrocytomas: long-term results comparing treatments in children.

Technology enabling radical resection has expanded treatment options for children with spinal cord astrocytomas. Comparison of long-term survival and neurological function after complete tumor removal with more conservative treatment may determine whether radical surgery can improve outcome in well-differentiated and anaplastic spinal cord astrocytomas. In all, 18 children with spinal cord astrocytomas were initially treated between 1976 and 1992 with biopsy in 6, subtotal removal in 7, and complete resection in 5.

Primary endodermal sinus tumor presenting with spinal cord compression. Case report.

Endodermal sinus tumor is an uncommon malignant germ-cell neoplasm. These tumors usually present in childhood or young adulthood as testicular or ovarian masses; however, mediastinal and intracranial tumors have been described. The authors report the occurrence of a primary paraspinal endodermal sinus tumor in a 21-month-old boy who presented with thoracic spinal cord compression.

Continuous intraoperative electromyographic monitoring of cranial nerves during resection of fourth ventricular tumors in children.

The authors reviewed the results of continuous intraoperative electromyographic (EMG) monitoring of muscles innervated by cranial nerves in 17 children whose preoperative imaging studies showed compression or infiltration of the fourth ventricular floor by tumor to determine how intraoperative EMG activity correlated with postoperative cranial nerve morbidity. Bilateral lateral rectus (sixth) and facial (seventh) nerve musculatures were monitored in all children. Cranial nerve function was documented immediately postoperatively and at 1 year.

Intrathecal baclofen in cerebral palsy movement disorders.

Intrathecal baclofen reduces spasticity in individuals with cerebral palsy. Intrathecal doses are far lower than oral doses and the effects are considerably greater, and the side effects are fewer. Response to intrathecal baclofen must be confirmed by a screening trial before implantation of a pump for chronic infusion.