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Dachling Pang and James E. Wilberger Jr.

excluded all birth injuries and children with cord injuries caused by electric shock, penetrating agents, or missiles. Since we were primarily interested in the vulnerability of the normal spine in the young to violence, we have also eliminated all congenital malformations associated with inherent instability of the spine, such as insufficiency of the transverse odontoid ligament, os odontoideum, ossiculum terminale, the Klippel-Feil syndrome, Down's syndrome, and occipitalization of the atlas. Age and Sex of Patients From 1960 to 1980, 36 children with closed

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Edmund D. Pellegrino

physician, in emergency rooms, intensive care units, chronic care units, nursing homes, and hospices gave eloquent testimony in their own words to their frustrations in trying to serve the conflicting demands of technological possibility, fiscal constraint, and the discordant values of patients, families, and the law. Even more revealing was the clear absence of any moral consensus, or of a clear and orderly way to approach the most common clinical dilemmas. The second example is the dilemmas exposed in two cases of infants with Down's syndrome and easily correctible

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Immunohistochemistry of central nervous system tumors

Its contributions to neurosurgical diagnosis

Jose M. Bonnin and Lucien J. Rubinstein

exposure to toxic substances such as aluminum, vinblastine, colchicine, hexacarbons, acrylamide, carbon disulfide, and β - β -iminodipropionitrile (IDPN). Neurofilaments are also involved in degenerative processes of the nervous system that include Down's syndrome, postencephalitic parkinsonism, the Parkinson-dementia complex of Guam, progressive supranuclear palsy, Pick's disease, and the senile dementias of the Alzheimer type. Large accumulations of NF material have also been noted in the neurons in the late stages of subacute sclerosing panencephalitis. Unlike the

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Management of lipomyelomeningoceles

Experience at the Hospital for Sick Children, Toronto

Harold J. Hoffman, Chopeow Taecholarn, E. Bruce Hendrick and Robin P. Humphreys

hydromyelic cavitation of the conus. No patient had an associated Chiari malformation. Four patients had associated anomalies of the urinary system, of whom two had bilateral duplication of their collecting system, one had agenesis of one kidney, and one had extrophy of the urinary bladder. One patient had anal stenosis and one had Down's syndrome. TABLE 5 Associated anomalies in 97 lipomyelomeningocele patients Associated Anomalies No. of Cases genitourinary tract anomalies 4 split spinal cord 3 diastematomyelia 3

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Joseph M. Bicknell, Wolff M. Kirsch, Robert Seigel and William Orrison

underlying disease, skeletal abnormality, nervous system compression, or vascular compression. Underlying diseases include arthritis, Down's syndrome, a short neck, or a low hairline. Neck stiffness, pain, and headache are common indicators of skeletal malalignment, but torticollis alone is not considered a reliable sign. 17 The anterior arch of the atlas may be palpable behind the upper pharynx, and the spinous process of the atlas may become unusually prominent beneath the occiput. Neurological deficits can be transient or progressive, and they include paraparesis

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Meredith V. Olds, Robert W. Griebel, Harold J. Hoffman, Marilyn Craven, Sylvester Chuang and Hart Schutz

). Certain HLA markers and autoantibodies occur with higher frequency in patients with moyamoya disease, but no key to the association has been identified. 14 TABLE 1 Conditions associated with moyamoya disease neurofibromatosis hypertension myopathy sickle-cell anemia Fanconi's anemia type I glycogenosis congenital heart disease previous radiation therapy Down's syndrome The age incidence of moyamoya disease has two peaks: one in the first decade and the other in the fourth decade. 12 The

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Gliomas of the optic nerve or chiasm

Outcome by patients' age, tumor site, and treatment

Ellsworth C. Alvord Jr. and Steven Lofton

for glioma of the optic nerve. Br J Ophthalmol 45: 54–58, 1961 47. Jonakin WL , Hensley MF : Optic glioma and Down's syndrome. J Am Osteopath Assoc 82 : 806 , 1983 (Letter) Jonakin WL, Hensley MF: Optic glioma and Down's syndrome. J Am Osteopath Assoc 82: 806, 1983 (Letter) 48. Koenig SB , Naidich TP , Zaparackas Z : Optic glioma masquerading as spasmus nutans. J Pediatr Ophthalmol Strabismus 19 : 20 – 24 , 1982 Koenig SB, Naidich TP, Zaparackas Z: Optic glioma

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Göran C. Blomstedt and Juha Kyttä

pulmonary emphysema with chronic bronchitis), and in five patients in Group 2 (arterial hypertension, diabetes, psoriasis, and Down's syndrome). There were more cases of trauma in Group 2, but this difference was not significant (p < 0.27). In conclusion, Groups 1 and 2 were similar for all practical purposes. The infections related to surgery and the results of this trial are summarized in Table 2 . Since there was a slight preponderance of trauma cases in Group 2, a fact that may have had an effect on the rate of infection, Table 3 shows the results when the trauma

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W. Craig Clark, Michael Coscia, James D. Acker, Keith Wainscott and James T. Robertson

cervical muscle spasm. Anatomic predisposition to atlantoaxial subluxation occurs in certain subgroups during adulthood. Up to 20% of patients with Down's syndrome have been found to have atlantoaxial instability, and this has been correlated with the degree of laxity of the transverse ligament. 16 Both a congenital ligamentous weakness and an intrinsic connective tissue defect have been postulated as possible etiologies. 15, 16 It must be quite rare, but it is presumed that this anatomical predisposition to ligamentous laxity might also occur in certain otherwise

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Victor W. Henderson and Caleb E. Finch

Guam, pugilistic dementia, Down's syndrome in middle-aged persons, postencephalic Parkinson's disease, and occasional cases of subacute sclerosing panencephalitis. 118, 298 It is not yet known whether PHF protein represents a modification of normal cytoskeletal elements or the synthesis of some new abnormal protein. Purification and analysis have been hindered by the marked insolubility of PHF's. 214, 246 Its composition, however, has been investigated immunohistochemically, demonstrating the presence of antigenic determinants shared by several normal cytoskeletal