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Treatment of Meningomyelocele in Indigent and Nonindigent Patients

Treatment of Meningomyelocele in Indigent and Nonindigent Patients Abstract The records for the years 1964 through 1971 of 38 indigent children with meningomyelocele treated at a municipal hospital and 52 nonindigent children with meningomyelocele treated at a private hospital were reviewed. In those cases not lost to follow-up, there was a 50% mortality in the indigent children compared with a 22% mortality in the nonindigent children. Forty-five percent of indigent patients who had shunt procedures became infected, in contrast to 15% of nonindigent children who had shunt procedures. Possible factors influencing success or failure of treatment are discussed, and methods to decrease morbidity and mortality in indigent patients with meningomyelocele are reviewed. References 1. Forrest DM, Cooper DGW: Complications of ventriculo-atrial shunts: A review of 455 cases . J Neurosurg 29:506-512, 1968.Crossref 2. Mawdsley T, Rickham PP: Further follow-up study of early operation for open meningomyelocele . Dev Med Child Neurol , (suppl 20) , pp 8-12, 1969. 3. Lorber J: Ventriculo-cardiac shunts in the first week of life: Results of a controlled trial in the treatment of hydrocephalus in infants born with spina bifida cystica or cranium bifidum . Dev Med Child Neurol , (suppl 20) , pp 13-22, 1969. 4. Findlay JA: An appraisal of the management of spina bifida cystica . Dev Med Child Neurol , (suppl 20) , pp 86-90, 1969. 5. Nobel TC, et al: Thrombotic and embolic complications of ventriculo-atrial shunts . Dev Med Child Neurol , (suppl 22) , pp 114-122, 1970. 6. Stauffer UG: "Shunt nephritis": Diffuse glomerulonephritis complicating ventriculo-atrial shunts . Dev Med Child Neurol , (suppl 22) , pp 161-164, 1970. 7. Luthardt T: Bacterial infections in ventriculoatrial shunt systems . Dev Med Child Neurol , (suppl 22) , pp 105-109, 1970. 8. Naggan L: Anencephaly and spina bifida in Israel . Pediatrics 47:577-586, 1971. 9. Naggan L, MacMahon B: Ethnic differences in the prevalence of anencephaly and spina bifida in Boston, Massachusetts . N Engl J Med 277:1119-1123, 1967.Crossref 10. Doran PA, Guthkelch AN: Studies in spina bifida cystica: I. General survey and reassessment of the problem . J Neurol Neurosurg Psychiatry 24:331-345, 1961.Crossref 11. Laurence KM: The survival of untreated spina bifida cystica . Dev Med Child Neurol , (suppl 11) , pp 10-19, 1966. 12. Bruce AM, et al: Persistent bacteremia following ventriculo-caval shunt operations for hydrocephalus in infants . Dev Med Child Neurol , (suppl 5) , pp 461-470, 1963. 13. McLaurin RL, Dodson D: Infected ventriculo-atrial shunts: Some principles of treatment . Dev Med Child Neurol , (suppl 25) , pp 71-76, 1971. 14. Schimke RT, et al: Indolent Staphylococcus albus or aureus bacteremia after ventriculoauriculostomy . N Engl J Med 264:264-270, 1961.Crossref 15. Holt RJ: Bacteriological studies on colonized ventriculo-atrial shunts . Dev Med Child Neurol , (suppl 22) , pp 83-87, 1970. 16. Holt RJ: The classification of staphylococci from colonized ventriculo-atrial shunts . J Clin Pathol 22:475-482, 1969.Crossref 17. Perrin JCS, McLaurin RL: Infected ventriculoatrial shunts: A method of treatment . J Neurosurg 27:21-26, 1967.Crossref 18. Shulman K (ed): Workshop in Hydrocephalus, Proceedings . Philadelphia, University of Pennsylvania School of Medicine, 1965, pp 115-151. 19. Nulsen FE, Becker DP: Control of valve regulated shunt: Infections and their prevention . Clin Neurosurg 14:256-273, 1966. 20. Kobak AJ, et al: Relation of protein deficiency to experimental wound healing . Surg Gynecol Obstet 85:751-756, 1947. 21. Chalkley HW, Algire GH, Morris HP: Effect of level of dietary protein on vascular repair in wounds . J Natl Cancer Inst 6:363-372, 1946. 22. Lee JAH, Morrison SL, Morris JN: Fatality from three common surgical conditions in teaching and non-teaching hospitals . Lancet 2:785-790, 1957.Crossref 23. Lee JAH, Morrison SL, Morris JN: Case-fatality in teaching and non-teaching hospitals . Lancet 1:170-171, 1960.Crossref 24. Ashley JSA, Howlett A, Morris JN: Case-fatality of hyperplasia of the prostate in two teaching and three regional-board hospitals . Lancet 2:1308-1311, 1971.Crossref 25. Last JM, Martin FM, Stanley GR: Academic record and subsequent career . Proc R Soc Med 60:813-816, 1967. 26. Nicholas JA, et al: Immediate shunt replacement in the treatment of bacterial colonization of Holter valves . Dev Med Child Neurol , (suppl 22) , pp 110-113, 1970. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Treatment of Meningomyelocele in Indigent and Nonindigent Patients

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References (31)

Publisher
American Medical Association
Copyright
Copyright © 1974 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1974.02110210032004
Publisher site
See Article on Publisher Site

Abstract

Abstract The records for the years 1964 through 1971 of 38 indigent children with meningomyelocele treated at a municipal hospital and 52 nonindigent children with meningomyelocele treated at a private hospital were reviewed. In those cases not lost to follow-up, there was a 50% mortality in the indigent children compared with a 22% mortality in the nonindigent children. Forty-five percent of indigent patients who had shunt procedures became infected, in contrast to 15% of nonindigent children who had shunt procedures. Possible factors influencing success or failure of treatment are discussed, and methods to decrease morbidity and mortality in indigent patients with meningomyelocele are reviewed. References 1. Forrest DM, Cooper DGW: Complications of ventriculo-atrial shunts: A review of 455 cases . J Neurosurg 29:506-512, 1968.Crossref 2. Mawdsley T, Rickham PP: Further follow-up study of early operation for open meningomyelocele . Dev Med Child Neurol , (suppl 20) , pp 8-12, 1969. 3. Lorber J: Ventriculo-cardiac shunts in the first week of life: Results of a controlled trial in the treatment of hydrocephalus in infants born with spina bifida cystica or cranium bifidum . Dev Med Child Neurol , (suppl 20) , pp 13-22, 1969. 4. Findlay JA: An appraisal of the management of spina bifida cystica . Dev Med Child Neurol , (suppl 20) , pp 86-90, 1969. 5. Nobel TC, et al: Thrombotic and embolic complications of ventriculo-atrial shunts . Dev Med Child Neurol , (suppl 22) , pp 114-122, 1970. 6. Stauffer UG: "Shunt nephritis": Diffuse glomerulonephritis complicating ventriculo-atrial shunts . Dev Med Child Neurol , (suppl 22) , pp 161-164, 1970. 7. Luthardt T: Bacterial infections in ventriculoatrial shunt systems . Dev Med Child Neurol , (suppl 22) , pp 105-109, 1970. 8. Naggan L: Anencephaly and spina bifida in Israel . Pediatrics 47:577-586, 1971. 9. Naggan L, MacMahon B: Ethnic differences in the prevalence of anencephaly and spina bifida in Boston, Massachusetts . N Engl J Med 277:1119-1123, 1967.Crossref 10. Doran PA, Guthkelch AN: Studies in spina bifida cystica: I. General survey and reassessment of the problem . J Neurol Neurosurg Psychiatry 24:331-345, 1961.Crossref 11. Laurence KM: The survival of untreated spina bifida cystica . Dev Med Child Neurol , (suppl 11) , pp 10-19, 1966. 12. Bruce AM, et al: Persistent bacteremia following ventriculo-caval shunt operations for hydrocephalus in infants . Dev Med Child Neurol , (suppl 5) , pp 461-470, 1963. 13. McLaurin RL, Dodson D: Infected ventriculo-atrial shunts: Some principles of treatment . Dev Med Child Neurol , (suppl 25) , pp 71-76, 1971. 14. Schimke RT, et al: Indolent Staphylococcus albus or aureus bacteremia after ventriculoauriculostomy . N Engl J Med 264:264-270, 1961.Crossref 15. Holt RJ: Bacteriological studies on colonized ventriculo-atrial shunts . Dev Med Child Neurol , (suppl 22) , pp 83-87, 1970. 16. Holt RJ: The classification of staphylococci from colonized ventriculo-atrial shunts . J Clin Pathol 22:475-482, 1969.Crossref 17. Perrin JCS, McLaurin RL: Infected ventriculoatrial shunts: A method of treatment . J Neurosurg 27:21-26, 1967.Crossref 18. Shulman K (ed): Workshop in Hydrocephalus, Proceedings . Philadelphia, University of Pennsylvania School of Medicine, 1965, pp 115-151. 19. Nulsen FE, Becker DP: Control of valve regulated shunt: Infections and their prevention . Clin Neurosurg 14:256-273, 1966. 20. Kobak AJ, et al: Relation of protein deficiency to experimental wound healing . Surg Gynecol Obstet 85:751-756, 1947. 21. Chalkley HW, Algire GH, Morris HP: Effect of level of dietary protein on vascular repair in wounds . J Natl Cancer Inst 6:363-372, 1946. 22. Lee JAH, Morrison SL, Morris JN: Fatality from three common surgical conditions in teaching and non-teaching hospitals . Lancet 2:785-790, 1957.Crossref 23. Lee JAH, Morrison SL, Morris JN: Case-fatality in teaching and non-teaching hospitals . Lancet 1:170-171, 1960.Crossref 24. Ashley JSA, Howlett A, Morris JN: Case-fatality of hyperplasia of the prostate in two teaching and three regional-board hospitals . Lancet 2:1308-1311, 1971.Crossref 25. Last JM, Martin FM, Stanley GR: Academic record and subsequent career . Proc R Soc Med 60:813-816, 1967. 26. Nicholas JA, et al: Immediate shunt replacement in the treatment of bacterial colonization of Holter valves . Dev Med Child Neurol , (suppl 22) , pp 110-113, 1970.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Feb 1, 1974

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