Browsing by Author "Peter, J C"

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    Adult neoplastic spinal cord compression
    (2000) Pillay, Robin; Peter, J C
    Spinal cord compression ( SCC ) constitutes a neurological emergency, and if left untreated, can result in permanent irreversible neurological dysfunction. Disabilities can range from mild weakness to complete quadriplegia with the inherent associated mental, physical and emotional suffering .The burden of cost to the individual and community is enormous.
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    Four decades of conjoined twins at Red Cross Children's Hospital - lessons learned
    (Health and Medical Publishing Group, 2006) Rode, H; Cywes, S; Lawrenson, J; Numanoglu, A; Fieggen, A G; Brown, R A; Davies, M R Q; Hewitson, J P; Hoffman, E B; Jee, L D; Mann, M D; Matthews, L S; Millar, A J W; Peter, J C; Thomas, J; Wainwright, H
    Conjoined twins represent a rare but fascinating congenital condition, the aetiology of which remains obscure. Over the past four decades, the paediatric surgeons at Red Cross Children's Hospital have been involved in the management of 46 pairs of conjoined twins, of which 33 have been symmetrical and 12 asymmetrical. Seventeen symmetrical twins have undergone separation with 22 children (65%) surviving; all of the live asymmetrical twins survived separation. We describe the important features of this unique cohort, outline our approach to management and present the results of this approach. We consider some of the ethical and moral dilemmas we have confronted, and discuss the prenatal diagnosis, obstetric implications and postnatal care of these children, including the relevant investigations and anaesthetic and surgical management. Specific aspects related to the cardiovascular system, hepatobiliary and gastrointestinal tracts, urogenital tract, central nervous system and musculoskeletal system are highlighted.
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    Intracranial endoscopy
    (Health and Medical Publishing Group, 2006) Figaji, A A; Fieggen, A G; Semple, P L; Peter, J C
    In modern neurosurgery there has been a strong trend towards the use of minimally invasive techniques, one of which is intracranial endoscopy. Endoscopic third ventriculostomy (ETV) is the commonest procedure performed; it is used to treat hydrocephalus caused by an obstruction to the ventricular system anywhere distal to the mamillary bodies of the third ventricle. The obstruction is bypassed by a stoma created in the floor of the third ventricle, allowing cerebrospinal fluid (CSF) to flow freely into the subarachnoid space. Endoscopy can also be used for the fenestration of various intracranial cysts, intraventricular biopsy, the placement and retrieval of ventricular catheters, the removal of small intraventricular lesions, and improved visualisation in microsurgical operations. At Red Cross Children’s Hospital and Groote Schuur Hospital endoscopy has become an indispensable tool in the management of a wide range of neurosurgical conditions. As experience has accumulated worldwide, a better understanding of the benefits and limitations of endoscopy in diverse circumstances has emerged.
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    Pituitary apoplexy : can histopathology, radiological imaging and predisposing factors be used in predicting outcome?
    (2008) Semple, Patrick Lyle; Peter, J C
    Pituitary apoplexy is an uncommon, yet potentially fatal illness, usually the result of infarction, hemorrhage or a combination of both in a pituitary tumor. The management of pituitary apoplexy consists of replacement therapy and in the majority of patients, surgical decompression, although some cases may be treated conservatively. Up to now no study has attempted to separate the two histopathological types of pituitary apoplexy or to analyze their clinical and radiological significance on presentation and outcome.
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    Surgical treatment for 'brain compartment syndrome' in children with severe head injury
    (Health and Medical Publishing Group, 2006) Figaji, A A; Fieggen, A G; Argent, A; Peter, J C
    OBJECTIVES: Traumatic brain injury accounts for a high percentage of deaths in children. Raised intracranial pressure (ICP) due to brain swelling within the closed compartment of the skull leads to death or severe neurological disability if not effectively treated. We report our experience with 12 children who presented with cerebral herniation due to traumatic brain swelling in whom decompressive craniectomy was used as an emergency. DESIGN: Prospective, observational. SETTING: Red Cross Children's Hospital. SUBJECTS: Children with severe traumatic brain injury and cerebral swelling. OUTCOME MEASURES: Computed tomography (CT) scanning, ICP control, clinical outcome. RESULTS: Despite the very poor clinical condition of these children preoperatively, aggressive management of the raised pressure resulted in unexpectedly good outcomes. CONCLUSION: Aggressive surgical measures to decrease ICP in the emergency situation can be of considerable benefit; the key concepts are selection of appropriate patients and early intervention.