Psychosocial adjustment of children with spina bifida.

It was the aim of the present prospective study to investigate the influence of age, sex, intellectual function, and school type as well as of hydrocephalus, the level of lesion, and of the degree of handicap on the psychosocial adjustment of children with spina bifida. Seventy-five patients with spina bifida, aged 6 to 16 years were assessed concerning their psychosocial adjustment and their intellectual function by use of standardized instruments. The findings were compared with those of nondisabled controls, matched for age and sex. Children with spina bifida showed a tendency to be at an increased risk for psychosocial maladjustment. Influencing factors were age, sex, and the degree of handicap. Twelve- to 16-year-old boys and girls displayed significant adjustment problems in specific areas in comparison with their controls. There was a tendency for children with spina bifida to be attending inappropriate school types according to their intellectual abilities. Perhaps the most striking finding of our study was that children with spina bifida who attended a school for disabled children, even though it might be an IQ-appropriate setting, had a higher rate of psychosocial maladjustment than the disabled children in mainstream schools.

M-mode sonography of the caudal spinal cord in patients with meningomyelocele. Work in progress.

The authors prospectively studied movement patterns of the spinal cord in 46 patients (aged 0.5-16 years) with meningomyelocele but without major neurologic deficits. Three different motion patients were observed. Reduced mobility correlated with a higher risk of developing secondary tethered cord syndrome after a mean observation time of 15 months. This technique may be helpful in identifying patients for early surgery.

Magnetic resonance imaging of dysraphic myelodysplasia. Findings in 56 children and adolescents with postrepair meningomyelocele.

The spinal cord in 56 children and adolescents was examined by magnetic resonance imaging (MRI) many years after neonatal surgery on a meningomyelocele (average age 12 years). In a high percentage of cases, the diagnosis "tethered cord" was made. Associated anomalies were found with a frequency of 21%. Typical findings are presented and the impact of these results on therapy planning is discussed.

[Proton spin tomography in childhood. Experience with 407 studies in 275 children and adolescents]. / Kernspintomographie im Kindesalter. Erfahrungen mit 407 Untersuchungen bei 275 Kindern und Jugendlichen.

Over a period of three years magnetic resonance imaging (MRI), mostly neuroradiological, was performed 407 times in 275 children. It was found that MRI largely replaced previously applied imaging methods for solving oncological and neurological problems. The sensitivity of the method is poor for demonstrating small calcifications (computed tomography is better), for diffuse meningeal lesions (lumbar puncture is better), and diffuse spinal-canal metastases (myelography is better). The great advantage of the method lies in its low x-ray exposure because of the low field strength, and it can therefore be safely used repeatedly.

Treatment of cryptorchidism with a potent analog of gonadotropin-releasing hormone.

Pernasal therapy of cryptorchidism with D-Leu6-des-Gly10-gonadotropin-releasing hormone ethylamide (D-Leu6-des-Gly10-GnRH-EA), a potent, long-acting GnRH analog, was attempted. Eleven prepubertal cryptorchid boys received between 25 microgram once daily and 25 to 50 microgram twice daily for 5 to 12 weeks. Complete testicular descent was achieved in 4 of the 11 boys. GnRH tests (1.5 microgram/kg intravenously), conducted in six boys before treatment, after 4 weeks of treatment, and in 2 boys 3 months after treatment, did not reveal changes in gonadotropin secretion indicative of precocious puberty or of decreased hypophyseal sensitivity to GnRH. Antibodies to the GnRH analog or to GnRH could not be detected.