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Pediatric neurosurgery, once an annex of general neurosurgery, has evolved into a well-defined and complex medical specialty. The last 10 years have witnessed major advances in documentation of the minute details of CNS diseases of childhood, refinement of the specific means of action and better adaptation of therapeutic efforts to the requirements of a developing organism. Pediatric neurosurgeons are now increasingly involved in beneficial cooperation within complex medical teams. This fact has by no means diminished the importance of pediatric neurosurgery; rather, in such settings it has proved to have better effects in the struggle for stable long-lasting good results of multi-modal treatments covering all pathological entities. Progress in neurological surgery for patients in the pediatric age group has emerged from the development of supranational scientific structures and from that of specific concepts exchanging channels, so that today pediatric neurosurgeons belong to an extremely specialized medical corps, working in harmony across geographical and socio-economic national features in the interests of humankind's young generation's health.

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The authors review the management of brain abscesses (BAbs) in 59 pediatric cases. The major surgical procedure used to treat them was repeated puncture and aspiration (51 cases, or 86.44%), excision (8 cases - 13.56%) being of secondary importance. The main etiology was metastatic lesions (24 cases - 40.68%), those due to cyanotic congenital heart disease being the most frequent. Single lesions dominated (41 cases - 69.49%). Gram-positive cocci were the main bacteria involved (31 cases, 52.5%). CT scan represented the main tool in the diagnosis and follow-up. Puncture and aspiration in BAbs led to a significant decrease in mortality (7 cases - 11.86%), and the incidence of seizures and neurological deficits was also reduced. Mortality was significantly correlated with the following factors: consciousness status, multiple BAbs location and hematogenous dissemination. There were recurrences in 11 cases (18.64%), all observed after aspiration procedures. The current concepts for complex management of BAbs, as reflected in recent literature data, are reviewed, with particular emphasis on the use of real-time CT or ultrasound-guided operative techniques.

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A study of astrocytomas occurring in children (mean age 9.13 years) is reported. Two hundred sixty-one cases operated within 10 years (1986-1995) were reviewed. The subtentorial localization was preponderant and was seen in 145 cases (55.04%). The pathological results for supratentorial astrocytomas show an important number of high-grade, malignant astrocytomas--74 cases (64.3%). Surgery was the most important aspect of the treatment. The microscopic tumoral removal was total in 201 cases (77%), subtotal in 37 cases (14.2%); bioptic sampling was done in only 23 cases (8.8%). In grade III and IV astrocytomas, radiotherapy (high-voltage) and chemotherapy were routinely used. The patients were followed-up, both clinically and by CT, between 6 months and 10 years. Neurological evaluation (6 months post-operative) shows a preponderance of minimal sequelae (71%). Clinical signs of recurrences occurred in 56 cases (21.45%). In 37 cases (66.07%), a surgical indication was retained. Cumulative probability of survival of children with intracranial astrocytomas at 1 year was 0.714 and at 5 years was 0.655.

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The authors present 27 cases of cerebral hydatid cyst (CHCy) treated between 1980 and 1992. These cases of CHCy represent 2.8% of all cases of expansive nontraumatic lesions in children. Most of the patients were between 6 and 10 years of age. There was a substantial prevalence of male patients-18 cases (66.6%). Most of the children with CHCy were from rural areas. The cysts were all located in the cerebral hemispheres (none in the posterior fossa). Usually two or three lobes were affected and the cysts were most often retrorolandic. Only 8 patients (29.6%) also had pulmonary or hepatic infestation. All patients were operated on immediately the diagnosis was established. Operative mortality was very low (1 patient died immediately after surgery). There have been 11 cases of recurrence; all these patients have been reoperated on. Neurological sequelae were mainly partial and general seizures. Epilepsy developed postoperatively in five patients. Paresis, which usually disappears in time, was the most common motor disturbance. Two other important postoperative complications were subdural effusion and ventricular dilatation (six cases). There have been five cases of multiple recurrences (four of these patients have since died). Treatment with albendazole was used in three cases without significant results.

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The case here presented is one of the histoplasmosis cases occurring sporadically in Romania. It is the first case with cerebral site and with the aspect of an extensive intracranial process. The diagnosis was made by a careful microscopic examination of the intraoperative specimens.

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A number of 20,000 children representing 91.19% of all the enlisted children aged 6-14 years were examined. The clinical status of each child was assessed according to the WHO criteria. Goiter was found in 3,363 (16.81%) children. Of these, 1504 (44.72%) were boys and the zero degree, 2,137 (63.54%) to the 1 degree and 84 (2.49%) to the 2nd degree. As related to the total number of children examined, the zero degree goiter was found in 5.71%, the ist degree in 10.68% and the 2nd degree in 0.42% of the cases. The incidence of goiter in rural and urban areas was in the range of 6.80%-38.46%. Only in 2 areas the incidence was higher: 42.33% and 60%. A predominantly increased incidence was found in those areas which were not screened in 1951 and consequently prophylaxis was not constantly applied.

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The authors have determined the neuro-muscular functional parameters of conductibility and excitability in normal and hyperthyroidized rats. The determination of hyperthyroidization and of the neuro-muscular functional parameters was accomplished by utilizing an own experimental model. The data obtained in rats were compared with those established by authors in normals and in patients suffering from hyperthyroidism. It resulted clearly that in rats hyperthyroidization disturbs particularly the conductibility of motor fibres while in man hyperthyroidism modified especially the excitability of motor fibres.

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The authors carried out a clinical, chemical and medico-social study of an endemic focus in the Arges Valley. Iodine deficiency and partially water hardness constitute the main goitrogenic factors. Owing to the curative-prophylactic means, the goitre frequency substantially decreased in school children (from 98.5% in 1949 to 18.3% in 1969) and serious forms of the third degree did not occur in the last 14 years. A certain percentage of diffuse goitre still remains in school children besides the residual pathology before the iodized prophylaxis. In the period when the prophylaxis with KI (potassium iodine) troches was neglected, a slight increase of goitre frequency was found in the investigated groups.

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Out of a total number of 875 cases of thyroid affections of various origins, hospitalized in the two surgical clinics of Tîrgu-Mures, the authors selected 16 cases of subacute and chronic thyroiditis. They indicate the difficulties encountered in establishing the diagnosis before surgery, a fact that determined wide excisions in extremely difficult local conditions. They suggest, as a first therapeutic attitude, a conservative treatment with steroid drugs, antibiotics and roentgentherapy (when necessary), and, if such treatments fail, or when malignancies are suspected, as well as compression phenomena have developed, surgical treatment preceded by an extemporaneous anatomo-pathological examination. When thyroiditis is diagnosed surgery should be limited to decompressing incisions.

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