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Sample records for intra-hepatic porto-systemic shunt

  1. Intra-hepatic arterioportal shunt mimicking a metastatic liver tumor: report of a case.

    PubMed

    Haruki, Koichiro; Wakiyama, Shigeki; Shiba, Hiroaki; Ishida, Yuichi; Yanaga, Katsuhiko

    2012-04-01

    The differential diagnosis of an arterioportal shunt (APS) is difficult and important. We report a case of an intra-hepatic APS mimicking a metastatic liver tumor on imaging scans in a patient without hepatic cirrhosis. The patient was a 64-year-old woman, who had undergone low anterior resection of the rectum for advanced rectal cancer, followed 2 months later by right hemihepatectomy, including the middle hepatic vein, for a synchronous metastatic liver tumor. About 2 years after the hepatectomy, a follow-up CT scan showed a new mass in the remnant liver, suggestive of a metastatic liver tumor, the assumption of which was further supported by an elevated serum carcinoembryonic antigen (CEA) level. However, the findings of magnetic resonance imaging were not consistent with a malignant tumor, and Doppler ultrasonography showed a low echoic area connected with the portal vein branch and the hepatic artery branch. Thus, we diagnosed intra-hepatic APS. The patient remains well without signs of growth of the hepatic lesion, although with fluctuating serum CEA levels.

  2. An unusual cause of progressive cyanosis post Fontan operation: congenital extra-hepatic porto-systemic shunt.

    PubMed

    Layangool, Thanarat; Kojaranjit, Vichao; Promphan, Worakan; Kirawittaya, Tawatchai; Sangtawesin, Chaisit; Prachasilchai, Pimpak

    2014-06-01

    To report an unusual case of progressive cyanosis post Fontan operation due to porto-systemic venous shunt and the result of its treatment. A patient with diagnosis of progressive cyanosis post Fontan operation from porto-systemic venous shunt at QSNICH RESULTS: This is a case of twelve years old girl, who had diagnosis of situs solitus, levocardia, atrio-ventricular concordant, ventriculo-arterial concordant, hypoplastic right ventricle with large ventricular septal defect. She had pulmonary artery banding at 4 months of age followed by a non-fenestrated extra-cardiac conduit Fontan performed at 7 years and 7 months of age. During the first year of post operation, her systemic oxygen saturation (SpO2) was 93-94% after which it decreased to 87%, 84%, 75% at 1.5, 2.5 and 3 years after surgery, respectively. Clinically she also had progressive dyspnea on exertion. Diffuse pulmonary arterio-venous malformation was demonstrated by contrast echocardiogram during cardiac catheterization. Cardiac magnetic resonance angiography showed abnormal extra-hepatic portal vein to inferior vena cava shunt. After balloon test occlusion in the cath lab, which showed no change in the portal venous pressure, complete occlusion of this porto-systemic venous shunt was performed by using Amplatzer Vascular Plug II. Her systemic oxygen saturation increased to 83% with functional class I at one-year post occlusion. The present report an unusual case of progressive cyanosis post Fontan operation due to pulmonary arteriovenous malformation, which was secondary to congenital extra-hepatic porto-systemic shunt. The venous blood from the intestinal and splenic veins was partially bypassing the liver into inferior vena cava. The patient's clinical condition and SpO2 improved after transcatheter occlusion of the shunt with the device.

  3. Transjugular Intrahepatic Porto-Systemic Shunt Placement in a Patient with Left-Lateral Split-Liver Transplant and Mesenterico-Left Portal Vein by Pass Placement

    SciTech Connect

    Miraglia, Roberto Maruzzelli, Luigi; Luca, Angelo

    2011-12-15

    This is a report of a successful placement of a transjugular intrahepatic porto-systemic shunt in a young patient with previous left-lateral, split-liver transplant and mesenterico-left portal vein by pass placement after posttransplant extrahepatic portal vein thrombosis.

  4. Embolization of congenital intrahepatic porto-systemic shunt by n-butyl cyanoacrylate.

    PubMed

    Gupta, Vivek; Kalra, Naveen; Vyas, Sameer; Sodhi, K S; Thapa, B R; Khandelwal, N

    2009-10-01

    Congenital intrahepatic portosystemic venous shunt (IHPSVS) is rare vascular anomaly. We present one case of a 14-month male child who presented with global developmental delay. Child had high ammonia levels with low glutamine and high bile salts on the previous investigations and had history of neonatal seizures since day 13 of life. On admission, serum ammonia levels were elevated to 112micromol/L. Other laboratory investigations including liver and renal function test, and electrolytes were normal. He was, diagnosed to have IHPSVS on the basis of Doppler and CT, and treated by embolization with n-butyl cyanoacrylate (glue). A brief review of diagnostic modalities and endovascular management for the IHPSVS is presented including the present case.

  5. Trans-jugular intrahepatic porto-systemic shunt placement for refractory ascites: a ‘real-world’ UK health economic evaluation

    PubMed Central

    Parker, Matthew J; Guha, Neil; Stedman, Brian; Hacking, Nigel; Wright, Mark

    2013-01-01

    Objective To assess the benefit of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement for refractory ascites. Design A retrospective observational study of all patients undergoing TIPS for refractory ascites in our hospital between 2003 and 2012. Setting Secondary care. Patients Cirrhotic patients with refractory ascites. Main outcome measures We examined direct real-world (National Health Service) health related costs in the year before and after the TIPS procedure took place. Data were collected relating to the need for reintervention and hepatic encephalopathy. Results Data were available for 24 patients who underwent TIPS for refractory ascites (86% of eligible patients). TIPS was technically successful in all cases. Mean number of bed days in the year prior to TIPS was 30.3 and 14.3 in the year following (p=0.005). No patient had ascites at the end of the year after the TIPS with less requirement for paracentesis over the course of the year (p<0.001). Mean reduction in cost was £2759 per patient. TIPS was especially cost-effective in patients requiring between 6 and 12 drains per year with a mean saving of £9204 per patient. Conclusions TIPS is both a clinically effective and economically advantageous therapeutic option for selected patients with refractory ascites. PMID:28839725

  6. [Portal hypertension in children. Therapeutic approach in cases of failure of a portosystemic shunt].

    PubMed

    Heloury, Y; Valayer, J; Hay, J M; Gauthier, F; Alagille, D

    1986-01-01

    88 porto systemic shunts were performed between 1977-1985; 14 failures were observed. These failures occurred in ten children with extra-hepatic portal obstruction and in four with intra-hepatic obstruction. The treatment of these failures was different in these two groups: 7 reoperations in the extra-hepatic obstruction, none in the intra-hepatic. That reoperation is often not suitable in the intrahepatic obstruction because of the hepatic failure. The use of sclerotherapy or the beta receptor blocking agents is discussed in this group.

  7. Impact of transjugular intrahepatic porto-systemic shunt on post liver transplantation outcomes: Study based on the United Network for Organ Sharing database

    PubMed Central

    Mumtaz, Khalid; Metwally, Sherif; Modi, Rohan M; Patel, Nishi; Tumin, Dmitry; Michaels, Anthony J; Hanje, James; El-Hinnawi, Ashraf; Hayes Jr, Don; Black, Sylvester M

    2017-01-01

    AIM To determine the impact of transjugular intrahepatic porto-systemic shunt (TIPS) on post liver transplantation (LT) outcomes. METHODS Utilizing the United Network for Organ Sharing (UNOS) database, we compared patients who underwent LT from 2002 to 2013 who had underwent TIPS to those without TIPS for the management of ascites while on the LT waitlist. The impact of TIPS on 30-d mortality, length of stay (LOS), and need for re-LT were studied. For evaluation of mean differences between baseline characteristics for patients with and without TIPS, we used unpaired t-tests for continuous measures and χ2 tests for categorical measures. We estimated the impact of TIPS on each of the outcome measures. Multivariate analyses were conducted on the study population to explore the effect of TIPS on 30-d mortality post-LT, need for re-LT and LOS. All covariates were included in logistic regression analysis. RESULTS We included adult patients (age ≥ 18 years) who underwent LT from May 2002 to September 2013. Only those undergoing TIPS after listing and before liver transplant were included in the TIPS group. We excluded patients with variceal bleeding within two weeks of listing for LT and those listed for acute liver failure or hepatocellular carcinoma. Of 114770 LT in the UNOS database, 32783 (28.5%) met inclusion criteria. Of these 1366 (4.2%) had TIPS between the time of listing and LT. We found that TIPS increased the days on waitlist (408 ± 553 d) as compared to those without TIPS (183 ± 330 d), P < 0.001. Multivariate analysis showed that TIPS had no effect on 30-d post LT mortality (OR = 1.26; 95%CI: 0.91-1.76) and re-LT (OR = 0.61; 95%CI: 0.36-1.05). Pre-transplant hepatic encephalopathy added 3.46 d (95%CI: 2.37-4.55, P < 0.001), followed by 2.16 d (95%CI: 0.92-3.38, P = 0.001) by TIPS to LOS. CONCLUSION TIPS did increase time on waitlist for LT. More importantly, TIPS was not associated with 30-d mortality and re-LT, but it did lengthen hospital LOS after

  8. A retrospective analysis of the impact of diastolic dysfunction on one-year mortality after transjugular intrahepatic porto-systemic shunt, liver transplantation and non-transplant abdominal surgery in patients with cirrhosis

    PubMed Central

    Shounak, Majumder; Vimal, Rabdiya; Colin, Swales; David I, Silverman

    2015-01-01

    Background The incidence of diastolic dysfunction (DD) approaches 40% in patients with cirrhosis. However, the clinical impact of DD remains a subject of considerable debate. Surgery in patients with cirrhosis is innately hazardous. Diastolic heart failure has been linked to increased mortality after transjugular intrahepatic porto-systemic shunt surgery (TIPSS). To date, none of the commonly accepted preoperative risk assessment models applied to patients with liver disease incorporates DD. We aimed to examine the relationship between DD and postoperative outcomes in patients with cirrhosis undergoing abdominal surgery. Methods Patients with cirrhosis who underwent abdominal surgery between January 2000 and December 2011 were included if they had preoperative echocardiography done within 3 months of surgery. The echocardiographic images were reviewed using flow and tissue Doppler techniques to identify the presence of DD. Outcomes analyzed included one-year mortality and postoperative complications. Results A total of 140 patients were included in the study of which 63 patients (45%) met pre-established criteria for DD. Those with DD were older (P < 0.005) and less likely to have an isolated viral etiology of cirrhosis (P<0.05). The one-year mortality rate was 22.2% (14/63) in patients with DD and 20.8% (16/77) in those without DD (P=0.42). Postoperative complications were not statistically different in the two groups. Conclusion DD is common in patients with cirrhosis. In patients with cirrhosis undergoing TIPS and/or abdominal surgery, the presence of DD does not increase post-procedure complications or one-year mortality. PMID:26129720

  9. Ligation of huge spontaneous porto-systemic collaterals to avoid portal inflow steal in adult living donor liver transplantation: A case-report.

    PubMed

    Elshobary, Mohamed; Shehta, Ahmed; Salah, Tarek; Sultan, Ahmed Mohamed; Shiha, Usama; Elghawalby, Ahmed Nabieh; Monier, Ahmed; Elsadany, Mohamed; AmrYassen; Fathy, Omar; Wahab, Mohamed Abdel

    2017-01-01

    In adult living donor liver transplantation (LDLT), maintenance of adequate portal inflow is essential for the graft regeneration. Portal inflow steal (PFS) may occur due to presence of huge spontaneous porto-systemic collaterals. A surgical procedure to increase the portal inflow is rarely necessary in adult LDLT. A 52 years male patient with end-stage liver disease due to chronic hepatitis C virus infection. Preoperative portography showed marked attenuated portal vein and its two main branches, patent tortuous splenic vein, multiple splenic hilar collaterals, and large lieno-renal collateral. He received a right hemi-liver graft from his nephew. Exploration revealed markedly cirrhotic liver, moderate splenomegaly with multiple collaterals and large lieno-renal collateral. Upon dissection of the hepato-duodenal ligament, a well-developed portal vein could be identified with a small mural thrombus. The recipient portal vein stump was anastomosed, in end to end fashion, to the graft portal vein. Doppler US showed reduced portal vein flow, so ligation of the huge lieno-renal collateral that allows steal of the portal inflow. After ligation of the lieno-renal collateral, improvement of the portal vein flow was observed in Doppler US. There is no accepted algorithm for managing spontaneous lieno-renal shunts before, during, or after liver transplantation, and evidence for efficacy of treatments remains limited. We report a case of surgical interruption of spontaneous huge porto-systemic collateral to prevent PFS during adult LDLT. Complete interruption of large collateral vessels might be needed as a part of adult LDLT procedure to avoid devastating postoperative PFS. Copyright © 2016. Published by Elsevier Ltd.

  10. Ventriculosinus shunt.

    PubMed

    Toma, Ahmed K; Tarnaris, Andrew; Kitchen, Neil D; Watkins, Laurence D

    2010-04-01

    Hydrocephalus can be managed successfully with cerebrospinal fluid shunting to extracranial compartments, most commonly the peritoneum. However, current shunt systems are not ideal with high revision rates on long-term follow-up. Draining the cerebrospinal fluid from the cerebral ventricles to the cerebral venous sinuses could mimic the physiological conditions with the added advantages of avoiding overdrainage and extracranial recipient site complications. A literature search was carried out using the keywords hydrocephalus, shunt, venous sinus and sagittal sinus. Seven clinical series of ventriculosinus shunts with a total of 265 patients were found. None of the patients developed venous sinus thrombosis, air embolism or intra-operative sinus bleeding. Ventriculosinus shunt is a potential alternative that can be done under local anaesthetic in ill patients where traditional shunts recipient sites are not feasible. However, further studies with extended follow-up period would provide better understanding of the suitability and indications of this technique.

  11. A Newborn with an Alternative Porto-Caval Shunt

    PubMed Central

    Damar, Çağrı; Alımlı, Ayşe Gül; Derinkuyu, Betül Emine; Özcan, Kudret Ebru; Olgaç, Asburçe; Koç, Ali Murat

    2017-01-01

    Summary Background Absent ductus venosus (ADV) is a rare condition, but it should be known that this embryonic anomaly may be detected by fetal echocardiographic or newborn ultrasound examinations. Case Report We present a baby with an ADV and an accompanying alternative porto-caval shunt between the right portal vein and inferior vena cava detected on postnatal ultrasound examination. Conclusions Variations in the fetal umbilical or porto-systemic circulations should be detected by fetal or newborn ultrasound examinations and kept in mind before common interventions such as UV catheterizations. PMID:28685004

  12. A Newborn with an Alternative Porto-Caval Shunt.

    PubMed

    Damar, Çağrı; Alımlı, Ayşe Gül; Derinkuyu, Betül Emine; Özcan, Kudret Ebru; Olgaç, Asburçe; Koç, Ali Murat

    2017-01-01

    Absent ductus venosus (ADV) is a rare condition, but it should be known that this embryonic anomaly may be detected by fetal echocardiographic or newborn ultrasound examinations. We present a baby with an ADV and an accompanying alternative porto-caval shunt between the right portal vein and inferior vena cava detected on postnatal ultrasound examination. Variations in the fetal umbilical or porto-systemic circulations should be detected by fetal or newborn ultrasound examinations and kept in mind before common interventions such as UV catheterizations.

  13. Ventriculoperitoneal shunt

    MedlinePlus

    ... of ventriculoperitoneal shunt. In: Jandial R, McCormick PC, Black PM, eds. Core Techniques in Operative Neurosurgery . Philadelphia, PA: Elsevier Saunders; ... Updated by: Joseph V. Campellone, MD, Division of Neurology, Cooper University ...

  14. Ventriculoperitoneal shunt - discharge

    MedlinePlus

    ... ventriculoperitoneal - discharge; VP shunt - discharge; Shunt revision - discharge; Hydrocephalus shunt placement - discharge ... Your child has hydrocephalus and needed a shunt placed to drain excess fluid and relieve pressure in the brain. This buildup of brain ...

  15. Digital histology quantification of intra-hepatic fat in patients undergoing liver resection.

    PubMed

    Parkin, E; O'Reilly, D A; Plumb, A A; Manoharan, P; Rao, M; Coe, P; Frystyk, J; Ammori, B; de Liguori Carino, N; Deshpande, R; Sherlock, D J; Renehan, A G

    2015-08-01

    High intra-hepatic fat (IHF) content is associated with insulin resistance, visceral adiposity, and increased morbidity and mortality following liver resection. However, in clinical practice, IHF is assessed indirectly by pre-operative imaging [for example, chemical-shift magnetic resonance (CS-MR)]. We used the opportunity in patients undergoing liver resection to quantify IHF by digital histology (D-IHF) and relate this to CT-derived anthropometrics, insulin-related serum biomarkers, and IHF estimated by CS-MR. A reproducible method for quantification of D-IHF using 7 histology slides (inter- and intra-rater concordance: 0.97 and 0.98) was developed. In 35 patients undergoing resection for colorectal cancer metastases, we measured: CT-derived subcutaneous and visceral adipose tissue volumes, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), fasting serum adiponectin, leptin and fetuin-A. We estimated relative IHF using CS-MR and developed prediction models for IHF using a factor-clustered approach. The multivariate linear regression models showed that D-IHF was best predicted by HOMA-IR (Beta coefficient(per doubling): 2.410, 95% CI: 1.093, 5.313) and adiponectin (β(per doubling): 0.197, 95% CI: 0.058, 0.667), but not by anthropometrics. MR-derived IHF correlated with D-IHF (rho: 0.626; p = 0.0001), but levels of agreement deviated in upper range values (CS-MR over-estimated IHF: regression versus zero, p = 0.009); this could be adjusted for by a correction factor (CF: 0.7816). Our findings show IHF is associated with measures of insulin resistance, but not measures of visceral adiposity. CS-MR over-estimated IHF in the upper range. Larger studies are indicated to test whether a correction of imaging-derived IHF estimates is valid. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. [Small-diameter portosystemic shunts: indications and limitations].

    PubMed

    Angel Mercado, M; Granados-García, J; Barradas, F; Chan, C; Contreras, J L; Orozco, H; Angel-Mercado, M

    1998-01-01

    Low diameter porto-systemic shunts for the treatment of portal hypertension bleeding have emerged as a consequence of the technical development of vascular grafts (PTFE) that allow the use of a narrow lumen. The experience with this kind of operation at the Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City during a 6-year period is reported. There were twenty-seven patients with good liver function (Child-Pugh A-B) were operated or electively, average Age 47.5 years (range 17-71), twenty three patients with liver cirrhosis, one with portal fibrosis and three with idiopathic portal hypertension. Operative mortality: 4%. Rebleeding: 14%. Postoperative encephalopathy was observed in 14 of 27, three of them being grade III-IV (11%). In the remaining 11 cases, it was mild and easily controlled. Postoperative angiography showed shunt patency in 81% of the cases; in 33% of the cases, portal vein diameter reduction was shown, as well as two cases with portal vein thrombosis. In 77% of the cases, adequate postoperative quality of life was observed. Survival (Kaplan-Meier): 86% at 12 months and 56% at 60 months. These kinds of shunts are a good alternate choice for patients considered for surgery, in which other portal blood flow preserving procedures (selective shunts, devascularization with transection) are not feasible.

  17. Cryptococcal ventriculoperitoneal shunt infection.

    PubMed

    Viereck, Matthew J; Chalouhi, Nohra; Krieger, David I; Judy, Kevin D

    2014-11-01

    The standard treatment of hydrocephalus is placement of a ventriculoperitoneal (VP) shunt. While infection is a common complication, rarely are fungal organisms implicated. Cryptococcus neoformans has been reported in only nine cases of shunt infection to our knowledge. The timing from shunt placement to symptom onset varies widely from 10 days to 15 months. We present a patient who developed a cryptococcal infection of his VP shunt more than two decades following shunt placement.

  18. Ventriculomammary shunt: an unusual ventriculoperitoneal shunt complication.

    PubMed

    Chaudhry, Nauman S; Johnson, Jeremiah N; Morcos, Jacques J

    2015-02-01

    Ventriculoperitoneal (VP) shunt malfunctions are common and can result in significant consequences for patients. Despite the prevalence of breast augmentation surgery and breast surgery for other pathologies, few breast related VP shunt complications have been reported. A 54-year-old woman with hydrocephalus post-subarachnoid hemorrhage returned 1 month after VP shunt placement complaining of painful unilateral breast enlargement. After investigation, it was determined that the distal VP shunt catheter had migrated from the peritoneal cavity into the breast and wrapped around her breast implant. The breast enlargement was the result of cerebrospinal fluid retention. We detail this unusual case and review all breast related VP shunt complications reported in the literature. To avoid breast related complications related to VP shunt procedures, it is important to illicit pre-procedural history regarding breast implants, evade indwelling implants during catheter tunneling and carefully securing the abdominal catheter to prevent retrograde catheter migration to the breast.

  19. Improving patient selection for selective internal radiation therapy of intra-hepatic cholangiocarcinoma: A meta-regression study.

    PubMed

    Cucchetti, Alessandro; Cappelli, Alberta; Mosconi, Cristina; Zhong, Jian-Hong; Cescon, Matteo; Pinna, Antonio D; Golfieri, Rita

    2017-07-01

    Selective internal radiation therapy (SIRT) is emerging as a potential therapy for unresectable intra-hepatic cholangiocarcinoma (iCCA) able to prolong life-expectancy. Aim of this study was to collect available literature meta-analyse data and results and investigate sources of heterogeneity through a meta-regression approach before suggesting SIRT as a valuable option. A systematic review of studies published until 1 September 2016 in PubMed and Scopus databases was performed. Patient survival was the primary outcome measure. Meta-analysis was performed using a random-effects model. Meta-regression was applied to investigate relationships existing between clinical and tumour features and the primary outcome. Nine observational studies were included in the analysis involving 224 patients. The 1-, 2- and 3-year pooled survival estimates were 55.7%, 33.1% and 20.2%. Clinical and tumour characteristics showed medium-to-considerable heterogeneity (I(2) >50%). Meta-regression analysis showed that determinants of best survivals were the presence of mass-forming iCCA type (median survival=19.9 months vs 8.1 months for the infiltrative type; P=.002) that also accounted for most of the heterogeneity between included studies (residual I(2) =0); SIRT as first-line therapy (median survival=24 months vs 11.5 months for non-naïve patients; P=.048) and the adoption of concomitant chemotherapy (median survival 19.5 months vs 5.5 months in patients not receiving chemotherapy; P=.042). There is considerable heterogeneity between studies highlighting that indications for SIRT are extremely varied. To ameliorate SIRT results naïve patients with mass-forming iCCA should be selected as the best candidates with the possibility of adding concomitant standard chemotherapy. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. [A case of double cancer of gastric and hepatocellular carcinoma associated with cirrhosis treated by hepatic resection after intra-hepatic arterial infusion chemotherapy].

    PubMed

    Une, Y; Nagabuchi, E; Ogasawara, K; Kamiyama, T; Sato, Y; Kawamukai, Y; Sato, N; Nakajima, Y; Uchino, J

    1990-08-01

    A case of double cancer, early gastric cancer and hepatocellular carcinoma, was reported. The patient was diabetic and had liver cirrhosis. After gastrectomy for gastric cancer which was hemorrhagic, he was treated by intra-hepatic arterial infusion chemotherapy followed by hepatic resection. Histopathologically, about half of the main tumor showed necrosis, but very viable new cancer cell nests were seen around the main nodule. The patient is in good condition without recurrence of hepatic lesion 1 year after resection. The usefulness of arterial infusion chemotherapy was demonstrated in the case of double cancer, in which it is difficult to resect both cancers simultaneously.

  1. Hydrocephalus and Shunts

    MedlinePlus

    ... Tomography (CT) scan or a Magnetic Resonance Imaging (MRI) scan will show this build-up, but a shunt ... doesn’t show up on a CT or MRI scan. New, long- term treatments using small endoscopes may ...

  2. Ventriculoperitoneal shunt - slideshow

    MedlinePlus

    ... ency/presentations/100123.htm Ventriculoperitoneal shunt - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  3. [Research advances in diagnosis and treatment of post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy].

    PubMed

    Yang, J F; Zhang, B Q

    2016-07-20

    Transjugular intrahepatic portosystemic shunt (TIPS) has become an important minimally invasive interventional technique for the treatment of complications of cirrhotic portal hypertension, and currently, it is often used in cirrhotic patients with esophagogastric variceal bleeding (EVB), intractable ascites, hepatic hydrothorax, and Budd-Chiari syndrome. On one hand, TIPS can effectively reduce portal vein pressure and the risk of EVB and intractable ascites; on the other hand, it may reduce the blood flow in liver perfusion, aggravate liver impairment, and cause porto-systemic encephalopathy. Related influencing factors should be evaluated comprehensively in order to prevent the development of post-TIPS hepatic encephalopathy. The diagnosis and treatment of post-TIPS hepatic encephalopathy is still a great challenge in current clinical practice. This article reviews the diagnosis and treatment of post-TIPS hepatic encephalopathy to enhance people's knowledge of this disease.

  4. Shunt tube calcification as a late complication of ventriculoperitoneal shunting.

    PubMed

    Salim, Abubakr Darrag; Elzain, Mohammed Awad; Mohamed, Haddab Ahmed; Ibrahim Zayan, Baha Eldin Mohamed

    2015-01-01

    Shunt calcification is a rare complication of ventriculoperitoneal shunting that occurs years later after the initial operation this condition is rarely reported in literature. Two patients with shunt calcifications were described. The first patient was 17-year-old lady who had congenital hydrocephalus and shunted in the early infancy, she was presented recently complaining of itching of the skin along the shunt track and limitation of neck movement. The patient was then operated with removal of the old peritoneal catheter and replacing it with a new one. The second patient was 17-year-old boy originally was a case of posterior fossa pilocytic astrocytoma associated with obstructive hydrocephalus, he was operated with both shunting for the hydrocephalus and tumor removal, 6 years later he presented with shunt exposure. Calcification of the shunt tube was discovered intraoperatively upon shunt removal. Shunt calcification has been observed mainly in barium-impregnated catheters. Introducing plain silicone-coated shunt tubing may reduce the rate of this condition. The usual complaints of the patients suffering from this condition are pain in the neck and chest wall along the shunt pathway and limitation of the neck movement due to shunt tube tethering, but features of shunt dysfunction and skin irritation above the shunt may be present. In this review, plain X-ray and operative findings showed that the most extensive calcification is present in the neck, where the catheters were subject to heavy mechanical stress. Disturbed calcium and phosphate metabolisms may be involved in this condition. Shunt calcification is a rare condition that occurs due to material aging presenting with features of shunt tethering, dysfunction or overlying skin irritation. Plain X-ray is needed to detect calcification while shunt removal, replacement or endoscopic third ventriculostomy may carry solution for this condition.

  5. Shunt tube calcification as a late complication of ventriculoperitoneal shunting

    PubMed Central

    Salim, Abubakr Darrag; Elzain, Mohammed Awad; Mohamed, Haddab Ahmed; Ibrahim Zayan, Baha Eldin Mohamed

    2015-01-01

    Shunt calcification is a rare complication of ventriculoperitoneal shunting that occurs years later after the initial operation this condition is rarely reported in literature. Two patients with shunt calcifications were described. The first patient was 17-year-old lady who had congenital hydrocephalus and shunted in the early infancy, she was presented recently complaining of itching of the skin along the shunt track and limitation of neck movement. The patient was then operated with removal of the old peritoneal catheter and replacing it with a new one. The second patient was 17-year-old boy originally was a case of posterior fossa pilocytic astrocytoma associated with obstructive hydrocephalus, he was operated with both shunting for the hydrocephalus and tumor removal, 6 years later he presented with shunt exposure. Calcification of the shunt tube was discovered intraoperatively upon shunt removal. Shunt calcification has been observed mainly in barium-impregnated catheters. Introducing plain silicone-coated shunt tubing may reduce the rate of this condition. The usual complaints of the patients suffering from this condition are pain in the neck and chest wall along the shunt pathway and limitation of the neck movement due to shunt tube tethering, but features of shunt dysfunction and skin irritation above the shunt may be present. In this review, plain X-ray and operative findings showed that the most extensive calcification is present in the neck, where the catheters were subject to heavy mechanical stress. Disturbed calcium and phosphate metabolisms may be involved in this condition. Shunt calcification is a rare condition that occurs due to material aging presenting with features of shunt tethering, dysfunction or overlying skin irritation. Plain X-ray is needed to detect calcification while shunt removal, replacement or endoscopic third ventriculostomy may carry solution for this condition. PMID:26396620

  6. Shunting in cryptococcal meningitis.

    PubMed

    Cherian, Jacob; Atmar, Robert L; Gopinath, Shankar P

    2016-07-01

    OBJECT Patients with cryptococcal meningitis often develop symptomatic intracranial hypertension. The need for permanent CSF diversion in these cases remains unclear. METHODS Cases of cryptococcal meningitis over a 5-year period were reviewed from a single, large teaching hospital. Sources of identification included ICD-9 codes, operative logs, and microscopy laboratory records. RESULTS Fifty cases of cryptococcal meningitis were identified. Ninety-eight percent (49/50) of patients were HIV positive. Opening pressure on initial lumbar puncture diagnosing cryptococcal meningitis was elevated (> 25 cm H2O) in 33 cases and normal (≤ 25 cm H2O) in 17 cases. Thirty-eight patients ultimately developed elevated opening pressure over a follow-up period ranging from weeks to years. Serial lumbar punctures for relief of intracranial hypertension were performed in 29 cases. Thirteen of these patients ultimately had shunting procedures performed after failing to improve clinically. Two factors were significantly associated with the need for shunting: patients undergoing shunt placement were more likely to be women (5/13 vs 0/16; p = 0.01) and to have a pattern of increasing CSF cryptococcal antigen (10/13 vs 3/16 cases; p = 0.003). All patients re-presenting with mycological relapse either underwent or were offered shunt placement. CONCLUSIONS Neurosurgeons are often asked to consider CSF diversion in cases of cryptococcal meningitis complicated by intracranial hypertension. Most patients do well with serial lumbar punctures combined with antifungal therapy. When required, shunting generally provided sustained relief from intracranial hypertension symptoms. Ventriculoperitoneal shunts are the favored method of diversion. To the authors' knowledge, the present study is the largest series on diversionary shunts in primarily HIV-positive patients with this problem.

  7. residue and shunting pinholes

    NASA Astrophysics Data System (ADS)

    Gorji, Nima E.

    2014-09-01

    The present work considers two observable phenomena through the experimental fabrication and electrical characterization of the rf-sputtered CdS/CdTe thin film solar cells that extremely reduce the overall conversion efficiency of the device: CdCl2 residue on the surface of the semiconductor and shunting pinholes. The former happens through nonuniform treatment of the As-deposited solar cells before annealing at high temperature and the latter occurs by shunting pinholes when the cell surface is shunted by defects, wire-like pathways or scratches on the metallic back contact caused from the external contacts. Such physical problems may be quite common in the experimental activities and reduce the performance down to 4-5 % which leads to dismantle the device despite its precise fabrication. We present our electrical characterization on the samples that received wet CdCl2 surface treatment (uniform or nonuniform) and are damaged by the pinholes.

  8. TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT

    PubMed Central

    Patidar, Kavish R.; Sydnor, Malcolm; Sanyal, Arun J.

    2014-01-01

    Transjugular intrahepatic portosystemic shunt (TIPS) is an established procedure for the complications of portal hypertension. The largest body of evidence for its use has been supported for recurrent or refractory variceal bleeding and refractory ascites. Its use has also been advocated for acute variceal bleed, hepatic hydrothorax, and hepatorenal syndrome. With the replacement of bare metal stents with polytetrafluoroethylen (PTFE) covered stents, shunt patency has improved dramatically thus improving outcomes. Therefore, reassessment of its utility, management of its complications, and understanding of various TIPS techniques is important. PMID:25438287

  9. Spinal arteriovenous shunts in children.

    PubMed

    Davagnanam, Indran; Toma, Ahmed K; Brew, Stefan

    2013-11-01

    Pediatric spinal arteriovenous shunts are rare and, in contrast to those in adults, are often congenital or associated with underlying genetic disorders. These are thought to be a more severe and complete phenotypic spectrum of all spinal arteriovenous shunts seen in the overall spinal shunt population. The pediatric presentation thus accounts for its association with significant morbidity and, in general, a more challenging treatment process compared with the adult presentation.

  10. Coagulopathy post peritoneovenous shunt.

    PubMed Central

    LeVeen, H H; Ip, M; Ahmed, N; Hutto, R B; LeVeen, E G

    1987-01-01

    In 1942, 53% of medically treated patients with cirrhosis were dead 6 months after the onset of ascites. Only 30% survived 1 year. This dismal outlook has improved only slightly with advances in medicine. Yet, some internists reject the peritoneovenous shunt (PVS) for this fatal condition even if they are aware that a diminished blood volume causes the abnormal sodium retention responsible for ascites. Their objections are based on life-threatening complications of PVS, especially post shunt coagulopathy (PSC). Blood shed into the peritoneal cavity becomes incoagulable. Such blood is immediately coagulated by a protocoagulant (soluble collagen) and concurrently lysed by tissue plasminogen activator (TPA) secreted by the peritoneal serosa. Wide zones of lysis surround peritoneal tissue placed on fibrin plates. Large volumes of ascitic fluid infused into circulating blood simulates the fate of blood shed into the peritoneal cavity with lysis playing the major role. Addition of ascitic fluid to normal platelet-rich plasma in vitro initiates clot lysis on thromboelastogram (TEG). Epsilon-aminocaproic acid (EACA) counteracts this lysis. EACA and clotting factors normalize the TEG and arrest PSC. Disposal of ascitic fluid at surgery prevents or ameliorates PSC. Mild PSC was encountered only twice in 150+ consecutive patients (1.3%) with only one case being clinically significant (0.6%). Severe PSC occurred seven times in 98 early shunt patients whose ascitic fluid was not discarded. Severe PSC requires shunt interruption and control of bleeding with clotting factors and EACA. Peritoneal lavage with saline prevents the recurrence of PSC on reopening the shunt. In four patients, EACA and clotting factors were adequate to arrest coagulopathy. Three earlier patients died of PSC before its cause and treatment were understood. Proper management eliminates this life-threatening complication, and PSC cannot be considered a deterrent to PVS. Disseminated intravascular

  11. Aqueous shunts for glaucoma.

    PubMed

    Tseng, Victoria L; Coleman, Anne L; Chang, Melinda Y; Caprioli, Joseph

    2017-07-28

    Aqueous shunts are employed to control intraocular pressure (IOP) for people with primary or secondary glaucomas who fail or are not candidates for standard surgery. To assess the effectiveness and safety of aqueous shunts for reducing IOP in glaucoma compared with standard surgery, another type of aqueous shunt, or modification to the aqueous shunt procedure. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 8), MEDLINE Ovid (1946 to August 2016), Embase.com (1947 to August 2016), PubMed (1948 to August 2016), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to August 2016), ClinicalTrials.gov (www.clinicaltrials.gov); searched 15 August 2016, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 15 August 2016. We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 15 August 2016. We also searched the reference lists of identified trial reports and the Science Citation Index to find additional trials. We included randomized controlled trials that compared various types of aqueous shunts with standard surgery or to each other in eyes with glaucoma. Two review authors independently screened search results for eligibility, assessed the risk of bias, and extracted data from included trials. We contacted trial investigators when data were unclear or not reported. We graded the certainty of the evidence using the GRADE approach. We followed standard methods as recommended by Cochrane. We included 27 trials with a total of 2099 participants with mixed diagnoses and comparisons of interventions. Seventeen studies reported adequate methods of randomization, and seven reported adequate allocation concealment. Data collection and follow-up times varied.Four trials compared an aqueous shunt (Ahmed or Baerveldt) with trabeculectomy, of which

  12. Peritoneovenous shunting in intractable ascites

    PubMed Central

    Deans, G T; Spence, R A J; Johnston, G W

    1985-01-01

    Fourteen patients in whom peritoneovenous shunts were inserted for intractable ascites or malignancy were reviewed. Reduction in ascites was obtained in all patients by the time of discharge with significant diuresis and weight loss. Significant decrease in haemoglobin, packed cell volume, platelet count and prothrombin time also occurred. Coagulation studies were abnormal in 60 per cent of patients in whom they were performed with bruising or detectable bleeding occurring in 28.5 per cent of all patients. Late blockage of the shunt occurred in five patients and was less frequent in Denver than in Le Veen type shunts. Cumulative mortality one month after shunt insertion was 28.5 per cent and at one year was 78.5 per cent reflecting the severity of the underlying disease. Peritoneovenous shunting should be reserved for palliation in patients resistant to full conventional medical therapy. PMID:4095803

  13. Transjugular intrahepatic portosystemic shunt (TIPS)

    MedlinePlus

    ... Transjugular intrahepatic portosystemic shunt. In: Mauro MA, Murphy KPJ, Thomson KR, Venbrux AC, Morgan RA, eds. Image- ... of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

  14. Aspergillus Growth within Ventriculoperitoneal Shunt Tube

    PubMed Central

    Kumar, Vikas; Loomba, Poonam Sood; Singh, Daljit; Saran, Ravindra Kumar

    2017-01-01

    Cerebrospinal fluid (CSF) shunt failure is commonly associated with infection or mechanical obstruction of the shunt system. A 4-year-old male child who had undergone multiple shunt revisions at another hospital for congenital hydrocephalus and later for shunt obstruction, presented with exposed shunt at the supraclavicular region. Shunt revision was performed. The CSF culture showed no growth; however, the histopathological examination of shunt tube showed Aspergillus growth inside the lumen of silicone tube well away from the tip of ventriculoperitoneal shunt. The skin biopsy from the exposed site revealed foreign body giant cell granulomatous reaction. The patient was discharged on postoperative day 6 without any complications. At 3 months follow-up, the patient is doing well. A growth of Aspergillus within the shunt tube prompted us to think of how the hardware can get infected and may remain a source of constant infection. PMID:28553391

  15. Failed Ventriculoperitoneal Shunt: Is Retrograde Ventriculosinus Shunt a Reliable Option?

    PubMed

    Oliveira, Matheus Fernandes de; Teixeira, Manoel Jacobsen; Reis, Rodolfo Casimiro; Petitto, Carlo Emanuel; Gomes Pinto, Fernando Campos

    2016-08-01

    Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications. In this preliminary report we describe our initial experience with retrograde ventriculosinus shunt (RVSS) after failed VPS. In 3 consecutive cases we applied RVSS to treat hydrocephalus in shunt-dependent patients who had previously undergone VPS revision and in which peritoneal space was full of adhesions and fibrosis. RVSS was performed as described by Shafei et al., with some modifications to each case. All 3 patients kept the same clinical profile after RVSS, with no perioperative or postoperative complications. However, revision surgery was performed in the first operative day in 1 out of 3 patients, in which the catheter was not positioned in the superior sagittal sinus. We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. 49 CFR 236.838 - Wire, shunt.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Wire, shunt. 236.838 Section 236.838 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Wire, shunt. A wire forming part of a shunt circuit. ...

  17. An unusual cause of ventriculoperitoneal shunt infection.

    PubMed

    Esmaeilzadeh, Majid; Islamian, Ariyan Pirayesh; Lang, Josef M; Hornef, Mathias; Suerbaum, Sebastian; Krauss, Joachim K

    2015-08-01

    Infection associated with ventriculoperitoneal (VP) shunt implantation can be a significant problem. VP shunt infection with Serratia marcescens, a gram-negative anaerobic rod, usually is related to underlying abdominal disease. This article describes treatment of two patients suffering from a VP shunt infection with S. marcescens without underlying abdominal disease.

  18. 49 CFR 236.838 - Wire, shunt.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Wire, shunt. 236.838 Section 236.838 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Wire, shunt. A wire forming part of a shunt circuit....

  19. 49 CFR 236.838 - Wire, shunt.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Wire, shunt. 236.838 Section 236.838 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Wire, shunt. A wire forming part of a shunt circuit....

  20. 49 CFR 236.838 - Wire, shunt.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Wire, shunt. 236.838 Section 236.838 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Wire, shunt. A wire forming part of a shunt circuit....

  1. 49 CFR 236.838 - Wire, shunt.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Wire, shunt. 236.838 Section 236.838 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Wire, shunt. A wire forming part of a shunt circuit....

  2. Adult hydrocoele complicating a lumboperitoneal shunt.

    PubMed

    Pollak, T A; Marcus, H J; James, G; Dorward, N; Thorne, L

    2011-10-01

    We report an adult patient who developed a right-sided hydrocoele following a lumboperitoneal shunt. While hydrocoeles have been described as a rare complication following ventriculo- and lumboperitoneal shunts in children, we are unaware of any previously reported cases of hydrocoeles resulting from such shunts in adults.

  3. Students with Shunts: Program Considerations.

    ERIC Educational Resources Information Center

    French, Ron; And Others

    1997-01-01

    Examines how the medical condition of hydrocephalus can affect physical education students and physical education programs, and stresses the need to provide physical educators with information on students' medical conditions. Describes hydrocephalus and its treatment with ventricular peritoneal shunts, and offers suggestions on modifying…

  4. Pulmonary hypertension in congenital shunts.

    PubMed

    Beghetti, Maurice; Tissot, Cecile

    2010-10-01

    Pulmonary arterial hypertension frequently arises in patients with congenital heart disease. The vast majority present with congenital cardiac shunts. Initially these may manifest as left-to-right (i.e. systemic-to-pulmonary) shunts. The natural history of disease progression involves vascular remodeling and dysfunction that lead to increased pulmonary vascular resistance and, finally, to the development of Eisenmenger's syndrome, which is the most advanced form. The anatomical, pathological and structural abnormalities occurring in the pulmonary circulation of these patients are, to some extent, similar to those observed in other forms of pulmonary arterial hypertension. This understanding has recently led to significant changes in the management of Eisenmenger's syndrome, with the introduction of treatment specifically targeting pulmonary vascular disease. Early closure of the cardiac shunt remains the best way of preventing pulmonary vascular lesions. However, it is still not clear which preoperative parameters predict safe and successful repair, though hemodynamic evaluation is still routinely used for assessment. Postoperative pulmonary hypertension, both in the immediate period after surgical repair and during long-term follow-up, remains a real therapeutic challenge. The clinical situation of a single ventricle with Fontan circulation also presents difficulties when pulmonary vascular lesions are present. This article reviews pulmonary hypertension associated with congenital shunts and discusses a number of the specific problems encountered.

  5. Students with Shunts: Program Considerations.

    ERIC Educational Resources Information Center

    French, Ron; And Others

    1997-01-01

    Examines how the medical condition of hydrocephalus can affect physical education students and physical education programs, and stresses the need to provide physical educators with information on students' medical conditions. Describes hydrocephalus and its treatment with ventricular peritoneal shunts, and offers suggestions on modifying…

  6. Reinfection following initial cerebrospinal fluid shunt infection

    PubMed Central

    Simon, Tamara D.; Hall, Matthew; Dean, J. Michael; Kestle, John R. W.; Riva-Cambrin, Jay

    2010-01-01

    Object Significant variation exists in the surgical and medical management of CSF shunt infection. The objectives of this study were to determine CSF shunt reinfection rates following initial CSF shunt infection in a large patient cohort and to determine management, patient, hospital, and surgeon factors associated with CSF shunt reinfection. Methods This retrospective cohort study included children who were in the Pediatric Health Information System (PHIS) database, who ranged in age from 0 to 18 years, and who underwent uncomplicated initial CSF shunt placement in addition to treatment for initial CSF shunt infection between January 1, 2001, and December 31, 2008. The outcome was CSF shunt reinfection within 6 months. The main predictor variable of interest was surgical approach to treatment of first infection, which was determined for 483 patients. Covariates included patient, hospital, surgeon, and other management factors. Results The PHIS database includes 675 children with initial CSF shunt infection. Surgical approach to treatment of the initial CSF shunt infection was determined for 483 children (71.6%). The surgical approach was primarily shunt removal/new shunt placement (in 286 children [59.2%]), but a substantial number underwent externalization (59 children [12.2%]), of whom a subset went on to have the externalized shunt removed and a new shunt placed (17 children [3.5% overall]). Other approaches included nonsurgical management (64 children [13.3%]) and complete shunt removal without shunt replacement (74 children [15.3%]). The 6-month reinfection rate was 14.8% (100 of 675 patients). The median time from infection to reinfection was 21 days (interquartile range [IQR] 5–58 days). Children with reinfection had less time between shunt placement and initial infection (median 50 vs 79 days, p = 0.06). No differences between those with and without reinfection were seen in patient factors (patient age at either shunt placement or initial infection, sex

  7. Ventriculoperitoneal shunt perforations of the gastrointestinal tract.

    PubMed

    Thiong'o, Grace Muthoni; Luzzio, Christopher; Albright, A Leland

    2015-07-01

    OBJECT The purposes of this study were to evaluate the frequency with which children presented with ventriculoperitoneal (VP) shunt perforations of the gastrointestinal (GI) tract, to determine the type of shunts that caused the perforations, and to compare the stiffness of perforating catheters with the stiffness of catheters from other manufacturers. METHODS Medical records were reviewed of 197 children who were admitted with VP shunt malfunction. Catheter stiffness was evaluated by measuring relative resistance to cross-sectional compression, resistance to column buckling, and elasticity in longitudinal bending. Catheter frictional force was measured per unit length. RESULTS Six children were identified whose VP shunts had perforated the GI tract; 2 shunts subsequently protruded through the anal orifice, 1 protruded through the oral cavity, and 3 presented with subcutaneous abscesses that tracked upward from the intestine to the chest. All perforating shunts were Chhabra shunts. Catheter stiffness and resistance to bending were greatest with a Medtronic shunt catheter, intermediate with a Codman catheter, and least with a Chhabra catheter. Frictional force was greatest with a Chhabra catheter and least with a Medtronic catheter. CONCLUSIONS The frequency of perforations by Chhabra shunts appears to be higher than the frequency associated with other shunts. The increased frequency does not correlate with their stiffness but may reflect their greater frictional forces.

  8. Ventriculopleural shunting with new technology valves.

    PubMed

    Martínez-Lage, J F; Torres, J; Campillo, H; Sanchez-del-Rincón, I; Bueno, F; Zambudio, G; Poza, M

    2000-12-01

    Ventriculoperitoneal shunting constitutes the standard procedure for draining cerebrospinal fluid (CSF) in children with hydrocephalus. Ventriculoatrial and ventriculopleural shunting are alternative methods of CSF drainage, which have gained less acceptance. Ventriculopleural shunts are seldom used owing to justified fears of pneumothorax and symptomatic effusions of CSF. The addition of an antisiphon device to standard shunt systems seems to have prevented CSF pleural effusion. From 1988 to 1998, we treated each of six hydrocephalic children with a ventriculopleural shunt. In five cases we used new-technology valves designed to prevent the effects of siphoning with current differential pressure valves. Peritoneal adhesions, recent peritonitis, ascites, and obstruction of a previous ventriculoatrial shunt were the indications for pleural shunting. After a mean follow-up period of 2.5 years all shunts were functioning adequately. Only one patient showed transient symptoms of CSF overdrainage, which were corrected by up-grading the valve setting with the magnet. A late death was unrelated to the pleural shunting procedure. The use of valves of a new design designed to prevent overdrainage seems to account for the satisfactory outcomes observed in this series. We suggest that ventriculopleural shunting should be considered as the preferred alternative to peritoneal drainage in children with intra-abdominal adhesions or with a history of recent peritoneal infection.

  9. Shunt regulation electric power system

    NASA Technical Reports Server (NTRS)

    Wright, W. H.; Bless, J. J. (Inventor)

    1971-01-01

    A regulated electric power system having load and return bus lines is described. A plurality of solar cells interconnected in a power supplying relationship and having a power shunt tap point electrically spaced from the bus lines is provided. A power dissipator is connected to the shunt tap point and provides for a controllable dissipation of excess energy supplied by the solar cells. A dissipation driver is coupled to the power dissipator and controls its conductance and dissipation and is also connected to the solar cells in a power taping relationship to derive operating power therefrom. An error signal generator is coupled to the load bus and to a reference signal generator to provide an error output signal which is representative of the difference between the electric parameters existing at the load bus and the reference signal generator. An error amplifier is coupled to the error signal generator and the dissipation driver to provide the driver with controlling signals.

  10. Bladder perforation by ventriculoperitoneal shunt.

    PubMed

    Miranda, Marcelo Eller; de Sousa, Mariana Bueno; Tatsuo, Edson Samesima; Quites, Lucas Viana; Giannetti, Alexandre Varella

    2016-12-01

    Bladder perforation by ventriculoperitoneal shunt is a rare complication that has been describe in 19 cases in prior literature. This work describes the case of a 4-month-old baby who presented with extrusion of the distal catheter through the urethra. The patient underwent a laparotomy; the catheter was cut close to the bladder wall and repositioned into the peritoneal cavity. The bladder wall was sutured, and the remaining distal portion of the catheter was removed through the urethra. Based on this single experience and a literature review, the authors classified the clinical signs and symptoms of bladder perforation by the ventriculoperitoneal shunt catheter. Finally, the authors propose a more conservative approach for this rare complication.

  11. Arterioportal shunts on dynamic computed tomography

    SciTech Connect

    Nakayama, T.; Hiyama, Y.; Ohnishi, K.; Tsuchiya, S.; Kohno, K.; Nakajima, Y.; Okuda, K.

    1983-05-01

    Thirty-two patients, 20 with hepatocelluar carcinoma and 12 with liver cirrhosis, were examined by dynamic computed tomography (CT) using intravenous bolus injection of contrast medium and by celiac angiography. Dynamic CT disclosed arterioportal shunting in four cases of hepatocellular carcinoma and in one of cirrhosis. In three of the former, the arterioportal shunt was adjacent to a mass lesion on CT, suggesting tumor invasion into the portal branch. In one with hepatocellular carcinoma, the shunt was remote from the mass. In the case with cirrhosis, there was no mass. In these last two cases, the shunt might have been caused by prior percutaneous needle puncture. In another case of hepatocellular carcinoma, celiac angiography but not CT demonstrated an arterioportal shunt. Thus, dynamic CT was diagnostic in five of six cases of arteriographically demonstrated arterioportal shunts.

  12. Cell shunt resistance and photovoltaic module performance

    SciTech Connect

    McMahon, T.J.; Basso, T.S.; Rummel, S.R.

    1996-09-01

    Shunt resistance of cells in photovoltaic modules can affect module power output and could indicate flawed manufacturing processes and reliability problems. The authors describe a two-terminal diagnostic method to directly measure the shunt resistance of individual cells in a series-connected module non-intrusively, without deencapsulation. Peak power efficiency vs. light intensity was measured on a 12-cell, series-connected, single crystalline module having relatively high cell shunt resistances. The module was remeasured with 0.5-, 1-, and 2-ohm resistors attached across each cell to simulate shunt resistances of several emerging technologies. Peak power efficiencies decreased dramatically at lower light levels. Using the PSpice circuit simulator, they verified that cell shunt and series resistances can indeed be responsible for the observed peak power efficiency vs. intensity behavior. They discuss the effect of basic cell diode parameters, i.e., shunt resistance, series resistance, and recombination losses, on PV module performance as a function of light intensity.

  13. Prolonged exposure to antibiotic-impregnated shunt catheters does not increase incidence of late shunt infections.

    PubMed

    Sciubba, Daniel M; McGirt, Matthew J; Woodworth, Graeme F; Carson, Benjamin; Jallo, George I

    2007-08-01

    Antibiotic-impregnated shunt (AIS) systems have been designed to prevent the colonization of shunt components by skin flora that occurs at surgery. Although such systems may decrease the incidence of early shunt infections (those occurring within 6 months of shunt placement), it is unclear if such exposure to prolonged antibiotics leads to an increased incidence or virulence of late shunt infections (those occurring later than 6 months after shunt placement). In this study, the authors evaluate the incidence of late shunt infection after the introduction of an AIS system in a pediatric hydrocephalus population. We prospectively reviewed all pediatric patients undergoing antibiotic-impregnated CSF shunt insertion or shunt revision operations at our institution for the 33 month period between October 1, 2002 and June 31, 2005. All shunt-related complications, including shunt infection, were evaluated in those patients with later than 6 months of follow-up. A total of 153 pediatric patients (between 1 and 21 years of age) underwent 262 shunting procedures involving the use of antibiotic-impregnated catheters. All patients were followed-up for later than 6 months with a mean follow-up of 21.7 months (range 13-46 months). Ten patients (3.82%) experienced an early shunt infection within the 6-month follow-up period. No patients experienced a late shunt infection. Although concern exists that AIS systems may delay shunt infections or even increase the rate or virulence of such infections, introduction of such catheters into a pediatric hydrocephalus cohort does not significantly increase incidence of late CSF shunt infection compared to historic controls.

  14. Asymptomatic bowel perforation by abandoned ventriculoperitoneal shunt.

    PubMed

    Rinker, Eric K; Osborn, Daniel A; Williams, Todd R; Spizarny, David L

    2013-09-01

    We report a case of an abandoned abdominal ventriculoperitoneal shunt that migrated into the gastric antrum, colonic hepatic flexure, and liver parenchyma, which was discovered incidentally on an abdominal CT obtained for renal stones. In regards to the migrated abandoned VP shunt, the patient was asymptomatic. Upon review of prior CT scans, these findings had progressed over approximately 7 years. We describe the case and discuss the clinical and radiologic findings, complications resulting from ventriculoperitoneal shunts, and possible approaches to their management.

  15. Shunt malfunction after roller coaster ride.

    PubMed

    Gegg, Christopher; Olavarria, Greg; Pattisapu, Jogi V

    2009-04-01

    We report a case of shunt malfunction after a child was subjected to G forces during a roller coaster ride. The temporal sequence of events suggests proximal catheter obstruction with subsequent symptoms of raised intracranial pressure immediately after experience with a G force ride. A shunt revision with catheter change led to resolution of symptoms, and findings were consistent with hemorrhage within the catheter. This case illustrates the risks of such an experience on children with shunts and the implications for patient counseling.

  16. Radiological Insertion and Management of Peritoneovenous Shunt

    SciTech Connect

    Bratby, M. J.; Hussain, F. F. Lopez, A. J.

    2007-06-15

    The purpose of the study was to report our experience of the management of complications following the insertion of a peritoneovenous shunt for intractable malignant ascites. From June 1999 to January 2006, 26 patients underwent insertion of a peritoneovenous shunt for ascites by interventional radiologists. We have used ultrasound and shuntography to assist in the diagnosis of the cause of shunt blockage. Successful techniques for the restoration of the shunt function include port- pumping, stripping of any fibrin sheath, and revision of either the venous or peritoneal catheter. The procedure was initially successful in all patients with continued patency until death in 17. A further four patients are still alive with a functioning shunt. There was one rapid postprocedure death resulting from pulmonary edema. Two patients developed pneumothorax, managed successfully with either a chest drain or aspiration. Shunt dysfunction occurred eight times in seven patients. There were five successful revisions in four patients. Overall, shunt patency has been maintained in 80.1% of patients. Shunt dysfunction is seen in a significant number of patients, but successful revision of the shunt can be achieved in the majority.

  17. [Unusual abdominal complication of ventriculoperitoneal shunt].

    PubMed

    Guillén, A; Costa, J M; Castelló, I; Claramunt, E; Cardona, E

    2002-10-01

    The most common complications after CSF shunting to treat hydrocephalus are shunt infection and obstruction. Although ventriculoperitoneal (VP) diversion of the CSF using artificial shunt devices is an accepted method for the management of hydrocephalus, high rates of various complications have been reported, ranging from 24% to 47%. Among these, abdominal complications account for approximately 25%. The incidence of bowel perforation by shunt-catheter is known to be as low as 0.1-0.7%. We describe a case of migration af a peritoneal catheter through a congenital hernia of Morgagni.

  18. Cerebral arteriovenous shunts in children.

    PubMed

    Toma, Ahmed K; Davagnanam, Indran; Ganesan, Vijeya; Brew, Stefan

    2013-11-01

    Intracranial arteriovenous shunts (AVSs) in children can be divided into pial arteriovenous malformations, vein of Galen malformations, and arteriovenous fistulae (AVF). Dural AVF and dural sinus malformations are rare entities within this group. The relative immaturity of the anatomy and physiology of the neonatal and infant brain results in the inability of the hydrovenous system to compensate in the face of such disorders. Thus, the clinical presentation reflects this difference in the underlying anatomy, physiology, and disorder between children and adults. In this article, we briefly review the presentation, natural history and management of these entities.

  19. 49 CFR 236.56 - Shunting sensitivity.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Shunting sensitivity. 236.56 Section 236.56 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION...: All Systems Track Circuits § 236.56 Shunting sensitivity. Each track circuit controlling home signal...

  20. 49 CFR 234.229 - Shunting sensitivity.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Shunting sensitivity. 234.229 Section 234.229 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION..., Inspection, and Testing Maintenance Standards § 234.229 Shunting sensitivity. Each highway-rail grade...

  1. 49 CFR 236.56 - Shunting sensitivity.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Shunting sensitivity. 236.56 Section 236.56 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION...: All Systems Track Circuits § 236.56 Shunting sensitivity. Each track circuit controlling home signal...

  2. 49 CFR 236.56 - Shunting sensitivity.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Shunting sensitivity. 236.56 Section 236.56 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION...: All Systems Track Circuits § 236.56 Shunting sensitivity. Each track circuit controlling home signal...

  3. 49 CFR 234.229 - Shunting sensitivity.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Shunting sensitivity. 234.229 Section 234.229 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... sensitivity. Each highway-rail grade crossing train detection circuit shall detect the application of a shunt...

  4. 49 CFR 234.229 - Shunting sensitivity.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Shunting sensitivity. 234.229 Section 234.229 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION..., Inspection, and Testing Maintenance Standards § 234.229 Shunting sensitivity. Each highway-rail grade...

  5. 49 CFR 236.56 - Shunting sensitivity.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Shunting sensitivity. 236.56 Section 236.56 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION...: All Systems Track Circuits § 236.56 Shunting sensitivity. Each track circuit controlling home signal...

  6. 49 CFR 236.56 - Shunting sensitivity.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Shunting sensitivity. 236.56 Section 236.56 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION...: All Systems Track Circuits § 236.56 Shunting sensitivity. Each track circuit controlling home signal...

  7. 49 CFR 234.229 - Shunting sensitivity.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Shunting sensitivity. 234.229 Section 234.229 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... sensitivity. Each highway-rail grade crossing train detection circuit shall detect the application of a shunt...

  8. 49 CFR 234.229 - Shunting sensitivity.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Shunting sensitivity. 234.229 Section 234.229 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... sensitivity. Each highway-rail grade crossing train detection circuit shall detect the application of a shunt...

  9. Does the Warren Shunt Correct Hypersplenism?

    PubMed Central

    Mavor, Andrew I. D.; Giles, Geoffrey R.

    1990-01-01

    It has been suggested that patients with bleeding varices and hypersplenism will show significant improvements in leucocyte and platelet counts following distal splenorenal (Warren) shunt surgery. Whilst this may be true in the short term, this report shows that in the long term hypersplenism is not relieved, whereas the lienorenal shunt is associated with a return of normal haematological values. PMID:2282329

  10. 21 CFR 874.3820 - Endolymphatic shunt.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3820 Endolymphatic shunt. (a) Identification. An endolymphatic shunt is a device that consists of a tube or sheet intended to be implanted to relieve the symptons of vertigo. The device permits the unrestricted flow of excess endolymph from...

  11. 21 CFR 874.3820 - Endolymphatic shunt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3820 Endolymphatic shunt. (a) Identification. An endolymphatic shunt is a device that consists of a tube or sheet intended to be implanted to relieve the symptons of vertigo. The device permits the unrestricted flow of excess endolymph from...

  12. 21 CFR 874.3820 - Endolymphatic shunt.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Endolymphatic shunt. 874.3820 Section 874.3820 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3820 Endolymphatic shunt....

  13. 21 CFR 874.3820 - Endolymphatic shunt.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Endolymphatic shunt. 874.3820 Section 874.3820 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3820 Endolymphatic shunt....

  14. 21 CFR 874.3820 - Endolymphatic shunt.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Endolymphatic shunt. 874.3820 Section 874.3820 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3820 Endolymphatic shunt....

  15. Congenital Portosystemic Shunt: Our Experience

    PubMed Central

    Timpanaro, Tiziana; Passanisi, Stefano; Sauna, Alessandra; Trombatore, Claudia; Pennisi, Monica; Petrillo, Giuseppe; Smilari, Pierluigi; Greco, Filippo

    2015-01-01

    Introduction. Congenital portosystemic venous malformations are rare abnormalities in which the portal blood drains into a systemic vein and which are characterized by extreme clinical variability. Case Presentations. The authors present two case reports of a congenital extrahepatic portosystemic shunt (Type II). In the first patient, apparently nonspecific symptoms, such as headache and fatigue, proved to be secondary to hypoglycemic episodes related to the presence of a portosystemic shunt, later confirmed on imaging. During portal vein angiography, endovascular embolization of the portocaval fistula achieved occlusion of the anomalous venous tract. In the second patient, affected by Down's syndrome, the diagnosis of a portosystemic malformation was made by routine ultrasonography, performed to rule out concurrent congenital anomalies. Because of the absence of symptoms, we chose to observe this patient. Conclusions. These two case reports demonstrate the clinical heterogeneity of this malformation and the need for a multidisciplinary approach. As part of a proper workup, clinical evaluation must always be followed by radiographic diagnosis. PMID:25709849

  16. Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience.

    PubMed

    Lee, Lester; Low, Sharon; Low, David; Ng, Lee Ping; Nolan, Colum; Seow, Wan Tew

    2016-11-01

    OBJECTIVE The introduction of ventriculoperitoneal shunts changed the way hydrocephalus was treated. Whereas much is known about the causes of shunt failure in the first few years, there is a paucity of data in the literature regarding the cause of late shunt failures. The authors conducted a study to find out the different causes of late shunt failures in their institution. METHODS A 10-year retrospective study of all the patients who were treated in the authors' hospital between 2006 and 2015 was conducted. Late shunt failures included those in patients who had to undergo shunt revision more than 5 years after their initial shunt insertion. The patient's notes and scans were reviewed to obtain the age and sex of the patient, the time it took for the shunt to fail, the reason for failure, and the patient's follow-up. RESULTS Forty-six patients in the authors' institution experienced 48 late shunt failures in the last 10 years. Their ages ranged from 7 to 26 years (12.23 ± 4.459 years [mean ± SD]). The time it took for the shunts to fail was between 6 and 24 years (mean 10.25 ± 3.77 years). Reasons for failure resulting in shunt revision include shunt fracture in 24 patients (50%), shunt blockage in 14 patients (29.2%), tract fibrosis in 6 patients (12.5%), shunt dislodgement in 2 patients (4.2%), and shunt erosion in 2 patients (4.2%). Postoperative follow-up for the patients ranged from 6 to 138 months (mean 45.15 ± 33.26 months). CONCLUSIONS Late shunt failure is caused by the effects of aging on the shunt, and the complications are different from early shunt failure. A large proportion are complications associated with shunt calcification. The authors advocate a long follow-up for pediatric patients with shunts in situ to monitor them for various causes of late shunt failure.

  17. Mycobacterium abscessus ventriculoperitoneal shunt infection and review of the literature.

    PubMed

    Montero, Jose A; Alrabaa, Sally F; Wills, Todd S

    2016-04-01

    A 30-year-old man with history of neonatal hydrocephalus requiring ventriculoperitoneal shunt placement presented with Mycobacterium abscessus shunt infection despite no shunt manipulation over 10 years prior to presentation. Cure was not achieved until complete removal of all CNS shunt foreign body was performed despite initial adequate antimicrobial therapy.

  18. Percutaneous transtubal scintigraphic assessment of patency of peritoneovenous shunts

    SciTech Connect

    Taggart, G.J.; Sullivan, D.C.; Gusberg, R.J.; Conn, H.O.

    1981-02-01

    Peritoneovenous shunts have been widely used in the management of patients with ascites when medical therapy has failed. Shunt malfunction is a frequent complication. Direct injection of a small amount of Tc-99m-sulfur colloid into the afferent limb of the shunt allow prompt, accurate determination of shunt patency while avoiding some of the hazards and pitfalls of previously described techniques.

  19. The Preventable Shunt Revision Rate: a potential quality metric for pediatric shunt surgery.

    PubMed

    Venable, Garrett T; Rossi, Nicholas B; Morgan Jones, G; Khan, Nickalus R; Smalley, Zachary S; Roberts, Mallory L; Klimo, Paul

    2016-07-01

    OBJECTIVE Shunt surgery consumes a large amount of pediatric neurosurgical health care resources. Although many studies have sought to identify risk factors for shunt failure, there is no consensus within the literature on variables that are predictive or protective. In this era of "quality outcome measures," some authors have proposed various metrics to assess quality outcomes for shunt surgery. In this paper, the Preventable Shunt Revision Rate (PSRR) is proposed as a novel quality metric. METHODS An institutional shunt database was queried to identify all shunt surgeries performed from January 1, 2010, to December 31, 2014, at Le Bonheur Children's Hospital. Patients' records were reviewed for 90 days following each "index" shunt surgery to identify those patients who required a return to the operating room. Clinical, demographic, and radiological factors were reviewed for each index operation, and each failure was analyzed for potentially preventable causes. RESULTS During the study period, there were 927 de novo or revision shunt operations in 525 patients. A return to the operating room occurred 202 times within 90 days of shunt surgery in 927 index surgeries (21.8%). In 67 cases (33% of failures), the revision surgery was due to potentially preventable causes, defined as inaccurate proximal or distal catheter placement, infection, or inadequately secured or assembled shunt apparatus. Comparing cases in which failure was due to preventable causes and those in which it was due to nonpreventable causes showed that in cases in which failure was due to preventable causes, the patients were significantly younger (median 3.1 vs 6.7 years, p = 0.01) and the failure was more likely to occur within 30 days of the index surgery (80.6% vs 64.4% of cases, p = 0.02). The most common causes of preventable shunt failure were inaccurate proximal catheter placement (33 [49.3%] of 67 cases) and infection (28 [41.8%] of 67 cases). No variables were found to be predictive of

  20. Vascular Shunts in Civilian Trauma

    PubMed Central

    Abou Ali, Adham N.; Salem, Karim M.; Alarcon, Louis H.; Bauza, Graciela; Pikoulis, Emmanuel; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2017-01-01

    Experience with temporary intravascular shunts (TIVS) for vessel injury comes from the military sector and while the indications might be clear in geographically isolated and under resourced war zones, this may be an uncommon scenario in civilian trauma. Data supporting TIVS use in civilian trauma have been extrapolated from the military literature where it demonstrated improved life and limb salvage. Few non-comparative studies from the civilian literature have also revealed similar favorable outcomes. Still, TIVS placement in civilian vascular injuries is uncommon and by some debatable given the absence of clear indications for placement, the potential for TIVS-related complications, the widespread resources for immediate and definitive vascular repair, and the need for curtailing costs and optimizing resources. This article reviews the current evidence and the role of TIVS in contemporary civilian trauma management. PMID:28775985

  1. Subtotal laryngectomy with myomucosal shunt.

    PubMed

    Chandrachud, H R; Chaurasia, M K; Sinha, K P

    1989-05-01

    This is a modified subtotal laryngectomy. On the tumour-free side of the larynx, some posterior structures, with their neurovascular supply are preserved. The endolaryngeal mucosa is tubed in continuity with the trachea below and projects into the pharynx above. Thus a myomucosal shunt is formed. Air is directed into it by finger occlusion of the tracheal stoma. The voice production is highly satisfactory. Aspiration is prevented by constriction of the thyroarytenoid muscle which provides a valved upper end of the tube. The possibility of leaving tumour in the laryngeal remnant is eliminated by careful selection of patients, and re-confirmation of tumour extent intra-operatively and a frozen section. Eleven such operations have been performed since October 1983 for squamous cell carcinoma, some previously irradiated. None of the patients had local recurrence. Only one had an aspiration problem which later resolved. All acquired a satisfactory voice.

  2. Ventriculoperitoneal Shunt Peritoneal Catheter Knot Formation

    PubMed Central

    Ul-Haq, Anwar; Al-Otaibi, Faisal; Alshanafey, Saud; Sabbagh, Mohamed Diya; Al Shail, Essam

    2013-01-01

    The ventriculoperitoneal (VP) shunt is a common procedure in pediatric neurosurgery that carries a risk of complications at cranial and abdominal sites. We report on the case of a child with shunt infection and malfunction. The peritoneal catheter was tethered within the abdominal cavity, precluding its removal. Subsequently, laparoscopic exploration identified a knot at the distal end of the peritoneal catheter around the omentum. A new VP shunt was inserted after the infection was healed. This type of complication occurs rarely, so there are a limited number of case reports in the literature. This report is complemented by a literature review. PMID:24109528

  3. Asymptomatic Bowel Perforation by Abandoned Ventriculoperitoneal Shunt

    PubMed Central

    Rinker, Eric K; Osborn, Daniel A.; Williams, Todd R.; Spizarny, David L.

    2013-01-01

    We report a case of an abandoned abdominal ventriculoperitoneal shunt that migrated into the gastric antrum, colonic hepatic flexure, and liver parenchyma, which was discovered incidentally on an abdominal CT obtained for renal stones. In regards to the migrated abandoned VP shunt, the patient was asymptomatic. Upon review of prior CT scans, these findings had progressed over approximately 7 years. We describe the case and discuss the clinical and radiologic findings, complications resulting from ventriculoperitoneal shunts, and possible approaches to their management. PMID:24421952

  4. Ventriculoperitoneal Shunting Surgery with Open Distal Shunt Catheter Placement in the Treatment of Hydrocephalus.

    PubMed

    Zhang, Yang; Zhu, Xiaobo; Zhao, Jinchuan; Hou, Kun; Gao, Xianfeng; Sun, Yang; Wang, Wei; Zhang, Xiaona

    2015-11-01

    Ventriculoperitoneal shunting (VPS) is a major therapy for hydrocephalus, but has a significant risk of device malfunctioning. In this study, we explored a novel distal shunt catheter placement method in VPS for the treatment of hydrocephalus. Five patients with different etiologies of hydrocephalus underwent VPS with open distant shunt catheter attached outside. We analyzed different variables (age, gender, medical history, clinical presentation, indication for surgery and surgical technique, postoperative complications) and occurrence of shunt failure and infection. All hydrocephalus patients who received the distal shunt catheter placed outside can undergo regular VPS again after the condition improves. The modified VPS in the treatment of hydrocephalus with the distal shunt catheter placed outside could potentially reduce the necessity of repeat surgery for addressing the complications caused by catheter obstruction and infections, reduce the chance of adhesions, and would be of benefit to those patients who need future revisions.

  5. Fasciocutaneous flap in esophageal stricture with ventriculoperitoneal shunt.

    PubMed

    Seong, Yong Won; Kang, Chang Hyun; Chang, Hak; Park, In Kyu; Kim, Young Tae

    2014-01-01

    Abdominal surgery in a patient with ventriculoperitoneal shunt may increase the risk of shunt malfunction and infection. We present a successful case of resection and reconstruction of the cervical esophagus by rolled lateral thoracic artery fasciocutaneous flap in a patient with corrosive esophageal stricture and preexisting ventriculoperitoneal shunt. Follow-up esophagogastroscopy after 3 months revealed wide patent graft. Rolled fasciocutaneous flap may be a safe alternative treatment without risk of shunt-associated complications in a patient with ventriculoperitoneal shunt.

  6. [Laparoscopic ventriculoperitoneal shunt with temporary external drainage for hydrocephalus: a comparison with conventional ventriculoperitoneal shunt].

    PubMed

    Chen, Jianfa; Liu, Changxu; Zhu, Hongsheng; Fu, Ming; Lin, Fulu; Liu, Jun; Xie, Kuilong; Li, Ping

    2012-12-01

    To investigate the clinical efficacy of laparoscopic ventriculoperitoneal shunt with temporary external drainage in the treatment of hydrocephalus. Fifty-two cases of hydrocephalus randomized into two groups to receive laparoscopic assisted ventriculoperitoneal shunt with temporary external drainage (19 male and 7 female patients) and conventional ventriculoperitoneal shunt (20 male and 6 female patients). The catheterization time in the abdominal cavity, release time of intracranial hypertension, average hospital stay, postoperative pains, and postoperative complications were compared between the two groups. Laparoscopic ventriculoperitoneal shunt with temporary external drainage was performed successfully in all the cases without intraoperative conversion to open surgery. Compared with the conventional ventriculoperitoneal shunt, laparoscopic ventriculoperitoneal shunt with temporary external drainage was associated with significantly shortened catheterization time in the abdominal cavity, release time of intracranial hypertension, and average hospital stay (P<0.01) as well as lowered postoperative pain score at 4, 8, 16, and 24 h after the operation. The pain scores at 48 and 72 h postoperatively were comparable between the two groups. During the follow-up 3 months, the patients receiving laparoscopic ventriculoperitoneal shunt were found to have significantly lower rates of peritoneal end obstruction and abdominal cavity infection than those having conventional shunt (3.8% vs 19.2%, P<0.01; 1.0% vs 23.1%, P<0.01). Laparoscopic ventriculoperitoneal shunt with temporary external drainage is feasible and produces better clinical therapeutic effect for management of hydrocephalus.

  7. Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factors.

    PubMed

    Woo, P Ym; Wong, H T; Pu, J Ks; Wong, W K; Wong, L Yw; Lee, M Wy; Yam, K Y; Lui, W M; Poon, W S

    2016-10-01

    To determine the frequency of primary ventriculoperitoneal shunt infection among patients treated at neurosurgical centres of the Hospital Authority and to identify underlying risk factors. This multicentre historical cohort study included consecutive patients who underwent primary ventriculoperitoneal shunting at a Hospital Authority neurosurgery centre from 1 January 2009 to 31 December 2011. The primary endpoint was shunt infection, defined as: (1) the presence of cerebrospinal fluid or shunt hardware culture that yielded the pathogenic micro-organism with associated compatible symptoms and signs of central nervous system infection or shunt malfunction; or (2) surgical incision site infection requiring shunt reinsertion (even in the absence of positive culture); or (3) intraperitoneal pseudocyst formation (even in the absence of positive culture). Secondary endpoints were shunt malfunction, defined as unsatisfactory cerebrospinal fluid drainage that required shunt reinsertion, and 30-day mortality. A primary ventriculoperitoneal shunt was inserted in 538 patients during the study period. The mean age of patients was 48 years (range, 13-88 years) with a male-to-female ratio of 1:1. Aneurysmal subarachnoid haemorrhage was the most common aetiology (n=169, 31%) followed by intracranial tumour (n=164, 30%), central nervous system infection (n=42, 8%), and traumatic brain injury (n=27, 5%). The mean operating time was 75 (standard deviation, 29) minutes. Shunt reinsertion and infection rates were 16% (n=87) and 7% (n=36), respectively. The most common cause for shunt reinsertion was malfunction followed by shunt infection. Independent predictors for shunt infection were: traumatic brain injury (adjusted odds ratio=6.2; 95% confidence interval, 2.3-16.8), emergency shunting (2.3; 1.0-5.1), and prophylactic vancomycin as the sole antibiotic (3.4; 1.1-11.0). The 30-day all-cause mortality was 6% and none were directly procedure-related. This is the first Hong Kong

  8. Delayed diagnosis of shunt overdrainage following functional hemispherotomy and ventriculoperitoneal shunt placement in a hemimegalencephaly patient.

    PubMed

    Nagahama, Yasunori; Peters, David; Kumonda, Sho; Vesole, Adam; Joshi, Charuta; J Dlouhy, Brian; Kawasaki, Hiroto

    2017-01-01

    Shunt overdrainage represents a nebulous condition of variable clinical and imaging presentations, where the diagnosis is primarily clinical. The condition presents a diagnostic challenge particularly in patients with cognitive impairment and developmental delays. Here we present a 3-year-old boy with drug-resistant focal onset seizures due to hemimegalencephaly who previously underwent functional hemispherotomy followed by ventriculoperitoneal shunt placement for postoperative hydrocephalus. The subsequent clinical course was complicated by delayed diagnosis of shunt overdrainage in the absence of significant image findings. Maintaining a high index of suspicion for the possibility of shunt overdrainage is critical even in the face of unremarkable imaging findings.

  9. Bilateral pneumothorax during subdural-peritoneal shunting.

    PubMed

    Solmaz, Ilker; Tehli, Ozkan; Kaya, Serdar; Erdogan, Ersin; Izci, Yusuf

    2011-01-01

    Pneumothorax is a very rare complication of ventriculoperitoneal shunting in children. We report a case of an iatrogenic bilateral tension pneumothorax during the placement of a subdural-peritoneal shunting. After the placement of peritoneal catheter, oxygen saturation of the patient quickly decreased, hypotension and bradycardia occurred. Intraoperative x-rays showed the pneumothorax. A thoracostomy tube was inserted and attached to an underwater seal. Vital signs improved in a short time period. The radiological improvement had been achieved in four days. Early diagnosis and prompt intervention are life-saving for this complication. To avoid this complication, the tip of the shunt tunneler should be always palpable during the placement of the peritoneal catheter, especially in children's shunt surgery.

  10. Laparoscopic revision of a ventriculoperitoneal shunt.

    PubMed

    Turner, Raymond; Chahlavi, Ali; Rasmussen, Peter; Brody, Fred

    2004-10-01

    Ventriculoperitoneal (VP) shunts are the most common treatment modality for hydrocephalus. Distal catheter malfunction represents a surgical emergency and a significant cause of procedural morbidity. We report the case of a patient with acute abdominal pain following VP shunt insertion. On examination she had a tender, irreducible bulge at the abdominal laparotomy site. Exploratory laparoscopy of the abdomen yielded no abdominal wall abnormalities. At the same time, the distal catheter was noted to be absent. The abdominal bulge was incised along the laparotomy scar and clear cerebrospinal fluid was encountered. The incision was explored and the distal catheter was coiled and knotted within the preperitoneal space. The catheter was laparoscopically returned to the peritoneal cavity. This case exemplifies the utility of laparoscopy for VP shunt revision and we present a review of laparoscopic shunt revision.

  11. Cerebrospinal fluid eosinophilia associated with intraventricular shunts.

    PubMed

    Bezerra, Sofia; Frigeri, Thomas More; Severo, Carlos Marcelo; Santana, João Carlos Batista; Graeff-Teixeira, Carlos

    2011-06-01

    CSF eosinophilia (CSF-eo) is uncommon and is usually caused by helminthic infections. However, it has also been found in ∼30% of patients experiencing intraventricular shunt malfunctions. We present a case report and review the conditions associated with CSF-eo and their prophylaxis. An 8 year-old boy with tetraventricular hydrocephalus has had several shunt malfunctions over the last three years. During hospitalization in January 2009 for shunt revision, a transient 30% eosinophilia was detected in his cerebral spinal fluid (CSF) concomitant with Staphylococcus epidermidis infection and long term vancomycin administration. After several shunt replacements and antibiotic treatment, CSF-eo eventually disappeared with good overall clinical response. CSF-eo is a transient and focal event mainly associated with infection, reactions to foreign substances, particles or blood, or obstruction of tubing by normal or fibro-granulomatous tissues. Infection associated with CSF-eo is usually caused by S. epidermidis and Propioniumbacterium acnes. In addition to infection, allergy to silicone and other foreign materials may also be a cause of CSF-eo. We review the diversity of conditions and proposed mechanisms associated with CSF-eo, as well as recommendations for the care of patients with shunts. Detection of CSF-eo has been shown to be a useful indicator of shunt malfunction. As such, it provides physicians with an indicator of a hypersensitivity reaction that is underway or the need to identify bacterial infection. We also highlight the need for improved biocompatibility of shunt hardware and describe strategies to avoid conditions leading to shunt malfunction.

  12. Endoscopic third ventriculostomy in previously shunted children.

    PubMed

    Brichtova, Eva; Chlachula, Martin; Hrbac, Tomas; Lipina, Radim

    2013-01-01

    Endoscopic third ventriculostomy (ETV) is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P) shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%). There were two serious complications (4.7%)-one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.

  13. Cell shunt resistance and photovoltaic module performance

    SciTech Connect

    McMahon, T.J.; Basso, T.S.; Rummel, S.R.

    1996-05-01

    Shunt resistance of cells in photovoltaic modules can affect module power output and could indicate flawed manufacturing processes and reliability problems. The authors describe a two-terminal diagnostic method to directly measure the shunt resistance of individual cells in a series-connected module non-intrusively, without deencapsulation. Peak power efficiency vs. light intensity was measured on a 12-cell, series-connected, single crystalline module having relatively high cell shunt resistances. The module was remeasured with 0.5-, 1-, and 2-ohm resistors attached across each cell to simulate shunt resistances of several emerging technologies. Peak power efficiencies decreased dramatically at lower light levels. Using the PSpice circuit simulator, the authors verified that cell shunt and series resistances can indeed be responsible for the observed peak power efficiency vs. intensity behavior. The authors discuss the effect of basic cell diode parameters, i.e., shunt resistance, series resistance, and recombination losses, on PV module performance as a function of light intensity.

  14. Validating a Clinical Prediction Rule for Ventricular Shunt Malfunction.

    PubMed

    Boyle, Tehnaz P; Kimia, Amir A; Nigrovic, Lise E

    2017-01-17

    This study aims to validate a published ventricular shunt clinical prediction rule for the identification of children at low risk for ventricular shunt malfunction based on the absence of 3 high-risk clinical predictors (irritability, nausea or vomiting, and headache). We identified children aged 21 years and younger with a ventricular shunt who presented between 2010 and 2013 to a single pediatric emergency department (ED) for evaluation of potential shunt malfunction. We defined a ventricular shunt malfunction as obstruction to cerebrospinal fluid flow requiring operative neurosurgical intervention within 72 hours of initial ED evaluation. We applied this ventricular shunt clinical prediction rule to the study population and report the test characteristics. We identified 755 ED visits for 294 children with potential ventricular shunt malfunction. Of these encounters, 146 (19%; 95% confidence interval [CI], 17%-22%) had a ventricular shunt malfunction. The ventricular shunt clinical prediction rule had a sensitivity of 99% (95% CI, 94%-100%), specificity of 7% (95% CI, 5%-9%), and negative predictive value of 95% (95% CI, 82%-99%). Two children with a ventricular shunt malfunction were misclassified as low risk by this clinical prediction rule. Ventricular shunt malfunctions were common. Although children classified as low risk by the ventricular shunt clinical prediction rule were less likely to have a shunt malfunction, routine neuroimaging may still be required because exclusion of ventricular shunt malfunction may be difficult on clinical grounds alone.

  15. An unusual ventriculoperitoneal shunt complication: spontaneous knot formation.

    PubMed

    Borcek, Alp Ozgun; Civi, Soner; Golen, Mustafa; Emmez, Hakan; Baykaner, M Kemali

    2012-01-01

    This article aims to describe an extraordinary complication of a ventriculoperitoneal shunt system that formed a knot spontaneously and lead to a shunt malfunction. A 3-year-old male patient was operated due to posttraumatic hydrocephalus. After an uneventful follow-up period of 34 months, he presented with shunt malfunction. During the shunt revision surgery, the peritoneal catheter was found to form a loop over itself. There are various complications of ventriculoperitoneal shunt systems. Migration to body cavities is among the most interesting ones. This is the fifth report describing this rare complication. Hydrocephalic patients should be closely followed up after shunt surgery for various extraordinary complications.

  16. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae

    PubMed Central

    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Singhara Na Ayudya, Sirintara (Pongpech)

    2016-01-01

    PURPOSE The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages. METHODS We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded. RESULTS Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction. CONCLUSION Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow. PMID:27767958

  17. Ventriculoperitoneal shunt surgery and the incidence of shunt revision in adult patients with hemorrhage-related hydrocephalus.

    PubMed

    Reddy, G Kesava

    2012-11-01

    Ventriculoperitoneal shunt surgery remains the most widely accepted neurosurgical procedure for the management of hydrocephalus. However, shunt failure and complications are common and may require multiple surgical procedures during a patient's lifetime. The purpose of this study is to evaluate the ventriculoperitoneal shunt surgery and the incidence of shunt revision in adult patients with hemorrhage-related hydrocephalus. Adult patients who underwent ventriculoperitoneal shunt placement for hemorrhage-related hydrocephalus from October 1990 to October 2009 were included in this study. Medical charts, operative reports, imaging studies, and clinical follow-up evaluations were reviewed and analyzed retrospectively. A total of 133 adult patients with the median age of 54.5 years were included. Among patients, 41% were males, and 62% Caucasians. The overall shunt revision rate was 51.9%. The shunt revision rate within the first 6 months after the initial placement of ventriculoperitoneal shunts was 45.1%. The median time to first shunt revision was 0.50 (95% CI, 0.24-9.2) months. No significant association was observed between perioperative variables (gender, ethnicity, hydrocephalus type, or hemorrhage type) and the shunt revision rate in these patients. Major causes of shunt revision include infection (3.6%), overdrainage (7.6%), obstruction (4.8%), proximal shunt complication (7.6%), distal shunt complication (3.6%), old shunt dysfunction (6.8%), valve malfunction (10.0%), externalization (3.6%), shunt complication (12.0%), shunt adjustment/replacement (24.0%) and other (16.4%). Although ventriculoperitoneal shunting remains to be the treatment of choice for adult patients with post hemorrhage-related hydrocephalus, a thorough understanding of predisposing factors related to the shunt failure is necessary to improve treatment outcomes. Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Hydrocephalus shunts and waves of intracranial pressure.

    PubMed

    Czosnyka, Z H; Cieslicki, K; Czosnyka, M; Pickard, J D

    2005-01-01

    The majority of contemporary hydrocephalus valves are designed to introduce a low resistance to flow into the cerebrospinal fluid (CSF) drainage pathway, and an therefore intended to stabilise intracranial pressure (ICP) at a level close to the shunt's operating pressure. However, this goal cannot always be attained. Accelerated CSF drainage with vertical body posture in ventriculo-peritoneal shunts is one reason for the ICP decreasing below the shunt's operating pressure. Another possible factor has been studied: the impact of the pulsating pattern in the ICP on the operating pressure. Six popular constructions of medium-pressure valves were studied (Radionics Low-profile, Delta, Hakim Precision, Holter, Integra In-line and Hakim NMT). Valves were mounted in the testing rig in the UK. Shunt Evaluation Laboratory and perfused with de-ionised water at a rate of 0.3 ml min(-1), and proximal pulsating pressures of different amplitudes (from 2 to 30mmHg peak-to-peak) and frequencies (70-10 cycles min(-1)) were superimposed. Laboratory findings were compared with clinical material containing recordings of ICP made in patients to diagnose reasons for ventriculomegaly. The mean operating pressure decreased in all valves when the simulated amplitude of heart pulsations increased. The rate of this decrease was dependent on the type of valve (variable from 2.5 to 5 mm Hg per increase in peak-to-peak amplitude by 10 mm Hg). The decrease was not related to the frequency of the wave. The relationship between pulse amplitude and ICP in 35 patients with blocked shunts was strong (R = 0.48; p < 0.03; slope 0.14) and in 25 patients with properly functioning shunts was non-significant (R = 0.057; p = 0.765). Two examples of decrease in mean ICP in the presence of increased vasogenic ICP waves in shunted patients are presented. The shunt operating pressure, which 'sets' the ICP in shunted patients may be influenced by the dynamics of a patient's ICP waveform.

  19. Simulation model for port shunting yards

    NASA Astrophysics Data System (ADS)

    Rusca, A.; Popa, M.; Rosca, E.; Rosca, M.; Dragu, V.; Rusca, F.

    2016-08-01

    Sea ports are important nodes in the supply chain, joining two high capacity transport modes: rail and maritime transport. The huge cargo flows transiting port requires high capacity construction and installation such as berths, large capacity cranes, respectively shunting yards. However, the port shunting yards specificity raises several problems such as: limited access since these are terminus stations for rail network, the in-output of large transit flows of cargo relatively to the scarcity of the departure/arrival of a ship, as well as limited land availability for implementing solutions to serve these flows. It is necessary to identify technological solutions that lead to an answer to these problems. The paper proposed a simulation model developed with ARENA computer simulation software suitable for shunting yards which serve sea ports with access to the rail network. Are investigates the principal aspects of shunting yards and adequate measures to increase their transit capacity. The operation capacity for shunting yards sub-system is assessed taking in consideration the required operating standards and the measure of performance (e.g. waiting time for freight wagons, number of railway line in station, storage area, etc.) of the railway station are computed. The conclusion and results, drawn from simulation, help transports and logistics specialists to test the proposals for improving the port management.

  20. Complications of fourth-ventricular shunts.

    PubMed

    Lee, M; Leahu, D; Weiner, H L; Abbott, R; Wisoff, J H; Epstein, F J

    1995-01-01

    Fourth-ventricular shunting is commonly used to treat symptomatic posterior fossa cysts of the Dandy-Walker malformation and trapped fourth ventricle. Although the benefits of this procedure have been widely reported, there is a paucity of data on the pitfalls of posterior fossa shunting in the neurosurgical literature. During the 4-year period from July 1989 to June 1993, we placed fourth-ventricular shunts in 12 patients. Remarkably, 5 patients suffered complications related to posterior fossa catheter placement (42% rate). Three of these patients developed new cranial nerve dysfunction caused by direct injury to the floor of the fourth ventricle, 1 patient suffered an intracystic hemorrhage and acute shunt malfunction, and 1 patient had the catheter tip in the brainstem on postoperative studies without new neurological deficit. We conclude that placement of fourth-ventricular shunts can be fraught with complications which we believe is related to technique. We propose that altering the trajectory of the ventricular catheter from our usual midline technique to a more lateral position will lessen the chances for injury to the floor of the fourth ventricle. In this manner we hope to decrease our incidence of complications for this procedure.

  1. Palliation of malignant ascites by the Denver peritoneovenous shunt.

    PubMed Central

    Downing, R.; Black, J.; Windsor, C. W.

    1984-01-01

    Five out of 8 Denver peritoneovenous shunts placed in 7 patients provided excellent palliation of malignant ascites. Subclinical consumptive coagulopathy was detected after placement of 6 shunts, but no patient developed overt bleeding. Images Fig. 1 Fig. 2 PMID:6207757

  2. New declotting catheters for arterio-venous shunts.

    PubMed

    Pearl, M A; Clark, W T

    1978-11-01

    Clotting is a serious problem in patients with A-V shunts. Balloon Embolectomy catheters or irrigating devices are frequently unsuccessful in declotting shunts, resulting in surgical revision of the shunt. Frequent surgical revisions reduce sites of vascular access, making it difficult to perform adequate hemodialysis. New instruments, constructed mainly of stainless steel, have been devised and used to declot A-V shunts. The instruments have been devised for specific purposes and labeled as follows: (1) Explanding Mesh, (2) Helix and (3) Rotating Cutter. These instruments will dislodge and remove organized clots, snare and cut fibrin "flaps", open and enlarge the vessel lumens. They have been used successfully in removing vascular obstructions adjacent to the vessel tips of the shunt or at the site of anastamosis of the shunt and vessel. These are the most common sites of obstruction. By prolonging shunt life we have been able to decrease the number of shunt revisions.

  3. Pathological Predictors of Shunt Stenosis and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt.

    PubMed

    He, Fuliang; Dai, Shan; Xiao, Zhibo; Wang, Lei; Yue, Zhendong; Zhao, Hongwei; Zhao, Mengfei; Lin, Qiushi; Dong, Xiaoqun; Liu, Fuquan

    2016-01-01

    Background. Transjugular intrahepatic portosystemic shunt (TIPS) is an artificial channel from the portal vein to the hepatic vein or vena cava for controlling portal vein hypertension. The major drawbacks of TIPS are shunt stenosis and hepatic encephalopathy (HE); previous studies showed that post-TIPS shunt stenosis and HE might be correlated with the pathological features of the liver tissues. Therefore, we analyzed the pathological predictors for clinical outcome, to determine the risk factors for shunt stenosis and HE after TIPS. Methods. We recruited 361 patients who suffered from portal hypertension symptoms and were treated with TIPS from January 2009 to December 2012. Results. Multivariate logistic regression analysis showed that the risk of shunt stenosis was increased with more severe inflammation in the liver tissue (OR, 2.864; 95% CI: 1.466-5.592; P = 0.002), HE comorbidity (OR, 6.266; 95% CI, 3.141-12.501; P < 0.001), or higher MELD score (95% CI, 1.298-1.731; P < 0.001). Higher risk of HE was associated with shunt stenosis comorbidity (OR, 6.266; 95% CI, 3.141-12.501; P < 0.001), higher stage of the liver fibrosis (OR, 2.431; 95% CI, 1.355-4.359; P = 0.003), and higher MELD score (95% CI, 1.711-2.406; P < 0.001). Conclusion. The pathological features can predict individual susceptibility to shunt stenosis and HE.

  4. Radionuclide demonstration of intrapulmonary shunting in cirrhosis

    SciTech Connect

    Bank, E.R.; Thrall, J.H.; Dantzker, D.R.

    1983-05-01

    The association of hepatic cirrhosis and severe arterial hypoxemia has been well described. Although alterations in ventilatory function may partially account for the hypoxemia, the principal mechanism is thought to be a microangiopathic change in the pulmonary arteriovenous shunting with resultant systemic desaturation. Whole-body radionuclide scans with technetium-99m macroaggrregated albumin (/sup 99m/Tc MAA) labeling have been diagnostic of right-to-left shunting by their demonstration of tracer accumulation within the extrapulmonary circulation. A case of severe pulmonary arteriovenous shunting in an alcoholic patient in whom hepatic disease had not been of apparent clinical significance before radionuclide scanning is reported. He did not have cutaneous angiomata as have all other patients with alcoholic cirrhosis and hypoxemia.

  5. Radionuclide demonstration of intrapulmonary shunting in cirrhosis

    SciTech Connect

    Bank, E.R.; Thrall, J.H.; Dantzker, D.R.

    1983-05-01

    The association of hepatic cirrhosis and severe arterial hypoxemia has been well described. Although alterations in ventilatory function may partially account for the hypoxemia, the principal mechanism is thought to be a microangiopathic change in the pulmonary vasculature resulting in intrapulmonary arteriovenous shunting with resultant systemic desaturation. Whole-body radionuclide scans with technetium-99m macroaggregated albumin labeling have been diagnostic of right-to-left shunting by their demonstration of tracer accumulation within the extrapulmonary circulation. A case of severe pulmonary arteriovenous shunting in an alcoholic patient in whom hepatic disease had not been of apparent clinical significance before radionuclide scanning is reported. He did not have cuntaeous angiomata as have all other patients with alcoholic cirrhosis and hypoxemia.

  6. Oculogyric crisis masquerading as ventriculoperitoneal shunt dysfunction.

    PubMed

    AlAzwary, Nail H; Muayqil, Taim; Siddiqi, Zaeem A; Ahmed, S Nizam

    2008-11-01

    Oculogyric crisis (OGC) is an underrecognized oculodystonic reaction associated with several medications including carbamazepine. The authors present a patient who had presented to the emergency department on multiple occasions with a questionable ventriculoperitoneal (VP) shunt dysfunction. Symptoms included nausea, vomiting, altered level of consciousness, ataxia, and vertical eye deviation. The patient underwent multiple revisions of the VP shunt with transient and questionable improvement. During her visit to the neurology clinic, OGC from carbamazepine was suspected, and the dose was reduced. The patient has been completely asymptomatic for the past 18 months. The authors report this case to increase the awareness of carbamazepine-induced OGC as one of the differential diagnoses for VP shunt dysfunction.

  7. Arteriovenous shunts resembling patent ductus arteriosus in dogs: 3 cases.

    PubMed

    Fujii, Yoko; Aoki, Takuma; Takano, Hiroshi; Ishikawa, Ryokichi; Wakao, Yoshito

    2009-12-01

    Three dogs presented for the evaluation of cardiac murmurs were diagnosed with aberrant arteriovenous shunts. All cases demonstrated the following findings: 1) relatively soft continuous murmur loudest at the left heart base resembling patent ductus arteriosus (PDA); 2) shunt flow signals in the pulmonary artery on echocardiography; and 3) no PDA on selective angiography, but evidence of anomalous shunting vessels from thoracic aorta to pulmonary vasculature. An aberrant arteriovenous shunt should be considered when a continuous murmur of relatively small intensity is heard.

  8. Intraoperative Fluoroscopy for Ventriculoperitoneal Shunt Placement.

    PubMed

    Coluccia, Daniel; Anon, Javier; Rossi, Frederic; Marbacher, Serge; Fandino, Javier; Berkmann, Sven

    2016-02-01

    Catheter malpositioning is one of the most frequent causes of ventriculoperitoneal shunt dysfunction and revision surgery. Most intraoperative tools used to improve the accuracy of catheter insertion are time consuming and expensive or do not display the final position. We evaluate the usefulness of intraoperative fluoroscopy to decrease catheter malpositioning, and define radiological landmarks to identify the correct localization. A total of 104 patients undergoing ventriculoperitoneal shunt placement were analyzed for shunt position, revision surgery and outcome. The results for patients operated on using intraoperative biplanar fluoroscopic assessment of catheter location (X-ray group, n = 57) were compared with a control group operated without intraoperative radiography (control, n = 47). In order to generate a surgical reference map for intraoperative validation of shunt location, different ventricular system landmarks were defined on three-dimensional computed tomography reconstructions of hydrocephalic patients (n = 60) and exported to a two-dimensional layer of the skull. The use of intraoperative X-ray imaging correlated with a significant increase of optimal catheter positions (X-ray group, n = 45, 79%; control group, n = 23, 49%; P = 0.0018). The sensitivity and positive predictive value for estimating an optimal shunt catheter position on biplanar imaging was 96% (95% confidence interval, 87%-99%). The specificity and negative predictive value were both 92% (95% confidence interval, 78%-98%). Intraoperative fluoroscopy is easy to perform and is a reliable method to assess correct catheter positioning. Based on its predictive value, corrections of malpositioned ventricular catheters can be performed during the same procedure. The use of intraoperative fluoroscopy decreases early surgical revisions in ventriculoperitoneal shunt treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Recovery from confabulation after normotensive hydrocephalus shunting.

    PubMed

    Dalla Barba, Gianfranco; Barbera, Claudia; Brazzarola, Marta; Marangoni, Sara

    2016-02-01

    Confabulation, the production of statements and actions that are unintentionally incongruous to the subject's history, background, present and future situation, is observed in several conditions affecting the nervous system, but it has never been described in normotensive hydrocephalus. In this article we report on a patient with normotensive hydrocephalus who suffered from an amnesic-confabulatory syndrome. After hydrocephalus shunting, both amnesia and confabulation cleared up abruptly. We discuss this finding in terms of a possible disconnection of the hippocampus, due to transitory white matter damage, which may have recovered after hydrocephalus shunting.

  10. Ventricular shunt infections: Immunopathogenesis and clinical management

    PubMed Central

    Gutierrez-Murgas, Yenis; Snowden, Jessica N.

    2014-01-01

    Ventricular shunts are the most common neurosurgical procedure performed in the United States. This hydrocephalus treatment is often complicated by infection of the device with biofilm-forming bacteria. In this review, we discuss the pathogenesis of shunt infection, as well as the implications of the biofilm formation on treatment and prevention of these infections. Many questions remain, including the contribution of glia and the impact of inflammation on developmental outcomes following infection. Immune responses within the CNS must be carefully regulated to contain infection while minimizing bystander damage; further study is needed to design optimal treatment strategies for these patients. PMID:25156073

  11. CT-Guided Transfemoral Portocaval Shunt Creation

    SciTech Connect

    Bloch, Robert; Fontaine, Arthur; Borsa, John; Hoffer, Eric; Kowdley, Kris

    2001-03-15

    A patient with superior vena cava (SVC) occlusion presented with severe ascites and urgent transjugular intrahepatic portosystemic shunt (TIPS) was requested. The patient had a chronically occluded SVC. An alternative to classic TIPS was employed using CT guidance to traverse the left portal vein to the inferior vena cava with a small gauge needle. Fluoroscopic guidance was then used to snare a wire placed through the needle and then work from the femoral vein to create a portocaval shunt that passed through the caudate lobe. This procedure was a technical success and improved the patient's ascites.

  12. 49 CFR 236.60 - Switch shunting circuit; use restricted.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Switch shunting circuit; use restricted. 236.60... Instructions: All Systems Track Circuits § 236.60 Switch shunting circuit; use restricted. Switch shunting circuit shall not be hereafter installed, except where tract or control circuit is opened by the circuit...

  13. 49 CFR 236.60 - Switch shunting circuit; use restricted.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Switch shunting circuit; use restricted. 236.60... Instructions: All Systems Track Circuits § 236.60 Switch shunting circuit; use restricted. Switch shunting circuit shall not be hereafter installed, except where tract or control circuit is opened by the circuit...

  14. 49 CFR 236.60 - Switch shunting circuit; use restricted.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Switch shunting circuit; use restricted. 236.60... Instructions: All Systems Track Circuits § 236.60 Switch shunting circuit; use restricted. Switch shunting circuit shall not be hereafter installed, except where tract or control circuit is opened by the circuit...

  15. 49 CFR 236.725 - Circuit, switch shunting.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Circuit, switch shunting. 236.725 Section 236.725 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Circuit, switch shunting. A shunting circuit which is closed through contacts of a switch circuit...

  16. 49 CFR 236.60 - Switch shunting circuit; use restricted.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Switch shunting circuit; use restricted. 236.60... Instructions: All Systems Track Circuits § 236.60 Switch shunting circuit; use restricted. Switch shunting circuit shall not be hereafter installed, except where tract or control circuit is opened by the circuit...

  17. 49 CFR 236.725 - Circuit, switch shunting.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Circuit, switch shunting. 236.725 Section 236.725 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Circuit, switch shunting. A shunting circuit which is closed through contacts of a switch circuit...

  18. 49 CFR 236.725 - Circuit, switch shunting.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Circuit, switch shunting. 236.725 Section 236.725 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Circuit, switch shunting. A shunting circuit which is closed through contacts of a switch circuit...

  19. 49 CFR 236.725 - Circuit, switch shunting.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Circuit, switch shunting. 236.725 Section 236.725 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Circuit, switch shunting. A shunting circuit which is closed through contacts of a switch circuit...

  20. 49 CFR 236.725 - Circuit, switch shunting.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Circuit, switch shunting. 236.725 Section 236.725 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Circuit, switch shunting. A shunting circuit which is closed through contacts of a switch circuit...

  1. 49 CFR 236.60 - Switch shunting circuit; use restricted.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Switch shunting circuit; use restricted. 236.60... Instructions: All Systems Track Circuits § 236.60 Switch shunting circuit; use restricted. Switch shunting circuit shall not be hereafter installed, except where tract or control circuit is opened by the circuit...

  2. 49 CFR 236.104 - Shunt fouling circuit.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Shunt fouling circuit. 236.104 Section 236.104 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION...: All Systems Inspections and Tests; All Systems § 236.104 Shunt fouling circuit. Shunt fouling circuit...

  3. 49 CFR 236.57 - Shunt and fouling wires.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Shunt and fouling wires. 236.57 Section 236.57...: All Systems Track Circuits § 236.57 Shunt and fouling wires. (a) Except as provided in paragraph (b) of this section, shunt wires and fouling wires hereafter installed or replaced shall consist of at...

  4. 49 CFR 236.104 - Shunt fouling circuit.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Shunt fouling circuit. 236.104 Section 236.104 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION...: All Systems Inspections and Tests; All Systems § 236.104 Shunt fouling circuit. Shunt fouling circuit...

  5. 49 CFR 236.57 - Shunt and fouling wires.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Shunt and fouling wires. 236.57 Section 236.57...: All Systems Track Circuits § 236.57 Shunt and fouling wires. (a) Except as provided in paragraph (b) of this section, shunt wires and fouling wires hereafter installed or replaced shall consist of at...

  6. 49 CFR 236.104 - Shunt fouling circuit.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Shunt fouling circuit. 236.104 Section 236.104 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION...: All Systems Inspections and Tests; All Systems § 236.104 Shunt fouling circuit. Shunt fouling circuit...

  7. 49 CFR 236.57 - Shunt and fouling wires.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Shunt and fouling wires. 236.57 Section 236.57...: All Systems Track Circuits § 236.57 Shunt and fouling wires. (a) Except as provided in paragraph (b) of this section, shunt wires and fouling wires hereafter installed or replaced shall consist of at...

  8. 49 CFR 236.57 - Shunt and fouling wires.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Shunt and fouling wires. 236.57 Section 236.57...: All Systems Track Circuits § 236.57 Shunt and fouling wires. (a) Except as provided in paragraph (b) of this section, shunt wires and fouling wires hereafter installed or replaced shall consist of at...

  9. 49 CFR 236.104 - Shunt fouling circuit.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Shunt fouling circuit. 236.104 Section 236.104 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION...: All Systems Inspections and Tests; All Systems § 236.104 Shunt fouling circuit. Shunt fouling circuit...

  10. 49 CFR 236.57 - Shunt and fouling wires.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Shunt and fouling wires. 236.57 Section 236.57...: All Systems Track Circuits § 236.57 Shunt and fouling wires. (a) Except as provided in paragraph (b) of this section, shunt wires and fouling wires hereafter installed or replaced shall consist of at...

  11. 49 CFR 236.104 - Shunt fouling circuit.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Shunt fouling circuit. 236.104 Section 236.104 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION...: All Systems Inspections and Tests; All Systems § 236.104 Shunt fouling circuit. Shunt fouling circuit...

  12. 21 CFR 882.4545 - Shunt system implantation instrument.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Shunt system implantation instrument. 882.4545... implantation instrument. (a) Identification. A shunt system implantation instrument is an instrument used in the implantation of cerebrospinal fluid shunts, and includes tunneling instruments for passing...

  13. [Intraabdominal metastasis of cerebellar medulloblastoma through ventriculoperitoneal shunt].

    PubMed

    Carrasco Torrents, R; Sancho, M A; Juliá, V; Montaner, A; Costa, J M; Morales, L

    2001-01-01

    We present a 6-year-old girl with cerebellar medulloblastoma causing obstructive hydrocephalus that was treated by ventriculoperitoneal shunting. The patient subsequently underwent surgical excision of the tumor followed by adjuvant craniospinal radiotherapy. Nine months after shunting, multiple intraabdominal metastatic lesions were found. Although the risk is low, ventriculoperitoneal shunting may facilitate the spread of malignant cells.

  14. Endoscopic observations of blocked ventriculoperitoneal (VP) shunt: a step toward better understanding of shunt obstruction and its removal.

    PubMed

    Singh, Daljit; Saxena, Anurag; Jagetia, Anita; Singh, Hukum; Tandon, Monica S; Ganjoo, Pragati

    2012-10-01

    Most of our understanding of ventriculoperitoneal (VP) shunt blockage (ventricular end) is based on in vitro studies of blocked VP shunts. Not much information is available regarding the in vivo changes that occur in the tube and in the surrounding ventricle. The primary aim of our study was to observe and analyse these changes, directly, through the endoscope, in patients with blocked shunts undergoing an endoscopic third ventriculostomy (ETV). Based on these findings, we have also suggested criteria for safe removal of the VP shunt tube following ETV. ETV was performed with standard technique in patients with blocked VP shunt. The ventricular end of the shunt tube was inspected through the endoscope, for changes in ventricle linings as well as in the shunt tube. These changes were correlated with the age of the patient, etiology of HC, type or make of the shunt tube, duration of shunt placement to ETV and the CSF findings. Fifty-three patients of blocked VP shunt underwent ETV from July 2006 to April 2010. Thirty patients had Chhabra (CH) V P Shunt (Surgiwear, India) and 23 had ceredrain (CD) shunt (Hindustan Latex, India). The age of the patients ranged from 2 months to 60 years (mean--13.33 years.). Various causes of hydrocephalus (HC) included congenital hydrocephalus (aqueductal stenosis) in 18 patients, post-meningitis hydrocephalus (PMH) in 32 cases, neuro-cysticercosis (NCC) in 2 patients and intraventricular haemorrhagic (IVH) in 1 patient. Clinical and radiological improvement occurred in 33 (62.21%), and 24 (45%) patients, respectively. Freedom from shunt was attained in 20 (38%) patients. The changes around the shunt tube were seen in 41 (77%). Hyperaemia and neovascularised ependyma was seen in 20 (37%) and 15 (28%) patients. Encasement of the tube was seen in 41%. Ependymal growth and neovascularised shunt tubes were noticed in 15% each. Choroid plexus blocking the tube was seen in only four cases (7%). VP shunt was revised in 14 patients (26

  15. Temporary arterial shunts in damage control: Experience and outcomes.

    PubMed

    Mathew, Sarah; Smith, Brian P; Cannon, Jeremy W; Reilly, Patrick M; Schwab, C William; Seamon, Mark J

    2017-03-01

    Arterial shunting is a well-described method to control hemorrhage and rapidly reestablish flow, but optimal shunt dwell times remain controversial. We hypothesized that prolonged shunt dwell times of more than 6 hours are related to adverse outcomes after major arterial injury. A review (2005-2013) of all patients with arterial shunts placed after traumatic injury at our urban Level I trauma center was undertaken. Patients who died prior to shunt removal (n = 7) were excluded. Shunt complications were defined as dislodgement, thrombosis, and distal ischemia. Patients were compared on the basis of shunt complications with respect to clinical parameters. The 42 patients who underwent arterial shunting after major vascular injury were primarily young (median, 26 years; interquartile range [IQR], 22-31 years) males (97.6%), severely injured (Injury Severity Score, 17.5 [IQR, 14-29]; shunted vessel Abbreviated Injury Scale score, 4 [IQR, 3-4]) by gunshot (85.7%) requiring neck/torso (33.3%) or upper-extremity (19.1%) or lower-extremity (47.6%) shunts. Thirty-five patients survived until shunt removal, and 5 (14.3%) of 35 developed shunt complications. Demographics and clinical characteristics were compared between those with shunt dwell times of less than 6 hours (n = 19) and more than 6 hours (n = 16). While patients appeared to have a greater injury burden overall in the group with dwell times of more than 6 hours, there were no statistical differences between groups with respect to age, gender, initial systolic blood pressure or hemodynamics during the shunt dwell period, use of vasopressors, Abbreviated Injury Scale score of the shunted vessel, Injury Severity Score, or outcomes including limb amputation or mortality. No patients (0/19) with shunt dwell times of less than 6 hours developed complications, whereas 5 (31.3%) of 16 patients with dwell times of more than 6 hours developed shunt complications (p = 0.05). In this civilian series, 14% of patients with

  16. 21 CFR 886.3920 - Aqueous shunt.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Aqueous shunt. 886.3920 Section 886.3920 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... neovascular glaucoma or with glaucoma when medical and conventional surgical treatments have failed....

  17. 21 CFR 886.3920 - Aqueous shunt.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Aqueous shunt. 886.3920 Section 886.3920 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... neovascular glaucoma or with glaucoma when medical and conventional surgical treatments have failed....

  18. 21 CFR 886.3920 - Aqueous shunt.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Aqueous shunt. 886.3920 Section 886.3920 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... neovascular glaucoma or with glaucoma when medical and conventional surgical treatments have failed....

  19. 21 CFR 886.3920 - Aqueous shunt.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Aqueous shunt. 886.3920 Section 886.3920 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... neovascular glaucoma or with glaucoma when medical and conventional surgical treatments have failed....

  20. 21 CFR 886.3920 - Aqueous shunt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Aqueous shunt. 886.3920 Section 886.3920 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... neovascular glaucoma or with glaucoma when medical and conventional surgical treatments have failed....

  1. Intrinsically shunted Josephson junctions for electronics applications

    NASA Astrophysics Data System (ADS)

    Belogolovskii, M.; Zhitlukhina, E.; Lacquaniti, V.; De Leo, N.; Fretto, M.; Sosso, A.

    2017-07-01

    Conventional Josephson metal-insulator-metal devices are inherently underdamped and exhibit hysteretic current-voltage response due to a very high subgap resistance compared to that in the normal state. At the same time, overdamped junctions with single-valued characteristics are needed for most superconducting digital applications. The usual way to overcome the hysteretic behavior is to place an external low-resistance normal-metal shunt in parallel with each junction. Unfortunately, such solution results in a considerable complication of the circuitry design and introduces parasitic inductance through the junction. This paper provides a concise overview of some generic approaches that have been proposed in order to realize internal shunting in Josephson heterostructures with a barrier that itself contains the desired resistive component. The main attention is paid to self-shunted devices with local weak-link transmission probabilities that are so strongly disordered in the interface plane that transmission probabilities are tiny for the main part of the transition region between two super-conducting electrodes, while a small part of the interface is well transparent. We discuss the possibility of realizing a universal bimodal distribution function and emphasize advantages of such junctions that can be considered as a new class of self-shunted Josephson devices promising for practical applications in superconducting electronics operating at 4.2 K.

  2. Neoglottic vibration in tracheoesophageal shunt phonation.

    PubMed

    Omori, K; Kojima, H

    1999-01-01

    The purpose of the present study was to examine vibratory patterns of the neoglottis and to ascertain the neoglottic conditions that could cause failure in tracheoesophageal shunt phonation. We studied 30 tracheoesophageal shunt speakers while using "trap-door" type voice prostheses. Videostroboscopy was undertaken to investigate vibratory patterns of the neoglottis during phonation of the sustained vowel sound /e/ in these patients. The voice qualities of the patients were judged perceptually. A regular neoglottic vibration was observed in 21 patients. Nine patients had irregular neoglottic vibrations. In this latter group, two patients had incomplete neoglottic closures with breathy voices, four patients had multiple contacts of several mucosal walls with rough voices, and three patients had tight neoglottic closures with strained voices. During stroboscopic evaluation of tracheoesophageal shunt phonation, regularity of the neoglottic vibration may be the most significant finding. These findings show that it is as important to evaluate neoglottic vibration in alaryngeal voicing as it is to study glottic vibration in laryngeal voicing. Stroboscopic examination may be a help to elucidate a cause of failure in cases of poor tracheoesophageal shunt speech.

  3. Muzzle shunt augmentation of conventional railguns

    SciTech Connect

    Parker, J.V.

    1990-01-01

    Augmentation is a well-known technique for reducing the armature current and hence the armature power dissipation in a plasma armature railgun. In spite of the advantages, no large augmented railguns have been built, primarily due to the mechanical and electrical complexity introduce by the extra conductors required. It is possible to achieve some of the benefits of augmentation in conventional railgun by diverting a fraction {phi} of the input current through a shunt path at the muzzle of the railgun. In particular, the relation between force and armature current is the same as that obtained in an n-turn, series connected augmented railgun with n = 1/(1-{phi}). The price of this simplification is a reduction in electrical efficiency and some additional complexity in the external electrical system. Additions to the electrical system are required to establish the shunt current and to control its magnitude during projectile acceleration. The relationship between muzzle shunt augmentation and conventional series augmentation is developed and various techniques is developed and various techniques for establishing and controlling the shunt current are illustrated with a practical example. 5 refs., 8 figs., 2 tabs.

  4. Platypnea-Orthodeoxia Syndrome: To Shunt or Not to Shunt, That is the Question.

    PubMed

    Klein, Michael R; Kiefer, Todd L; Velazquez, Eric J

    2016-06-01

    Platypnea-orthodeoxia syndrome is a rare disease defined by dyspnea and deoxygenation, induced by an upright position, and relieved by recumbency. Causes include shunting through a patent foramen ovale and pulmonary arteriovenous malformations. A 79-year-old woman experienced 2 syncopal episodes at rest and presented at another hospital. In the emergency department, she was hypoxic, needing 6 L/min of oxygen. Her chest radiograph showed nothing unusual. Transthoracic echocardiograms with saline microcavitation evaluation were mildly positive early after agitated-saline administration, suggesting intracardiac shunting. She was then transferred to our center. Right-sided heart catheterization revealed no oximetric evidence of intracardiac shunting while the patient was supine and had a low right atrial pressure. However, her oxygen saturation dropped to 78% when she sat up. Repeat transthoracic echocardiography while sitting revealed a dramatically positive early saline microcavitation-uptake into the left side of the heart. Transesophageal echocardiograms showed a patent foramen ovale, with right-to-left shunting highly dependent upon body position. The patient underwent successful percutaneous patent foramen ovale closure, and her oxygen supplementation was suspended. In patients with unexplained or transient hypoxemia in which a cardiac cause is suspected, it is important to evaluate shunting in both the recumbent and upright positions. In this syndrome, elevated right atrial pressure is not necessary for significant right-to-left shunting. Percutaneous closure, if feasible, is first-line therapy in these patients.

  5. Advantages of temporary venoatrial shunt using centrifugal pump during bidirectional cavopulmonary shunt.

    PubMed

    Kotani, Yasuhiro; Honjo, Osami; Ishino, Kozo; Osaki, Satoru; Kuroko, Yosuke; Kawabata, Takuya; Ugaki, Shinya; Yoshizumi, Ko; Kasahara, Shingo; Kawada, Masaaki; Sano, Shunji

    2006-01-01

    Single-ventricle palliation without the use of cardiopulmonary bypass carries advantages that reduce systemic edema and inflammatory responses; however, simple clamping of the superior vena cava (SVC) without a temporary shunt leads to increase in cerebral venous pressure and subsequent decrease in cerebral blood flow during bidirectional cavopulmonary shunt (BCPS). We report our experience of BCPS, using a centrifugal pump-assisted temporary shunt. The criteria included an unrestrictive interatrial communication, the absence of atrioventricular valve regurgitation, and the existence of an antegrade pulmonary blood flow. From August 2000, 14 children with single-ventricle physiology met the criteria. The mean age was 1.0 +/- 0.9 years, and the mean weight was 8.4 +/- 2.6 kg. A temporary shunt was established between the SVC and the right atrium with right-angle cannulae, which were connected to a centrifugal pump to accelerate the blood flow from the SVC to the right atrium. All patients tolerated the procedure. Mean central venous pressure was 17 +/- 4 mm Hg, and transcutaneous oxygen saturation was maintained at 77 +/- 8% during anastomosis. No patients required blood transfusion. There were no postoperative neurological complications. The centrifugal pump-assisted temporary shunt offered safer and more effective circulatory support than other shunt systems, with excellent venous drainage in pediatric patients undergoing BCPS.

  6. Laparoscopic Guidance or Revision of Ventriculoperitoneal Shunts in Children

    PubMed Central

    Yu, Sherman; Bensard, Denis D.; Partrick, David A.; Petty, John K.; Karrer, Frederick M.

    2006-01-01

    Background: Ventriculoperitoneal shunt is the preferred treatment for hydrocephalus. Known complications include infection, obstruction, and disconnection with the fractured fragment migrating in the peritoneal cavity. We report 17 cases of laparoscopic evaluation and revision of ventriculoperitoneal shunts in children. Methods: From January 2000 through October 2002, we retrospectively reviewed our experience with laparoscopy and ventriculoperitoneal shunts. Results: Laparoscopy was performed in 17 children with a malfunctioning shunt, presumed shunt dislodgment or disconnection, reinsertion of a shunt after externalization, and primary shunt placement. Six patients (35%) were converted to an open laparotomy due to dense adhesions. Eleven patients (65%) underwent successful laparoscopic-assisted ventriculoperitoneal shunt placement: 5/11 (45%) had lysis of adhesions or pseudocyst marsupialization with repositioning of a functional shunt, or both; 3/11 (27%) had successful retrieval of a disconnected catheter with reinsertion of a new catheter; 2/11 (18%) had laparoscopic confirmation of satisfactory placement and function, requiring no revision; 1/11 (9%) had an initial shunt placed with laparoscopic guidance due to the obesity. Operative time for the laparoscopic procedure ranged from 30 minutes to 60 minutes. All laparoscopic procedures used 1-mm or two 5-mm ports. Perioperatively, no adverse neurological sequelae occurred due to the pneumoperitoneum. Conclusion: Laparoscopic guidance or revision of ventriculoperitoneal shunts permits (1) direct visualization of catheter insertion within the peritoneal cavity, (2) satisfactory positioning, (3) lysis of adhesions or marsupialization with catheter repositioning, or both, and (4) retrieval of fractured catheters. PMID:16709376

  7. Clinical peritonitis from allergy to silicone ventriculoperitoneal shunt.

    PubMed

    Kurin, Michael; Lee, Kenneth; Gardner, Paul; Fajt, Merritt; Umapathy, Chandraprakash; Fasanella, Kenneth

    2017-03-06

    Silicones are inorganic compounds that have been used for the purpose of shunting ventricular fluid since the mid-20th century [1]. Complications of ventriculoperitoneal shunts have rarely been attributed to silicone allergy, with only a handful of cases reported in literature. The classic presentation of allergy to silicone ventriculoperitoneal shunt, i.e., abdominal pain with recurrent skin breakdown along the shunt tract, is nonspecific and difficult to distinguish clinically from other causes of shunt-related symptoms. It can be diagnosed by detection of antisilicone antibodies and is treated with removal of the shunt and replacement, if needed, with a polyurethane shunt system. We report the first case of suspected silicone allergy presenting as clinical peritonitis without overt colonic perforation.

  8. Intraparenchymal pericatheter cyst following disconnection of ventriculoperitoneal shunt system.

    PubMed

    Balasubramaniam, S; Tyagi, D K; Sawant, H V

    2013-01-01

    Ventriculoperitoneal (VP) shunt is one of the most commonly performed procedures in neurosurgery, but it is also the procedure, which is most prone to complications. Spread of cerebrospinal fluid (CSF) into the brain parenchyma is a rare complication of VP shunt and can take the form of CSF edema or a porencephalic cyst. We describe a case of a 1½-year-old child who presented to us with seizures. Computed tomography scan revealed pericatheter porencephalic cyst. Surgical exploration revealed a disconnected VP shunt system. Patient was neurologically observed after shunt extraction. He was seizure free and radiological follow-up showed resolution of cyst. Ours is the first case to document the presence of pericatheter cyst following complete disconnection of shunt system. Though shunt revision is the accepted treatment modality, careful neurological observation can be done after shunt removal especially in asymptomatic cases with compensated hydrocephalus.

  9. Passively Shunted Piezoelectric Damping of Centrifugally-Loaded Plates

    NASA Technical Reports Server (NTRS)

    Duffy, Kirsten P.; Provenza, Andrew J.; Trudell, Jeffrey J.; Min, James B.

    2009-01-01

    Researchers at NASA Glenn Research Center have been investigating shunted piezoelectric circuits as potential damping treatments for turbomachinery rotor blades. This effort seeks to determine the effects of centrifugal loading on passively-shunted piezoelectric - damped plates. Passive shunt circuit parameters are optimized for the plate's third bending mode. Tests are performed both non-spinning and in the Dynamic Spin Facility to verify the analysis, and to determine the effectiveness of the damping under centrifugal loading. Results show that a resistive shunt circuit will reduce resonant vibration for this configuration. However, a tuned shunt circuit will be required to achieve the desired damping level. The analysis and testing address several issues with passive shunt circuit implementation in a rotating system, including piezoelectric material integrity under centrifugal loading, shunt circuit implementation, and tip mode damping.

  10. Free floating ventricular shunt catheter between lateral ventricles: a case report of an unusual ventriculoperitoneal shunt complication.

    PubMed

    Erol, Fatih Serhat; Cakin, Hakan; Ozturk, Sait; Donmez, Osman; Kaplan, Metin

    2013-01-01

    Ventriculoperitoneal (VP) shunt proximal tip disconnection is rarely seen as a shunt complication. Shunt dysfunction and hydrocephaly can develop due to this disconnection. Presented here is a case of a disconnection of the ventricular catheter from the shunt valve, which passed between both lateral ventricles by free floating in the brain CT. The patient was operated on for hydrocephaly. The dysfunctional shunt valve and peritoneal catheter were removed and a new VP shunt system was implemented. Although some publications report that the ventricular catheter can be disconnected from the shunt valve, can adhere to the intraventricular structures, and can be a source of infection, no studies similar to the current case were found in the literature reporting a free floating ventricular catheter between the lateral ventricles.

  11. Pathological Predictors of Shunt Stenosis and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt

    PubMed Central

    He, Fuliang; Dai, Shan; Xiao, Zhibo; Wang, Lei; Yue, Zhendong; Zhao, Hongwei; Zhao, Mengfei; Lin, Qiushi; Dong, Xiaoqun

    2016-01-01

    Background. Transjugular intrahepatic portosystemic shunt (TIPS) is an artificial channel from the portal vein to the hepatic vein or vena cava for controlling portal vein hypertension. The major drawbacks of TIPS are shunt stenosis and hepatic encephalopathy (HE); previous studies showed that post-TIPS shunt stenosis and HE might be correlated with the pathological features of the liver tissues. Therefore, we analyzed the pathological predictors for clinical outcome, to determine the risk factors for shunt stenosis and HE after TIPS. Methods. We recruited 361 patients who suffered from portal hypertension symptoms and were treated with TIPS from January 2009 to December 2012. Results. Multivariate logistic regression analysis showed that the risk of shunt stenosis was increased with more severe inflammation in the liver tissue (OR, 2.864; 95% CI: 1.466–5.592; P = 0.002), HE comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P < 0.001), or higher MELD score (95% CI, 1.298–1.731; P < 0.001). Higher risk of HE was associated with shunt stenosis comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P < 0.001), higher stage of the liver fibrosis (OR, 2.431; 95% CI, 1.355–4.359; P = 0.003), and higher MELD score (95% CI, 1.711–2.406; P < 0.001). Conclusion. The pathological features can predict individual susceptibility to shunt stenosis and HE. PMID:27975051

  12. Who Needs a Revision? 20 Years of Cambridge Shunt Lab.

    PubMed

    Czosnyka, Zofia; Czosnyka, Marek; Pickard, John D; Chari, Aswin

    2016-01-01

    Shunt testing independent of manufacturers provides knowledge that can significantly improve the management of patients with hydrocephalus. The Cambridge Shunt Evaluation Laboratory was created 20 years ago. Thanks to financial support from the Department of Health (1993-1998), all shunts in use in the UK were systematically evaluated, with "blue reports" being published. Later new devices were tested as they appeared in public domain.Twenty-six models have been evaluated. The majority of the valves had a non-physiologically low hydrodynamic resistance that may result in over-drainage, both related to posture and during nocturnal cerebral vasogenic waves. A long distal catheter increases the resistance of these valves by 100-200 %. Drainage through valves without a siphon-preventing mechanism is very sensitive to body posture. Shunts with siphon-preventing accessories offer a reasonable resistance to negative outlet pressure. Bench parameters were used to test shunt performance in vivo using infusion tests. A criterion for correctly performing a shunt procedure was established. Pressure measured in the shunt prechamber during the plateau phase of infusion should not remain more than 5 mmHg above the le shunt's operating pressure plus hydrodynamic resistance of the valve multiplied by the infusion rate. "Critical levels" for every shunt and every performance level have been used in the shunt testing wizard of ICM+ software.

  13. Effect of Electromagnetic Navigated Ventriculoperitoneal Shunt Placement on Failure Rates

    PubMed Central

    Jung, Nayoung

    2013-01-01

    Objective To evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement. Methods All patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma. Results A total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test). Conclusion The use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates. PMID:23634264

  14. Hydrocephalus shunt technology: 20 years of experience from the Cambridge Shunt Evaluation Laboratory.

    PubMed

    Chari, Aswin; Czosnyka, Marek; Richards, Hugh K; Pickard, John D; Czosnyka, Zofia H

    2014-03-01

    The Cambridge Shunt Evaluation Laboratory was established 20 years ago. This paper summarizes the findings of that laboratory for the clinician. Twenty-six models of valves have been tested long-term in the shunt laboratory according to the expanded International Organization for Standardization 7197 standard protocol. The majority of the valves had a nonphysiologically low hydrodynamic resistance (from 1.5 to 3 mm Hg/[ml/min]), which may result in overdrainage related to posture and during nocturnal cerebral vasogenic waves. A long distal catheter increases the resistance of these valves by 100%-200%. Drainage through valves without a siphon-preventing mechanism is very sensitive to body posture, which may result in grossly negative intracranial pressure. Siphon-preventing accessories offer a reasonable resistance to negative outlet pressure; however, accessories with membrane devices may be blocked by raised subcutaneous pressure. In adjustable valves, the settings may be changed by external magnetic fields of intensity above 40 mT (exceptions: ProGAV, Polaris, and Certas). Most of the magnetically adjustable valves produce large distortions on MRI studies. The behavior of a valve revealed during testing is of relevance to the surgeon and may not be adequately described in the manufacturer's product information. The results of shunt testing are helpful in many circumstances, such as the initial choice of shunt and the evaluation of the shunt when its dysfunction is suspected.

  15. Incisional Hernia Following Ventriculoperitoneal Shunt Positioning.

    PubMed

    Bonatti, Matteo; Vezzali, Norberto; Frena, Antonio; Bonatti, Giampietro

    2016-06-01

    Incisional hernia represents a rare complication after ventriculoperitoneal shunt positioning due to failure of the fascial suture in the site of abdominal entrance of ventriculoperitoneal catheter. Clinical presentation can be extremely variable, according to patient's performance status, herniated material constitution (i.e. mesenteric fat, bowel loops or both) and complication occurrence (e.g. strangulation or intestinal obstruction). Early diagnosis is fundamental in order to surgically repair the defect and prevent further complications. We present the case of a paucisymptomatic incisional hernia following ventriculoperitoneal shunt positioning. Diagnosis was made by means of ultrasound and confirmed by means of computed tomography. The patient was successfully managed by means of surgical repositioning of herniated loop and re-suture.

  16. Mycobacterium fortuitum infection of ventriculoperitoneal shunt.

    PubMed

    Midani, S; Rathore, M H

    1999-07-01

    Mycobacterium fortuitum is one of the rapidly growing mycobacteria found in soil, dust, and water. It can be isolated as a normal colonizing organism, but as a pathogen this organism causes mainly skin and soft tissue infection preceded by trauma. A wide variety of infections can occur in individuals with predisposing conditions. Central nervous system infection with M fortuitum is rare, and meningitis occurs after surgery or trauma. We believe that ventriculoperitoneal (VP) shunt infection with this organism has not been reported in the literature. Practitioners should be aware of this rare entity and should suspect it in the presence of cerebrospinal fluid pleocytosis with sterile culture, and after trauma, surgery, or manipulation of the VP shunt hardware. Mycobacterium fortuitum is resistant to most first-line and second-line antituberculous drugs, and treatment should include surgical debridement in addition to prolonged antimicrobial therapy.

  17. An alternative to the glyoxylate shunt.

    PubMed

    Schink, Bernhard

    2009-09-01

    A cycle remains a cycle only as long as the spokes of the wheel are not stolen. To keep the citric acid cycle going requires anaplerotic reactions such as the glyoxylate shunt to restore the cycle intermediates that are withdrawn for the biosynthesis of cell constituents, e.g. amino acids and haemin precursors. The article by Erb et al. in this issue of Molecular Microbiology documents an alternative path that replenishes four-carbon intermediates during growth on acetate in the absence of the glyoxylate shunt. The reaction sequence forms malate and succinyl-CoA from three acetyl-CoA, one CO(2) and one HCO(3) in a linear pathway. This new pathway was discovered in phototrophic anoxygenic bacteria and in few aerobic bacteria, but it is probably widespread among many metabolic groups of bacteria.

  18. Incisional Hernia Following Ventriculoperitoneal Shunt Positioning

    PubMed Central

    Bonatti, Matteo; Vezzali, Norberto; Frena, Antonio; Bonatti, Giampietro

    2016-01-01

    Incisional hernia represents a rare complication after ventriculoperitoneal shunt positioning due to failure of the fascial suture in the site of abdominal entrance of ventriculoperitoneal catheter. Clinical presentation can be extremely variable, according to patient’s performance status, herniated material constitution (i.e. mesenteric fat, bowel loops or both) and complication occurrence (e.g. strangulation or intestinal obstruction). Early diagnosis is fundamental in order to surgically repair the defect and prevent further complications. We present the case of a paucisymptomatic incisional hernia following ventriculoperitoneal shunt positioning. Diagnosis was made by means of ultrasound and confirmed by means of computed tomography. The patient was successfully managed by means of surgical repositioning of herniated loop and re-suture. PMID:27761180

  19. [Transjugular portosystemic shunt. The current concepts].

    PubMed

    Ferral, H; Alcántara-Peraza, A; Kimura-Fujikami, Y; Castañeda-Zúñiga, W

    1994-01-01

    The transjugular intrahepatic portosystemic shunt (TIPS) is an alternative therapeutic approach in the treatment of hemorrhagic portal hypertension. The use of this procedure was established in 1988 and since then, its use has extended impressively. Currently, the accepted indication for TIPS is the variceal bleeding secondary to portal hypertension refractory to medical management or sclerotherapy. In this paper the basic concepts of the TIPS procedure are reviewed, including historical perspective, technical aspects, indications, contraindications and complications.

  20. [Congenital portosystemic shunt in dogs and cats].

    PubMed

    Grevel, V; Schmidt, S; Lettow, E; Suter, P F; Schmidt, G U

    1987-01-01

    An overview of the circulation of the liver and of the pathogenesis of hepatic encephalopathy as a result of portal vascular anomalies is given. Clinical signs associated with portal systemic shunts are described on the basis of 16 cases, 14 dogs and 2 cats. These animals ranged in age at the time of presentation from 4 months to 7 years. The predominant abnormality observed were central nervous signs, which differed in severity. The different techniques of contrast angiography allowing demonstration of a portal systemic shunt are presented along with a discussion of the pros and cons of each. Additionally the significance of making portal venous pressure measurements prior to each angiography is also explained. In most cases mesenteric portography was chosen. Based on their location the anomalies could be categorized as intrahepatic (4 dogs) or extrahepatic (10 dogs, 2 cats). In both groups breeds of various size are represented. The extrahepatic shunts could be further described as portal-caval (n = 5), portal-phrenic (n = 4) and portal-azygos (n = 3). In five of the older animals angiography showed in addition some hepatic perfusion by the portal vein. Laboratory evaluation revealed increased resting blood ammonia concentrations (greater than 200-912 micrograms/100 ml) in all animals. Seven dogs had definitely subnormal BUN concentrations (less than 10 mg%) and ten dogs low total plasma protein levels (less than 5.4 g%). Free amino acids (24) were determined in four dogs and a lowered hepatic encephalopathy index (less than 1.64) found. Medical palliative therapy to control the clinical signs is discussed. The only effective long term therapy is, however, surgery. The shunt vessel is narrowed so that a greater volume of portal blood reaches the liver. Experience gained from the surgical therapy of 14 animals is presented. Ten of these survived well without requiring further therapy at a later time. Finally the etiology, prognosis, and differential diagnosis are

  1. Efficacy of postoperative antibiotic injection in and around ventriculoperitoneal shunt in reduction of shunt infection: A randomized controlled trial.

    PubMed

    Moussa, Wael Mohamed Mohamed; Mohamed, Mohamed Abbas Aly

    2016-04-01

    Infection is a common complication of ventriculoperitoneal (VP) shunt surgery. The incidence of shunt infection is still high despite routine administration of perioperative antibiotics. A lower incidence of shunt infection was observed when antibiotic-impregnated shunts (AIS) were used to treat hydrocephalus and a rapid cure was reported in cases of ventriculitis when antibiotics were injected into external ventricular drain (EVD). That is why we theorized that postoperative prophylactic injection of antibiotics in and around the shunt hardware would reduce the incidence of shunt infection. A randomized controlled clinical trial where 60 patients up to one year old, diagnosed with congenital hydrocephalus and submitted to VP shunt insertion, were randomly assigned to one of 3 groups. The treatment groups received the conventional perioperative antibiotics in addition to vancomycin and gentamicin injection in the reservoir and around the peritoneal catheter either once (group A) or twice (group B), while the control group (C) received only the conventional perioperative antibiotics. Cases were followed-up for up to 1 year. The majority of patients were less than 1 month old. The follow-up period ranged from 2 to 12 months with a mean of 8.9 months. The mean duration of onset of infection after surgery was 30 days. Prematurity (p=0.00236), age less than one month (p<0.0001) and duration of surgery of 90 min or more (p<0.00001) were significant risk factors for postoperative shunt infection. Significantly more cases of shunt infection occurred within one month after surgery (p=0.021). The control group had significantly more cases of postoperative shunt infection than the treatment groups (p=0.0042). In congenital hydrocephalus patients submitted to VP shunt insertion, injection of prophylactic vancomycin and gentamicin in and around the shunt hardware significantly reduced the incidence of postoperative shunt infection. Copyright © 2016 Elsevier B.V. All rights

  2. Quantitative evaluation fo cerebrospinal fluid shunt flow

    SciTech Connect

    Chervu, S.; Chervu, L.R.; Vallabhajosyula, B.; Milstein, D.M.; Shapiro, K.M.; Shulman, K.; Blaufox, M.D.

    1984-01-01

    The authors describe a rigorous method for measuring the flow of cerebrospinal fluid (CSF) in shunt circuits implanted for the relief of obstructive hydrocephalus. Clearance of radioactivity for several calibrated flow rates was determined with a Harvard infusion pump by injecting the Rickham reservoir of a Rickham-Holter valve system with 100 ..mu..Ci of Tc-99m as pertechnetate. The elliptical and the cylindrical Holter valves used as adjunct valves with the Rickham reservoir yielded two different regression lines when the clearances were plotted against flow rats. The experimental regression lines were used to determine the in vivo flow rates from clearances calculated after injecting the Rickham reservoirs of the patients. The unique clearance characteristics of the individual shunt systems available requires that calibration curves be derived for an entire system identical to one implanted in the patient being evaluated, rather than just the injected chamber. Excellent correlation between flow rates and the clinical findings supports the reliability of this method of quantification of CSF shunt flow, and the results are fully accepted by neurosurgeons.

  3. Active shunt capacitance cancelling oscillator circuit

    DOEpatents

    Wessendorf, Kurt O.

    2003-09-23

    An oscillator circuit is disclosed which can be used to produce oscillation using a piezoelectric crystal, with a frequency of oscillation being largely independent of any shunt capacitance associated with the crystal (i.e. due to electrodes on the surfaces of the crystal and due to packaging and wiring for the crystal). The oscillator circuit is based on a tuned gain stage which operates the crystal at a frequency, f, near a series resonance frequency, f.sub.S. The oscillator circuit further includes a compensation circuit that supplies all the ac current flow through the shunt resistance associated with the crystal so that this ac current need not be supplied by the tuned gain stage. The compensation circuit uses a current mirror to provide the ac current flow based on the current flow through a reference capacitor that is equivalent to the shunt capacitance associated with the crystal. The oscillator circuit has applications for driving piezoelectric crystals for sensing of viscous, fluid or solid media by detecting a change in the frequency of oscillation of the crystal and a resonator loss which occur from contact of an exposed surface of the crystal by the viscous, fluid or solid media.

  4. [Percutaneous endoscopic gastrostomy in children with ventriculoperitoneal shunt].

    PubMed

    Valletta, E; Angelini, G; Castagnini, A; Fontana, E; Piccoli, R; Ulmi, D

    2003-01-01

    The complications of percutaneous endoscopic gastrostomy (PEG) placement or replacement or of home management of gastrostomy, must be taken in account in patients with hydrocephalus and ventriculoperitoneal shunt. In this report we describe four children with spastic quadriplegia and ventriculoperitoneal shunt who had a median follow-up of 15 months (range 4-32 months) after PEG placement. Intravenous antibiotic prophylaxis was always used during routine procedures and no shunt infection was observed. In a patient, during accidental PEG dislodgement, peritoneal infection developed that required temporary diversion of the catheter. A second dislodgement, in the same individual, determined a large amount of serous peritoneal fluid that needed to be evacuated but no shunt infection or malfunction. In nobody of our patients, the shunt, located in the upper left abdomen, interfered with gastrostomy placement. Our experience confirms that PEG is not contraindicated in patients with ventriculoperitoneal shunt, provided that the risks of catheter infection are known and prevented.

  5. Ventriculoperitoneal shunt infection following uterine instrumentation for dysfunctional uterine bleeding.

    PubMed

    Shaw, Andrew B; Marlin, Evan S; Ikeda, Daniel S; Ammirati, Mario

    2014-08-01

    Shunt infections are most common within the first 6 months following implantation. A shunt infection 19 years after implantation secondary to uterine ablation has not been reported to our knowledge. Office hysteroscopic procedures have become commonplace in gynecologic practice. Infectious complication rates are low, but peritonitis has been described. We present a patient with a ventriculoperitoneal shunt infection following a uterine ablation for dysfunctional uterine bleeding. Three days following the ablation she developed abdominal pain. CT scan of the abdomen 5 months after the procedure revealed a pseudocyst. She then underwent removal of her shunt with intra-operative cultures revealing Streptococcus agalactiae. Definitive treatment consisted of shunt explantation and antibiotic treatment with complete resolution of her pain and pseudocyst. Consideration for prophylactic antibiotics should be made when a patient with a ventriculoperitoneal shunt undergoes any transvaginal procedure.

  6. Shunt current loss of the vanadium redox flow battery

    NASA Astrophysics Data System (ADS)

    Xing, Feng; Zhang, Huamin; Ma, Xiangkun

    The shunt current loss is one of main factors to affect the performance of the vanadium redox flow battery, which will shorten the cycle life and decrease the energy transfer efficiency. In this paper, a stack-level model based on the circuit analog method is proposed to research the shunt current loss of the vanadium redox flow battery, in which the SOC (state of charge) of electrolyte is introduced. The distribution of shunt current is described in detail. The sensitive analysis of shunt current is reported. The shunt current loss in charge/discharge cycle is predicted with the given experimental data. The effect of charge/discharge pattern on the shunt current loss is studied. The result shows that the reduction of the number of single cells in series, the decrease of the resistances of manifold and channel and the increase of the power of single cell will be the further development for the VRFB stack.

  7. Liver transplant in a patient with a ventriculoperitoneal shunt.

    PubMed

    Faybush, Elisa; Mulligan, David C; Birch, Barry D; Sirven, Joseph I; Balan, Vijayan

    2005-04-01

    There are no published accounts of patients with ventriculoperitoneal shunts undergoing liver transplantation in the literature. Because patients with ventriculoperitoneal shunts are prone to infections, this may be a theoretical contraindication to transplantation. We present a case of a patient with cirrhosis who had a ventriculoperitoneal shunt placed many years prior to transplantation. The patient had no neurological complications and the shunt was intact and functioning. Prior to transplantation, the patient underwent a ventriculoperitoneal to ventriculopleural shunt conversion that was reversed posttransplantation. Apart from some minor complications, the patient has done remarkably well from a graft and neurological perspective. In conclusion, patients who have ventriculoperitoneal shunts may be considered for liver transplantation as the risk of infectious and neurological complications is low and there are no deleterious effects on graft survival.

  8. Ventriculopleural shunt: thoracoscopic placement of the distal catheter.

    PubMed

    Kurschel, S; Eder, H G; Schleef, J

    2003-11-01

    Ventriculopleural shunting is usually reserved for patients with limited options for shunt revisions. We report the case of a 16-year-old boy with posthemorrhagic hydrocephalus who required numerous shunt procedures. At the age of 6 years, a ventriculopleural shunt was inserted by an intercostal thoracotomy, and 4 years later replacement of the distal catheter was necessary. Recently, he presented again with a shunt malfunction due to migration of the pleural catheter. We describe a technique for performing the placement of the distal catheter under direct thoracoscopic vision by a peel-off needle into the unscarred thoracic cavity despite two previous pleural procedures. The postoperative course was uneventful. Thoracoscopic assistance in ventriculopleural shunt placement appears to be a safe and effective technique, offering several advantages over the open procedure: it is less invasive, allows a precise positioning of the thoracic catheter under visual control, and confirms appropriate function.

  9. Spontaneous bowel perforation complicating ventriculoperitoneal shunt: a case report

    PubMed Central

    Birbilis, Theodosios; Liratzopoulos, Nikolaos; Oikonomou, Anastasia; Karanikas, Michael; Kontogianidis, Kosmas; Kouklakis, Georgios

    2009-01-01

    Ventriculoperitoneal shunt placement is an effective treatment of hydrocephalus diverting the cerebrospinal fluid into the peritoneal cavity. Unfortunately, the shunt devices have a high incidence of malfunction mainly due to catheter obstruction or infection and are associated with various complications, 25% of which are abdominal. Spontaneous bowel perforation is a rare potentially fatal complication of ventriculoperitoneal shunt occurring anytime, few weeks to several years, after the placement of the ventriculoperitoneal shunt device. A 54-year-old Greek man with spontaneous perforation of sigmoid colon as a complication of distal ventriculoperitoneal shunt migration was treated successfully by antibiotic prophylaxis and abdominal surgery. Clinicians managing patients with ventriculoperitoneal shunt must be familiar with its possible complications and be aware for early recognition of them. PMID:19918409

  10. Reduction of ventricular size after shunting for normal pressure hydrocephalus related to CSF dynamics before shunting.

    PubMed Central

    Tans, J T; Poortvliet, D C

    1988-01-01

    Reduction of ventricular size was determined by repeated computed tomography in 30 adult patients shunted for normal pressure hydrocephalus (NPH) and related to the pressure-volume index (PVI) and resistance to outflow of cerebrospinal fluid (Rcsf) measured before shunting. Rapid and marked reduction of ventricular size (n = 10) was associated with a significantly lower PVI than slow and moderate to marked (n = 13) or minimal to mild reduction (n = 7). Otherwise no relationship could be found between the reduction of ventricular size and PVI or Rcsf. It is concluded that both rate and magnitude of reduction of ventricular size after shunting for NPH are extremely variable. High brain elasticity seems to be the best predictor of rapid and marked reduction. PMID:3379425

  11. Cranial dural arteriovenous shunts. Part 4. Clinical presentation of the shunts with leptomeningeal venous drainage.

    PubMed

    Baltsavias, Gerasimos; Spiessberger, Alex; Hothorn, Torsten; Valavanis, Anton

    2015-04-01

    Cranial dural arteriovenous fistulae have been classified into high- and low-risk lesions mainly based on the pattern of venous drainage. Those with leptomeningeal venous drainage carry a higher risk of an aggressive clinical presentation. Recently, it has been proposed that the clinical presentation should be considered as an additional independent factor determining the clinical course of these lesions. However, dural shunts with leptomeningeal venous drainage include a very wide spectrum of inhomogeneous lesions. In the current study, we correlated the clinical presentation of 107 consecutive patients harboring cranial dural arteriovenous shunts with leptomeningeal venous drainage, with their distinct anatomic and angiographic features categorized into eight groups based on the "DES" (Directness and Exclusivity of leptomeningeal venous drainage and features of venous Strain) concept. We found that among these groups, there are significant angioarchitectural differences, which are reflected by considerable differences in clinical presentation. Leptomeningeal venous drainage of dural sinus shunts that is neither direct nor exclusive and without venous strain manifested only benign symptoms (aggressive presentation 0%). On the other end of the spectrum, the bridging vein shunts with direct and exclusive leptomeningeal venous drainage and venous strain are expected to present aggressive symptoms almost always and most likely with bleeding (aggressive presentation 91.5%). Important aspects of the above correlations are discussed. Therefore, the consideration of leptomeningeal venous drainage alone, for prediction of the clinical presentation of these shunts appears insufficient. Angiographic analysis based on the above concept, offers the possibility to distinguish the higher- from the lower-risk types of leptomeningeal venous drainage. In this context, consideration of the clinical presentation as an additional independent factor for the prediction of their clinical

  12. Characterization of multiple acquired portosystemic shunts using transplenic portal scintigraphy.

    PubMed

    Morandi, Federica; Sura, Patricia A; Sharp, Dorothy; Daniel, Gregory B

    2010-01-01

    We describe the scintigraphic patterns observed in 14 patients with confirmed multiple portosystemic shunts imaged via transplenic portal scintigraphy. Parameters evaluated included presence of multiple anomalous vessels, presence of hepatofugal flow caudal to spleen, and/or to cranial margin of the kidneys, slow absorption resulting in longer spleen to heart transit time, and presence of biphasic or fragmented bolus. Twenty-eight additional patients, 14 with a confirmed single portocaval and 14 with a portoazygos shunt, were used for comparison. Nine of 14 (64.3%) patients with multiple shunts had multiple vessels, five (35.7%) had a biphasic bolus, 13 (92.9%) had hepatofugal flow caudal to the cranial margin of the kidneys. In all single portocaval shunts, a single anomalous vessel was identified. None had hepatofugal flow caudal to the border of the kidneys. Among portoazygos shunts, 4/14 (28.6%) had flow caudal to the injection site. Six portoazygos and one portocaval shunts had biphasic bolus. Median transit time from spleen to heart was significantly longer (1.9 s) in patients with multiple shunts than in patients with a portocaval shunt (1.0 s), but not in patients with a portoazygos shunt (1.3 s). Although a distinct plexus of anomalous vessels is not detected in all patients with multiple shunts imaged using transplenic portal scintigraphy, findings of hepatofugal flow caudal to the margin of the kidneys, and longer transit time compared with single portocaval shunts were characteristic. Flow caudal to the splenic injection site but cranial to the kidneys and biphasic bolus can also be seen with a single congenital shunt.

  13. Hydrothorax Due to Migration of Ventriculoperitoneal Shunt Catheter

    PubMed Central

    Kim, Hong-Ki; Cho, Yong-jae; Kim, Sang-Jin

    2008-01-01

    A cerebrospinal fluid hydrothorax is a very rare complication following ventriculoperitoneal (VP) shunt and usually reported in children. We report a case of 47-year-old woman who developed massive hydrothorax and respiratory distress following intrathoracic migration of distal shunt catheter. After the confirmation of catheter in thoracic cavity using radionuclide shuntogram, the patient was successfully treated with laparoscopic shunt catheter reposition. PMID:19096625

  14. Factors affecting ventriculoperitoneal shunt survival in adult patients

    PubMed Central

    Khan, Farid; Rehman, Abdul; Shamim, Muhammad S.; Bari, Muhammad E.

    2015-01-01

    Background: Ventriculoperitoneal (VP) shunt insertion remains the mainstay of treatment for hydrocephalus despite a high rate of complications. The predictors of shunt malfunction have been studied mostly in pediatric patients. In this study, we report our 11-year experience with VP shunts in adult patients with hydrocephalus. We also assess the various factors affecting shunt survival in a developing country setting. Methods: A retrospective chart analysis was conducted for all adult patients who had undergone shunt placement between the years 2001 and 2011. Kaplan–Meier curves were used to determine the duration from shunt placement to first malfunction and log-rank (Cox–Mantel) tests were used to determine the factors affecting shunt survival. Results: A total of 227 patients aged 18–85 years (mean: 45.8 years) were included in the study. The top four etiologies of hydrocephalus included post-cranial surgery (23.3%), brain tumor or cyst (22.9%), normal pressure hydrocephalus (15%), and intracranial hemorrhage (13.7%). The overall incidence of shunt malfunction was 15.4% with the median time to first shunt failure being 120 days. Etiology of hydrocephalus (P = 0.030) had a significant association with the development of shunt malfunction. Early shunt failure was associated with age (P < 0.001), duration of hospital stay (P < 0.001), Glasgow Coma Scale (GCS) score less than 13 (P = 0.010), excision of brain tumors (P = 0.008), and placement of extra-ventricular drains (P = 0.033). Conclusions: Patients with increased age, prolonged hospital stay, GCS score of less than 13, extra-ventricular drains in situ, or excision of brain tumors were more likely to experience early shunt malfunction. PMID:25722930

  15. Rescue endoscopic third ventriculostomy for repeated shunt blockage

    PubMed Central

    Goyal, Puneet K.; Meher, Sujit K.; Singh, Daljit; Singh, Hukum; Tandon, Monica

    2011-01-01

    The role of endoscopic third ventriculostomy (ETV) is getting more popular for all types of hydrocephalus. It has several advantages and is also being considered for malfunctioning of ventriculo-peritoneal shunt. A 16-year-old child had fourteen shunt revisions in his life. He was eventually treated with ETV with successful result. Repeated shunt failure can be an additional indication of ETV. PMID:21977099

  16. Ventriculoperitoneal shunt malfunction caused by proximal catheter fat obstruction.

    PubMed

    Mizrahi, Cezar José; Spektor, Sergey; Margolin, Emil; Shoshan, Yigal; Ben-David, Eliel; Cohen, José E; Moscovici, Samuel

    2016-08-01

    Ventriculoperitoneal (VP) shunt placement is the mainstay of treatment for hydrocephalus, yet shunts remain vulnerable to a variety of complications. Although fat droplet migration into the subarachnoid space and cerebrospinal fluid pathways following craniotomy has been observed, a VP shunt obstruction with fat droplets has never been reported to our knowledge. We present the first reported case of VP shunt catheter obstruction by migratory fat droplets in a 55-year-old woman who underwent suboccipital craniotomy for removal of a metastatic tumor of the left medullocerebellar region, without fat harvesting. A VP shunt was inserted 1month later due to communicating hydrocephalus. The patient presented with gait disturbance, intermittent confusion, and pseudomeningocele 21days after shunt insertion. MRI revealed retrograde fat deposition in the ventricular system and VP shunt catheter, apparently following migration of fat droplets from the fatty soft tissue of the craniotomy site. Spinal tap revealed signs of aseptic meningitis. Steroid treatment for aseptic "lipoid" meningitis provided symptom relief. MRI 2months later revealed partial fat resorption and resolution of the pseudomeningocele. VP shunt malfunction caused by fat obstruction of the ventricular catheter should be acknowledged as a possible complication in VP shunts after craniotomy, even in the absence of fat harvesting. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Superconducting fault current-limiter with variable shunt impedance

    DOEpatents

    Llambes, Juan Carlos H; Xiong, Xuming

    2013-11-19

    A superconducting fault current-limiter is provided, including a superconducting element configured to resistively or inductively limit a fault current, and one or more variable-impedance shunts electrically coupled in parallel with the superconducting element. The variable-impedance shunt(s) is configured to present a first impedance during a superconducting state of the superconducting element and a second impedance during a normal resistive state of the superconducting element. The superconducting element transitions from the superconducting state to the normal resistive state responsive to the fault current, and responsive thereto, the variable-impedance shunt(s) transitions from the first to the second impedance. The second impedance of the variable-impedance shunt(s) is a lower impedance than the first impedance, which facilitates current flow through the variable-impedance shunt(s) during a recovery transition of the superconducting element from the normal resistive state to the superconducting state, and thus, facilitates recovery of the superconducting element under load.

  18. Intracranial calcified pseudocyst reaction to a shunt catheter.

    PubMed

    Yowtak, June; Hughes, Douglas; Heger, Ian; Macomson, Samuel D

    2014-02-01

    A 9-year-old boy with spina bifida, Chiari II malformation, and hydrocephalus presented with signs of increased intracranial pressure consistent with a shunt malfunction. Radiological investigations revealed an intracranial calcified lesion along the ventricular catheter. A shunt tap revealed a translucent milky white fluid. The patient underwent a ventriculostomy and, eventually, a shunt revision. Pathology findings were consistent with the formation of dystrophic calcification and a pseudocyst around the shunt catheter. Postoperatively, the patient returned to his neurological baseline. This is, to the best of the authors' knowledge, the first report of an intracranial calcified pseudocyst in a patient with normal renal function.

  19. A compact, coaxial shunt current diagnostic for X pinches.

    PubMed

    Wang, Liangping; Zhang, Jinhai; Li, Mo; Zhang, Xinjun; Zhao, Chen; Zhang, Shaoguo

    2015-08-01

    A compact coaxial shunt was applied in X-pinches experiments on Qiangguang pulsed power generator. The coaxial shunt was designed to have a compact construction for smaller inductance and more, for conveniently assembling upon the X pinch load structure. The coaxial shunt is also a cheap current probe and was easily built by research groups. The shunt can monitor a 100 kA high current with a 100 ns rise time. The calibration results showed that the probe used in the experiments has a resistance of 3.2 mΩ with an uncertainty of 3%, and its response time to the step signal is less than 7 ns.

  20. Laparoscopy for a Ventriculoperitoneal Shunt Tube Dislocated into the Colon

    PubMed Central

    Detzner, Michael; Heiss, Markus M.; Weber, Friedrich; Bulian, Dirk R.

    2013-01-01

    Introduction: Implantation of a ventriculoperitoneal (VP) shunt is a standard procedure for hydrocephalus. Different complications can occur, one of them being migration of the distal end of the tube. Case Description: The abdominal end of a VP shunt tube had migrated into the descending colon. In a laparoscopic procedure, the shunt was retrieved, and the colonic perforation site was resected. The patient had a favorable outcome. Discussion: Laparoscopy can play a key role and is recommended not only to make an exact diagnosis, but also for definite, safe, and trauma-minimizing treatment of intraabdominal VP shunt dysfunction. PMID:24398218

  1. Intrathoracic migration of ventriculoperitoneal shunt: a case report

    PubMed Central

    Karapolat, S; Onen, A; Sanli, A

    2008-01-01

    Introduction Intrathoracic migration of ventriculoperitoneal shunt can be transdiaphragmatic or supradiaphragmatic. This complication causes important respiratory symptoms. Case presentation A 7 year-old Caucasian female, hospitalized with the prediagnosis of pneumonia, was determined to have ventriculoperitoneal shunt migration at left hemithorax. A left thoracotomy was performed and the shunt was successfully removed transdiaphragmatically. Conclusion The patients with intrathoracic migration of ventriculoperitoneal shunt must be treated surgically as soon as possible. Transdiaphragmatic surgical approach would be more suitable from the point of surgical easiness. PMID:18637179

  2. Clinical and laboratory experience with heparin-impregnated silicone shunts for carotid endarterectomy.

    PubMed

    Piepgras, D G; Sundt, T M

    1976-11-01

    Our experience with use of a Silastic shunt for carotid endarterectomy is reviewed briefly, and the complication of shunt thrombosis despite intraoperative administration of heparin is noted. Of obvious importance are the reduction of blood flow and the possibility of embolization caused by accumulating thrombus. Shunt thrombosis has been abolished by the use of heparin-impregnated Silastic shunts. In experiments in dogs, such heparin-treated shunts showed greater thromboresistance than did untreated shunts.

  3. Rate of shunt revision as a function of age in patients with shunted hydrocephalus due to myelomeningocele.

    PubMed

    Dupepe, Esther B; Hopson, Betsy; Johnston, James M; Rozzelle, Curtis J; Jerry Oakes, W; Blount, Jeffrey P; Rocque, Brandon G

    2016-11-01

    OBJECTIVE It is generally accepted that cerebrospinal fluid shunts fail most frequently in the first years of life. The purpose of this study was to describe the risk of shunt failure for a given patient age in a well-defined cohort with shunted hydrocephalus due to myelomeningocele (MMC). METHODS The authors analyzed data from their institutional spina bifida research database including all patients with MMC and shunted hydrocephalus. For the entire population, the number of shunt revisions in each year of life was determined. Then the number of patients at risk for shunt revision during each year of life was calculated, thus enabling them to calculate the rate of shunt revision per patient in each year of life. In this way, the timing of all shunt revision operations for the entire clinic population and the likelihood of having a shunt revision during each year of life were calculated. RESULTS A total of 655 patients were enrolled in the spina bifida research database, 519 of whom had a diagnosis of MMC and whose mean age was 17.48 ± 11.7 years (median 16 years, range 0-63 years). Four hundred seventeen patients had had a CSF shunt for the treatment of hydrocephalus and thus are included in this analysis. There were 94 shunt revisions in the 1st year of life, which represents a rate of 0.23 revisions per patient in that year. The rate of shunt revision per patient-year initially decreased as age increased, except for an increase in revision frequency in the early teen years. Shunt revisions continued to occur as late as 43 years of age. CONCLUSIONS These data substantiate the idea that shunt revision surgeries in patients with MMC are most common in the 1st year of life and decrease thereafter, except for an increase in the early teen years. A persistent risk of shunt failure was observed well into adult life. These findings underscore the importance of routine follow-up of all MMC patients with shunted hydrocephalus and will aid in counseling patients and

  4. A Laparoscopic Technique for Retrieval and Prevention of Migration of Ventriculoperitoneal Shunt Tubing

    PubMed Central

    Klee, Vanessa M.; Zimmerman, Richard S.; Harold, Kristi L.

    2009-01-01

    A 31-year-old female with a history of pseudotumor cerebri presented with headache and abdominal discomfort after placement of a ventriculoperitoneal (VP) shunt. The VP shunt was placed after prior failure and revision of a lumbar peritoneal shunt. Computed tomography demonstrated shunt migration into the subcutaneous tissue. Laparoscopy was used to reposition the VP shunt, directing the shunt toward the pelvis. The patient presented for further evaluation one month later, at which point the shunt was shown to have migrated into the subcutaneous tissue once again. Laparoscopy was again used to reposition the shunt and affix it to the abdominal wall by using polytetrafluoroethylene (PTFE) mesh. PMID:19366553

  5. Laboratory testing of hydrocephalus shunts -- conclusion of the U.K. Shunt evaluation programme.

    PubMed

    Czosnyka, Z; Czosnyka, M; Richards, H K; Pickard, J D

    2002-06-01

    16 models of valves, currently in use in the U.K., have been tested long-term in the U.K. Shunt Evaluation Laboratory according to the protocol based on the new ISO 7197 standard. Valves tested were: Medtronic PS Medical: Delta Valve, Flow Control and Lumbo-Peritoneal Shunt, Heyer-Schulte Nero-Care: In-line, Low Profile and Pudenz Flushing Valve, Codman: Codman-Hakim Programmable, Hakim Precision, Accu-Flo, Holter, Uni-Shunt, and siphon-preventing device -- SiphonGuard, NMT: Orbis-Sigma Valve, Omni-Shunt and Hakim Valve, Sophysa: Sophy Programmable Valve, Radionics: Contour-Flex Valve. The majority of the valves had a non-physiologically low hydrodynamic resistance (with the exception of Orbis-Sigma, PS Lumbo-Peritoneal and Heyer-Schulte In-Line). This may result in overdrainage both related to posture and during nocturnal cerebral vasogenic waves. A long distal catheter increases the resistance of these valves by 100-200%. Drainage through valves without siphon-preventing mechanism is very sensitive to body posture. This may produce grossly negative intracranial pressure after implantation. A few shunts (Delta, Low Profile and Pudenz-Flushing with Anti-Siphon Devices) offer a reasonable resistance to negative outlet pressure, and hence potentially might prevent complications related to overdrainage. On the other hand, valves with siphon-preventing devices may be blocked by raised subcutaneous pressure (exception: SiphonGuard, but this device may block the drainage because of its faulty design). In most of the silicone-diaphragm valves, closing pressure varied and reached values lower than that specified by the manufacturer (exception: Heyer-Schulte Pudenz Flushing Valve). All programmable valves are susceptible to overdrainage in the upright body position. Programmed settings may be changed by external magnetic fields. Most shunts are very sensitive to the presence of small particles in the drained fluid. The behavior of a valve revealed during such testing is of

  6. Role of radiological parameters in predicting overall shunt outcome after ventriculoperitoneal shunt insertion in pediatric patients with obstructive hydrocephalus.

    PubMed

    Patra, Devi Prasad; Bir, Shyamal C; Maiti, Tanmoy K; Kalakoti, Piyush; Cuellar, Hugo; Guthikonda, Bharat; Sun, Hai; Notarianni, Christina; Nanda, Anil

    2016-11-01

    OBJECTIVE Despite significant advances in the medical field and shunt technology, shunt malfunction remains a nightmare of pediatric neurosurgeons. In this setting, the ability to preoperatively predict the probability of shunt malfunction is quite compelling. The authors have compared the preoperative radiological findings in obstructive hydrocephalus and the subsequent clinical course of the patient to determine any association with overall shunt outcome. METHODS This retrospective study included all pediatric patients (age < 18 years) who had undergone ventriculoperitoneal shunt insertion for obstructive hydrocephalus. Linear measurements were taken from pre- and postoperative CT or MRI studies to calculate different indices and ratios including Evans' index, frontal horn index (FHI), occipital horn index (OHI), frontooccipital horn ratio (FOHR), and frontooccipital horn index ratio (FOIR). Other morphological features such as bi- or triventriculomegaly, right-left ventricular symmetry, and periventricular lucency (PVL) were also noted. The primary clinical outcomes that were reviewed included the need for shunt revision, time interval to first shunt revision, frequency of shunt revisions, and revision-free survival. RESULTS A total of 121 patients were eligible for the analysis. Nearly half of the patients (47.9%) required shunt revision. The presence of PVL was associated with lower revision rates than those in others (39.4% vs 58.2%, p = 0.03). None of the preoperative radiological indices or ratios showed any correlation with shunt revision. Nearly half of the patients with shunt revision required early revision (< 90 days of primary surgery). The reduction in the FOHR was high in patients who required early shunt revision (20.16% in patients with early shunt revision vs 6.4% in patients with late shunt revision, p = 0.009). Nearly half of the patients (48.3%) requiring shunt revision ultimately needed more than one revision procedure. Greater occipital horn

  7. Quantization of inductively shunted superconducting circuits

    NASA Astrophysics Data System (ADS)

    Smith, W. C.; Kou, A.; Vool, U.; Pop, I. M.; Frunzio, L.; Schoelkopf, R. J.; Devoret, M. H.

    2016-10-01

    We present a method for calculating the energy levels of superconducting circuits that contain highly anharmonic, inductively shunted modes with arbitrarily strong coupling. Our method starts by calculating the normal modes of the linearized circuit and proceeds with numerical diagonalization in this basis. As an example, we analyze the Hamiltonian of a fluxonium qubit inductively coupled to a readout resonator. While elementary, this simple example is nontrivial because it cannot be efficiently treated by the method known as "black-box quantization," numerical diagonalization in the bare harmonic oscillator basis, or perturbation theory. Calculated spectra are compared to measured spectroscopy data, demonstrating excellent quantitative agreement between theory and experiment.

  8. Thermal Shunts in Thermoelectric Energy Scavengers

    NASA Astrophysics Data System (ADS)

    Leonov, V.

    2009-07-01

    The necessity for an additional component in thermoelectric generators and low-dimensional thermopiles for improving the efficiency of energy scavengers is discussed. Energy scavengers usually work at a small temperature difference and high thermal resistance of the heat source and sink, i.e., of the environment. The name “thermal shunt” is given to this component because, firstly, it is connected thermally in parallel to a certain zone of the environment in the vicinity of a thermopile and, secondly, it shunts this zone thermally. As a result, the heat flow through the thermopile increases, improving its performance characteristics.

  9. Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience.

    PubMed

    Reddy, G Kesava; Bollam, Papireddy; Caldito, Gloria

    2012-07-01

    Infection remains the most significant complication of ventriculoperitoneal shunt surgery and the reported rates of cerebrospinal fluid shunt infection vary widely across studies in patients with hydrocephalus. The objective of this study is to review and evaluate the infections complicating ventriculoperitoneal shunt surgery in patients with hydrocephalus. Patients who underwent ventriculoperitoneal shunt surgery for hydrocephalus between 1961 and 2010 were included. Medical charts, operative reports, imaging studies, and clinical follow-up evaluations were reviewed and analyzed retrospectively. A total of 1015 patients with hydrocephalus who underwent ventriculoperitoneal shunt surgery were included. The mean and median follow-up was 9.2 and 6.5 years, respectively. The median age of the patients at the time of ventriculoperitoneal shunt placement was 41.6 years. Pediatric patients (<17 years) accounted for 30.0% of the patients. A total 1224 shunt revisions occurred in 1015 patients. Of the 1224 shunt revisions, 162 were due to infection, which occurred in a total of 107 patients. Single infection episodes occurred in 67 patients (6.6%), and multiple infection episodes occurred in 40 patients (3.9%). The overall infection rate was 7.2% per procedure and 10.5% per patient. The overall infection rate was 9.5% in pediatric patients and 5.1% in adult patients per procedure. Gender, age, and etiology of hydrocephalus were significantly associated with shunt infection. Pediatric patients had significantly lower infection-free survival than adults (79.9% vs. 94.4%, P<0.01). Infection remains the most serious complication of ventriculoperitoneal shunt surgery. The findings of this retrospective study show that gender, age, and etiology of hydrocephalus significantly correlated independently with the incidence of infection. Prospective studies are needed to assess the observed associations between the risk factors and incidence of infection in hydrocephalus patients

  10. 49 CFR 236.724 - Circuit, shunt fouling.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Circuit, shunt fouling. 236.724 Section 236.724 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Circuit, shunt fouling. The track circuit in the fouling section of a turnout, connected in multiple with...

  11. 49 CFR 236.724 - Circuit, shunt fouling.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Circuit, shunt fouling. 236.724 Section 236.724 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Circuit, shunt fouling. The track circuit in the fouling section of a turnout, connected in multiple with...

  12. 49 CFR 236.724 - Circuit, shunt fouling.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Circuit, shunt fouling. 236.724 Section 236.724 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Circuit, shunt fouling. The track circuit in the fouling section of a turnout, connected in multiple with...

  13. 49 CFR 236.724 - Circuit, shunt fouling.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Circuit, shunt fouling. 236.724 Section 236.724 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Circuit, shunt fouling. The track circuit in the fouling section of a turnout, connected in multiple with...

  14. 49 CFR 236.724 - Circuit, shunt fouling.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Circuit, shunt fouling. 236.724 Section 236.724 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Circuit, shunt fouling. The track circuit in the fouling section of a turnout, connected in multiple with...

  15. 21 CFR 874.3850 - Endolymphatic shunt tube with valve.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Endolymphatic shunt tube with valve. 874.3850... tube with valve. (a) Identification. An endolymphatic shunt tube with valve is a device that consists of a pressure-limiting valve associated with a tube intended to be implanted in the inner ear...

  16. 21 CFR 874.3850 - Endolymphatic shunt tube with valve.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Endolymphatic shunt tube with valve. 874.3850... tube with valve. (a) Identification. An endolymphatic shunt tube with valve is a device that consists of a pressure-limiting valve associated with a tube intended to be implanted in the inner ear...

  17. 21 CFR 874.3850 - Endolymphatic shunt tube with valve.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Endolymphatic shunt tube with valve. 874.3850... tube with valve. (a) Identification. An endolymphatic shunt tube with valve is a device that consists of a pressure-limiting valve associated with a tube intended to be implanted in the inner ear...

  18. Internal carotid artery rupture caused by carotid shunt insertion.

    PubMed

    Illuminati, Giulio; Caliò, Francesco G; Pizzardi, Giulia; Vietri, Francesco

    2015-01-01

    Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously. A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected and was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the procedure whose postoperative course was uneventful. Shunting during combined CEA-CABG may be advisable to assure cerebral protection from possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery disease. Awareness and prompt management of possible shunt-related complications, including the newly reported one, may contribute to limiting their harmful effect. Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  19. Neural tube defect repair and ventriculoperitoneal shunting: indications and outcome.

    PubMed

    Sinha, Shandip K; Dhua, Anjan; Mathur, Mohit Kumar; Singh, Sudhir; Modi, Manoj; Ratan, Simmi K

    2012-01-01

    Neural tube defect with its global involvement of nervous system has lot of implications. There is cotroversy in terms of timing of repair, simultaneous or metachronous ventriculoperitoneal shunt and criteria for shunt surgery in neonatal age. We are reporting our approach and results of management of this disease in neonatal period.

  20. Internal carotid artery rupture caused by carotid shunt insertion

    PubMed Central

    Illuminati, Giulio; Caliò, Francesco G.; Pizzardi, Giulia; Vietri, Francesco

    2015-01-01

    Introduction Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously. Presentation of case A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected and was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the procedure whose postoperative course was uneventful. Discussion Shunting during combined CEA-CABG may be advisable to assure cerebral protection from possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery disease. Awareness and prompt management of possible shunt-related complications, including the newly reported one, may contribute to limiting their harmful effect. Conclusion Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA. PMID:26255001

  1. Linezolid treatment of ventriculoperitoneal shunt infection without implant removal.

    PubMed

    Castro, P; Soriano, A; Escrich, C; Villalba, G; Sarasa, M; Mensa, J

    2005-09-01

    Ventriculoperitoneal shunt infection is a serious clinical problem for which implant removal is considered the treatment of choice. However, surgery is sometimes associated with considerable risks that may outweigh the benefits. Presented here is a case of ventriculoperitoneal shunt infection treated successfully with linezolid without implant removal. This case shows linezolid could be a therapeutic alternative when surgery is contraindicated.

  2. Tension hydrothorax in a pediatric patient with a ventriculopleural shunt.

    PubMed

    Wu, Teresa S; Kuroda, Ronald

    2011-06-01

    Ventriculopleural shunts have been utilized in the management of hydrocephalus since the early 1900s. Shunt malfunctions can lead to fluid accumulation in the pleural space and a tension hydrothorax can develop. Improved diagnostic and therapeutic resources have led to an increasing number of ventriculopleural shunts being utilized in patients with symptomatic hydrocephalus. Emergency physicians are being called upon more frequently to diagnose and help manage many of the critical complications that can arise with ventricular shunts. Very little literature exists concerning the evaluation and treatment of patients with a suspected tension hydrothorax secondary to a ventriculopleural shunt malfunction. If left unrecognized and untreated, tension pneumothoraces can progress and result in hemodynamic decompensation and cardiopulmonary arrest. Patient survival depends on early diagnosis and prompt fluid drainage in this clinically challenging scenario. This is the first article in the emergency medicine literature to describe the presentation and management of a pediatric patient who presents to the Emergency Department with a rare diagnosis of a tension hydrothorax secondary to a defective ventriculopleural shunt. The increasing number of ventriculopleural shunts being utilized requires emergency physicians to become familiar with the life-threatening complications that can be associated with these types of shunts. Correctly identifying this complication and initiating immediate treatment can lead to improved patient outcomes. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Shunt current calculation of fuel cell stack using Simulink ®

    NASA Astrophysics Data System (ADS)

    Schaeffer, Jeremy A.; Chen, Lea-Der; Seaba, James P.

    Presence of shunt current in fuel cell stacks can lead to corrosion and power loss problems. The objective of this paper is to develop a stack-level model for calculation of shunt currents. The simulation model was based on electrical circuit, and created using Simulink ® software. The Simulink ® results were validated by using PSpice ® software and comparing with experimental data of an electrolyzer stack. The Simulink ® model is also used to evaluate the effectiveness of a protective current method to reduce the shunt current. The protective current method was found to effectively reduce shunt current of a 100-cell stack. The Simulink ® model also shows that shunt current is highest at end cells of the 100-cell stack examined, suggesting extra care be applied to end cells for corrosion prevention. Monte Carlo simulation was performed to examine sensitivity of variance in voltage, manifold, channel and cell resistance on calculated shunt current. The sensitivity analysis shows that calculated shunt current is most sensitive to variance in manifold resistance and followed by variance in voltage, electrolyte and channel resistance. The calculated power loss due to shunt current is within 1% for the conditions examined.

  4. 21 CFR 874.3850 - Endolymphatic shunt tube with valve.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3850 Endolymphatic shunt tube with valve. (a) Identification. An endolymphatic shunt tube with valve is a device that consists... device is the FDA guidance document “Class II Special Controls Guidance Document: Endolymphatic...

  5. 21 CFR 874.3850 - Endolymphatic shunt tube with valve.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3850 Endolymphatic shunt tube with valve. (a) Identification. An endolymphatic shunt tube with valve is a device that consists... device is the FDA guidance document “Class II Special Controls Guidance Document: Endolymphatic...

  6. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) Identification. A peritoneo-venous shunt is an implanted device that consists of a catheter and a pressure... for the treatment of intractable ascites. (b) Classification. Class II. The special controls for this...) Backflow specification and testing to prevent reflux of blood into the shunt....

  7. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) Identification. A peritoneo-venous shunt is an implanted device that consists of a catheter and a pressure... for the treatment of intractable ascites. (b) Classification. Class II. The special controls for this...) Backflow specification and testing to prevent reflux of blood into the shunt....

  8. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) Identification. A peritoneo-venous shunt is an implanted device that consists of a catheter and a pressure... for the treatment of intractable ascites. (b) Classification. Class II. The special controls for this...) Backflow specification and testing to prevent reflux of blood into the shunt....

  9. 21 CFR 882.4545 - Shunt system implantation instrument.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Shunt system implantation instrument. 882.4545 Section 882.4545 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4545 Shunt...

  10. 21 CFR 882.4545 - Shunt system implantation instrument.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Shunt system implantation instrument. 882.4545 Section 882.4545 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4545 Shunt...

  11. 21 CFR 882.4545 - Shunt system implantation instrument.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Shunt system implantation instrument. 882.4545 Section 882.4545 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4545 Shunt...

  12. Hepatic cerebrospinal fluid pseudocyst: A rare complication of ventriculoperitoneal shunt

    PubMed Central

    Dabdoub, Carlos B.; Fontoura, Emilio A.; Santos, Egmond A.; Romero, Paulo C.; Diniz, Cristiano A.

    2013-01-01

    Background: Ventriculoperitoneal (VP) shunts are among the most frequently performed operations in the management of hydrocephalus. Hepatic cerebrospinal fluid (CSF) pseudocyst is a rare but important complication in patients with a VP shunt insertion. In addition to presenting our own case, we performed a PubMed search to comprehensively illustrate the predisposing factors, clinical picture, diagnostic methods, and surgical treatment. This article represents an update for this condition. Case Description: A 40-year-old male was admitted to a hospital complaining of fever, abdominal distention, and pain. He had undergone a VP shunt for communicating hydrocephalus caused by a head trauma one year earlier. Laboratory studies showed liver enzymes alterations, and imaging studies demonstrated a well-defined intraaxially hepatic cyst with the shunt catheter placed inside. Staphylococcus epidermis was cultured via CSF. After removing the VP shunt and an adequate antibiotic treatment, the complication of hepatic CSF pseudocyst was resolved. Conclusion: Hepatic CSF pseudocyst is a rare complication of a VP shunt. Once the diagnosis is verified and if the CSF is sterile, just simply remove the peritoneal catheter and reposition a new one in the abdomen. We believe that it is not necessary to remove or aspirate the hepatic intraaxial pseudocyst, because of the risk of bleeding. In case of CSF infection, the VP shunt can be removed and/or an external derivation can be made, and after treatment with antibiotics, a new VP shunt is placed in the opposite side of the peritoneum. PMID:24523999

  13. Spontaneous Intrahepatic Portal Venous Shunt: Presentation and Endovascular Treatment.

    PubMed

    Sheth, Nakul; Sabbah, Nathanael; Contractor, Sohail

    2016-07-01

    Spontaneous intrahepatic portal venous shunts are rare with only few case reports published. Treatments using various endovascular techniques have been described, although no single technique has been shown to be preferred. We present a patient who was referred for treatment of a spontaneous portal venous shunt and describe our treatment approach and present a review on previously reported cases.

  14. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Peritoneo-venous shunt. 876.5955 Section 876.5955 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a...

  15. Shunt attachment and method for interfacing current collection systems

    DOEpatents

    Denney, P.E.; Iyer, N.C.; Hannan, W.F. III.

    1992-12-08

    A composite brush to shunt attachment wherein a volatile component of a composite but mostly metallic brush, used for current collection purposes, does not upon welding or brazing, adversely affect the formation of the interfacial bond with a conductive shunt which carries the current from the zone of the brush. The brush to shunt attachment for a brush material of copper-graphite composite and a shunt of copper, or substituting silver for copper as an alternative, is made through a hot isostatic pressing (HIP). The HIP process includes applying high pressure and temperature simultaneously at the brush to shunt interface, after it has been isolated or canned in a metal casing in which the air adjacent to the interface has been evacuated and the interfacial area has been sealed before the application of pressure and temperature. 6 figs.

  16. Shunt attachment and method for interfacing current collection systems

    DOEpatents

    Denney, Paul E.; Iyer, Natraj C.; Hannan, III, William F.

    1992-01-01

    A composite brush to shunt attachment wherein a volatile component of a composite but mostly metallic brush, used for current collection purposes, does not upon welding or brazing, adversely affect the formation of the interfacial bond with a conductive shunt which carries the current from the zone of the brush. The brush to shunt attachment for a brush material of copper-graphite composite and a shunt of copper, or substituting silver for copper as an alternative, is made through a hot isostatic pressing (HIP). The HIP process includes applying high pressure and temperature simultaneously at the brush to shunt interface, after it has been isolated or canned in a metal casing in which the air adjacent to the interface has been evacuated and the interfacial area has been sealed before the application of pressure and temperature.

  17. Percutaneous peritoneovenous shunt positioning: technique and preliminary results.

    PubMed

    Orsi, Franco; Grasso, Rosario Francesco; Bonomo, Guido; Monti, Cinzia; Marinucci, Irene; Bellomi, Massimo

    2002-05-01

    Nine peritoneovenous shunts were positioned by percutaneous technique in seven patients with advanced malignancy causing severe refractory ascites, and in two patients with hepatic cirrhosis (one with hepatocarcinoma). In all patients the shunts were percutaneously placed through the subclavian vein in the angiographic suite under digital fluoroscopic guide. No complications directly related to the procedure occurred. The shunt was successfully positioned in all patients in 60 min average time. No patient showed symptoms related to pulmonary overload or to disseminated intravascular coagulation. All patients had a significant improvement of the objective symptoms related to ascites such as respiratory symptoms, dyspepsia, and functional impairment to evacuation describing an improvement of their quality of life. Maximum shunt patency was 273 days. Percutaneous placement of peritoneovenous shunt is a safe, fast, and inexpensive procedure, extremely useful in resolution of refractory ascites, reducing symptoms, and allowing effective palliation, with a great improvement in quality of life.

  18. Choroid plexus cyst development and growth following ventricular shunting.

    PubMed

    Binning, Mandy J; Couldwell, William T

    2008-01-01

    Choroid plexus cysts are typically incidental, asymptomatic cysts. They have been reported to hemorrhage and grow, causing symptoms of obstruction. However, growth and multiplication has not been reported following ventriculoperitoneal shunt procedures. A 66-year-old woman initially underwent a suboccipital retrosigmoid craniotomy for resection of a large petroclival meningioma. Preoperatively, the patient had hydrocephalus. After surgery the patient required a ventriculoperitoneal shunt. Two years after the initial shunting procedure, imaging demonstrated significant growth of new bilateral choroid plexus cysts as compared with pre-shunt imaging. Post-shunt imaging also demonstrated evidence of diffuse dural enhancement characteristic of intracranial hypotension. Despite radiographic growth and multiplication of the cysts, the patient was clinically asymptomatic and had a good neurological outcome.

  19. Congenital intrahepatic portosystemic shunt diagnosed during intrauterine life

    PubMed Central

    Bellettini, Camila Vieira; Wagner, Rafaela; Balzanelo, Aleocídio Sette; Andretta, André Luis de Souza; de Moura, Arthur Nascimento; Fabris, Catia Carolina; Gubert, Eduardo Maranhão

    2016-01-01

    Abstract Objective: To report a patient with prenatal diagnosis of portosystemic shunt; a rare condition in humans. Case description: 17-Day-old female infant admitted for investigation of suspected diagnosis of portosystemic shunt, presumed in obstetric ultrasound. The hypothesis was confirmed after abdominal angiography and liver Doppler. Other tests such as echocardiography and electroencephalogram were performed to investigate possible co-morbidities or associated complications, and were normal. We chose conservative shunt treatment, as there were no disease-related complications and this was intrahepatic shunt, which could close spontaneously by the age of 2 years. Comments: Portosystemic shunt can lead to various complications such as hepatic encephalopathy, hypergalactosemia, liver tumors, and hepatopulmonary syndrome. Most diagnoses are done after one month of age, after such complications occur. The prenatal diagnosis of this patient provided greater security for the clinical picture management, as well as regular monitoring, which allows the anticipation of possible complications and perform interventional procedures when needed. PMID:27133713

  20. Ventriculoperitoneal shunt infection with Listeria innocua.

    PubMed

    Karli, Arzu; Sensoy, Gulnar; Unal, Nevzat; Yanik, Keramettin; Cigdem, Halit; Belet, Nursen; Sofuoglu, Ayse

    2014-08-01

    Listeria species may cause life-threatening events including meningitis and invasive infection in newborns, pregnant women, older and immunodeficient people. The most common Listeria species that causes infection is L. monocytogenes. It is known that Listeria innocua has no pathogenicity. A 9-month-old baby had ventriculoperitoneal shunt and was treated with adrenocorticotropic hormone because of infantile spasms. He was brought to hospital with fever and vomiting. Upon physical examination, the patient seemed uncomfortable and had a temperature of 38.6°C. Laboratory results were as follows: hemoglobin, 6.7 g/dL; leukocyte count, 5420/mm(3) ; platelet count, 169,000/mm(3) ; and C-reactive protein, 100 mg/L (normal <5 mg/L). On analysis of cerebrospinal fluid (CSF), leukocyte count was 480/mm(3) , protein was 46 mg/dL and CSF glucose was 35 mg/dL. L. innocua was isolated in CSF culture. We describe this unusual case of ventriculoperitoneal shunt infection with L. innocua.

  1. Biosynthetic route towards saxitoxin and shunt pathway

    PubMed Central

    Tsuchiya, Shigeki; Cho, Yuko; Konoki, Keiichi; Nagasawa, Kazuo; Oshima, Yasukatsu; Yotsu-Yamashita, Mari

    2016-01-01

    Saxitoxin, the most potent voltage-gated sodium channel blocker, is one of the paralytic shellfish toxins (PSTs) produced by cyanobacteria and dinoflagellates. Recently, putative biosynthetic genes of PSTs were reported in these microorganisms. We previously synthesized genetically predicted biosynthetic intermediates, Int-A’ and Int-C’2, and also Cyclic-C’ which was not predicted based on gene, and identified them all in the toxin-producing cyanobacterium Anabaena circinalis (TA04) and the dinoflagellate Alexandrium tamarense (Axat-2). This study examined the incorporation of 15N-labeled intermediates into PSTs (C1 and C2) in A. circinalis (TA04). Conversions from Int-A’ to Int-C’2, from Int-C’2 to Cyclic-C’, and from Int-A’ and Int-C’2 to C1 and C2 were indicated using high resolution-LC/MS. However, Cyclic-C’ was not converted to C1 and C2 and was detected primarily in the extracellular medium. These results suggest that Int-A’ and Int-C’2 are genuine precursors of PSTs, but Int-C’2 converts partially to Cyclic-C’ which is a shunt product excreted to outside the cells. This paper provides the first direct demonstration of the biosynthetic route towards saxitoxin and a shunt pathway. PMID:26842222

  2. Prevention of ventriculoperitoneal shunt complications after intraperitoneal urological surgeries.

    PubMed

    Ikeda, Takashi; Akiyama, Sayaka; Kim, Woo Jin; Ito, Susumu; Yamazaki, Yuichiro

    2017-07-01

    To evaluate perioperative management for the prevention of postoperative shunt infection and malfunction after intraperitoneal urological surgery in patients with myelodysplasia and a ventriculoperitoneal shunt. From 2005 to 2015, 20 consecutive patients with myelodysplasia and a ventriculoperitoneal shunt who underwent intraperitoneal urological surgeries were managed with the same perioperative regimen. Intraperitoneal surgeries involved opening gastrointestinal tracts, including bladder augmentation by enterocystoplasty, creating continent catheterizable channels and Malone antegrade continent enema. We compared results with those from seven previous reports regarding postoperative shunt complications, surgical histories of previous shunt revisions, management of bacteriuria before surgery preoperative bowel preparation, antibiotic regimens, and duration of indwelling drain. Of 20 patients, 18 received prior shunt revisions, and 14 had positive urine culture before surgery that was managed with oral antibiotics. Thirteen patients underwent bladder augmentation with ileum, and one underwent augmentation with sigmoid colon. Nineteen patients underwent Malone antegrade continent enema using the appendix. All parenteral antibiotics were stopped on postoperative day 2.5. Mean duration of indwelling peritoneal drain was 2.7days. Mean follow-up period was 59.8months. Neither postoperative shunt infections nor intraperitoneal shunt malfunctions were recognized during follow-up period. This is the first study to evaluate postoperative ventriculoperitoneal shunt complications in patients with myelodysplasia who underwent intraperitoneal urological surgeries with a specific perioperative regimen. Shunt complications are greatly reduced by rigorous perioperative management, including preoperative control of bacteriuria, appropriate administration of prophylactic antibiotics, and early removal of intraperitoneal drains. The type of study: Case series with no comparison group

  3. Lumboperitoneal shunts for the treatment of normal pressure hydrocephalus.

    PubMed

    Bloch, Orin; McDermott, Michael W

    2012-08-01

    Ventriculoperitoneal shunt placement is the standard of care for idiopathic normal pressure hydrocephalus (iNPH). Studies have reported shunt complication rates up to 38%, with subdural hemorrhage rates as high as 10%. Lumboperitoneal (LP) shunts with horizontal-vertical valves (HVV) are an alternative for cerebrospinal fluid (CSF) diversion that avoids direct cerebral injury and may reduce the risk of overdrainage. Here we reviewed our experience with LP-HVV shunt placement for iNPH. We retrospectively reviewed our 33 patients with LP-HVV shunts inserted for the treatment of iNPH from 1998 to 2009. Patients were evaluated for improvements in gait, urinary function, and dementia after shunt placement. All patients had evidence of ventriculomegaly and a positive response to pre-operative lumbar puncture or extended lumbar drainage. All 33 (100%) patients had pre-operative gait dysfunction, 28 (85%) had incontinence, and 20 (61%) had memory deficits. Mean follow-up time was 19 months. Following shunt placement, 33/33 (100%) patients demonstrated improved gait, 13/28 (46%) had improvement in incontinence, and 11/20 (55%) had improvement in memory. Shunt failures requiring revision occurred in nine patients (27%), with an average time to failure of 11 months. Infections occurred in two patients (6%). There were no neurologic complications, including no hemorrhages. Thus, LP-HVV shunt placement is a safe and effective alternative to ventriculoperitoneal shunting for iNPH, resulting in significant symptomatic improvement with a low risk of overdrainage. It should be considered as an option for the treatment of patients with iNPH who demonstrate clinical improvement following lumbar drainage. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Parylene MEMS patency sensor for assessment of hydrocephalus shunt obstruction.

    PubMed

    Kim, Brian J; Jin, Willa; Baldwin, Alexander; Yu, Lawrence; Christian, Eisha; Krieger, Mark D; McComb, J Gordon; Meng, Ellis

    2016-10-01

    Neurosurgical ventricular shunts inserted to treat hydrocephalus experience a cumulative failure rate of 80 % over 12 years; obstruction is responsible for most failures with a majority occurring at the proximal catheter. Current diagnosis of shunt malfunction is imprecise and involves neuroimaging studies and shunt tapping, an invasive measurement of intracranial pressure and shunt patency. These patients often present emergently and a delay in care has dire consequences. A microelectromechanical systems (MEMS) patency sensor was developed to enable direct and quantitative tracking of shunt patency in order to detect proximal shunt occlusion prior to the development of clinical symptoms thereby avoiding delays in treatment. The sensor was fabricated on a flexible polymer substrate to eventually allow integration into a shunt. In this study, the sensor was packaged for use with external ventricular drainage systems for clinical validation. Insights into the transduction mechanism of the sensor were obtained. The impact of electrode size, clinically relevant temperatures and flows, and hydrogen peroxide (H2O2) plasma sterilization on sensor function were evaluated. Sensor performance in the presence of static and dynamic obstruction was demonstrated using 3 different models of obstruction. Electrode size was found to have a minimal effect on sensor performance and increased temperature and flow resulted in a slight decrease in the baseline impedance due to an increase in ionic mobility. However, sensor response did not vary within clinically relevant temperature and flow ranges. H2O2 plasma sterilization also had no effect on sensor performance. This low power and simple format sensor was developed with the intention of future integration into shunts for wireless monitoring of shunt state and more importantly, a more accurate and timely diagnosis of shunt failure.

  5. Migration of Ventriculoperitoneal Shunt into a Hernia Sac: An Unusual Complication of Ventriculoperitoneal Shunt Surgery in Children.

    PubMed

    Singh, Sudhir; Pant, Nitin; Kumar, Piyush; Pandey, Anand; Khan, Tanvir Roshan; Gupta, Archika; Rawat, Jiledar

    2016-01-01

    We report 2 cases of ventriculoperitoneal (VP) shunt migration into an inguinal hernia sac. In both cases hernia manifested itself on the right side in late infancy. We attempted to analyse the anatomical and mechanical factors leading to shunt migration as seen in the X-rays of our cases.

  6. Prediction of Susceptibility to Acute Mountain Sickness Using Hypoxia-Induced Intrapulmonary Arteriovenous Shunt and Intracardiac Shunt Fractions

    DTIC Science & Technology

    2012-10-31

    proposed that greater degrees of intrapulmonary and intracardiac shunting (through patent foramen ovale (PFO)) are responsible for the greater degree of...determine the characteristics of a patent foramen ovale predicts that subjects who demonstrate intracardiac shunting without performing a Valsalva...susceptible. Using saline contrast echocardiography to detect the presence and characteristics of a patent foramen ovale , can predict AMS

  7. Refractory hepatic encephalopathy due to concomitant transjugular intrahepatic portosystemic shunt and spontaneous mesocaval shunt controlled by embolization of the competitive portosystemic shunt.

    PubMed

    Cura, Marco

    2009-01-01

    Spontaneous mesocaval shunt (SMCS) is an uncommon cause of refractory encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) creation. We report a patient who presented with refractory hepatic encephalopathy (HE) post-TIPS creation for variceal bleeding in whom a SMCS was found. Percutaneous transhepatic occlusion of the SMCS reduced the portal vein flow diverted from the liver and provided sufficient liver perfusion to reverse the HE while maintaining satisfactory decompression of esophageal varices.

  8. Is the elapsed time following the placement of a ventriculoperitoneal shunt catheter an individual risk factor for shunt fractures?

    PubMed

    Kaplan, Metin; Cakin, Hakan; Ozdemir, Niyazi; Gocmez, Cuneyt; Ozturk, Sait; Erol, Fatih S

    2012-01-01

    In this study, we examined whether the resistance of peritoneal catheters against the retraction force changed over time following shunt placement, and the role of this resistance in shunt fracture is discussed. We investigated peritoneal catheters removed from patients treated with a ventriculoperitoneal shunt because of hydrocephalus; previously, patients underwent shunt revision. The maximum tension, maximum elongation and elongation percentages of the peritoneal catheters were measured. The mean and maximum tension values of the revised peritoneal catheters were increased compared to the unused catheters. The maximum elongation and elongation rates were significantly decreased. The changes in the maximum elongation, elongation rate and tension values were unrelated to the time elapsed after catheter insertion. This finding indicates that the time elapsed following peritoneal catheter placement was not an individual factor based on the strength of the response of the organism to the foreign body and the mechanical trauma exposed in shunt fractures.

  9. Vascular collateralization along ventriculoperitoneal shunt catheters in moyamoya disease.

    PubMed

    Singla, Amit; Lin, Ning; Ho, Allen L; Scott, R Michael; Smith, Edward R

    2013-06-01

    Surgically created openings such as bur holes can serve as avenues for the development of collateral blood supply to the brain in patients with moyamoya disease. When such collateralization occurs through preexisting shunt catheter sites, the potential exists for perioperative stroke if these vessels are damaged during revision of a ventricular catheter for shunt malfunction. In this paper the authors report on a series of patients with a history of ventriculoperitoneal (VP) shunts who later developed moyamoya disease and were found to have spontaneous transdural collateral vessels at ventricular catheter sites readily visualized on diagnostic angiography. A consecutive surgical series of 412 patients with moyamoya disease treated at Boston Children's Hospital from 1990 to 2010 were reviewed to identify patients with concomitant moyamoya and a VP shunt. The clinical records and angiograms of these patients were reviewed to determine the extent of bur hole collaterals through the shunt site. Three patients were identified who had VP shunts placed for hydrocephalus and subsequently developed moyamoya disease. All 3 patients demonstrated spontaneous transdural collaterals at the ventricular catheter bur hole, as confirmed by angiography during the workup for moyamoya disease. No patients required subsequent revision of their ventricular catheters following the diagnosis of moyamoya. All patients have remained stroke free and clinically stable following pial synangiosis. Although the association of moyamoya and shunted hydrocephalus is rare, it may present a significant potential problem for the neurosurgeon treating a shunt malfunction in this patient population, because shunt bur holes may become entry sites for the ingrowth of significant cortical transdural collateral blood supply to the underlying brain. Shunt revision might therefore be associated with an increased risk of postoperative stroke or operative-site hemorrhage in this population if this

  10. Determination of Porto-Azygos Shunt Anatomy in Dogs by Computed Tomography Angiography.

    PubMed

    Or, Matan; Ishigaki, Kumiko; de Rooster, Hilde; Kutara, Kenji; Asano, Kazushi

    2016-11-01

    To describe the morphology of porto-azygos shunts in a large series of dogs using computed tomography (CT) angiography. Retrospective study. Dogs (n=36) with porto-azygos shunts. CT angiography was performed in dogs subsequently proven to have a porto-azygos shunt. The origin and insertion of the shunts were assessed on native images. The diameter of the porto-azygos shunt and the portal vein, cranial and caudal to the shunt origin, were measured. The porto-azygos shunt anatomy was studied on three-dimensional images. All porto-azygos shunts originated either in the left gastric vein (33 left gastro-azygos shunts) or the right gastric vein (3 right gastro-azygos shunts). Two left gastro-azygos shunts had concurrent caval-azygos continuation and 2 right gastro-azygos shunts had a caudal splenic loop. All shunts crossed the diaphragm through the esophageal hiatus. The majority of porto-azygos shunts (32) followed a straight pathway after traversing the diaphragm, although 4 shunts followed a tortuous route. All shunts terminated in the thoracic part of the azygos vein, perpendicular to the aorta. The shunt diameter at insertion was only 3 mm on average. The insertion site was consistently the narrowest part of the shunt. CT angiography was well suited to provide anatomic details of porto-azygos shunts and comprehensively documented that all porto-azygos shunts had a thoracic terminus, after crossing the diaphragm through the esophageal hiatus. Different shunt types existed with minor variations. © Copyright 2016 by The American College of Veterinary Surgeons.

  11. Transanal protrusion of ventriculoperitoneal shunt reflecting asymptomatic perforation of the large bowel

    PubMed Central

    Plummer, Nicholas Russell; Tokala, Ajay; Date, Ravindra S

    2014-01-01

    Perforation into the gastrointestinal tract is a rare complication of ventriculoperitoneal shunt insertion. We present a case of transanal protrusion of the shunt catheter in an otherwise asymptomatic patient, with only transient signs of shunt failure some 2 months prior to presentation, and discuss treatment options to rationalise our decision to treat with laparotomy and preservation of the shunt. PMID:24827668

  12. Hyperammonemia and orotic aciduria in portacaval-shunted rats.

    PubMed

    Steele, R D

    1984-01-01

    The effect of a portacaval shunt-induced alteration in liver function on nitrogen metabolism was studied in rats. Within a few days after surgery, portacaval-shunted rats grew with an average daily gain in body weight equal to sham-operated control rats. Within 1 week after surgery, portacaval-shunted rats excreted 20% more orotic acid in their urine compared to control rats. The difference increased to 37% after 3 weeks. Plasma ammonia levels were elevated by 78% in portacaval-shunted rats compared to control rats after 2 weeks. Portacaval-shunted rats injected with a challenging load of ammonium chloride (5 mmol/kg) excreted half as much orotic acid in their urine over a 24-hour period as similarly injected controls. The simultaneous injection of 1.5 mmol/kg of arginine prevented the ammonia-induced increase in orotic acid excretion in both shunted and control rats. However, feeding rats diets supplemented with 1% arginine did not prevent the chronic hyperammonemia and orotic aciduria produced by the construction of portacaval shunts. Similar experiments with diets supplemented with 1% sodium benzoate to induce alternative pathways for nitrogen excretion were also without effect. These results are in contrast to recent clinical studies reporting the effectiveness of sodium benzoate in treating hyperammonemia in patients with urea cycle enzyme defects.

  13. Mechanism of ribosome shunting in Rice tungro bacilliform pararetrovirus.

    PubMed

    Pooggin, Mikhail M; Ryabova, Lyubov A; He, Xiaoyuan; Fütterer, Johannes; Hohn, Thomas

    2006-05-01

    In plant pararetroviruses, pregenomic RNA serves both as a template for replication through reverse transcription and a polysictronic mRNA. This RNA has a complex leader sequence preceding the first large ORF. The leader contains multiple short ORFs and strong secondary structure, both inhibiting ribosome scanning. Translation on this RNA is initiated by shunting, in which scanning ribosomes bypass a large portion of the leader with the inhibitory secondary structure and short ORFs. In Cauliflower mosaic virus (CaMV), the ribosome shunting mechanism involves translation of the 5'-proximal short ORF terminating in front of the secondary structure that appears to force ribosomes to take off and resume scanning at a landing site downstream of the structure. Using two plant protoplast systems and shunt-competent wheat-germ extracts, we demonstrate that in Rice tungro bacilliform virus (RTBV) shunting also depends on the first short ORF followed by strong secondary structure. Swapping of the conserved shunt elements between CaMV and RTBV revealed the importance of nucleotide composition of the landing sequence for efficient shunting. The results suggest that the mechanism of ribosome shunting is evolutionary conserved in plant pararetroviruses.

  14. [Laparoscopy-assisted ventriculoperitoneal and lumboperitoneal shunt surgery].

    PubMed

    Aoki, Tsukasa; Ayuzawa, Satoshi; Matsuo, Ryota; Hosoo, Hisayuki; Tanno, Syougo; Miki, Shunichiro; Matsubara, Teppei; Matsumura, Akira

    2012-06-01

    Recently, laparoscopy (also referred to as minimally invasive surgery) has been used during peritoneal catheter implantation in shunt placement for hydrocephalus; however, the procedure and devices for this technique have not yet been well established. We adopted umbilical and paraumbilical laparoscopy for peritoneal catheter insertion. In this paper, we describe the technique we used and its clinical results and benefits. Ten consecutive patients with hydrocephalus who underwent laparoscopic shunt surgery (6 cases of ventriculoperitoneal shunt and 4 of lumboperitoneal shunt) were enrolled for this study. The follow-up period ranged from 21 to 434 days (mean, 263 days). After a standard cranial/spinal procedure, an approximately 5-mm incision was made in the lateral side of the umbilicus, where the abdominal catheter was introduced subcutaneously. Thereafter, we inserted a laparoscope into the peritoneal cavity via a small incision beneath or just on the umbilicus. A shunt catheter was laparoscopically inserted through a peel-off cannula and placed after taking note of the outflow of cerebrospinal fluid (CSF) from the catheter tip. In all patients, the shunt was inserted with no complications, and good patency was achieved. Laparoscopy allows implantation of the catheter into the peritoneal cavity, and the outflow of CSF can be confirmed intraoperatively. Furthermore, the abdominal surgical wounds are minimal, even for obese patients, and fascia/muscle incisions are not needed. Laparoscopy-assisted shunt surgery for hydrocephalus is effective and safe and also has cosmetic advantages.

  15. Exploration of nonlinearly shunted piezoelectrics as vibration absorbers

    NASA Astrophysics Data System (ADS)

    Zhou, B.; Zang, C.; Wang, X.

    2016-09-01

    Practical realization of a nonlinearly shunted piezoelectric vibration absorber is numerically explored in this research. It is widely known that the linear resonant piezoelectric shunting strategy, acting as a tuned mass damper, is limited by the massive inductance required in low-frequency cases and sensitivity to drifts in structural frequencies. In order to overcome this limitation, a nonlinear piezoelectric shunting strategy is proposed based on the nonlinear energy sink theory. The essential idea is to passively absorb vibrational energy from the host structure through the intentional use of nonlinearity in piezoelectric shunting. The nonlinearly shunted piezoelectrics are supposed to work over a broad frequency band with a smaller inductance requirement compared with the linear resonant shunting. The nonlinearly shunted piezoelectric vibration absorber is built and applied in a cantilevered beam. Major challenges coming from the nonlinear tuning design for an effective vibration absorber exempted from high isolated response curves will be covered in this research. This numerical study is supposed to pave the way for experimental investigations that are currently in process.

  16. [Selective portal-systemic shunts for bleeding portal hypertension].

    PubMed

    Orozco, H; Mercado, M A; Takahashi, T; García-Tsao, G; Guevara, L; Hernandez-Ortiz, J; Tielve, M

    1990-07-01

    At the beginning of the seventies, we began to perform regularly selective shunts for the treatment of portal hypertension. In a 15 year period, 177 patients (155 with liver cirrhosis) were operated with three kinds of selective shunts: 128 with a Warren shunt, 29 with an end to end renosplenic shunt and 20 with a splenocaval shunt. 167 cases were operated in an elective fashion. The 15 years global operative mortality, was 14.4%. Operative mortality of the Child A patients, was 11.6%. Survival for the Child A group was 74.6% at 1 year, 68.2% at 5 years and 64.6% at 15 years. Incapacitating encephalopathy was observed in 6.9%, rebleeding 6.2% and shunt thrombosis in 6.2%. Portal vein alterations in the postoperative period were observed: in 13.3% a reduction in diameter ocurred and in 20.5%, thrombosis was recorded. It is concluded that when feasible, the selective shunts are the treatment of choice for portal hypertension in those patients with good liver function.

  17. Laparoscopic Management of Ventriculoperitoneal and Lumboperitoneal Shunt Complications

    PubMed Central

    Kavic, Stephen M.; Segan, Ross D.; Taylor, Michelle D.

    2007-01-01

    Background and Objectives: Minimally invasive approaches for the initial placement of ventriculoperitoneal (VP) and lumboperitoneal (LP) shunts have been well described. A laparoscopic approach has multiple advantages over open techniques, including decreased morbidity, more rapid recovery, and ability to visually assess catheter function. However, few series have addressed the role of laparoscopy in the management of VP and LP shunt complications. Methods: We present here the largest published series of laparoscopic treatment of VP and LP shunt complications in adults, by retrospectively reviewing all cases performed in a 1-year interval by a single surgeon. Results: Ten patients presented with complications of previous shunting; all were managed laparoscopically. Eighty percent of these patients had a successful single laparoscopic intervention. One patient developed a cerebrospinal fluid leak from the lumbar wound, and 2 patients required additional laparoscopic shunt revisions. Conclusions: We conclude that laparoscopy has great utility in the assessment of shunt function. Laparoscopic techniques should be considered not only for placement of peritoneal catheters, but also for the management of distal shunt malfunction and diagnosis of abdominal pain in these patients. PMID:17651550

  18. Fungal infection of a ventriculoperitoneal shunt: histoplasmosis diagnosis and treatment.

    PubMed

    Veeravagu, Anand; Ludwig, Cassie; Camara-Quintana, Joaquin Q; Jiang, Bowen; Lad, Nandan; Shuer, Lawrence

    2013-01-01

    Histoplasmosis is a fungal disease caused by Histoplasma capsulatum, commonly found in the Americas, and Histoplasma duboisii, located in Africa. In the United States, H. capsulatum is prevalent in the Ohio and Mississippi river valleys. In rare circumstances, central nervous system (CNS) histoplasmosis infection can be caused by shunt placement. We present a case report of a 45-year-old woman in whom CNS histoplasmosis developed after having a ventriculoperitoneal (VP) shunt placed for communicating hydrocephalus. A review of the literature on fungal infections after CNS shunt placement as well as treatment options for this subset of patients was undertaken. The PubMed database current to 1958 was filtered and limited to English-language articles. Fifty-eight articles were selected for review based on evidence of information regarding the fungal organism responsible for shunt infection, symptoms, treatment, and/or outcomes. Also included in this review is our case study. A thorough analysis of the PubMed database revealed 58 reported cases of CNS shunt-related fungal infections in the English-language medical literature as well as 7 therapeutic agents used to treat patients in whom postshunt fungal infections developed. We describe the steps in diagnosis of histoplasmosis after shunt placement, provide an effective therapeutic regimen, and review the present understanding of CNS fungal infections. The medical literature was surveyed to compare and analyze various CNS fungal infections that can arise from shunt placement as well as treatments rendered. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. The hydrokinetic parameters of shunts for hydrocephalus might be inadequate

    PubMed Central

    Sotelo, Julio

    2012-01-01

    Long-term treatment of hydrocephalus continues to be dismal. Shunting is the neurosurgical procedure more frequently associated with complications, which are mostly related with dysfunctions of the shunting device, rather than to mishaps of the rather simple surgical procedure. Overdrainage and underdrainage are the most common dysfunctions; of them, overdrainage is a conspicuous companion of most devices. Even when literally hundreds of different models have been proposed, developed, and tested, overdrainage has plagued all shunts for the last 60 years. Several investigations have demonstrated that changes in the posture of the subject induce unavoidable and drastic differences of intraventricular hydrokinetic pressure and cerebrospinal fluid (CSF) drainage through the shunt. Of all the parameters that participate in the pathophysiology of hydrocephalus, the only invariable one is cerebrospinal fluid production at a constant rate of approximately 0.35 ml/min. However, this feature has not been considered in the design of currently available shunts. Our experimental and clinical studies have shown that a simple shunt, whose drainage capacity complies with this unique parameter, would prevent most complications of shunting for hydrocephalus. PMID:22530174

  20. A plasma polymerization technique to overcome cerebrospinal fluid shunt infections.

    PubMed

    Cökeliler, D; Caner, H; Zemek, J; Choukourov, A; Biederman, H; Mutlu, M

    2007-03-01

    Prosthetic devices, mainly shunts, are frequently used for temporary or permanent drainage of cerebrospinal fluid. The pathogenesis of shunt infection is a very important problem in modern medicine and generally this is characterized by staphylococcal adhesion to the cerebrospinal fluid shunt surfaces. In this paper, the prevention of the attachment of test microorganism Staphylococcus epidermidis on the cerebrospinal fluid shunt surfaces by 2-hydroxyethylmethacrylate (HEMA) precursor modification in the plasma polymerization system, is reported. Different plasma polymerization conditions (RF discharge power 10-20-30 W, exposure time 5-10-15 min) were employed during the surface modification. The surface chemistry and topology of unmodified and modified shunts was characterized by x-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM) and atomic force microscopy (AFM). Also, static contact angle measurements were performed to state the change of surface hydrophilicity. All samples were tested in vitro with Staphylococcus epidermidis. A plasma-polymerized HEMA film (PP HEMA) was found to be an alternative simple method to decrease the microorganism attachment and create bacterial anti-fouling surfaces. The attachment of the model microorganism Staphylococcus epidermidis on the shunt surface modified by PP HEMA at 20 W and 15 min was reduced 62.3% if compared to the unmodified control surface of the shunt.

  1. Delayed pneumocephalus following shunting for hydrocephalus.

    PubMed

    Honeybul, S; Bala, A

    2006-11-01

    Delayed pneumocephalus is a rare but well-reported complication of cerebrospinal fluid diversion procedures. In most cases the air enters the intracranial cavity via a skull base defect. We report a case of hydrocephalus secondary to aqueduct stenosis. The patient developed pneumocephalus 2 months after successful placement of a ventriculoperitoneal shunt. We describe an attempt at endoscopic diagnosis and repair of the fistula. This was unsuccessful, presumably because the defect was too small to localize even with the use of intrathecal fluorescein. We subsequently performed a conventional craniotomy and anterior fossa repair with placement of an antisiphon device. We suggest that in certain cases, when patients present with long-standing hydrocephalus, it may be advisable to insert either a high-pressure valve or antisiphon device as a primary measure.

  2. Muzzle shunt augmentation of conventional railguns

    SciTech Connect

    Parker, J.V. . Physics Div.)

    1991-01-01

    This paper reports on augmentation which is a technique for reducing the armature current and hence the armature power dissipation in a plasma armature railgun. In spite of the advantages, no large augmented railguns have been built, primarily due to the mechanical and electrical complexity introduced by the extra conductors required. it is possible to achieve some of the benefits of augmentation in a conventional railgun by diverting a fraction {phi} of the input current through a shunt path at the muzzle of the railgun. In particular, the relation between force and armature current is the same as that obtained in an n-turn, series-connected augmented railgun with n = 1/(1 {minus} {phi}). The price of this simplification is a reduction in electrical efficiency and some additional complexity in the external electrical system.

  3. A shunt-excited inductive power link.

    PubMed

    Sylvan, K; Jordan, J R; Whittington, H W

    1989-01-01

    An alternative derivation of the separation-insensitive property of series-excited self-oscillating inductive power transfer circuits is presented. This analysis is based on network theory and does not include the explicit determination of frequency as a step in the derivation. The separation-insensitivity principle is extended to shunt-excited links which exhibit a theoretical voltage transfer function of unity while the coupling factor exceeds the reciprocal of the secondary quality factor. This requires the inclusion of a series resistor in the primary resonator's capacitive arm. Series RC elements are replaced by parallel forms in both the primary and secondary; this provides a more convenient output impedance level without the need for another transformer. A demonstration circuit is described and tested. It is found that separation-insensitivity occurs while the coupling factor exceeds the reciprocal of the loaded secondary quality factor. Somewhat inferior response is obtained from a simpler circuit having no added resistances in the primary.

  4. Intraabdominal Pseudocyst Developed after Ventriculoperitoneal Shunt: A Case Report.

    PubMed

    Ayan, Erdogan; Tanriverdi, Halil Ibrahim; Caliskan, Tezcan; Senel, Ufuk; Karaarslan, Numan

    2015-06-01

    Abdominal pseudocyst is a rare complication developing after ventriculoperitoneal shunt treatment. It is more commonly seen particularly in children. The underlying pathogenesis may be associated with repeat revisions or infections. Morphologically, it has no complete cyst wall, presenting only with a pseudocapsule among the intestinal loops, around the lower shunt tip. The principal problem appears to be the reduced peritoneal absorption capacity. The treatment is complicated and difficult. In this report, we present an 8-year-old abdominal pseudocyst case with a history of many shunt revisions.

  5. Ion beam sputter-etched ventricular catheter for hydrocephalus shunt

    NASA Technical Reports Server (NTRS)

    Banks, B. A. (Inventor)

    1983-01-01

    A cerebrospinal fluid shunt in the form of a ventricular catheter for controlling the condition of hydrocephalus by relieving the excessive cerebrospinal fluid pressure is described. A method for fabrication of the catheter and shunting the cerebral fluid from the cerebral ventricles to other areas of the body is also considered. Shunt flow failure occurs if the ventricle collapse due to improper valve function causing overdrainage. The ventricular catheter comprises a multiplicity of inlet microtubules. Each microtubule has both a large openings at its inlet end and a multiplicity of microscopic openings along its lateral surfaces.

  6. Ventriculoperitoneal shunt for intracranial hypertension in cryptococcal meningitis without hydrocephalus.

    PubMed

    Petrou, Panayota; Moscovici, Samuel; Leker, Ronen R; Itshayek, Eyal; Gomori, John M; Cohen, José E

    2012-08-01

    The use of a ventriculoperitoneal (VP) shunt to treat uncontrollable intracranial hypertension in patients with cryptococcal meningitis without hydrocephalus is somewhat unusual and still largely unreported. However, uncontrollable intracranial hypertension without hydrocephalus in these patients is a potentially life-threatening condition. Early diagnosis and shunt placement are essential to improve survival and neurological function. We report uncontrollable intracranial hypertension without hydrocephalus in a 23-year-old woman, which was successfully managed by VP shunt placement. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Migration of Distal Ventriculoperitoneal Shunt Catheter into the Pulmonary Artery

    PubMed Central

    Imagawa, Hiroshi; Nagashima, Mitsugi; Shikata, Fumiaki; Hashimoto, Naoki; Kawachi, Kanji

    2009-01-01

    A 50-year-old man presented with an abdominal bulge 2 years after receiving a ventriculoperitoneal (VP) shunt for hydrocephalus. Chest radiography revealed that the peritoneal end of the catheter had migrated into the right pulmonary artery. Exploration through a small neck incision revealed that the shunt catheter had entered the internal jugular vein. The catheter was extracted and positioned in the subcutaneous space in preparation for reimplantation. This type of shunt migration is quite unusual, but it could cause lethal pulmonary infarction or arrhythmia. Follow-up radiography should be scheduled to detect such complications. PMID:23555358

  8. Ventriculoperitoneal shunt as a primary neurosurgical procedure in newborn posthemorrhagic hydrocephalus: report of a series of 47 shunted patients.

    PubMed

    Romero, L; Ros, B; Ríus, F; González, L; Medina, J M; Martín, A; Carrasco, A; Arráez, M A

    2014-01-01

    Intraventricular hemorrhage is the most common cause of infantile acquired hydrocephalus. Our objective is to determine if the implantation of ventriculoperitoneal shunt in posthemorrhagic hydrocephalus as a primary and definitive neurosurgical treatment, with no previous temporary procedures, would decrease complication rates with good functional outcomes. Two hundred seventy-one patients with germinal matrix hemorrhage were diagnosed at the Carlos Haya Hospital between 2003 and 2010. Forty-seven patients underwent ventriculoperitoneal shunt after developing symptomatic hydrocephalus. The minimum weight required for shunt implantation was 1,500 g. We recorded complications related to the surgical procedure and analyzed functional state with a self-developed four-grade scale. One hundred thirty-nine (51.3 %) patients with intraventricular hemorrhage developed ventricular dilatation, but only 47 patients (17.34 %) needed shunting. In seven cases, temporary neurosurgical procedures were performed, but in all of them, this was followed by ventriculoperitoneal shunt implantation. The infection rate was 4.25 %, and shunt obstruction rate was 4.25 %. More than 80 % of patients were classified as good or excellent functional state. Mean follow-up period was 38.75 months (SD, 27.09; range, 1-102 months). Ventriculoperitoneal shunting as a primary neurosurgical treatment in posthemorrhagic hydrocephalus would decrease surgical morbidity with good functional outcome.

  9. Risk of failure in pediatric ventriculoperitoneal shunts placed after abdominal surgery.

    PubMed

    Burks, Joshua D; Conner, Andrew K; Briggs, Robert G; Glenn, Chad A; Bonney, Phillip A; Cheema, Ahmed A; Chen, Sixia; Gross, Naina L; Mapstone, Timothy B

    2017-05-01

    OBJECTIVE Experience has led us to suspect an association between shunt malfunction and recent abdominal surgery, yet information about this potential relationship has not been explored in the literature. The authors compared shunt survival in patients who underwent abdominal surgery to shunt survival in our general pediatric shunt population to determine whether such a relationship exists. METHODS The authors performed a retrospective review of all cases in which pediatric patients underwent ventriculoperitoneal shunt operations at their institution during a 7-year period. Survival time in shunt operations that followed abdominal surgery was compared with survival time of shunt operations in patients with no history of abdominal surgery. Univariate and multivariate analyses were used to identify factors associated with failure. RESULTS A total of 141 patients who underwent 468 shunt operations during the period of study were included; 107 of these 141 patients had no history of abdominal surgery and 34 had undergone a shunt operation after abdominal surgery. Shunt surgery performed more than 2 weeks after abdominal surgery was not associated with time to shunt failure (p = 0.86). Shunt surgery performed within 2 weeks after abdominal surgery was associated with time to failure (adjusted HR 3.6, 95% CI 1.3-9.6). CONCLUSIONS Undergoing shunt surgery shortly after abdominal surgery appears to be associated with shorter shunt survival. When possible, some patients may benefit from shunt placement utilizing alternative termini.

  10. To shunt or not to shunt? An experimental study comparing temporary vascular shunts and venous ligation as damage control techniques for vascular trauma.

    PubMed

    Marinho de Oliveira Góes Junior, Adenauer; de Campos Vieira Abib, Simone; de Seixas Alves, Maria Teresa; Venerando da Silva Ferreira, Paulo Sérgio; Carvalho de Andrade, Mariseth

    2014-04-01

    To evaluate vascular flow through temporary vascular shunts inserted into peripheral arteries and veins and the repercussion, on the arterial perfusion, of venous ligation and venous shunt insertion in an experimental model for damage control. Experimental study in pigs. Animals were distributed in 5 groups: group 1, right external iliac artery (EIA) shunting and right external iliac vein (EIV) ligation; group 2, right EIA shunting and right EIV shunting; group 3, right EIV ligation; group 4, right EIV shunting; group 5, no vascular shunting and no venous ligation. Flowmeters were used to measure vascular flow on right and left external iliac vessels, and blood samples were collected from the EIVs for biochemical analysis. A right anterior limb biopsy was performed before shock. Hemorrhagic shock was induced through the external right jugular vein, until the vascular flow through right iliac external artery shunt or right iliac external vein shunt (group 4) ceased or until the animal's death. After the end of the experiments, biopsies of bilateral hind limb were obtained for histologic analysis. For statistical analysis, Microsoft Office Excel 2007 and BioEstat 5.0 (2007) were used. In the absence of hemorrhagic shock, venous ligation (group 1) was associated with a 38.8% reduction (P < 0.05) and venous shunting with a 28.4% reduction on the vascular flow through the arterial shunt. When associated with hemorrhagic shock, the mean vascular flow on the right EIA was 13 mL/min and on the left EIA was 41.2 mL/min; on group 2, the right EIA flow was 8.5 mL/min and the left EIA flow was 8.1 mL/min. When associated with hemorrhagic shock, the pO2 was 25.8 mm Hg on right EIV and 33.8 mm Hg on the left EIV for group 1 (P < 0.05), whereas for group 2, the pO2 was 22.6 mm Hg on right EIV and 22.8 mm Hg on the left EIV. On group 1, serum potassium was 3.84 mEq/L on the right EIV and 3.96 mEq/L on the left EIV, whereas on group 2, it was 7.1 mEq/L on the right EIV and 5.88 m

  11. Dynamics of superconducting nanowires shunted with an external resistor

    NASA Astrophysics Data System (ADS)

    Brenner, Matthew W.; Roy, Dibyendu; Shah, Nayana; Bezryadin, Alexey

    2012-06-01

    We present a study of superconducting nanowires shunted with an external resistor, geared towards understanding and controlling coherence and dissipation in nanowires. The dynamics is probed by measuring the evolution of the V-I characteristics and the distributions of switching and retrapping currents upon varying the shunt resistor and temperature. Theoretical analysis of the experiments indicates that as the value of the shunt resistance is decreased, the dynamics turns more coherent, presumably due to stabilization of phase-slip centers in the wire, and furthermore the switching current approaches the Bardeen's prediction for equilibrium depairing current. By a detailed comparison between theory and experiment, we make headway into identifying regimes in which the quasi-one-dimensional wire can effectively be described by a zero-dimensional circuit model analogous to the resistively and capacitively shunted Josephson junction model of Stewart and McCumber. Aside from its fundamental significance, our study has implications for a range of promising technological applications.

  12. Malignant cause of ventriculoperitoneal shunt 'pseudocyst': a case report.

    PubMed

    Awori, Jonathan; Wu, Chris Y; Maher, Cormac O

    2015-01-01

    Abdominal pseudocysts are an uncommon complication of ventriculoperitoneal (VP) shunts. We present the case of a 4-year-old boy with a history of complicated hydrocephalus managed with a VP shunt due to sequelae of prematurity. The patient presented with abdominal distention, and a pseudocyst was diagnosed. Despite shunt externalization and aspiration, the pseudocyst continued to produce up to 1 liter of serosanguineous fluid per day. After MRI revealed malignant features within the pseudocyst, laparotomy was performed and the pseudocyst was partially excised. Pathology reports suggested sarcoma. The cystic mass grew back aggressively, accompanied by distant metastasis. The patient's condition deteriorated and he died from his disease. To our knowledge, this represents the first report of an abdominal malignancy mimicking a pseudocyst and causing VP shunt failure.

  13. Intracardiac migration and knotting of a ventriculoperitoneal shunt.

    PubMed

    Frahm-Jensen, Gert; Newton, Peter R; Drummond, Katharine J; Wagner, Tim P; Mees, Barend M E

    2015-04-01

    We report a patient with delayed migration of the distal ventriculoperitoneal shunt catheter from the peritoneum to the right atrium with associated knotting of the catheter complicating removal. We also review the literature on this topic.

  14. A case of breast cancer involving a ventriculoperitoneal shunt.

    PubMed

    Kamei, Mirei; Kikuchi, Nobuyuki; Ichimura, Homare; Chujo, Masao; Takahashi, Yoshiaki; Sugio, Kenji

    2016-12-01

    An 84-year-old woman was examined for an enlargement of an induration in the left breast. A ventriculoperitoneal shunt had been placed for postoperative normal pressure hydrocephalus of a cerebral hemorrhage, and it had penetrated the mass according to the computed tomography findings. Breast cancer was diagnosed after a close examination; however, close observation was selected because her family rejected treatment. She developed somnolence 7 months after the initial examination, and ventricular dilatation and expansion of the low-density region around the ventricle were noted on computed tomography, suggesting that the enlarged tumor had excluded the shunt and caused obstruction. The growth of breast carcinoma involving a shunt tube can be the cause of obstruction of a ventriculoperitoneal shunt. Our findings suggest that a breast lesion should be evaluated at both pre- and postoperation.

  15. Intra-bronchial migration of peritoneal catheter of lumboperitoneal shunt

    PubMed Central

    Kawahara, Takashi; Yanagi, Masakazu; Hirano, Hirofumi; Arita, Kazunori

    2015-01-01

    Background: A rare case of intra-bronchial migration of peritoneal catheter of lumboperitoneal (LP) shunt was treated under the bronchoscopic and fluoroscopic observation. Case Description: A 71-year-old man, who underwent LP shunt installation due to idiopathic normal pressure hydrocephalus a year before, presented with history of high fever and sputum production. Roentgenography and computed tomography of the chest revealed migration of distal end of the peritoneal catheter into the left main bronchus. Migrated catheter was gently extracted through the abdominal wound incision under the bronchoscopic and fluoroscopic observation. Contrast material infused into the catheter did not spread into the pleural cavity. The patient was free of the symptoms within 2 postoperative weeks. Moreover, he underwent the ventriculo-peritoneal shunt surgery 1-month later. Conclusion: This is the first case of the migration of peritoneal catheter of LP shunt into the main bronchus. PMID:26962468

  16. HEPATIC IRON STORAGE AND ERYTHROKINETICS AFTER PORTACAVAL SHUNT,

    DTIC Science & Technology

    used in the production of hemoglobin is stored in the liver as hemosiderin. The significance of these findings relative to the reported human cases of hemochromatosis after portal-systemic shunting is discussed. (Author)

  17. Shunt capacitor effect on electrical distribution system reliability

    NASA Astrophysics Data System (ADS)

    Sallam, Abdelhay A.; Desouky, Mohamed; Desouky, Hussien

    1994-03-01

    To improve the security & reliability of a distribution system, as much power as feasible must go through a given transmission line. This can be achieved by using shunt capacitors as compensators. These shunt capacitive compensators improve the load carrying capability of the line by controlling the reactive power flow. Consequently, the capacitor existence can not be ignored in evaluating system reliability. The paper applies the state-space method to calculate the reliability indices for compensated & uncompensated systems with different success criteria. The importance of using shunt capacitors to improve the level of distribution system reliability is illustrated in addition to their original function as reactive power controllers. Our procedure, based on a Markov process, is applied to a numerical example, and indicates that system reliability is improved when using shunt capacitors.

  18. Simultaneous Umbilical Hernia Repair with Transumbilical Ventriculoperitoneal Shunt Placement.

    PubMed

    Montalbano, Michael J; Loukas, Marios; Oakes, W Jerry; Tubbs, R Shane

    2017-01-01

    Recently, placement of a ventriculoperitoneal shunt via a transumbilical approach has been reported. Herein, we report the repair of an umbilical hernia via the same incision and introduction of the distal end of a ventricultoperitoneal shunt into the peritoneal cavity in 3 patients. A case illustration is included. Both hernia repair and placement of the distal end of the ventriculoperitoneal shunt were uncomplicated in our small case series. To our knowledge, simultaneous repair of an umbilical hernia followed by transumbilical shunt placement has not been reported. As umbilical hernias are so common in infants, this finding, based on our experience, should not exclude placement of peritoneal tubing in the same setting. © 2017 S. Karger AG, Basel.

  19. Zero tolerance to shunt infections: can it be achieved?

    PubMed Central

    Choksey, M; Malik, I

    2004-01-01

    Objective: To evaluate the rigid application of a technique of shunt placement aimed at the eradication of postoperative shunt infection in neurosurgical practice. Method: All shunt procedures were performed or closely supervised by the senior author (MSC). The essentials were the use of intravenous peri- and postoperative antimicrobials, rigid adherence to classical aseptic technique, liberal use of topical antiseptic (Betadine®), and avoidance of haematomas. Results: Of 176 operations, 93 were primary procedures; 33 patients underwent revisions, some multiple. Only one infection occurred, seven months postoperatively, secondary to appendicitis with peritonitis. The infecting Streptococcus faecalis appeared to ascend from the abdominal cavity. Conclusion: A rigidly applied protocol and strict adherence to sterile technique can reduce shunt infections to a very low level. PMID:14707314

  20. Percutaneous ultrasound-guided insertion of ventriculo-atrial shunts.

    PubMed

    McCracken, James Albert; Bahl, Anuj; McMullan, John

    2016-08-01

    Ventriculo-atrial (VA) shunts have been in use for >60 years but less frequently so of late. This is due to a combination of the risk of cardiac complications, lack of expertise and a lengthy operation. We present our consecutive prospective series of 10 VA shunts inserted using a percutaneous method employing the Sonowand Invite™ neuronavigation system for both the distal and proximal catheters, over a 13-month period. We had two complications of cases needing revision, but our series highlights a safe and reproducible method of inserting a VA shunt. About 30% of the procedures were carried out by a trainee as the primary surgeon. This technique does not necessarily require the expertise of a complex hydrocephalus surgeon and is thus able to be in the armoury of any neurosurgeon needing to do a VA shunt procedure. The indications, operative data and outcomes of our patients are discussed.

  1. Multicenter evaluation of temporary intravascular shunt use in vascular trauma.

    PubMed

    Inaba, Kenji; Aksoy, Hande; Seamon, Mark J; Marks, Joshua A; Duchesne, Juan; Schroll, Rebecca; Fox, Charles J; Pieracci, Fredric M; Moore, Ernest E; Joseph, Bellal; Haider, Ansab A; Harvin, John A; Lawless, Ryan A; Cannon, Jeremy; Holland, Seth R; Demetriades, Demetrios

    2016-03-01

    The indications and outcomes associated with temporary intravascular shunting (TIVS) for vascular trauma in the civilian sector are poorly understood. The objective of this study was to perform a contemporary multicenter review of TIVS use and outcomes. Patients sustaining vascular trauma, requiring TIVS insertion (January 2005 to December 2013), were retrospectively identified at seven Level I trauma centers. Clinical demographics, operative details, and outcomes were abstracted. A total of 213 injuries (2.7%; 94.8% arterial) requiring TIVS were identified in 7,385 patients with vascular injuries. Median age was 27.0 years (range, 4-89 years), 91.0% were male, Glasgow Coma Scale (GCS) score was 15.0 (interquartile range, 4.0), Injury Severity Score (ISS) was 16.0 (interquartile range, 15.0), 26.0% had an ISS of 25 or greater, and 71.1% had penetrating injuries. The most common mechanism was gunshot wound (62.7%), followed by auto versus pedestrian (11.4%) and motor vehicle collision (6.5%). Shunts were placed for damage control in 63.4%, staged repair for combined orthopedic and vascular injuries in 36.1%, and for insufficient surgeon skill set in 0.5%. The most common vessel shunted was the superficial femoral artery (23.9%), followed by popliteal artery (18.8%) and brachial artery (13.2%). An argyle shunt (81.2%) was the most common conduit, followed by Pruitt-Inahara (9.4%). Dwell time was less than 6 hours in 61.4%, 24 hours in 86.5%, 48 hours in 95.9%, with only 4.1% remaining in place for more than 48 hours. Of the patients, 81.6% survived to definitive repair, and 79.6% survived overall. Complications included shunt thrombosis (5.6%) and dislodgment (1.4%). There was no association between dwell time and shunt thrombosis. The use of a noncommercial shunt (chest tube/feeding tube) did not impact shunt thrombosis but was an independent risk factor for subsequent graft failure. The limb salvage rate was 96.3%. No deaths could be attributed to a shunt

  2. Clopidogrel in infants with systemic-to-pulmonary-artery shunts.

    PubMed

    Wessel, David L; Berger, Felix; Li, Jennifer S; Dähnert, Ingo; Rakhit, Amit; Fontecave, Sylvie; Newburger, Jane W

    2013-06-20

    Infants with cyanotic congenital heart disease palliated with placement of a systemic-to-pulmonary-artery shunt are at risk for shunt thrombosis and death. We investigated whether the addition of clopidogrel to conventional therapy reduces mortality from any cause and morbidity related to the shunt. In a multicenter, double-blind, event-driven trial, we randomly assigned infants 92 days of age or younger with cyanotic congenital heart disease and a systemic-to-pulmonary-artery shunt to receive clopidogrel at a dose of 0.2 mg per kilogram of body weight per day (467 infants) or placebo (439 infants), in addition to conventional therapy (including aspirin in 87.9% of infants). The primary efficacy end point was a composite of death or heart transplantation, shunt thrombosis, or performance of a cardiac procedure due to an event considered to be thrombotic in nature before 120 days of age. The rate of the composite primary end point did not differ significantly between the clopidogrel group (19.1%) and the placebo group (20.5%) (absolute risk difference, 1.4 percentage points; relative risk reduction with clopidogrel, 11.1%; 95% confidence interval, -19.2 to 33.6; P=0.43), nor did the rates of the three components of the composite primary end point. There was no significant benefit of clopidogrel treatment in any subgroup, including subgroups defined by shunt type. Clopidogrel recipients and placebo recipients had similar rates of overall bleeding (18.8% and 20.2%, respectively) and severe bleeding (4.1% and 3.4%, respectively). Clopidogrel therapy in infants with cyanotic congenital heart disease palliated with a systemic-to-pulmonary-artery shunt, most of whom received concomitant aspirin therapy, did not reduce either mortality from any cause or shunt-related morbidity. (Funded by Sanofi-Aventis and Bristol-Myers Squibb; ClinicalTrials.gov number, NCT00396877.).

  3. Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement.

    PubMed

    Bourm, Kelsey; Pfeifer, Cory; Zarchan, Adam

    2016-06-01

    Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment.

  4. Ventriculoperitoneal shunt infection with Mycobacterium fortuitum: a rare offending organism.

    PubMed

    Cadena, Gilbert; Wiedeman, Jean; Boggan, James E

    2014-12-01

    Postsurgical infection is one of the greatest potential morbidities of ventriculoperitoneal shunt surgery. The majority of infections can be linked to contamination with skin flora at the time of surgery, a phenomenon that has been well described. However, there is a paucity of literature regarding infection with nontuberculous mycobacteria. The authors report a case of postoperative ventriculoperitoneal shunt infection with Mycobacterium fortuitum and review the available neurosurgical literature and treatment strategies.

  5. Cross-Species Functionality of Pararetroviral Elements Driving Ribosome Shunting

    PubMed Central

    Pooggin, Mikhail M.; Fütterer, Johannes; Hohn, Thomas

    2008-01-01

    Background Cauliflower mosaic virus (CaMV) and Rice tungro bacilliform virus (RTBV) belong to distinct genera of pararetroviruses infecting dicot and monocot plants, respectively. In both viruses, polycistronic translation of pregenomic (pg) RNA is initiated by shunting ribosomes that bypass a large region of the pgRNA leader with several short (s)ORFs and a stable stem-loop structure. The shunt requires translation of a 5′-proximal sORF terminating near the stem. In CaMV, mutations knocking out this sORF nearly abolish shunting and virus viability. Methodology/Principal Findings Here we show that two distant regions of the CaMV leader that form a minimal shunt configuration comprising the sORF, a bottom part of the stem, and a shunt landing sequence can be replaced by heterologous sequences that form a structurally similar configuration in RTBV without any dramatic effect on shunt-mediated translation and CaMV infectivity. The CaMV-RTBV chimeric leader sequence was largely stable over five viral passages in turnip plants: a few alterations that did eventually occur in the virus progenies are indicative of fine tuning of the chimeric sequence during adaptation to a new host. Conclusions/Significance Our findings demonstrate cross-species functionality of pararetroviral cis-elements driving ribosome shunting and evolutionary conservation of the shunt mechanism. We are grateful to Matthias Müller and Sandra Pauli for technical assistance. This work was initiated at Friedrich Miescher Institute (Basel, Switzerland). We thank Prof. Thomas Boller for hosting the group at the Institute of Botany. PMID:18286203

  6. In vitro flow measurements in ion sputtered hydrocephalus shunts

    NASA Technical Reports Server (NTRS)

    Cho, Y. I.; Back, L. H.

    1989-01-01

    This paper describes an experimental procedure for accurate measurements of the pressure-drop/flow rate relationship in hydrocephalus shunts. Using a fish-hook arrangement, small flow rates in a perforated ion-sputtered Teflon microtubule were measured in vitro in a pressured system and were correlated with pressure in the system. Results indicate that appropriate drainage rates could be obtained in the physiological range for hydrocephalus shunts.

  7. Digital implementation of shunting-inhibitory cellular neural network

    NASA Astrophysics Data System (ADS)

    Hammadou, Tarik; Bouzerdoum, Abdesselam; Bermak, Amine

    2000-05-01

    Shunting inhibition is a model of early visual processing which can provide contrast and edge enhancement, and dynamic range compression. An architecture of digital Shunting Inhibitory Cellular Neural Network for real time image processing is presented. The proposed architecture is intended to be used in a complete vision system for edge detection and image enhancement. The present hardware architecture, is modeled and simulated in VHDL. Simulation results show the functional validity of the proposed architecture.

  8. Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement

    PubMed Central

    Bourm, Kelsey; Pfeifer, Cory; Zarchan, Adam

    2016-01-01

    Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment. PMID:27761183

  9. In vitro flow measurements in ion sputtered hydrocephalus shunts

    NASA Technical Reports Server (NTRS)

    Cho, Y. I.; Back, L. H.

    1989-01-01

    This paper describes an experimental procedure for accurate measurements of the pressure-drop/flow rate relationship in hydrocephalus shunts. Using a fish-hook arrangement, small flow rates in a perforated ion-sputtered Teflon microtubule were measured in vitro in a pressured system and were correlated with pressure in the system. Results indicate that appropriate drainage rates could be obtained in the physiological range for hydrocephalus shunts.

  10. Characteristics of delayed intracerebral hemorrhage after ventriculoperitoneal shunt insertion

    PubMed Central

    Yu, Zhengquan; Wang, Zhong; Chen, Gang; Zhang, Shiming; Wu, Jiang

    2017-01-01

    Background Delayed intracerebral hemorrhage after ventriculoperitoneal (VP) shunt insertion is rare and has not been well investigated previously. Its characteristics is still unknown. Objective We reported 12 patients with delayed intracerebral hemorrhage after VP shunt to investigate the potential risk factors and the outcome. Results 12 patients (1.59%) of all the 754 hydrocephalus had delayed intracerebral hemorrhage after VP shunt insertion. 4 patients were women and 8 patients were men, ranging in age from 50 to 76 years. The delayed cerebral hemorrhage from day 3 to day 7 post operation was diagnosed by repeated CT. The delayed intracerebral hemorrhage was significantly related to age, prior craniotomy operation history and manipulation of valve system (3–7 days). Neither gender sexuality nor potential risk factors for postoperative hemorrhage (including anticoagulation/antiplatelet status, liver disease, diabetes, hypertension), time of shunt attempt affected the happen of delayed intracerebral hemorrhage. Materials and Methods The clinical characteristics including sex, age, anticoagulation/antiplatelet status, liver disease, diabetes, hypertension, craniotomy operation history, manipulation of valve system and time of shunt attempt of 754 patients who were surgically treated of VP shunt at the first affiliated hospital of Soochow University between 2007 and 2013 were reviewed retrospectively. The potential risk factors of the delayed intracerebral hemorrhage were statistically analyzed. Conclusions This study summarizes the presentation and outcome of a series of 12 patients with delayed intracerebral hemorrhage after VP shunt. Age ≥ 60 years, prior craniotomy operation and manipulation of the valve system are statistically significant to the delayed hematoma secondary to VP shunt. PMID:28496010

  11. Assessment lumboperitoneal or ventriculoperitoneal shunt patency by radionuclide technique: a review experience cases.

    PubMed

    Chiewvit, Sunanta; Nuntaaree, Sarun; Kanchaanapiboon, Potjanee; Chiewvit, Pipat

    2014-05-01

    Hydrocephalus-related symptoms that worsen after shunt placement may indicate a malfunctioning or obstructed shunt. The assessment of shunt patency and site of obstruction is important for planning of treatment. The radionuclide cerebrospinal fluid (CSF) shunt study provides a simple, effective, and low-radiation-dose method of assessing CSF shunt patency. The radionuclide CSF shuntography is a useful tool in the management of patients presenting with shunt-related problems not elucidated by conventional radiological examination. This article described the imaging technique of ventriculoperitoneal (VP) shunt and lumbar puncture (LP) shunt. The normal finding, abnormal finding of completed obstruction and partial obstruction is present by our cases experience. The radiopharmaceutical (Tc-99m diethylenetriaminepentaacetic acid) was injected via the reservoir for VP shunt and via lumbar puncture needle in subarachnoid space for LP shunt, then serial image in the head and abdominal area. The normal function of VP and LP shunt usually rapid spillage of the radioactivity in the abdominal cavity diffusely. The patent proximal tube VP shunt demonstrates ventricular reflux. The early image of patent LP shunt reveals no activity in the ventricular system contrast to distal LP shunt reveals early reflux of activity in the ventricular system. The completed distal VP and LP shunt obstruction show absence of tracer in the peritoneal area or markedly delayed appearance of abdominal activity. The partial distal VP and LP shunt obstruction recognized by slow transit or accumulation of tracer at the distal end or focal tracer in the peritoneal cavity near the tip of distal shunt. The images of the normal and abnormal CSF shunt as describe before are present in the full paper. Radionuclide CSF shuntography is a reliable and simple procedure for assessment shunt patency.

  12. Familiarization with lumboperitoneal shunt using some technical resources.

    PubMed

    Kanazawa, Ryuzaburo; Ishihara, Shoichiro; Sato, Shun; Teramoto, Akira; Kuniyoshi, Noboru

    2011-01-01

    Although lumboperitoneal (LP) shunts are thought to be less invasive, they are used less frequently compared with ventriculoperitoneal shunts in the treatment of communicating hydrocephalus. This may be due to limitations such as troublesome patient positioning, difficulty in valve pressure confirmation and adjustment, and concerns regarding overdrainage. The aim of this study was to increase operator familiarization with the technical aspects of LP shunt procedures. To reduce the abovementioned shortcomings, we developed a new device called SiphonGuard. Our method has the following technical advantages: avoidance of a halfway incision, valve placement between the dermis and subcutaneous fat in the patient's lumbar region near the puncture point, and minimal space requirement for valve placement. Two reversible complications were experienced, and there were no infectious complications. A relatively low rate of complications was achieved. Valve pressure detection on an anteroposterior view of a plain abdominal X-ray was possible in all patients with our method. Our method provides solutions to certain troublesome issues concerning LP shunt procedures; in practical terms, resolution of these issues may contribute to more widespread usage of LP shunt procedures by neurosurgeons. In this study, we demonstrate our familiarization procedure for LP shunt procedures. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. Quantifying lung shunting during planning for radio-embolization

    NASA Astrophysics Data System (ADS)

    Willowson, Kathy; Bailey, Dale L.; Baldock, Clive

    2011-07-01

    A method is proposed for accurate quantification of lung uptake during shunt studies for liver cancer patients undergoing radio-embolization. The current standard for analysis of [99mTc]-MAA shunt studies is subjective and highly variable. The technique proposed in this work involves a small additional peripheral intravenous injection of macroaggregated albumin (MAA) and two additional static acquisitions (before and after injection) to quantify the absolute activity in the lungs as a result of arterio-venous shunting. Such quantification also allows for estimates of absorbed dose to lung tissue at the time of treatment based on MIRD formalism. The method was used on six radio-embolization patients attending the department for lung shunt analysis. Quantitative values for each were compared to a previously validated technique using fully quantitative SPECT/CT imaging, treated as the gold standard. The average difference between absolute activity shunted to the lungs calculated by the proposed technique compared to the previously validated technique was found to be 2%, with a range of (1-8)%. The proposed method is simple and fast, allowing for accurate quantification of lung shunting and estimates of absorbed dose to lung tissue at treatment, and may one day be used in a one-stop procedure for planning and therapy in a single interventional procedure.

  14. Calibration of piezoelectric RL shunts with explicit residual mode correction

    NASA Astrophysics Data System (ADS)

    Høgsberg, Jan; Krenk, Steen

    2017-01-01

    Piezoelectric RL (resistive-inductive) shunts are passive resonant devices used for damping of dominant vibration modes of a flexible structure and their efficiency relies on the precise calibration of the shunt components. In the present paper improved calibration accuracy is attained by an extension of the local piezoelectric transducer displacement by two additional terms, representing the flexibility and inertia contributions from the residual vibration modes not directly addressed by the shunt damping. This results in an augmented dynamic model for the targeted resonant vibration mode, in which the residual contributions, represented by two correction factors, modify both the apparent transducer capacitance and the shunt circuit impedance. Explicit expressions for the correction of the shunt circuit inductance and resistance are presented in a form that is generally applicable to calibration formulae derived on the basis of an assumed single-mode structure, where modal interaction has been neglected. A design procedure is devised and subsequently verified by a numerical example, which demonstrates that effective mitigation can be obtained for an arbitrary vibration mode when the residual mode correction is included in the calibration of the RL shunt.

  15. First Report of Ventriculoperitoneal Shunt Infection due to Cyberlindnera fabianii

    PubMed Central

    Baghdadi, Jonathan; Hemarajata, Peera; Humphries, Romney; Kelesidis, Theodoros

    2015-01-01

    Fungal infections in the central nervous system (CNS) are associated with significant morbidity and death. Transient fungemia in immunocompetent patients without any other risk factors for fungemia has been suggested as a possible mechanism that may lead to serious fungal ventriculoperitoneal (VP) shunt infections, but evidence is lacking. The clinical spectrum, diagnosis, and optimal therapy of Cyberlindnera fabianii infections remain to be determined. We describe the first case of CNS infection due to C. fabianii that occurred in an immunocompetent adult with a VP shunt. Spontaneous translocation with yeast that is not part of the normal gastrointestinal flora in the setting of ingestion of multiple servings of a fermentation product was the likely source from which Cyberlindnera fabianii gained entrance into the VP shunt system, causing meningitis in this patient. The authors conclude that, in view of the high morbidity associated with yeast infection of the CNS, long-term antifungal therapy should be strongly considered in cases where the VP shunt cannot be completely removed. Transient fungemia may lead to invasive disease in an immunocompetent host with VP shunt, even in the absence of any other risk factors for fungemia and even after remote placement of the VP shunt. PMID:26618013

  16. Activity of an antimicrobial hydrocephalus shunt catheter against Propionibacterium acnes.

    PubMed

    Bayston, Roger; Vera, Litza; Ashraf, Waheed

    2010-12-01

    Shunt infection is a major complication affecting approximately 10% of procedures. Propionibacterium acnes, an anaerobic skin bacterium, is increasingly recognized as a shunt pathogen, causing up to 14% of infections. Though susceptible to penicillin and cephalosporins, P. acnes shunt infections are not preventable by means of perioperative prophylaxis, due to poor cerebrospinal fluid penetration. Antimicrobial shunts with activity against staphylococci are available, but their activity against P. acnes is unknown, and the study was designed to determine this. Three methods of evaluation were used in order to determine the emergence of resistance when exposure is to high inocula for long periods, the time taken to kill 100% of the bacteria attached to the shunt, and the duration of activity under constant flow conditions with repeated bacterial challenge. Despite repeated exposure to high bacterial inocula over 70 days, no resistance was seen. The time taken to kill all attached bacteria, 96 h, was twice that taken to kill attached staphylococci. Nevertheless, under constant flow conditions with repeated challenges, the antimicrobial catheters resisted colonization by P. acnes for 56 days. Using tests that were designed to be clinically predictive when done together, the results suggest that the antimicrobial catheters will be able to prevent colonization of hydrocephalus shunts by P. acnes.

  17. Intraventricular hemorrhage after ventriculoperitoneal shunt revision: a retrospective review.

    PubMed

    Calayag, Mark; Paul, Alexandra R; Adamo, Matthew A

    2015-07-01

    OBJECT The authors review their ventriculoperitoneal (VP) shunt revisions over a 3-year period to determine the rate of intraventricular hemorrhage (IVH) and subsequent need for re-revision. METHODS Review of medical records identified 35 pediatric patients who underwent 52 VP shunt revisions between 2009 and 2012. The presence and amount of IVH as determined by CT and the time to re-revision were documented. The reason for shunting, catheter position, and time between initial VP shunt placement and subsequent revisions were also recorded. RESULTS After 13 (25%) of the 52 revisions, IVH was evident on postoperative CT scans. The majority of patients had a trace amount of IVH, with only 2% having IVH greater than 5 ml. After 2 (15%) of the 13 revisions associated with IVH, re-revision was required within 1 month. In contrast, the re-revision rate in patients without IVH was 18%. All of the patients who developed IVH had occipital catheters. CONCLUSIONS Some degree of IVH can be expected after approximately one-quarter of all VP shunt revision procedures in pediatric patients, but the rate of significant IVH is low. Furthermore, the presence of IVH does not necessitate an early shunt revision.

  18. Clinical and economic results of ventriculoperitoneal shunt infections in children.

    PubMed

    Kanik, Ali; Sirin, Seda; Kose, Engin; Eliacik, Kayı; Anil, Murat; Helvaci, Mehmet

    2015-01-01

    This study evaluated the clinical and economic outcomes of ventriculoperitoneal shunt infections. Patients diagnosed with ventriculoperitoneal shunt infections for the first time between 1 January 2007 and 31 December 2011 were included in this study. Demographic, clinical, and economic data were analyzed retrospectively. A cost coefficient (total cost/follow-up period) and hospitalization coefficient (duration of hospitalization/follow-up period) were calculated for each patient. In total, 132 shunt infections (mean follow-up, 734 ± 367 days) were evaluated in 51 patients (mean age, 16.6 ± 9.22 months; median age, 3 months; range, 1-88 months; 28 females, 21 males). In 23 patients (45%), shunt infections were seen in the first 2 months following shunt placement. Seven patients died during the follow-up. There was a negative correlation between the age at diagnosis and the hospitalization duration (p = 0.005, r = -0.381). The average cost of hospitalization per patient was 6397 ± 4338 TL. There was a negative correlation between the cost index and the age at diagnosis (p = 0.04, r = -0.292). Ventriculoperitoneal shunt infections have significant medical and economic impacts. Younger the diagnosis of patients, the hospitalization duration and treatment cost were higher.

  19. Design of an intelligent and personalised shunting system for hydrocephalus.

    PubMed

    Momani, Lina; Alkharabsheh, Abdel Rahman; Al-Nuaimy, Waleed

    2008-01-01

    Hydrocephalus is a neurological disease that manifests itself in an elevated fluid pressure within the brain, and if left untreated, may be fatal. It is currently treated using shunt implants, which consist of a mechanical valve and tubes that regulate the pressure of cerebrospinal fluid (CSF) by draining excess fluid into the abdomen. Hydrocephalus shunting systems are no longer expected simply to regulate the intracranial pressure (ICP), but also to offer the option of regaining independence of the shunt. Additionally, they could offer personalised valve management which is one of the main limitations of current shunts. This paper describes the design of a multi-agent system for an intelligent and personalised CSF management system. Patient feedback and intracranial pressure readings will play important roles in the process of CSF regulation and weaning, introduces an element of personalisation to the treatment. The new shunting system would deliver both reactive and goal-driven solutions for the treatment, at the same time the intelligent part of the system will be monitoring how well the shunt is performing. These tasks can be achieved by implementing an agent approach in designing this system. Such system would help us to understand more about the dynamics of hydrocephalus.

  20. Prediction of Susceptibility to Acute Mountain Sickness Using Hypoxia-Induced Intrapulmonary Arteriovenous Shunt and Intracardiac Shunt Fractions

    DTIC Science & Technology

    2013-10-01

    intracardiac shunting (through patent foramen ovale (PFO)) are responsible for the greater degree of arterial hypoxemia in AMS susceptible subjects compared...arteriovenous anastomoses, patent foramen ovale and nuclear medicine shunt fraction quantification Post-doctoral fellow JJ Duke is working to complete...significant differences. Non-Task Specific Accomplishments: Collaboration with Dr. Robert Roach, role of patent foramen ovale in symptoms of acute mountain

  1. Temporary arterial shunts to maintain limb perfusion after arterial injury: an animal study

    NASA Technical Reports Server (NTRS)

    Dawson, D. L.; Putnam, A. T.; Light, J. T.; Ihnat, D. M.; Kissinger, D. P.; Rasmussen, T. E.; Bradley, D. V. Jr

    1999-01-01

    BACKGROUND: Temporary shunt placement can quickly restore perfusion after extremity arterial injury. This study examined the adequacy of limb blood flow with shunt use, non-heparin-bonded shunt patency over prolonged periods, and the safety of this technique. METHODS: Common iliac arteries were divided and 4.0-mm Silastic Sundt shunts placed in 16 anesthetized pigs. Eight (group I) had shunts placed immediately; eight others (group II) were shunted after an hour of limb ischemia and hemorrhagic shock. Physiologic parameters and femoral artery blood flow in both hindlimbs were continuously monitored. Limb lactic acid generation, oxygen utilization, and hematologic and metabolic effects were serially evaluated for 24 hours. RESULTS: Shunts remained patent in 13 of 16 pigs. Shunts thrombosed in two group I animals because of technical errors, but functioned well after thrombectomy and repositioning. Patency could not be maintained in one animal that died from shock. Flow in group I shunted limbs was 57 (+/-11 SD) % of control. For group II animals in shock, shunted limb flow initially averaged 46 +/- 15% of control, but 4 hours after shunt placement, the mean limb blood flow was the same as in group I. Increased oxygen extraction compensated for the lower flow. Lactic acid production was not increased in comparison to control limbs. CONCLUSION: Shunts provided adequate flow in this model of extremity trauma. Correctly placed shunts stayed patent for 24 hours, without anticoagulation, if shunt placement followed resuscitation.

  2. Fever in a child with cerebrospinal fluid access device or shunt: a pragmatic approach to management.

    PubMed

    Cleave, Betsy; Cartmill, Maria; Soo, Shiu Shing; Vyas, Harish

    2016-10-20

    Children with shunts commonly present with fever, and often the focus of infection will be unrelated to their shunt. However, as shunt infections may present with few or even no specific symptoms, evaluation of a child with a shunt presenting with fever should be careful and comprehensive to ensure shunt infections are not missed. Treatment of an infected shunt involves removal of the shunt followed by a long course of antibiotics; missing or partially treating shunt infections can result in significant morbidity and potentially even mortality. Our experience of managing children with shunts presenting with fever is that many non-specialist clinicians have little experience in this area so initial management may not always be appropriate. Those children who are most at risk of shunt infection are those who within the preceding 8 weeks have had insertion, revision or access of their shunt or chemotherapy device, or have had abdominal surgery in the presence of a ventriculoperitoneal shunt. We have chosen 8 weeks as a pragmatic time point, as in our experience the vast majority of children who have had shunt infections have presented within this period. The caveat is that this should not be used as an absolute cut-off where there is strong suspicion of shunt infection or no clear focus at a later time point.

  3. Ventriculoperitoneal shunt surgery outcome in adult transition patients with pediatric-onset hydrocephalus.

    PubMed

    Reddy, G Kesava; Bollam, Papireddy; Caldito, Gloria; Guthikonda, Bharat; Nanda, Anil

    2012-02-01

    Ventriculoperitoneal shunting remains the most widely used neurosurgical procedure for the management of hydrocephalus, albeit with many complications. To review and assess the long-term clinical outcome of ventriculoperitoneal shunt surgery in adult transition patients with pediatric-onset hydrocephalus. Patients 17 years or older who underwent ventriculoperitoneal shunt placement for hydrocephalus during their pediatric years (younger than 17 years) were included. Medical charts, operative reports, imaging studies, and clinical follow- up evaluations were reviewed and analyzed retrospectively. A total of 105 adult patients with pediatric-onset hydrocephalus were included. The median age of the patients was 25.9 years. The median age at the time of the initial ventriculoperitoneal shunt placement was 1.0 year. The median follow-up time for all patients was 17.7 years. The incidence of shunt failure at 6 months was 15.2%, and the overall incidence of shunt failure was 82.9%. Single shunt revision occurred in 26.7% of the patients, and 56.2% had multiple shunt revisions. The cause of hydrocephalus was significantly associated with shunt survival for patients who had shunt failure before the age of 17 years. Being pediatric at first shunt revision, infection, proximal shunt complication, and other causes were independently associated with multiple shunt failures. The findings of this retrospective study show that the long-term ventriculoperitoneal shunt survival remains low in adult transition patients with pediatric-onset hydrocephalus.

  4. Laparoscopic treatment of abdominal complications following ventriculoperitoneal shunt

    PubMed Central

    Grigorean, VT; Onose, G; Popescu, M; Strambu, V; Sandu, AM

    2009-01-01

    The aim of this study is the evaluation of laparoscopic treatment in abdominal complications following ventriculoperitoneal (VP) shunt. Methods: We report a retrospective study including 17 patients with abdominal complications secondary to VP shunt for hydrocephalus, laparoscopically treated in our department, between 2000 and 2007. Results: Patients' age ranged from 1 to 72 years old (mean age 25.8 years old). Male: female ratio was 1.4. Abdominal complications encountered were: shunt disconnection with intraperitoneal distal catheter migration 47.05% (8/17), infections 23.52% (4/17) such as abscesses and peritonitis, pseudocysts 11.76% (2/17), CSF ascites 5.88% (1/17), inguinal hernia 5.88% (1/17), and shunt malfunction due to excessive length of intraperitoneal tube 5.88% (1/17). Free–disease interval varies from 1 day to 21 years, depending on the type of complication, short in peritoneal irritation syndrome and abscesses (days) and long in ascites, pseudocysts(months– years). Laparoscopic treatment was: extraction of the foreign body in shunt disconnection with intraperitoneal distal catheter migration, evacuation, debridement, lavage and drainage for pseudocysts, abscess and peritonitis, shortening of the tube in shunt malfunction due to excessive length of intraperitoneal tube a nd hernioraphy. One diagnostic laparoscopy was performed in a peritoneal irritation syndrome, which found only CSF ascites. There were no conversions to open surgery. The overall mortality was of 5.88% and postoperative morbidity was of 11.76%. In 7 patients operated for abscesses, peritonitis, pseudocysts, and CSF ascites the shunting system was converted in to a ventriculocardiac shunt. Conclusions: Abdominal complication following VP shunt can be successfully performed laparoscopically. Abdominal surgery required, in selected cases, the repositioning of the distal catheter, frequently as a ventriculocardiac shunt. There are abdominal complications with no indication of

  5. Reducing CSF shunt placement in patients with spinal myelomeningocele

    PubMed Central

    Sankhla, Suresh; Khan, G. M.

    2009-01-01

    Object: The incidence of hydrocephalus requiring shunts in children with myelomeningocele (MMC) is reported to be very high. Shunt-related complications are a significant cause of morbidity and mortality in this population. In order to minimize shunt placements, we used very rigid clinical selection criteria and followed them in all patients who had myelomeningocele and enlarged ventricles. The follow-up outcome of this retrospective study is reported. Methods: From 2000 to 2007, 23 patients with myelomeningocele and variable degree of hydrocephalus were treated at our institute with primary surgical closure of their myelomeningoceles without a CSF diversion procedure. Patients with severe hydrocephalus who required immediate shunt insertion, and those with no significant associated hydrocephalus were not included in this study. Data regarding the surgical results and complications, postoperative management, and the outcome at follow-up were obtained from their hospital records. Results: Initially increased size of the ventricular system was found to have decreased or stabilized in 17 (81%) patients postoperatively. However, ventriculomegaly continued to progress further in 4 (19%) out of 21 patients. Of 11 patients who presented with enlarged head, eight (73%) patients showed reduction or stabilization in their head circumference. Three (27%) children continued to have progressive head enlargement in the postoperative period and required shunt placement. Signs of raised intracranial pressure observed in six patients on admission, improved in two (33%) and persisted or worsened in four (67%) patients who eventually improved after the insertion of a shunt. Eight (35%) patients experienced wound-related complications following closure of the MMC, including CSF leak in four, wound infection in three, wound breakdown in three, and pseudomeningocele in two patients. Shunt placement was required in the postoperative period in 13 (56.5%) patients to treat raised

  6. Liver transplantation and transjugular intrahepatic portosystemic shunt.

    PubMed

    Moreno, A; Meneu, J C; Moreno, E; Fraile, M; García, I; Loinaz, C; Abradelo, M; Jiménez, C; Gomez, R; García-Sesma, A; Manrique, A; Gimeno, A

    2003-08-01

    Describe the results of liver transplantation after installing Transjugular Intrahepatic Portosystemic Shunt (TIPS) and compare them with those of a control group in a comparative, longitudinal, retrospective study. Between April 1986 and October 2002, we performed 875 liver transplantations. Between January 1996 and October 2002, 26 transplantations were performed on TIPS carriers. This group was compared with a control cohort of 50 randomly selected patients who underwent transplantation in this period (non-TIPS carriers). Both groups were homogeneous with no significant differences between age, sex United Network for Organ Sharing (UNOS) score, Child stage, or etiology. Actuarial survival rates at 1 and 3 years: TIPS group 96.15% and 89.29% versus control cohort 87.8% and 81%, respectively. In 73.9%, the TIPS was clearly effective; in 88.9%, a postoperative Doppler revealed normal flow. There were no statistically significant differences compared with time on the waiting list for transplant, duration of the operation, ischemia times, intraoperative consumption of hemoderivates, vascular or nonvascular postoperative complications, duration of stay in the intensive care unit, hospital stay, or retransplantation rate. In our experience, TIPS insertion does not affect either the intraoperative or postoperative evolution and is not associated with an increased time on the liver transplant waiting list.

  7. Psychosocial adaptations of shunted hydrocephalic children.

    PubMed

    Moilanen, I; Meira, L; Serlo, W; von Wendt, L

    1985-12-01

    The personality, psychosomatic symptoms and family characteristics of 55 shunted hydrocephalic children older than four years were studied. Hydrocephalic childrens' self-concept, measured by the Children's Appereception Test, was found to be very significantly poorer than that of the control children. They also frequently showed behaviour disorders of the MBD-type, e.g. concentration difficulties, aggressiveness, fastidious eating and nervousness. The hydrocephalic childrens' families showed very significantly more cohesion and less rigidity, and significantly less authoritarianism than average Finnish families. When examining the parents' attitudes to their sick child, one third of the children were seen to be in a healthy role, with parental expectations realistically related to the child's abilities. One third of the children were seen as "babies", with unnecessarily over-protective attitudes on the part of their parents, and one third as "scapegoats", with accusatory attitudes from their mother and father. Those in the role of "scapegoats" had the poorest perceptual skills, the highest frequencies of behaviour disorders and the poorest self-concept.

  8. Depiction of ventriculoperitoneal shunt obstruction with single-photon emission computed tomography/computed tomography.

    PubMed

    Aksoy, Sabire Yılmaz; Vatankulu, Betül; Uslu, Lebriz; Halac, Metin

    2016-01-01

    An 83-year-old male patient with ventriculoperitoneal shunt underwent radionuclide shunt study using single-photon emission computed tomography/computed tomography (SPECT/CT) to evaluate the shunt patency. The planar images showed activity at the cranial region and spinal canal but no significant activity at the peritoneal cavity. However, SPECT/CT images clearly demonstrated accumulation of activity at the superior part of bifurcation level with no activity at the distal end of shunt as well as no spilling of radiotracer into the peritoneal cavity indicating shunt obstruction. SPECT/CT makes the interpretation of radionuclide shunt study more accurate and easier as compared with traditional planar images.

  9. Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures.

    PubMed

    Heo, Juneyoung; Park, Sukh Que; Cho, Sung Jin; Chang, Jae Chil; Park, Hyung-Ki

    2014-08-01

    Some patients with severe brain swelling treated with decompressive craniectomy may develop hydrocephalus. Consequently, these patients require cranioplasty and a ventriculoperitoneal (VP) shunt to relieve the hydrocephalus. However, there is no consensus as to the timing of the cranioplasty and VP shunt placement in patients requiring both. The authors assessed the results of performing cranioplasty and VP shunt placement at the same time in patients with cranial defects and hydrocephalus. A retrospective review was performed of 51 patients who had undergone cranioplasty and VP shunt operations after decompressive craniectomy for refractory intracranial hypertension between 2003 and 2012 at the authors' institution. Patient characteristics, data on whether the operations were performed simultaneously, brain bulging, hydrocephalus, cranial defect size, and complications were analyzed. The overall complication rate was 43% (22 of 51 patients). In 32 cases, cranioplasty and VP shunt placement were performed at the same time. Complications included subdural hematoma, subdural fluid collection, and infection. The group undergoing cranioplasty and VP shunt placement at the same time had higher complication rates than the group undergoing the procedures at different times (56% vs 21%, respectively). The severity of complications was also greater in the former group. Patients with severe brain bulging had higher complication rates than did those without brain bulging (51% vs 0%, respectively). Cranial defect size, severity of hydrocephalus, indication for decompressive craniectomy, age, sex, and interval between decompressive craniectomy and subsequent operation did not affect complication rates. Patients undergoing cranioplasty and VP shunt placement at the same time had higher complication rates, especially those with severe brain bulging.

  10. Single-Incision laparoscopic surgery (SILS) for ventriculoperitoneal shunt placement.

    PubMed

    Hong, Wei-Chen; Lai, Peng-Sheng; Chien, Yin-Hsuan; Tu, Yong-Kwang; Tsai, Jui-Chang

    2013-11-01

    Single-incision laparoscopic surgery (SILS) may facilitate safer shunt placement and lower distal obstruction rate than is seen in conventional surgery. We reviewed our 2-year experience in SILS for ventriculoperitoneal shunt placement to evaluate its usefulness and safety.Materials and Methods In this retrospective study, we enrolled patients older than 18 years with dilated ventricle and syndromes of hydrocephalus. A total of 31 patients underwent 31 primary ventriculoperitoneal shunt placement surgery and two underwent revision surgery. All the procedures were performed by the SILS technique. The entire duration of ventriculoperitoneal shunt implantation ranged from 45 to 80 minutes, with mean operation time of 65 ± 15.3 minutes. No major laparoscopy-related complications were noted. Shunt infection, peritonitis, and distal catheter malfunction occurred in one case (3.2%), proximal malfunction in one case (3.2%), and subcutaneous emphysema occurred in two cases (6.4%). The emphysema resolved within 2 days. Cosmetic results were "very good to good" in 17 patients (54.8%) and "satisfactory" in 14 patients (45.2%). The abdominal scars in most cases were nearly invisible. SILS is a safe and effective technique for ventriculoperitoneal shunt placement and can be accomplished with no higher risk of shunt infection and distal malfunction. Without an additional port, SILS allows good visualization of the peritoneal cavity to avoid major intra-abdominal complications. Only one 6-mm incision at the umbilicus area is required and is almost invisible after wound healing. Georg Thieme Verlag KG Stuttgart · New York.

  11. Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate.

    PubMed

    Wang, Joanna Y; Amin, Anubhav G; Jallo, George I; Ahn, Edward S

    2014-11-01

    The most common neurosurgical condition observed in preterm infants is intraventricular hemorrhage (IVH), which often results in posthemorrhagic hydrocephalus (PHH). These conditions portend an unfavorable prognosis; therefore, the potential for poor neurodevelopmental outcomes necessitates a better understanding of the comparative effectiveness of 2 temporary devices commonly used before the permanent insertion of a ventriculoperitoneal (VP) shunt: the ventricular reservoir and the ventriculosubgaleal shunt (VSGS). The authors analyzed retrospectively collected information for 90 patients with IVH and PHH who were treated with insertion of a ventricular reservoir (n = 44) or VSGS (n = 46) at their institution over a 14-year period. The mean gestational age and weight at device insertion were lower for VSGS patients (30.1 ± 1.9 weeks, 1.12 ± 0.31 kg) than for reservoir patients (31.8 ± 2.9 weeks, 1.33 ± 0.37 kg; p = 0.002 and p = 0.004, respectively). Ventricular reservoir insertion was predictive of more CSF taps prior to VP shunt placement compared with VSGS placement (10 ± 8.7 taps vs 1.6 ± 1.7 taps, p < 0.001). VSGS patients experienced a longer time interval prior to VP shunt placement than reservoir patients (80.8 ± 67.5 days vs 48.8 ± 26.4 days, p = 0.012), which corresponded to VSGS patients gaining more weight by the time of shunt placement than reservoir patients (3.31 ± 2.0 kg vs 2.42 ± 0.63 kg, p = 0.016). Reservoir patients demonstrated a trend toward more positive CSF cultures compared with VSGS patients (n = 9 [20.5%] vs n = 5 [10.9%], p = 0.21). There were no significant differences in the rates of overt device infection requiring removal (reservoir, 6.8%; VSGS, 6.5%), VP shunt insertion (reservoir, 77.3%; VSGS, 76.1%), or early VP shunt infection (reservoir, 11.4%; VSGS, 13.0%) between the 2 cohorts. Although the rates of VP shunt requirement and device infection were similar between patients treated with the reservoir versus the VSGS

  12. Scalp necrosis overlying a ventriculoperitoneal shunt: a case report and literature review.

    PubMed

    Nguyen, Tuyet A; Cohen, Philip R

    2015-10-16

    The use of ventriculoperitoneal (VP) shunts has become ubiquitous in neurosurgery for the treatment of hydrocephalus. VP shunts work by creating a conduit for cerebrospinal fluid (CSF) to flow from the cerebral ventricles to the peritoneum and thus relieving pressure. Although typically safe, VP shunt complications are extremely common, occurring in up to 29% of adult cases and approximately half of pediatric cases. These complications may require patients to undergo several revisions throughout their lifetime Purpose: We describe a man who developed scalp necrosis overlying his VP shunt. We also summarize the potential complications of VP shunts. We discuss the presentation and pathogenesis of scalp necrosis in these patients. A PubMed search of the following terms was performed and relevant citations were assessed: ventriculoperitoneal shunt, VP shunt, shunt complications, scalp necrosis, skin necrosis, ventriculoperitoneal shunt induced scalp necrosis, ventriculoperitoneal shunt induced skin necrosis. A 73-year-old man developed VP shunt-induced scalp necrosis leading to loss of skin overlying the shunt valve. The patient was emergently referred to neurosurgery and admitted for revision of the shunt due to the significant risk for infection. The VP shunt was replaced with an external drain and a skin flap was used to repair the defect. VP shunts are devices that are frequently used for reducing intracranial pressure associated with hydrocephalus. The insertion of the shunt beneath the scalp sets the stage for potential pressure-induced scalp necrosis. The early recognition and diagnosis of VP shunt-induced scalp necrosis is essential to prevent infections and future complications.

  13. Clinical outcomes after ventriculoatrial shunting for idiopathic normal pressure hydrocephalus.

    PubMed

    Liu, Ann; Sankey, Eric W; Jusué-Torres, Ignacio; Patel, Mira A; Elder, Benjamin D; Goodwin, C Rory; Hoffberger, Jamie; Lu, Jennifer; Rigamonti, Daniele

    2016-04-01

    Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder that classically presents with a triad of progressive gait impairment, urinary incontinence, and cognitive deterioration. Treatment predominantly involves ventriculoperitoneal (VP) shunting, but one alternative is ventriculoatrial (VA) shunting. This study sought to describe and evaluate the clinical outcomes of patients with iNPH primarily treated with VA shunting. A retrospective review of patients with iNPH who were treated with VA shunting at a single institution, from 2003 to 2013, was performed. 58 patients with iNPH underwent primary VA shunting at a median age of 74 (IQR: 70-80) years. The most common comorbidities included hypertension (n=39, 67%) and diabetes mellitus (n=11, 19%). Median duration of symptoms prior to VA shunting was 24 (IQR: 12-36) months. All patients had gait impairment, 52 (90%) had cognitive decline, and 43 (74%) had urinary incontinence. Forty-three (74%) patients had all three symptoms. At a median last follow-up of 16 (IQR: 7-26) months, median iNPH score improved from 6 to 3 (p<0.0001), mini mental status exam (MMSE) tended to increase from 26 to 29 (p=0.082), timed up-and-go (TUG) improved from 18 to 13s (p<0.0001), and Tinetti score improved from 19 to 25 (p<0.0001) after VA shunting. 78% of patients had improvement in at least one of their symptoms with 66% of patients having improvement in gait, 53% having improvement in their cognition, and 52% having improved urinary incontinence. A total of 21 patients (36%) had improvement in all 3 symptoms. There were significant improvements in functional outcomes as evaluated via the iNPH score, TUG, and Tinetti score, while improvement in MMSE trended toward significance. Patients also had improvement of clinical symptoms related to gait, urinary function and cognition. These results suggest that VA shunting can be an effective primary treatment alternative to VP shunting for iNPH. Published by Elsevier B.V.

  14. Atrial Septal Aneurysm with Right-to-Left Interatrial Shunting

    PubMed Central

    Chidambaram, Mala; Mink, Steven; Sharma, Sat

    2003-01-01

    Interatrial shunting in the presence of an atrial septal aneurysm is an uncommon but well recognized abnormality. Previous case reports have demonstrated that elevated right atrial pressure secondary to pulmonary embolism or right ventricular infarction may cause right-to-left interatrial shunting in the presence of an atrial septal aneurysm. We describe a unique situation in which an atrial septal aneurysm was associated with a right-to-left shunt secondary to severe systemic hypotension and normal right atrial pressure. In this patient, we used midodrine, an oral alpha-1 agonist, to increase systemic arterial pressure, decrease the severity of the shunt, and treat the severe hypoxemia. This case establishes that right-to-left interatrial shunting can result from a decrease in left ventricular afterload with normal right atrial pressure. Oral alpha-1 agonist therapy can be used successfully to treat patients such as ours and possibly others with similar functional abnormalities. (Tex Heart Inst J 2003;30:68–70) PMID:12638676

  15. Shunt insufficiency due to knot formation in the peritoneal catheter.

    PubMed

    Fekete, Gábor; Nagy, Andrea; Pataki, István; Bognar, László; Novák, László

    2013-07-30

    The authors report a rare case of the peripheral obstruction of a ventriculoperitoneal shunt. Premature baby was operated on hydrocephalus due to germinal matrix bleeding. After two months of implantation of venticuloperitoneal shunt peripheral insufficiency of the system was emerged. During the shunt revision extensive knot formation became visible. We simply cut the catheter above the knot and the working shunt was replaced into the abdominal cavity. The postoperative course was uneventful and the baby was free of complaints for more than one year. The pathomechanism of knot formation is not clear thus the discovery of the problem during the operation is an unexpected event. In our opinion tight knot cannot be spontaneously formed intraabdominally. Loose knots can be developed and can reduce the capacity of liquor flow. We think that the knot tightens during pulling out. Longer peritoneal catheters can precipitate multiple looping and/or axial torquations and increase the peripheral resistance of the shunt. In such cases when the pulling out is challenged conversion to laparotomy is suggested.

  16. Coherence properties of a capacitively-shunt flux qubit

    NASA Astrophysics Data System (ADS)

    Birenbaum, Jeffrey; Sears, Adam; Nugroho, Christopher; Gudmundsen, Ted; Welander, Paul; Yoder, Jonilyn; Kamal, Archana; Gustavsson, Simon; Kerman, Jamie; Oliver, William; Clarke, John

    2014-03-01

    Coherence times for typical flux qubits have plateaued at 5 - 10 μ s for T1 and 1 - 3 μ s for TRamsey. To achieve longer coherence times we study capacitively-shunted flux qubits using high-Q capacitors to individually shunt all four Josephson junctions (JJs). The additional shunt capacitance moves 90 + % of the qubit energy from the lossy capacitance of the JJs into the high-Q shunts while preserving an anharmonicity greater than 100 % and maintaining f01 shunted flux qubit inductively coupled to a lumped-element readout resonator. The qubit junctions are deposited via aluminum e-beam evaporation using a bridgeless mask. We characterize the influence of qubit design parameters such as capacitance and geometry on the coherence time of the device. This research was funded in part by the Office of the Director of National Intelligence (ODNI), Intelligence Advanced Research Projects Activity (IARPA), through the Army Research Office.

  17. Laparoendoscopic removal of peroral extrusion of a ventriculoperitoneal shunt.

    PubMed

    Mandhan, Parkash; Wong, Marilyn; Samarakkody, Udaya

    2015-02-01

    Ventriculoperitoneal shunts for hydrocephalic children are known to cause serious complications such as GI perforation. Peroral extrusion of the peritoneal part of a ventriculoperitoneal shunt is very rare, and management could be a challenge. An 11-year-old girl presented with peroral extrusion of the distal end of a ventriculoperitoneal shunt tube. Endoscopy and imaging studies showed that the peritoneal end had perforated the stomach and then extruded from the mouth. We used a surgical technique that combined endoscopy and laparoscopy to manage this rare complication. Peroral extrusion of a ventriculoperitoneal shunt tube occurs secondary to perforation of the upper GI tract. Managing this condition involves removing the shunt tube, attention to the perforated viscus and associated infection. A combination of endoscopy and laparoscopy provided superior views, enabled identification of the site and size of the perforated viscus, and facilitated the uneventful removal of the tube. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  18. Predictors of admission and shunt revision during emergency department visits for shunt-treated adult patients with idiopathic intracranial hypertension.

    PubMed

    Sankey, Eric W; Elder, Benjamin D; Liu, Ann; Carson, Kathryn A; Goodwin, C Rory; Jusué-Torres, Ignacio; Rigamonti, Daniele

    2016-09-23

    OBJECTIVE Factors associated with emergency department admission and/or shunt revision for idiopathic intracranial hypertension (IIH) are unclear. In this study, the associations of several factors with emergency department admission and shunt revision for IIH were explored. METHODS The authors performed a retrospective review of 31 patients (169 total emergency department visits) who presented to the emergency department for IIH-related symptoms between 2003 and 2015. Demographics, comorbidities, symptoms, IIH diagnosis and treatment history, ophthalmological examination, diagnostic lumbar puncture (LP), imaging findings, and data regarding admission and management decisions were collected. Multivariable general linear models regression analysis was performed to assess the predictive factors associated with admission and shunt revision. RESULTS Thirty-one adult patients with a history of shunt placement for IIH visited the emergency department a total of 169 times for IIH-related symptoms, with a median of 3 visits (interquartile range 2-7 visits) per patient. Five patients had more than 10 emergency department visits. Baseline factors associated with admission included male sex (OR 10.47, 95% CI 2.13-51.56; p = 0.004) and performance of an LP (OR 3.10, 95% CI 1.31-7.31; p = 0.01). Contrastingly, older age at presentation (OR 0.94, 95% CI 0.90-0.99; p = 0.01), and a greater number of prior emergency department visits (OR 0.94, 95% CI 0.89-0.99; p = 0.02) were slightly protective against admission. The presence of papilledema (OR 11.62, 95% CI 3.20-42.16; p < 0.001), Caucasian race (OR 40.53, 95% CI 2.49-660.09 p = 0.009), and systemic hypertension (OR 7.73, 95% CI 1.11-53.62; p = 0.03) were independent risk factors for shunt revision. In addition, a greater number of prior emergency department visits (OR 0.86, 95% CI 0.77-0.96; p = 0.009) and older age at presentation (OR 0.93, 95% CI 0.87-0.99; p = 0.02) were slightly protective against shunt revision, while

  19. Retrieval of a disconnected ventriculoperitoneal shunt catheter by laparoscopy in a newborn child: case report.

    PubMed

    Deinsberger, W; Langhans, M; Winking, M; Böker, D K

    1995-09-01

    In rare cases the peritoneal catheter of a ventriculoperitoneal shunt dislodges from the valve and the peritoneal tube migrates into the peritoneal cavity. For retrieval of the free intraperitoneal shunt, tube laparoscopy is the initial method of choice.

  20. [Intracardiac migration of a ventriculoatrial shunt catheter treated by endovascular transvenous retrieval].

    PubMed

    Matsubara, Noriaki; Miyachi, Shigeru; Tsukamoto, Nobuhiro

    2012-06-01

    The authors report a case of intracardiac migration of a ventriculoatrial (VA) shunt catheter and transvenous retrieval of the migrated shunt catheter. A 67-year-old male, who had previously undergone a VA shunt for hydrocephalus after subarachnoid hemorrhage, presented disorientation, memory disturbance and gait disturbance without any cardiopulmonary symptom. Head CT scan revealed ventriculomegaly that indicated hydrocephalus due to shunt malfunction. Radiogram revealed that the caudal segment of the broken atrial catheter had migrated into the heart (right ventricle). The migrated shunt catheter was retrieved by a transfemoral approach with a pigtail catheter and a snare retriever catheter, although the rostral catheter segment partially remained because of tight adhesion. The VA shunt was then reconstructed. Postoperatively, symptoms due to recurrent hydrocephalus were markedly improved and the VA shunt functioned well. Transvenous catheter retrieval was a less invasive and effective method for VA shunt catheter migration.

  1. Laparoscopic cecal cancer resection in a patient with a ventriculoperitoneal shunt: A case report

    PubMed Central

    Torigoe, Takayuki; Koui, Shiro; Uehara, Tomohito; Arase, Koichi; Nakayama, Yoshifumi; Yamaguchi, Koji

    2013-01-01

    INTRODUCTION The presence of a ventriculoperitoneal shunt has been considered to be a contraindication for laparoscopic surgery till date; however, laparoscopic cholecystectomy was recently reported as safe for patients with this shunt. PRESENTATION OF CASE We present the first case, to the best of our knowledge, of laparoscopic colectomy for cecal cancer in a patient with a ventriculoperitoneal shunt. A 59-year-old woman with a ventriculoperitoneal shunt for hydrocephalus was referred to our hospital with cecal cancer. Laparoscopic cecal cancer resection was performed successfully and uneventfully by manipulating the shunt. DISCUSSION Clamping of the shunt catheter at the subcutaneous region was performed before insufflation of carbon dioxide to prevent adverse effects from the pneumoperitoneum. CONCLUSION We believe that laparoscopic colectomy for colon cancer can be performed safely in patients with a ventriculoperitoneal shunt by optimal manipulation of the shunt. PMID:23416501

  2. Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts.

    PubMed

    de Leval, M R; McKay, R; Jones, M; Stark, J; Macartney, F J

    1981-01-01

    Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried out at The Hospital for Sick Children, Great Ormond Street. The operation consists of interposing between the subclavian artery and the pulmonary artery a prosthesis of greater diameter than that of the subclavian artery. The first 13 operations were performed with a prosthesis of woven Dacron. Conduits of expanded polytetrafluorethylene (PTFE) were used for 86 MBTSs, and these form the basis of this report. Forty-four (51.1%) shunts were performed in infancy, 25 in patients under the age of 1 month (29.0%). Prostheses of 4 mm were used in 34 cases, 5 mm in 14, and 6 mm in 38. There were five shunt failures (5.8%) documented at postmortem or angiocardiographic investigation. Including two late deaths for which postmortem examinations were not obtained, the overall failure rate was 8.1% (seven patients). All these patients were operated upon in infancy, four of them in the neonatal period. Although a longer follow-up is necessary to assess the validity of these shunts, the early results are encouraging. We believe we can now recommend MBTS as an alternative when the classical Blalock-Taussig shunt is considered unsuitable.

  3. Imaging of Ventriculoperitoneal Shunt Complications: Comparison of Whole Body Low-Dose Computed Tomography and Radiographic Shunt Series.

    PubMed

    Afat, Saif; Pjontek, Rastislav; Hamou, Hussam A; Herz, Klaus; Nikoubashman, Omid; Bamberg, Fabian; Brockmann, Marc A; Nikolaou, Konstantin; Clusmann, Hans; Wiesmann, Martin; Othman, Ahmed E

    To determine diagnostic value and radiation exposure of low-dose computed tomography (LD-CT) compared to radiographic shunt series (SS) for the detection of ventriculoperitoneal (VP) shunt complications. Fourteen VP shunts were implanted in 7 swine cadavers. Mechanical complications were induced in 50% of VP shunts. Low-dose CT (80 kVp, 10 mAs, Pitch = 1.5) and SS were acquired. Dose area product (DAP) and effective doses for SS and LD-CT were collected. Scoring of diagnostic confidence and blinded readings of SS and CT data were performed. The sensitivity of LD-CT was high (0.97; 95% confidence interval, 0.91-1.00) with excellent interobserver agreement (κ = 0.88). Similarly, the sensitivity of SS was high (0.82; 95% confidence interval, 0.68-0.95) with good interobserver agreement (κ = 0.68). In contrast, LD-CT was associated with significantly higher diagnostic confidence (4.64 ± 0.41 vs 2.71 ± 0.73; P < 0.01) and significantly lower radiation exposure (effective dose: 0.26 mSv vs 1.06 mSv; DAP: 265.4 μGym vs 724.8 μGym; P < 0.001). For the assessment of suspected VP shunt complications, LD-CT provides excellent sensitivity and higher diagnostic confidence with lower radiation exposure compared with SS.

  4. Material-induced shunts in multicrystalline silicon solar cells

    SciTech Connect

    Breitenstein, O. Bauer, J.; Rakotoniaina, J. P.

    2007-04-15

    By applying lock-in thermography imaging, light-beam-induced current imaging, electron-beam-induced current imaging at different stages of sample preparation, and infrared light microscopy in transmission mode, the physical nature of the dominant material-induced shunts in multicrystalline solar cells made from p-type silicon material has been investigated. It turns out that these shunts are due to silicon carbide (SiC) filaments, which grow preferentially in grain boundaries and cross the whole cell. These filaments are highly n-type doped, like the emitter layer on the surface of the cells. They are electrically connected both with the emitter and with the back contact, thereby producing internal shunts in the solar cell.

  5. [Intrathoracic migration of a ventriculoperitoneal shunt catheter: a case report].

    PubMed

    Sánchez-Medina, Yanire; Domínguez-Báez, Jaime; Lazo-Fernández, Eglis; Pérez Del Rosario, Pedro Antonio; Zanabria-Ortiz, Robert

    2015-01-01

    The intrathoracic complications from ventriculoperitoneal shunt placement are very rare. However, they are potentially serious if not treated. We report the case of thoracic migration of a peritoneal catheter after ventriculoperitoneal shunt and we also review the literature references with discussion of the different mechanisms of shunt-tip migration described. No case of previous sternotomy as in our patient has been found published. All reports recommend early catheter repositioning into the peritoneal cavity after diagnosing the migration described, to prevent worse complications. Moreover, it is important to keep in mind that intrathoracic migration can happen and it is necessary to palpate the catheter continuously during passage through subcutaneous tunnelling to prevent it. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  6. [Usefulness of IPC continuous monitoring in shunt dysfunction].

    PubMed

    Horcajadas, A; Román, A; Olivares, G; Saura, E; Jorques, A; Cordero, N; Ibáñez, B; Sánchez, C; Roldán, M A

    2011-08-01

    Shunt dysfunction is a common situation in neurosurgery. Often symptoms, physical examination and radiology are not enough to set a diagnosis. ICP continuous monitoring is a safe and reliable tool that provides valuable information about CSF dynamics in these patients. Not only quantitative analysis is needed but also a qualitative one that enables pathological waves identification, because high amplitude B waves are strongly related to shunt dysfunction. In this paper experience about ICP continuous monitoring in patients with shunt dysfunction suspect is presented. Quantitative and qualitative data analysis led to a correct diagnosis, improving all the patients treated according to this criterion. An intraparenchymatous Camino® sensor and neuroPICture software (developed by first author) for data collection and graphic representation were used. Complications related to monitoring were absent and graphics obtained useful for qualitative analysis.

  7. A Subglandular Breast Cerebrospinal Fluid Pseudocyst Following Postsurgical Shunt Migration

    PubMed Central

    Mlynek, Karolina; Frautschi, Russell; Halasa, Brianna; Kwiecien, Grzegorz

    2015-01-01

    Summary: Cerebrospinal fluid (CSF) drainage catheters have been associated with numerous complications in various anatomic locations, because of migration, infection, and obstruction. However, breast-related CSF shunt complications tend to occur infrequently or have seldom been reported in the empirical literature. Therefore, a case is presented detailing a breast pseudocyst caused by migration and subsequent coiling of a ventriculoperitoneal shunt in the right breast pocket. To the best of the authors’ knowledge, this is the first case that has been reported in the peer-reviewed literature of a pseudocyst resulting from a CSF drainage catheter coiling around the breast implant post pancreaticoduodenectomy. Moreover, this case highlights the importance of cross-disciplinary procedural awareness, particularly in regards to breast, ventriculoperitoneal shunt, and pancreatic procedures. PMID:26894004

  8. A Subglandular Breast Cerebrospinal Fluid Pseudocyst Following Postsurgical Shunt Migration.

    PubMed

    Mlynek, Karolina; Frautschi, Russell; Halasa, Brianna; Kwiecien, Grzegorz; Papay, Francis

    2015-12-01

    Cerebrospinal fluid (CSF) drainage catheters have been associated with numerous complications in various anatomic locations, because of migration, infection, and obstruction. However, breast-related CSF shunt complications tend to occur infrequently or have seldom been reported in the empirical literature. Therefore, a case is presented detailing a breast pseudocyst caused by migration and subsequent coiling of a ventriculoperitoneal shunt in the right breast pocket. To the best of the authors' knowledge, this is the first case that has been reported in the peer-reviewed literature of a pseudocyst resulting from a CSF drainage catheter coiling around the breast implant post pancreaticoduodenectomy. Moreover, this case highlights the importance of cross-disciplinary procedural awareness, particularly in regards to breast, ventriculoperitoneal shunt, and pancreatic procedures.

  9. Delayed intracerebellar hemorrhage secondary to lumboperitoneal shunt insertion

    PubMed Central

    Er, Uygur; Akyol, Çetin; Bavbek, Murad

    2016-01-01

    Aim of this paper is to present and discuss a case of a delayed cerebellar parenchymal hemorrhage developing after L/P shunt placement with a NPH patient. A hypertensive patient admitted to our clinic with a diagnosis of NPH. The patient was placed a pressure adjustable L/P shunt without any surgical complication. He was discharged with an uneventful period. The patient was admitted to the emergency clinic of our hospital with a 1.5 × 1.5 cm diameter hematoma at the left cerebellar hemisphere on 2 days after his discharge. CSF drainage by an L/P shunt can generate intracerebellar hemorrhages especially in hypertensive patients. PMID:27695558

  10. Predicting shunt currents in stacks of bipolar plate cells

    NASA Astrophysics Data System (ADS)

    White, R. E.; Walton, C. W.; Burney, H. S.; Beaver, R. N.

    1986-03-01

    A method is presented for predicting shunt currents in stacks of undivided and divided bipolar plate cells. The method is an efficient way of solving the coupled sets of algebraic equations that arise from using circuit analog models to represent the current paths in stacks of undivided or divided bipolar plate cells. These algebraic equations can be either linear or nonlinear depending upon the current-potential relationships used in the model (i.e., nonlinear circuit elements can be included). The method is used to show the importance of including nonsymmetrical resistances and nonlinear circuit elements in the models. Also, the method is used to predict the shunt currents for a nine cell stack of pilot plant scale bipolar plate, membrane chlor-alkali cells. It is shown that these predictions agree qualitatively with measured values. Finally, the method is used to predict the shunt currents for stacks of 60 and 120 of these cells.

  11. Tunable-Delay Shunts for Paper Microfluidic Devices

    PubMed Central

    Toley, Bhushan J.; McKenzie, Brittney; Liang, Tinny; Buser, Joshua R.; Yager, Paul; Fu, Elain

    2014-01-01

    We demonstrate a novel method for controlling fluid flow in paper-based devices. The method delays fluid progress through a porous channel by diverting fluid into an absorbent pad-based shunt placed into contact with the channel. Parameters to control the delay include the length and the thickness of the shunt. Using this method, reproducible delays ranging from 3 to 20 minutes were achieved. A simple electrical circuit model was presented and used to predict the delays in a system. Results from the model showed good agreement with experimental observations. Finally, the shunts were used for the sequential delivery of fluids to a detection zone in a point-of-care compatible folding card device using biochemical reagents for the amplified detection of the malaria protein PfHRP2. PMID:24245747

  12. Cerebrospinal fluid galactorrhea: a rare complication of ventriculoperitoneal shunting.

    PubMed

    Lee, Sai-Cheung; Chen, Jyi-Feng; Tu, Po-Hsun; Lee, Shih-Tseng

    2008-06-01

    In this report we describe a 26-year-old woman who had an intra-abdominal pseudocyst located at the peritoneal catheter tip following ventriculo-peritoneal (VP) shunt implantation. Retrograde cerebrospinal fluid (CSF) flowed outside the catheter and communicated with the right breast lactiferous ductal system and leaked from the nipple orifice. CSF galactorrhea only occurs when the lactiferous duct is injured during VP shunt implantation, in combination with the formation of an intra-abdominal CSF pseudocyst prior to lactiferous duct healing. Leakage of CSF from the nipple orifice can be successfully treated by simply guiding the peritoneal catheter tip into the peritoneal cavity through a new laparotomy; that is, shunt revision is not always required.

  13. Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study.

    PubMed

    Hayhurst, Caroline; Beems, Tjemme; Jenkinson, Michael D; Byrne, Patricia; Clark, Simon; Kandasamy, Jothy; Goodden, John; Nandoe Tewarie, Rishi D S; Mallucci, Conor L

    2010-12-01

    As many as 40% of shunts fail in the first year, mainly due to proximal obstruction. The role of catheter position on failure rates has not been clearly demonstrated. The authors conducted a prospective cohort study of navigated shunt placement compared with standard blind shunt placement at 3 European centers to assess the effect on shunt failure rates. All adult and pediatric patients undergoing de novo ventriculoperitoneal shunt placement were included (patients with slit ventricles were excluded). The first cohort underwent standard shunt placement using anatomical landmarks. All centers subsequently adopted electromagnetic (EM) navigation for routine shunt placements, forming the second cohort. Catheter position was graded on postoperative CT in both groups using a 3-point scale developed for this study: (1) optimal position free-floating in CSF; (2) touching choroid or ventricular wall; or (3) intraparenchymal. Episodes and type of shunt revision were recorded. Early shunt failure was defined as that occurring within 30 days of surgery. Patients with shunts were followed-up for 12 months in the standard group, for a median of 6 months in the EM-navigated group, or until shunt failure. A total of 75 patients were included in the study, 41 with standard shunts and 34 with EM-navigated shunts. Seventy-four percent of navigated shunts were Grade 1 compared with 37% of the standard shunts (p=0.001, chi-square test). There were no Grade 3 placements in the navigated group, but 8 in the standard group, and 75% of these failed. Early shunt failure occurred in 9 patients in the standard group and in 2 in the navigated group, reducing the early revision rate from 22 to 5.9% (p=0.048, Fisher exact test). Early shunt failures were due to proximal obstruction in 78% of standard shunts (7 of 9) and in 50% of EM-navigated shunts (1 of 2). Noninvasive EM image guidance in shunt surgery reduces poor shunt placement, resulting in a significant decrease in the early shunt

  14. Treatment of Portosystemic Shunt Myelopathy with a Stent Graft Deployed through a Transjugular Intrahepatic Route

    SciTech Connect

    Jain, Deepak Arora, Ankur; Deka, Pranjal; Mukund, Amar Bhatnagar, Shorav; Jindal, Deepti Kumar, Niteen Pamecha, Viniyendra

    2013-08-01

    A case of surgically created splenorenal shunt complicated with shunt myelopathy was successfully managed by placement of a stent graft within the splenic vein to close the portosystemic shunt and alleviate myelopathy. To our knowledge, this is the first report of a case of shunt myelopathy in a patient with noncirrhotic portal fibrosis without cirrhosis treated by a novel technique wherein a transjugular intrahepatic route was adopted to deploy the stent graft.

  15. Importance of technical preparation of intraarterial shunts to prevent iatrogenic arterial injury during urgent procedures.

    PubMed

    Awad, Nadia; Choudry, Rashad; Durinka, Joel; Prabhu, Aparna; Dissin, Jonathan

    2013-02-01

    Although intraarterial shunting during carotid endarterectomy is a well-defined practice, its use remains controversial. Complication rates associated with shunt placement remain low, but may be underreported. When complications secondary to routine intraarterial shunting occur, they can cause significant morbidity or even mortality, emphasizing the importance of meticulous technique to prevent adverse outcomes. We report a case of internal carotid artery dissection and pseuedoaneurysm due to the technical failure of a safety device of an intraarterial shunt used during carotid endarterectomy.

  16. In Vitro and In Vivo Comparison of Two Suprachoroidal Shunts

    PubMed Central

    Oatts, Julius T.; Zhang, Ze; Tseng, Harry; Shields, M. Bruce; Sinard, John H.; Loewen, Nils A.

    2013-01-01

    Purpose. To compare fibrosis, aqueous humor dynamics, and intraocular pressure (IOP) of two suprachoroidal shunts as part of a new class of glaucoma drainage devices. Methods. Following proliferation analysis in vitro, 20 rabbits were implanted with either a gold shunt (GS, GMSplus+, SOLX) or a polypropylene shunt (PS, Aquashunt, OPKO). Ten eyes received mitomycin C (MMC) and triamcinolone. Peak and trough IOP were monitored with a pneumatonometer and tono-pen for 15 weeks. Aqueous humor dynamics were evaluated fluorophotometrically and tonographically. Fibrosis was quantified. Results. In vitro proliferation was similar. In vivo, both shunts were devoid of foreign body reaction but exhibited fibrosis, and GS showed vascularization. There was no significant difference in aqueous or uveoscleral flow. Preoperative morning IOP was 23.7 ± 2 mm Hg, and evening IOP was 26.5 ± 2 mm Hg (P = 0.000). Morning IOP was decreased through 15 weeks and evening IOP through 8 weeks in all groups. The morning IOP decrease was most profound at 15 weeks in PS (41%) compared to GS (18%). Antifibrotics initially enhanced but eventually diminished shunt performance. At 15 weeks, thickness of scleral fibrosis was greater in GS (246 ± 47 μm) and PS (188 ± 47 μm, P = 0.285) compared with GS+MMC (109 ± 26 μm, P = 0.023 to GS) and PS+MMC (48 ± 30 μm, P = 0.028 to PS). Conclusions. In a rabbit model, suprachoroidal polypropylene and gold shunts allow access to a new drainage pathway with different IOP profiles that can be modified with antifibrotics. PMID:23847318

  17. Shunted Piezoelectric Vibration Damping Analysis Including Centrifugal Loading Effects

    NASA Technical Reports Server (NTRS)

    Min, James B.; Duffy, Kirsten P.; Provenza, Andrew J.

    2011-01-01

    Excessive vibration of turbomachinery blades causes high cycle fatigue problems which require damping treatments to mitigate vibration levels. One method is the use of piezoelectric materials as passive or active dampers. Based on the technical challenges and requirements learned from previous turbomachinery rotor blades research, an effort has been made to investigate the effectiveness of a shunted piezoelectric for the turbomachinery rotor blades vibration control, specifically for a condition with centrifugal rotation. While ample research has been performed on the use of a piezoelectric material with electric circuits to attempt to control the structural vibration damping, very little study has been done regarding rotational effects. The present study attempts to fill this void. Specifically, the objectives of this study are: (a) to create and analyze finite element models for harmonic forced response vibration analysis coupled with shunted piezoelectric circuits for engine blade operational conditions, (b) to validate the experimental test approaches with numerical results and vice versa, and (c) to establish a numerical modeling capability for vibration control using shunted piezoelectric circuits under rotation. Study has focused on a resonant damping control using shunted piezoelectric patches on plate specimens. Tests and analyses were performed for both non-spinning and spinning conditions. The finite element (FE) shunted piezoelectric circuit damping simulations were performed using the ANSYS Multiphysics code for the resistive and inductive circuit piezoelectric simulations of both conditions. The FE results showed a good correlation with experimental test results. Tests and analyses of shunted piezoelectric damping control, demonstrating with plate specimens, show a great potential to reduce blade vibrations under centrifugal loading.

  18. Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush

    PubMed Central

    Groth, Sylvia L; Greider, Kelsi L

    2015-01-01

    ABSTRACT Objective: To assess the utility of viscoelastic injection to induce bleb expansion and decrease intraocular pressure (IOP) in eyes with encapsulated glaucoma tube shunt blebs. Design: Case series. Subjects and participants: Forty-three glaucomatous eyes, including 13 eyes with congenital, 13 uveitic, 5 neovascular, 5 open angle, 4 narrow angle and 3 traumatic glaucomas. Methods, interventions or testing: All patients underwent viscoelastic flush procedure. A pre-bent 27 or 30-gauge cannula was passed through a 25-gauge paracentesis, advanced over the iris across the anterior chamber, and insinuated into the tube shunt lumen. Once the cannula was firmly lodged in position, 0.45 to 0.85 ml of viscoelastic was injected to hyperinflate the bleb. Main outcome measures: Paired t-tests were performed comparing preoperative IOP and number of medications used preoperatively vs levels measured at 1, 6, 12, 18 and 24 months. Results: Intraocular pressure was reduced from a mean preoperative level of 26.0 ± 1.2 (sem) mm Hg to 15.8 ± 1.0 at 1 month, remaining stable thereafter at each 6-month interval with 15.1 ± 1.1 mm Hg at 24 months (p < 0.0001). Medication use did not vary significantly from baseline. Pressure remained < 21 mm Hg after 2 years in 85% of eyes cannulated within 1 year of primary tube shunt implantation (n = 23), and in 62% of eyes cannulated more than 1 year after tube shunt placement (n = 20). Conclusion: Tube shunt expansion with bolus viscoelastic flush successfully restored encapsulated bleb function, providing a substantial (~10 mm Hg) IOP decrease into the mid-normal pressure range. This persisted in the majority of treated eyes for the entire study period. How to cite this article: Groth SL, Greider KL, Sponsel WE. Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush. J Curr Glaucoma Pract 2015;9(3):73-76. PMID:26997840

  19. Ventriculoperitoneal shunting: Laparoscopically assisted versus conventional open surgical approaches

    PubMed Central

    Nigim, Fares; Thomas, Ajith J.; Papavassiliou, Efstathios; Schneider, Benjamin E.; Critchlow, Jonathan F.; Chen, Clark C.; Siracuse, Jeffrey J.; Zinn, Pascal O.; Kasper, Ekkehard M.

    2014-01-01

    Objectives: Ventriculoperitoneal shunting (VPS) is a mainstay of hydrocephalus therapy, but carries a significant risk of device malfunctioning. This study aims to compare the outcomes of laparoscopic ventriculoperitoneal shunting versus open ventriculoperitoneal shunting (OVPS) VPS-placement and reviews our findings in the pertinent context of the literature from 1993 to 2012. Materials and Methods: Between 2003 and 2012, a total of 232 patients underwent first time VPS placement at Beth Israel Deaconess Medical Center. Of those, 155 were laparoscopically guided and 77 were done conventionally. We analyzed independent variables (age, gender, medical history, clinical presentation, indication for surgery and surgical technique) and dependent variables (operative time, post-operative complications, length of stay in the hospital) and occurrence of shunt failure. Results: Mean operative time was 43.7 min (18.0-102.0) in the laparoscopic group versus 63.0 min (30.0-151.0) in the open group, (P < 0.05). Length of stay was similar, 5 days in the laparoscopic and in the open group, (P = 0.945). The incidence of shunt failure during the entire follow-up period was not statistically different between the two groups, occurring in 14.1% in the laparoscopic group and 16.9% in the open group, (P = 0.601). Kaplan-Meier analysis demonstrated no difference in shunt survival between the two groups (P = 0.868), with functionality in 85% at 6-months and 78.5% at 1-year. Conclusion: According to our study, LVPS-placement results compare similarly to OVPS placement in most aspects. Since laparoscopic placement is not routinely indicated, we suggest a prospective study to assess its value as an alternate technique especially suitable in obese patients and patients with previous abdominal operations. PMID:25126122

  20. Ventriculoperitoneal shunting: Laparoscopically assisted versus conventional open surgical approaches.

    PubMed

    Nigim, Fares; Thomas, Ajith J; Papavassiliou, Efstathios; Schneider, Benjamin E; Critchlow, Jonathan F; Chen, Clark C; Siracuse, Jeffrey J; Zinn, Pascal O; Kasper, Ekkehard M

    2014-04-01

    Ventriculoperitoneal shunting (VPS) is a mainstay of hydrocephalus therapy, but carries a significant risk of device malfunctioning. This study aims to compare the outcomes of laparoscopic ventriculoperitoneal shunting versus open ventriculoperitoneal shunting (OVPS) VPS-placement and reviews our findings in the pertinent context of the literature from 1993 to 2012. Between 2003 and 2012, a total of 232 patients underwent first time VPS placement at Beth Israel Deaconess Medical Center. Of those, 155 were laparoscopically guided and 77 were done conventionally. We analyzed independent variables (age, gender, medical history, clinical presentation, indication for surgery and surgical technique) and dependent variables (operative time, post-operative complications, length of stay in the hospital) and occurrence of shunt failure. Mean operative time was 43.7 min (18.0-102.0) in the laparoscopic group versus 63.0 min (30.0-151.0) in the open group, (P < 0.05). Length of stay was similar, 5 days in the laparoscopic and in the open group, (P = 0.945). The incidence of shunt failure during the entire follow-up period was not statistically different between the two groups, occurring in 14.1% in the laparoscopic group and 16.9% in the open group, (P = 0.601). Kaplan-Meier analysis demonstrated no difference in shunt survival between the two groups (P = 0.868), with functionality in 85% at 6-months and 78.5% at 1-year. According to our study, LVPS-placement results compare similarly to OVPS placement in most aspects. Since laparoscopic placement is not routinely indicated, we suggest a prospective study to assess its value as an alternate technique especially suitable in obese patients and patients with previous abdominal operations.

  1. Portosystemic Shunts: Stable Utilization and Improved Outcomes, Two Decades After the Transjugular Intrahepatic Portosystemic Shunt.

    PubMed

    Perry, Brandon C; Kwan, Sharon W

    2015-12-01

    The aim of this study was to assess national trends in utilization, demographics, hospital characteristics, and outcomes of patients undergoing surgical or percutaneous portal decompression since the introduction of transjugular intrahepatic portosystemic shunts (TIPS). A retrospective analysis of patients undergoing surgical portal decompression and TIPS procedures was conducted using Medicare Physician/Supplier Procedure Summary Master Files from January 2003 through December 2013 and National (Nationwide) Inpatient Sample data from 1993, 2003, and 2012. Utilization rates normalized to the annual number of Medicare enrollees, estimated means, and 95% confidence intervals were calculated. The Medicare total annual utilization rate per million for all portosystemic decompression procedures decreased by 6.5% during the study period, from 15.3 in 2003 to 14.3 in 2013. TIPS utilization increased by 19.4% (from 10.3 to 12.3 per million), whereas open surgical shunt utilization decreased by 60.0% (from 5.0 to 2.0 per million). TIPS procedures represented 86% of all procedures in 2013. From 1993 to 2012, mean age increased slightly (from 53.0 to 55.5 years, P < .05). The percentage of procedures performed at teaching hospitals increased, whereas in-hospital mortality and length of stay decreased by 42% (P < .05) and 20% (P < .05), respectively. Of factors evaluated, the performance of procedures on an elective basis was the most influential on in-hospital mortality (P < .01, all years studied) and length of stay (P < .0001, all years studied). Approximately two decades after the introduction of TIPS, the utilization of all portal decompression procedures has remained relatively stable. The TIPS procedure represents the dominant portal decompression technique. In-hospital mortality and mean length of stay after decompression have decreased, partially because of the performance of procedures during elective admissions. Copyright © 2015 American College of Radiology

  2. Multifocal intraparenchymal hemorrhages after ventriculoperitoneal shunt surgery in infants.

    PubMed

    Choi, Jung Won; Kim, Seung-Ki; Wang, Kyu-Chang; Lee, Ji Yeoun; Cheon, Jung-Eun; Phi, Ji Hoon

    2014-10-01

    Ventriculoperitoneal (VP) shunt surgery is the most common treatment for hydrocephalus. In certain situations, uncommon complications can occur after shunting procedures. The authors undertook this study to analyze the clinical characteristics of pediatric patients who developed multifocal intraparenchymal hemorrhages (MIPHs) as a complication of shunt surgery. The authors also analyzed the risk factors for MIPH in a large cohort of patients with hydrocephalus. This study included all pediatric patients (age < 18 years) who underwent VP shunt surgery at the authors' institution between January 2001 and December 2012. During this period, 507 VP shunt operations were performed in 330 patients. Four of these patients were subsequently diagnosed as having MIPH. The authors analyzed the clinical characteristics of these patients in comparison with those of the entire group of shunt-treated patients. The incidence of MIPH was 1.2% (4 of 330 cases) for all pediatric patients who underwent VP shunt placement but 2.9% (4 of 140 cases) for infants less than 1 year old. When the analysis was limited to patients whose corrected age was less than 3 months, the incidence was 5.3% (4 of 76 cases). Of the 4 patients with MIPH, 2 were male and 2 were female. Their median age at surgery was 54 days (range 25-127 days), and in all 4 cases, the patients' corrected age was less than 1 month. Three patients were preterm infants, whereas one patient was full-term. None of these patients had a prior history of intracranial surgery (including CSF diversion procedures). All showed severe hydrocephalus during the preoperative period. Their clinical courses as patients with MIPH were comparatively favorable, despite the radiological findings. MIPH is a rare but not negligible complication of VP shunt surgery. This complication might be a unique phenomenon in infants, especially young, preterm infants with severe hydrocephalus. Moreover, the absence of previous intracranial procedures might be

  3. A Rare Complication of Subdural-peritoneal Shunt: Migration of Catheter Components through the Pelvic Inlet into the Subdural Space.

    PubMed

    Çakir, Mürteza; Yilmaz, Atilla; Çalikoğlu, Çağatay

    2017-01-01

    Subdural-peritoneal (SP) shunting is a simple procedure to treat subdural hygromas; however, several rare complications such as shunt migration exist. A 15-year-old boy presented with headache, nausea, and vomiting, and underwent SP shunting for left frontoparietal chronic subdural effusion. Six weeks later, radiographic examinations revealed total migration of the shunt through the pelvic inlet. The migrated shunt was replaced with a new SP shunt. Four weeks later, radiographic examinations revealed shunt migration into the subdural space. The shunt catheter was removed and the subdural effusion was evacuated. Shunt migration may result from pressure differences between the abdomen and the cranium or from head movement, and insufficient fixation and/or large burr holes can facilitate shunt migration. Double firm anchoring and small-sized burr holes can prevent this complication. SP shunt is a simple procedure, and its assumed complications can be prevented through precaution.

  4. Successful Embolization of a Spontaneous Mesocaval Shunt Using the Amplatzer Vascular Plug II

    SciTech Connect

    Boixadera, Helena; Tomasello, Alejandro; Quiroga, Sergi; Cordoba, Joan; Perez, Mercedes; Segarra, Antoni

    2010-10-15

    A 48-year-old man with alcoholic liver cirrhosis and hepatic encephalopathy was found to have a large, spontaneous mesocaval shunt. The shunt was successfully occluded with the use of an Amplatzer Vascular Plug. To our knowledge, this is the first report of the use of this device to embolize a mesocaval shunt involving the superior mesenteric vein.

  5. A Retrospective Analysis of Ventriculoperitoneal Shunt Revision Cases of a Single Institute

    PubMed Central

    Park, Man-Kyu; Kim, Myungsoo; Park, Ki-Su; Park, Seong-Hyun; Hwang, Jeong-Hyun

    2015-01-01

    Objective Ventriculoperitoneal (VP) shunt complication is a major obstacle in the management of hydrocephalus. To study the differences of VP shunt complications between children and adults, we analyzed shunt revision surgery performed at our hospital during the past 10 years. Methods Patients who had undergone shunt revision surgery from January 2001 to December 2010 were evaluated retrospectively by chart review about age distribution, etiology of hydrocephalus, and causes of revision. Patients were grouped into below and above 20 years old. Results Among 528 cases of VP shunt surgery performed in our hospital over 10 years, 146 (27.7%) were revision surgery. Infection and obstruction were the most common causes of revision. Fifty-one patients were operated on within 1 month after original VP shunt surgery. Thirty-six of 46 infection cases were operated before 6 months after the initial VP shunt. Incidence of shunt catheter fracture was higher in younger patients compared to older. Two of 8 fractured catheters in the younger group were due to calcification and degradation of shunt catheters with fibrous adhesion to surrounding tissue. Conclusion The complications of VP shunts were different between children and adults. The incidence of shunt catheter fracture was higher in younger patients. Degradation of shunt catheter associated with surrounding tissue calcification could be one of the reasons of the difference in facture rates. PMID:26113963

  6. Endovascular Retrieval of Migrated Distal End of Ventriculoperitoneal Shunt from Bilateral Pulmonary Arteries: A Technical Note.

    PubMed

    Dossani, Rimal Hanif; Maiti, Tanmoy Kumar; Patra, Devi Prasad; Nanda, Anil; Cuellar, Hugo

    2017-06-21

    Ventriculoperitoneal (VP) shunting of cerebrospinal fluid is one of the most common procedures performed by neurosurgeons around the world. Migration of distal VP shunt catheter into bilateral segmental pulmonary arteries is an extremely rare complication of VP shunt placement. In the present case, a 30-year-old male underwent VP shunting complicated by migration of distal VP shunt catheter into the bilateral pulmonary arteries. Despite manual attempt at externalizing the distal VP shunt catheter at the level of the clavicle, a small piece of distal VP shunt catheter in bilateral pulmonary arteries was noted on computed tomography of the chest obtained after manual externalization. This persistent distal VP shunt catheter was likely left behind after a break in the distal VP shunt catheter during manual externalization procedure. Given the small size of the segmental pulmonary arteries, a novel endovascular technique was used to move the distal VP shunt catheter from the bilateral segmental pulmonary arteries to the main pulmonary trunk. Once in the main pulmonary trunk, a snare device was used to retrieve the distal shunt catheter through the femoral vein. In this technical note, the authors highlight the relevant endovascular technical details to first move the VP shunt catheter from the bilateral segmental arteries followed by successful catheter retrieval using snare device. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. New and improved ways to treat hydrocephalus: Pursuit of a smart shunt.

    PubMed

    Lutz, Barry R; Venkataraman, Pranav; Browd, Samuel R

    2013-01-01

    The most common treatment for hydrocephalus is placement of a cerebrospinal fluid shunt to supplement or replace lost drainage capacity. Shunts are life-saving devices but are notorious for high failure rates, difficulty of diagnosing failure, and limited control options. Shunt designs have changed little since their introduction in 1950s, and the few changes introduced have had little to no impact on these long-standing problems. For decades, the community has envisioned a "smart shunt" that could provide advanced control, diagnostics, and communication based on implanted sensors, feedback control, and telemetry. The most emphasized contribution of smart shunts is the potential for advanced control algorithms, such as weaning from shunt dependency and personalized control. With sensor-based control comes the opportunity to provide data to the physician on patient condition and shunt function, perhaps even by a smart phone. An often ignored but highly valuable contribution would be designs that correct the high failure rates of existing shunts. Despite the long history and increasing development activity in the past decade, patients are yet to see a commercialized smart shunt. Most smart shunt development focuses on concepts or on isolated technical features, but successful smart shunt designs will be a balance between technical feasibility, economic viability, and acceptable regulatory risk. Here, we present the status of this effort and a framework for understanding the challenges and opportunities that will guide introduction of smart shunts into patient care.

  8. Predictors of mortality after transjugular portosystemic shunt

    PubMed Central

    Ascha, Mona; Abuqayyas, Sami; Hanouneh, Ibrahim; Alkukhun, Laith; Sands, Mark; Dweik, Raed A; Tonelli, Adriano R

    2016-01-01

    AIM: To investigate if echocardiographic and hemodynamic determinations obtained at the time of transjugular intrahepatic portosystemic shunt (TIPS) can provide prognostic information that will enhance risk stratification of patients. METHODS: We reviewed medical records of 467 patients who underwent TIPS between July 2003 and December 2011 at our institution. We recorded information regarding patient demographics, underlying liver disease, indication for TIPS, baseline laboratory values, hemodynamic determinations at the time of TIPS, and echocardiographic measurements both before and after TIPS. We recorded patient comorbidities that may affect hemodynamic and echocardiographic determinations. We also calculated Model for End-stage Liver Disease (MELD) score and Child Turcotte Pugh (CTP) class. The following pre- and post-TIPS echocardiographic determinations were recorded: Left ventricular ejection fraction, right ventricular (RV) systolic pressure, subjective RV dilation, and subjective RV function. We recorded the following hemodynamic measurements: Right atrial (RA) pressure before and after TIPS, inferior vena cava pressure before and after TIPS, free hepatic vein pressure, portal vein pressure before and after TIPS, and hepatic venous pressure gradient (HVPG). RESULTS: We reviewed 418 patients with portal hypertension undergoing TIPS. RA pressure increased by a mean ± SD of 4.8 ± 3.9 mmHg (P < 0.001), HVPG decreased by 6.8 ± 3.5 mmHg (P < 0.001). In multivariate linear regression analysis, a higher MELD score, lower platelet count, splenectomy and a higher portal vein pressure were independent predictors of higher RA pressure (R = 0.55). Three variables predicted 3-mo mortality after TIPS in a multivariate analysis: Age, MELD score, and CTP grade C. Change in the RA pressure after TIPS predicted long-term mortality (per 1 mmHg change, HR = 1.03, 95%CI: 1.01-1.06, P < 0.012). CONCLUSION: RA pressure increased immediately after TIPS particularly in

  9. [A new technique of intrahepatic cholangiodigestive shunt in the right lobe of the liver].

    PubMed

    Machado, M C; da Cunha, J E; Bacchella, T; Penteado, S; Pinotti, H W

    1992-01-01

    Intra-hepatic cholangiojejunostomy in the left liver lobe is a well standardized procedure. For the right lobe however this procedure may be tedious, difficult and followed by early and late complications. A new technique is described based on two principles: minimal sacrifice of hepatic parenchyma and establishment of latero-lateral cholangio-intestinal anastomoses. Five patients were submitted to this procedure and one of them is alive without jaundice three years after the operation. It's concluded that this technique can be indicated in cases of biliary obstruction in which the anastomoses of the left duct cannot be performed because of local changes and in cases with cholangitis.

  10. High-Flow Arterio-Hepatic Venous Shunt in Hepatocellular Carcinoma: Use of Multi-Electrode Radiofrequency for Shunt Obliteration

    SciTech Connect

    Pua, Uei

    2015-10-15

    Intra-tumoral arterio-hepatic venous shunting (AHVS) poses an impediment to transarterial chemoembolization of liver tumors. Not only does it present a potential hazard for systemic shunting and embolization, but also the altered flow dynamics may also result in poor delivery of drug/embolics to the target tumor bed. Current available techniques to overcome AVHS include arterial embolization (particles, coils, glue, etc.) or temporary venous occlusion using balloons. We hereby illustrate the use of radiofrequency ablation to obliterate a complex AHVS consisting of a varix-like venous aneurysm.

  11. Complications and subsequent removal of retained shunt hardware after endoscopic third ventriculostomy: case series.

    PubMed

    Pindrik, Jonathan; Jallo, George I; Ahn, Edward S

    2013-06-01

    This case series highlights multiple complications and subsequent removal of retained shunt hardware in pediatric patients after successful endoscopic third ventriculostomy (ETV). Removal or retention of existing shunt hardware following ETV represents an important dilemma. Prior studies have reported infections and organ perforation related to nonfunctioning shunts but none in the context of successful ETV. Data obtained in 3 children with hydrocephalus treated at the authors' institution were retrospectively reviewed after the patients experienced complications due to retained shunt hardware following ETV. Etiologies of hydrocephalus included tectal glioma and intraventricular hemorrhage. All 3 patients had a history of multiple shunt revisions and underwent urgent ETV in the setting of a shunt malfunction. In each case, the entire shunt system was left in situ, but it became the source of subsequent complications. Two of the 3 patients presented with the shunt infected by gram-negative bacilli 10 days and 4.5 months postoperatively, respectively. The remaining patient experienced wound dehiscence over the shunt valve 4.5 months after ETV. In all patients, the complications were managed successfully by removing the shunt hardware. None of the patients required repeat shunt insertion from the time of removal throughout the follow-up period (mean 24 months, range 9-36 months). During the study period, a total of 6 patients with indwelling shunt hardware underwent ETV with the expectation of being shunt independent. Among these 6 patients, 3 experienced no complications from the retained hardware whereas 3 patients (50%) ultimately experienced adverse consequences related to retained hardware. This case series illustrates complications involving retained shunt hardware after successful ETV. These examples support consideration of shunt removal at the time of ETV in the appropriate context.

  12. Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study.

    PubMed

    Riva-Cambrin, Jay; Kestle, John R W; Holubkov, Richard; Butler, Jerry; Kulkarni, Abhaya V; Drake, James; Whitehead, William E; Wellons, John C; Shannon, Chevis N; Tamber, Mandeep S; Limbrick, David D; Rozzelle, Curtis; Browd, Samuel R; Simon, Tamara D

    2016-04-01

    OBJECT The rate of CSF shunt failure remains unacceptably high. The Hydrocephalus Clinical Research Network (HCRN) conducted a comprehensive prospective observational study of hydrocephalus management, the aim of which was to isolate specific risk factors for shunt failure. METHODS The study followed all first-time shunt insertions in children younger than 19 years at 6 HCRN centers. The HCRN Investigator Committee selected, a priori, 21 variables to be examined, including clinical, radiographic, and shunt design variables. Shunt failure was defined as shunt revision, subsequent endoscopic third ventriculostomy, or shunt infection. Important a priori-defined risk factors as well as those significant in univariate analyses were then tested for independence using multivariate Cox proportional hazard modeling. RESULTS A total of 1036 children underwent initial CSF shunt placement between April 2008 and December 2011. Of these, 344 patients experienced shunt failure, including 265 malfunctions and 79 infections. The mean and median length of follow-up for the entire cohort was 400 days and 264 days, respectively. The Cox model found that age younger than 6 months at first shunt placement (HR 1.6 [95% CI 1.1-2.1]), a cardiac comorbidity (HR 1.4 [95% CI 1.0-2.1]), and endoscopic placement (HR 1.9 [95% CI 1.2-2.9]) were independently associated with reduced shunt survival. The following had no independent associations with shunt survival: etiology, payer, center, valve design, valve programmability, the use of ultrasound or stereotactic guidance, and surgeon experience and volume. CONCLUSIONS This is the largest prospective study reported on children with CSF shunts for hydrocephalus. It confirms that a young age and the use of the endoscope are risk factors for first shunt failure and that valve type has no impact. A new risk factor-an existing cardiac comorbidity-was also associated with shunt failure.

  13. Pericardial effusion and cardiac tamponade after ventriculoperitoneal shunt placement: a case report.

    PubMed

    Wiwattanadittakul, Natrujee; Katanyuwong, Kamornwan; Jetjumnong, Chumpon; Sittiwangkul, Rekwan; Makonkawkeyoon, Krit

    2016-10-01

    Insertion of a ventriculoperitoneal shunt is a common neurosurgical procedure in both adult and paediatric patients. It is one of the most important treatments in cases of hydrocephalus; however, there is a wide range of complications: the most common complication being a shunt infection, and examples of rare complications are shunt migrations and cardiac tamponade. Several reports of distal ventriculoperitoneal shunt migration in different sites, including chest, right ventricle, pulmonary artery, bowel and scrotum were published. But pericardial effusion with cardiac tamponade and its relationship to distal ventriculoperitoneal shunt migration into the pericardial sac has never been reported.

  14. A Rare Case of Repeated Migration and Transurethral Extrusion of Ventriculoperitoneal Shunt

    PubMed Central

    Al Fauzi, Asra; Djatisoesanto, Wahjoe; Wahyuhadi, Joni; Parenrengi, Muhammad Arifin; Turchan, Agus

    2017-01-01

    Bladder migration and transurethral extrusion is an extremely rare complication of ventriculoperitoneal (VP) shunt. Only eight cases have been reported in the English literature since 1995. We report a case of a 4-year-old boy with cerebral palsy, hydrocephalus, and VP shunted on both sides who presented with a protruded distal VP shunt from his urethral orifice. The patient was reported for having previous shunt extrusion through the anus. The patient was treated on by a multidisciplinary approach, involving a neurosurgeon and urologist. Shunt removal with simple procedure was smoothly achieved without morbidities. He was discharged home in satisfactory condition. PMID:28553396

  15. Demonstration of circular shunt in fetal Ebstein anomaly

    PubMed Central

    Sasikumar, Deepa; Sasidharan, Bijulal; Sivasubramanian, Sivasankaran

    2015-01-01

    Ebstein's anomaly was diagnosed in a fetus at 24 weeks of gestation. There was significant cardiomegaly and severe tricuspid regurgitation (TR). There was functional pulmonary atresia with severe pulmonary regurgitation (PR) and this was causing a circular shunt. There was no fetal hydrops. PMID:26556976

  16. Focally spared area of fatty liver caused by arterioportal shunt

    SciTech Connect

    Arita, Takeshi; Matsunaga, Naofumi; Honma, Yutaka

    1996-05-01

    We describe a case with a focally spared area in fatty liver caused by arterioportal shunt. Furthermore, we discuss the cause of the focally spared area related to a localized dilution or reduction in portal blood flow. 13 refs., 1 fig.

  17. Extracardiac Fontan operation after late bidirectional Glenn shunt.

    PubMed

    Ganigara, Madhusudan; Prabhu, Atul; Varghese, Roy; Pavithran, Sreeja; Valliatu, John; Nair, Raghavan Suresh Kumar

    2010-06-01

    The outcomes of 33 consecutive extracardiac Fontan operations performed between 1999 and 2008 in patients who mostly had initial Glenn shunts beyond infancy were reviewed. Preoperatively, the median oxygen saturation was 76.2% and mean pulmonary artery pressure was 10.5 mm Hg. The median age was 4.1 years at Glenn shunt procedure and 10 years at Fontan operation. The duration of chest tube drainage was longer in these patients than in series where Glenn shunts were created at a younger age. All patients received warfarin for 1 year, then warfarin and/or aspirin. At follow-up (median, 14 months), there was no significant ventricular dysfunction. Median oxygen saturation at the last follow-up was 92%. All patients in sinus rhythm preoperatively continued in this status. There was no Fontan failure or mortality. All patients were in New York Heart Association class I or II, although objective cardiopulmonary exercise evaluation in 8 patients showed impaired exercise tolerance. Despite a trend towards prolonged pleural effusion, there was no adverse outcome in the short or intermediate term. Long-term follow-up is required to see whether delayed creation of a Glenn shunt is associated with late disadvantages.

  18. Demonstration of circular shunt in fetal Ebstein anomaly.

    PubMed

    Sasikumar, Deepa; Sasidharan, Bijulal; Sivasubramanian, Sivasankaran

    2015-01-01

    Ebstein's anomaly was diagnosed in a fetus at 24 weeks of gestation. There was significant cardiomegaly and severe tricuspid regurgitation (TR). There was functional pulmonary atresia with severe pulmonary regurgitation (PR) and this was causing a circular shunt. There was no fetal hydrops.

  19. [Circular shunting of blood: a complication of neonatal Ebstein anomaly].

    PubMed

    Paranon, S; Plat-Wilson, G; Marcoux, M-O; Acar, P

    2010-12-01

    We report a severe neonatal presentation of Ebstein anomaly with homodynamic aggravation at birth attributed to patent ductus arteriosus and circular shunt. Prenatal diagnosis of Ebstein anomaly of the tricuspid valve with functional pulmonary atresia was made at 37 weeks gestation by fetal two- and three-dimensional echocardiography. A cesarean section was performed in view of poor fetal tolerance. The newborn was born with hydrops and multivisceral failure. A post-natal echocardiography demonstrated a left-to-right shunt across the patent ductus arteriosus and functional pulmonary atresia with severe pulmonary insufficiency with absent forward flow. This created a circular shunt, where blood flowed through the ductus to the pulmonary arteries, retrograde through the pulmonary artery and Ebstein valve, across the patent foramen ovale and out the aorta. Prostaglandin E1 infusion was stopped, resulting in clinical and echocardiographic improvement. The management of the phenomenon of a circular shunt across a patent ductus arteriosus with Ebstein malformation involves promoting early ductal closure by stopping prostaglandin therapy.

  20. The Evolution of Transjugular Intrahepatic Portosystemic Shunt: Tips

    PubMed Central

    Fanelli, Fabrizio

    2014-01-01

    Since Richter's description in the literature in 1989 of the first procedure on human patients, transjugular intrahepatic portosystemic shunt (TIPS) has been worldwide considered as a noninvasive technique to manage portal hypertension complications. TIPS succeeds in lowering the hepatic sinusoidal pressure and in increasing the circulatory flow, thus reducing sodium retention, ascites recurrence, and variceal bleeding. Required several revisions of the shunt TIPS can be performed in case of different conditions such as hepatorenal syndrome, hepatichydrothorax, portal vein thrombosis, and Budd-Chiari syndrome. Most of the previous studies on TIPS procedure were based on the use of bare stents and most patients chose TIPS 2-3 years after traditional treatment, thus making TIPS appear to be not superior to endoscopy in survival rates. Bare stents were associated with higher incidence of shunt failure and consequently patients required several revisions during the follow-up. With the introduction of a dedicated e-PTFE covered stent-graft, these problems were completely solved, No more reinterventions are required with a tremendous improvement of patient's quality of life. One of the main drawbacks of the use of e-PTFE covered stent-graft is higher incidence of hepatic encephalopathy. In those cases refractory to the conventional medical therapy, a shunt reduction must be performed. PMID:27335841

  1. Embolization of nonvariceal portosystemic collaterals in transjugular intrahepatic portosystemic shunts

    SciTech Connect

    Bilbao, Jose Ignacio; Arias, Mercedes; Longo, Jesus Maria; Alejandre, Pedro Luis; Betes, Maria Teresa; Elizalde, Arlette Maria

    1997-03-15

    Percutaneous embolization of large portosystemic collaterals was performed in three patients following placement of a transjugular intrahepatic portosystemic shunt in order to improve hepatopetal portal flow. Improved hepatic portal perfusion was achieved in these cases, thereby theoretically reducing the risk of chronic hepatic encephalopathy.

  2. CONTEXT VIEW ALONG EXISTING PERIMETER TRACKS LOOKING TOWARDS SHUNTS IN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    CONTEXT VIEW ALONG EXISTING PERIMETER TRACKS LOOKING TOWARDS SHUNTS IN THEIR PRESENT-DAY POSITIONS, STORAGE SHED, AND MACHINE SHOP. LOOKING NORTHEAST. - Pennsylvania Railway Ore Dock, Lake Erie at Whiskey Island, approximately 1.5 miles west of Public Square, Cleveland, Cuyahoga County, OH

  3. Selection of cranial site for shunting debilitated patients.

    PubMed

    Kouyialis, A T; Stranjalis, G; Boviatsis, E J; Korfias, S; Sakas, D E

    2005-07-01

    The optimum cranial site for ventricular catheter insertion in CSF shunts is still under debate and there has been no general consensus as far as surgical technicalities are concerned. Furthermore, there have been no reports dealing with appropriate cranial site selection in debilitated patients. The aim of this report is to stress the need to utilize a frontal approach when dealing with patients who are likely to remain bed-bound for long periods and to emphasize the well-known prerequisites such as meticulous surgical technique and peri-operative general and local care. A retrospective analysis of all shunt operations and revisions performed in our department during the last 6 years. This analysis revealed 8 long-term recumbent patients with late valve extrusion (N1 = 5) or primary wound breakdown (N2 = 3), all through the occipital area. Extended periods of bed rest due to neurological disease combined with poor nursing and dietary intake had led to either chronic valve extrusion or wound breakdown. Shunt revision was performed successfully by a frontal approach in 5 whereas 2 tolerated shunt removal and one died of meningitis. In debilitated patients or those who are likely to remain bed-bound for long periods, a frontal approach for proximal catheter insertion may help prevent immediate postoperative wound breakdown or late valve extrusion.

  4. 21 CFR 882.4545 - Shunt system implantation instrument.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Shunt system implantation instrument. 882.4545 Section 882.4545 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... components under the skin. (b) Classification. Class I (general controls). When made only of surgical grade...

  5. Transjugular Intrahepatic Portosystemic Shunt Complications: Prevention and Management

    PubMed Central

    Suhocki, Paul V.; Lungren, Matthew P.; Kapoor, Baljendra; Kim, Charles Y.

    2015-01-01

    Transjugular intrahepatic portosystemic shunt (TIPS) insertion has been well established as an effective treatment in the management of sequelae of portal hypertension. There are a wide variety of complications that can be encountered, such as hemorrhage, encephalopathy, TIPS dysfunction, and liver failure. This review article summarizes various approaches to preventing and managing these complications. PMID:26038620

  6. Does Ventriculoperitoneal Shunting Improve Thyroid Hormone Levels in Hydrocephalic Newborns?

    PubMed

    Ucler, Necati; Erol, Fatih Serhat; Ozturk, Sait; Akgun, Bekir; Kaplan, Metin; Sen, Yasar

    2017-01-01

    The aim of this report was to investigate the effect of ventriculoperitoneal shunt insertion for the treatment of hydrocephalus on thyroid hormones in the first 3 months of life. Thyroid-stimulating hormone (TSH), free T3 (fT3), and free T4 (fT4) levels were compared at 7 days (preoperatively) and at 30 and 90 days (postoperatively) after birth between 25 ventriculoperitoneal shunt-inserted hydrocephalic newborns and 20 healthy newborns. The TSH level at 7 days was higher in the hydrocephalic patient group (6.33 µIU) compared to the control group (3.76 µIU). This value was significantly decreased at 90 days in the ventriculoperitoneal shunt-inserted newborns (2.35 µIU) compared to the control group (3.33 µIU; p < 0.05). There were no significant differences between time points for fT4 and fT3 values in the patient group or for TSH, fT4, and fT3 values in the control group. We propose that a ventriculoperitoneal shunt inserted in the early period of life may have beneficial effects on thyroid hormones. © 2016 S. Karger AG, Basel.

  7. Cerebrospinal fluid shunt operations without cranial bandaging. Clinical article.

    PubMed

    Winston, Ken R; Trinidad, Elizabeth; Wilkinson, C Corbett; McBride, Lori A

    2009-06-01

    Cranial bandages are commonly applied over scalp incisions immediately after cerebrospinal fluid (CSF) shunt surgery, putatively to prevent complications, particularly infection. These bandages require resources, consume the time of healthcare workers, and incur non-negligible expenses. It is therefore both reasonable and important to examine the efficacy of cranial bandaging. The combined experience of 3 neurosurgeons over 6.75 years with using no cranial bandaging after operations for implantation or revision of CSF shunts is the basis of this report. These data were prospectively accrued and retrospectively analyzed. The infection rate was 4.2% (95% CI 3.1-5.6%) for 1064 operations performed without postoperative cranial bandaging after either shunt insertion or revision surgery through clean or clean-contaminated wounds. The age distribution extended from premature infants through adults 77 years of age. The results of this investigation support the position that bandaging scalp wounds after CSF shunt implantation or revision surgery adds no benefit beyond the easier, simpler, faster, and cheaper practice of using antibiotic ointment as a dressing without bandaging.

  8. New and improved ways to treat hydrocephalus: Pursuit of a smart shunt

    PubMed Central

    Lutz, Barry R.; Venkataraman, Pranav; Browd, Samuel R.

    2013-01-01

    The most common treatment for hydrocephalus is placement of a cerebrospinal fluid shunt to supplement or replace lost drainage capacity. Shunts are life-saving devices but are notorious for high failure rates, difficulty of diagnosing failure, and limited control options. Shunt designs have changed little since their introduction in 1950s, and the few changes introduced have had little to no impact on these long-standing problems. For decades, the community has envisioned a “smart shunt” that could provide advanced control, diagnostics, and communication based on implanted sensors, feedback control, and telemetry. The most emphasized contribution of smart shunts is the potential for advanced control algorithms, such as weaning from shunt dependency and personalized control. With sensor-based control comes the opportunity to provide data to the physician on patient condition and shunt function, perhaps even by a smart phone. An often ignored but highly valuable contribution would be designs that correct the high failure rates of existing shunts. Despite the long history and increasing development activity in the past decade, patients are yet to see a commercialized smart shunt. Most smart shunt development focuses on concepts or on isolated technical features, but successful smart shunt designs will be a balance between technical feasibility, economic viability, and acceptable regulatory risk. Here, we present the status of this effort and a framework for understanding the challenges and opportunities that will guide introduction of smart shunts into patient care. PMID:23653889

  9. Risk factors associated with distal catheter migration following ventriculoperitoneal shunt placement.

    PubMed

    Abode-Iyamah, Kingsley O; Khanna, Ryan; Rasmussen, Zachary D; Flouty, Oliver; Dahdaleh, Nader S; Greenlee, Jeremy; Howard, Matthew A

    2016-03-01

    Ventriculoperitoneal (VP) shunt placement is used to treat hydrocephalus. Shunt migration following VP shunt placement has been reported. The risk factors related to this complication have not been previously evaluated to our knowledge. In this retrospective cohort study, we aimed to determine risk factors leading to distal catheter migration and review the literature on the current methods of management and prevention. Adult patients undergoing VP shunt placement from June 2011 to December 2013 at a single institution were identified using electronic health records. The records were reviewed for demographic and procedural information, and subsequent treatment characteristics. The parameters of patients with distal shunt migration were compared to those undergoing new VP shunt placement for the same time period. We identified 137 patients undergoing 157 new VP shunt procedures with an average age of 57.7 ± standard deviation of 18.4 years old. There were 16 distal shunt migrations. Body mass index >30 kg/m(2) and number of previous shunt procedures were found to be independent risk factors for distal catheter migration. Obesity and number of previous shunt procedures were factors for distal catheter migration. Providers and patients should be aware of these possible risk factors prior to VP shunt placement. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Experimental Comparison of Piezoelectric and Magnetostrictive Shunt Dampers

    NASA Technical Reports Server (NTRS)

    Asnani, Vivake M.; Deng, Zhangxian; Dapino, Marcelo J.; Scheidler, Justin J.

    2016-01-01

    A novel mechanism called the vibration ring is being developed to enable energy conversion elements to be incorporated into the driveline of a helicopter or other rotating machines. Unwanted vibration is transduced into electrical energy, which provides a damping effect on the driveline. The generated electrical energy may also be used to power other devices (e.g., health monitoring sensors). PZT (piezoceramic) and PMN-30PT (single crystal) stacks, as well as a Tb_0.3 Dy_0.7 Fe_1.92 (Terfenol-D) rod with a bias magnet array and a pickup coil, were tested as alternative energy conversion elements to use within the vibration ring. They were tuned for broadband damping using shunt resistors, and dynamic compression testing was conducted in a high-speed load frame. Energy conversion was experimentally optimized at 750Hz by tuning the applied bias stress and resistance values. Dynamic testing was conducted up to 1000Hz to determine the effective compressive modulus, shunt loss factor, internal loss factor, and total loss factor. Some of the trends of modulus and internal loss factor versus frequency were unexplained. The single crystal device exhibited the greatest shunt loss factor whereas the Terfenol-D device had the highest internal and total loss factors. Simulations revealed that internal losses in the Terfenol-D device were elevated by eddy current effects, and an improved magnetic circuit could enhance its shunt damping capabilities. Alternatively, the Terfenol-D device may be simplified to utilize only the eddy current dissipation mechanism (no pickup coil or shunt) to create broadband damping.

  11. Fourth ventricular entrapment caused by rostrocaudal herniation following shunt malfunction.

    PubMed

    Montgomery, C T; Winfield, J A

    1993-01-01

    The subacute development of isolated fourth ventricle (IFV) is a recognized complication following shunting of the lateral ventricles for congenital and acquired hydrocephalus. We present an unusual case of acute IFV in a clinical setting which has not previously been described. Subsequent to rostrocaudal herniation caused by an obstructed frontally placed ventricular catheter, IFV developed in our patient 24 h following shunt revision, necessitating placement of an additional fourth ventricle shunt system. No signs of intraventricular hemorrhage or cerebrospinal fluid (CSF) infection were detected at the time of shunt revision and there was no documentation of similar events in the perinatal history. Dependent upon the actual underlying etiology of this child's hydrocephalus, we hypothesize that two mechanisms may have accounted for this unusual and precipitous development of IFV. Following rostrocaudal herniation and caudal shift of the brainstem, progressive edema in the pons developed. If communicating hydrocephalus was the primary etiology, then midbrain edema occluded the aqueduct of Sylvius, preventing retrograde flow of CSF to the shunt. A distinctly different mechanism for acute IFV must be invoked if aqueductal stenosis was the preexisting cause for congenital hydrocephalus. Following herniation, brainstem displacement and edema resulted in obliteration of the lateral pontine and ambient cisterns, preventing the normal rostral migration of CSF around and over the mesencephalon. Cerebellar tonsillar herniation with impaction of the tonsils into the foramen magnum may have also contributed to obstruction of fourth ventricular outflow in both settings. This unusual case of acute onset IFV is presented in detail. The underlying etiologies and clinical settings in which IFV may develop is reviewed as well.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Experimental comparison of piezoelectric and magnetostrictive shunt dampers

    NASA Astrophysics Data System (ADS)

    Asnani, Vivake M.; Deng, Zhangxian; Scheidler, Justin J.; Dapino, Marcelo J.

    2016-04-01

    A novel mechanism called the vibration ring is being developed to enable energy conversion elements to be incorporated into the driveline of a helicopter or other rotating machines. Unwanted vibration is transduced into electrical energy, which provides a damping effect on the driveline. The generated electrical energy may also be used to power other devices (e.g., health monitoring sensors). PZT (`piezoceramic') and PMN-30%PT (`single crystal') stacks, as well as a Tb0.3Dy0.7Fe1.92 (`Terfenol-D') rod with a bias magnet array and a pickup coil, were tested as alternative energy conversion elements to use within the vibration ring. They were tuned for broadband damping using shunt resistors, and dynamic compression testing was conducted in a high-speed load frame. Energy conversion was experimentally optimized at 750Hz by tuning the applied bias stress and resistance values. Dynamic testing was conducted up to 1000Hz to determine the effective compressive modulus, shunt loss factor, internal loss factor, and total loss factor. Some of the trends of modulus and internal loss factor versus frequency were unexplained. The single crystal device exhibited the greatest shunt loss factor whereas the Terfenol-D device had the highest internal and total loss factors. Simulations revealed that internal losses in the Terfenol-D device were elevated by eddy current effects, and an improved magnetic circuit could enhance its shunt damping capabilities. Alternatively, the Terfenol-D device may be simplified to utilize only the eddy current dissipation mechanism (no pickup coil or shunt) to create broadband damping.

  13. Management of complicated shunt infections: a clinical report.

    PubMed

    James, Hector E; Bradley, John S

    2008-03-01

    The authors present their experience with a protocol for the treatment of patients with complicated shunt infections. Complicated shunt infections are defined for the purpose of this protocol as multiple compartment hydrocephalus, multiple organism shunt infection, severe peritonitis, or infections in other sites of the body. The initial treatment protocol for these patients was 3 weeks of intravenous antibiotic therapy and 2 weeks of twice daily intraventricular/intrashunt antibiotic therapy. Cerebrospinal fluid (CSF) cultures were monitored during therapy and obtained again 48 hours after completion. The shunt was completely replaced. Additionally, follow-up cultures were obtained in all patients 3-6 months after therapy was completed. A cure of the infection was achieved in all patients as defined by negative cultures obtained at completion of antibiotic therapy and in follow-up studies. The follow-up period was 2-11 years (mean 4.4 +/- 2.5 years). The treatment protocol was modified in the patients treated after 1991, and 18 patients were treated with this modified treatment regime. In these patients, intraventricular antibiotics were administered only once daily for 14 days, and the CSF was cultured 24 hours after antibiotic therapy had been stopped instead of after 48 hours. The results were similar to those obtained with the initial protocol. Based on their prospective nonrandomized series, the authors believe that patients with complicated shunt infections can be successfully treated with 2 weeks of intraventricular antibiotic therapy administered once daily, concurrent with 3 weeks of intravenous antibiotic therapy. This protocol reduces length of treatment and hospital stay, and avoids recurrence of infection.

  14. Experimental Comparison of Piezoelectric and Magnetostrictive Shunt Dampers

    NASA Technical Reports Server (NTRS)

    Asnani, Vivake M.; Deng, Zhangxian; Scheidler, Justin J.; Dapino, Marcelo J.

    2016-01-01

    A novel mechanism called the vibration ring is being developed to enable energy conversion elements to be incorporated into the driveline of a helicopter or other rotating machines. Unwanted vibration is transduced into electrical energy, which provides a damping effect on the driveline. The generated electrical energy may also be used to power other devices (e.g., health monitoring sensors). PZT (piezoceramic) and PMN-30%PT (single crystal) stacks, as well as a Tb_0.3 Dy_0.7 Fe_1.92 (Terfenol-D) rod with a bias magnet array and a pickup coil, were tested as alternative energy conversion elements to use within the vibration ring. They were tuned for broadband damping using shunt resistors, and dynamic compression testing was conducted in a high-speed load frame. Energy conversion was experimentally optimized at 750Hz by tuning the applied bias stress and resistance values. Dynamic testing was conducted up to 1000Hz to determine the effective compressive modulus, shunt loss factor, internal loss factor, and total loss factor. Some of the trends of modulus and internal loss factor versus frequency were unexplained. The single crystal device exhibited the greatest shunt loss factor whereas the Terfenol-D device had the highest internal and total loss factors. Simulations revealed that internal losses in the Terfenol-D device were elevated by eddy current effects, and an improved magnetic circuit could enhance its shunt damping capabilities. Alternatively, the Terfenol-D device may be simplified to utilize only the eddy current dissipation mechanism (no pickup coil or shunt) to create broadband damping.

  15. Magnetic Resonance Imaging–Guided Transcatheter Cavopulmonary Shunt

    PubMed Central

    Ratnayaka, Kanishka; Rogers, Toby; Schenke, William H.; Mazal, Jonathan R.; Chen, Marcus Y.; Sonmez, Merdim; Hansen, Michael S.; Kocaturk, Ozgur; Faranesh, Anthony Z.; Lederman, Robert J.

    2017-01-01

    OBJECTIVES The aim of this study was to test the hypothesis that real-time magnetic resonance imaging (MRI) would enable closed-chest percutaneous cavopulmonary anastomosis and shunt by facilitating needle guidance along a curvilinear trajectory, around critical structures, and between a superior vena cava “donor” vessel and a pulmonary artery “target.” BACKGROUND Children with single-ventricle physiology require multiple open heart operations for palliation, including sternotomies and cardiopulmonary bypass. The reduced morbidity of a catheter-based approach would be attractive. METHODS Fifteen naive swine underwent transcatheter cavopulmonary anastomosis and shunt creation under 1.5-T MRI guidance. An MRI antenna-needle was advanced from the superior vena cava into the target pulmonary artery bifurcation using real-time MRI guidance. In 10 animals, balloon-expanded off-the-shelf endografts secured a proximal end-to-end caval anastomosis and a distal end-to-side pulmonary anastomosis that preserved blood flow to both branch pulmonary arteries. In 5 animals, this was achieved with a novel, purpose-built, self-expanding device. RESULTS Real-time MRI needle access of target vessels (pulmonary artery), endograft delivery, and superior vena cava shunt to pulmonary arteries were successful in all animals. All survived the procedure without complications. Intraprocedural real-time MRI, post-procedural MRI, x-ray angiography, computed tomography, and necropsy showed patent shunts with bidirectional pulmonary artery blood flow. CONCLUSIONS MRI guidance enabled a complex, closed-chest, beating-heart, pediatric, transcatheter structural heart procedure. In this study, MRI guided trajectory planning and reproducible, reliable bidirectional cavopulmonary shunt creation. PMID:27085581

  16. Management of surgical splenorenal shunt-related hepatic myelopathy with endovascular interventional techniques.

    PubMed

    Wang, Mao-Qiang; Liu, Feng-Yong; Duan, Feng

    2012-12-21

    We present a case with hepatic myelopathy (HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques. A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt. A portal venogram identified a widened patent splenorenal shunt. We used an occlusion balloon catheter initially to occlude the shunt. Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength. We then used an Amplatzer vascular plug (AVP) to enable closure of the shunt. During the follow up period of 7 mo, the patient experienced significant clinical improvement and normalization of blood ammonia, without any complications. Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.

  17. Recanalisation of an occluded modified Blalock-Taussig shunt by balloon dilatation.

    PubMed Central

    Sreeram, N; Walsh, K; Peart, I

    1993-01-01

    A four year old boy with pulmonary atresia and ventricular septal defect had an acute cyanotic episode three years after undergoing a right-sided, 6 mm diameter, modified Blalock-Taussig shunt. On admission no continuous murmur could be heard from the shunt and the typical high velocity, continuous flow profile of the shunt could not be identified by Doppler echocardiography. At catheterisation a right subclavian artery angiogram confirmed shunt occlusion. From the subclavian artery, an 0.035 inch wire was used to enter the occluded shunt and then the pulmonary artery. Balloon angioplasty of the entire length of the shunt was performed with 6 mm diameter balloon. After angioplasty the arterial oxygen saturation increased from 63% to 83%. The patient was treated with intravenous heparin followed by warfarin. Repeat catheterisation and angiography eight days later confirmed wide patency of the shunt. Images PMID:8260283

  18. Sylvian aqueduct syndrome with slit ventricles in shunted hydrocephalus due to adult aqueduct stenosis.

    PubMed

    Maroulis, Helen; Halmagyi, G Michael; Heard, Robert; Cook, Raymond J

    2008-11-01

    The authors report on 3 patients who developed sylvian aqueduct syndrome (SAS) in the context of shunt dysfunction and slit ventricles. All 3 patients had received shunts for adult onset hydrocephalus due to aqueduct stenosis and were stable for years before presenting with loss of upward gaze, convergence-retraction nystagmus, and slit ventricles, all due to shunt overdrainage. All 3 improved after either shunt revision or a third ventriculostomy procedure. Although it is well known that SAS can be caused by shunt blockage producing a transtentorial pressure gradient, these cases emphasize that an identical clinical pattern can occur with a reverse transtentorial pressure gradient and slit ventricles due to shunt overdrainage. The authors propose a simple management plan for patients with shunted hydrocephalus who develop SAS.

  19. Symptomatic vaginal enterocele associated with malfunctioning ventriculoperitoneal shunt and cerebrospinal ascites.

    PubMed

    Karp, Deborah R; Rizvi, Tazeen Z; Davila, G Willy

    2011-09-01

    Abdominal pseudocyst formation is a rare adult complication associated with ventriculoperitoneal (VP) shunts. Presenting symptoms are primarily abdominal and include distention, pain and anorexia, and secondarily neurological with signs and symptoms of shunt malfunction. We describe a case of VP shunt-related pseudocyst formation presenting as symptomatic pelvic organ prolapse with stage 4 enterocele 4 years after VP shunt placement. The patient's vaginal enterocele enlarged and became more symptomatic as intra-abdominal cyst formation expanded. Symptomatic relief of pelvic floor symptomatology including resolution of exteriorized prolapse was established by conservative measures and eventual VP shunt revision and removal. VP shunt malfunction may present as symptomatic pelvic organ prolapse and may require shunt removal or revision for resolution of symptoms.

  20. Lumboatrial shunt in a patient with Crouzon syndrome complicated by pseudotumor cerebri.

    PubMed

    Sankey, Eric W; Khattab, Mohamed H; Elder, Benjamin D; Goodwin, C Rory; Rekate, Harold L; Rigamonti, Daniele

    2015-09-01

    A 25-year-old man with Crouzon syndrome complicated by pseudotumor cerebri and multiple shunt failures presented with progressive back and neck pain, intermittent headaches, and associated vomiting secondary to shunt infection. Due to his previous history of repeated failure of both ventriculoperitoneal and lumboperitoneal (LP) shunting procedures, the decision was made to place a lumboatrial (LA) shunt via an approach through the internal jugular vein. The procedure was uncomplicated and the man's symptoms were relieved. Despite significant improvement, the LA shunt limited his exercise tolerance, and as an avid runner and weight lifter, he requested reconversion back to an LP shunt. At a follow-up of 20months, he continued to do well both clinically and radiographically. This case report summarizes the successful placement and use of an LA shunt for the treatment of intracranial hypertension in the setting of Crouzon syndrome. Published by Elsevier Ltd.

  1. Peritoneovenous Shunt Insertion for Intractable Ascites-A District General Hospital Experience

    SciTech Connect

    Hussain, Fuad F. Meer, Ziad F.; Lopez, Anthony J.

    2004-08-15

    Ascites often contributes to patient morbidity and discomfort. When refractory to medical management, it has been managed with repeated paracentesis, implantable ports for drainage, or diversion to the urinary bladder. Peritoneovenous shunt insertion has been a technique that was traditionally performed only by surgeons but is now within the realm of interventional radiologists. Its advantage is that protein-rich ascitic fluid is returned to the intravascular compartment. This retrospective study elaborates on the successes and problems encountered during shunt insertion in our first 13 patients. Two patients are well with a functioning shunt at 14 and 32 weeks. In 6 the shunt functioned until the patients' death from the underlying malignancy. Two required revision with variable success and in 2, shunt function could not be salvaged. There was one procedure-related mortality. Radiological insertion of these shunts is feasible and should be considered for selected patients. Options are available for assessment and salvaging of dysfunctional shunts.

  2. Ventriculoperitoneal Shunt Complications In Children: An Evidence-Based Approach To Emergency Department Management.

    PubMed

    Bober, Jacqueline; Rochlin, Jonathan; Marneni, Shashidhar

    2016-02-01

    Although much is known about ventriculoperitoneal shunts, there are still large gaps in the literature and no evidence-based guidelines on management. To date, there is no general consensus on workup and treatment, and there are many differing diagnostic and therapeutic strategies for management of complications. Ventriculoperitoneal shunt complications can be separated into 3 categories: mechanical failure, infection, and functional failure. Knowing the basic anatomy of ventriculoperitoneal shunts, the time of shunt placement, and the clinical manifestations suggestive of potential complications can help with the management of patients with ventriculoperitoneal shunts. This review summarizes the literature on complications of ventriculoperitoneal shunts, examines the literature regarding the workup and management of patients with ventriculoperitoneal shunts, and makes recommendations for the management of these patients in the emergency department.

  3. Fuzzy Inference System Approach for Locating Series, Shunt, and Simultaneous Series-Shunt Faults in Double Circuit Transmission Lines.

    PubMed

    Swetapadma, Aleena; Yadav, Anamika

    2015-01-01

    Many schemes are reported for shunt fault location estimation, but fault location estimation of series or open conductor faults has not been dealt with so far. The existing numerical relays only detect the open conductor (series) fault and give the indication of the faulty phase(s), but they are unable to locate the series fault. The repair crew needs to patrol the complete line to find the location of series fault. In this paper fuzzy based fault detection/classification and location schemes in time domain are proposed for both series faults, shunt faults, and simultaneous series and shunt faults. The fault simulation studies and fault location algorithm have been developed using Matlab/Simulink. Synchronized phasors of voltage and current signals of both the ends of the line have been used as input to the proposed fuzzy based fault location scheme. Percentage of error in location of series fault is within 1% and shunt fault is 5% for all the tested fault cases. Validation of percentage of error in location estimation is done using Chi square test with both 1% and 5% level of significance.

  4. The presence of spontaneous portosystemic shunts increases the risk of complications after transjugular intrahepatic portosystemic shunt (TIPS) placement.

    PubMed

    Borentain, P; Soussan, J; Resseguier, N; Botta-Fridlund, D; Dufour, J-C; Gérolami, R; Vidal, V

    2016-06-01

    The goal of this study was to identify clinical and imaging variables that are associated with an unfavorable outcome during the 30 days following transjugular intrahepatic portosystemic shunt (TIPS) placement. Fifty-four consecutive patients with liver cirrhosis (Child-Pugh 6-13, Model for End-stage Liver Disease 7-26) underwent TIPS placement for refractory ascites (n=25), recurrent or uncontrolled variceal bleeding (n=23) or both (n=6). Clinical, biological and imaging variables including type of stent (covered n=40; bare-stent n=14), presence of spontaneous portosystemic shunt (n=31), and variations in portosystemic pressure gradient were recorded. Early severe complication was defined as the occurrence of overt hepatic encephalopathy or death within the 30days following TIPS placement. Sixteen patients (30%) presented with early severe complication after TIPS placement. Child-Pugh score was independently associated with complication (HR=1.52, P<0.001). Among the imaging variables, opacification of spontaneous portosystemic shunt during TIPS placement but before its creation was associated with an increased risk of early complication (P=0.04). The other imaging variables were not associated with occurrence of complication. Identification of spontaneous portosystemic shunt during TIPS placement reflects the presence of varices and is associated with an increased risk of early severe complication. Copyright © 2016 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  5. Fuzzy Inference System Approach for Locating Series, Shunt, and Simultaneous Series-Shunt Faults in Double Circuit Transmission Lines

    PubMed Central

    Swetapadma, Aleena; Yadav, Anamika

    2015-01-01

    Many schemes are reported for shunt fault location estimation, but fault location estimation of series or open conductor faults has not been dealt with so far. The existing numerical relays only detect the open conductor (series) fault and give the indication of the faulty phase(s), but they are unable to locate the series fault. The repair crew needs to patrol the complete line to find the location of series fault. In this paper fuzzy based fault detection/classification and location schemes in time domain are proposed for both series faults, shunt faults, and simultaneous series and shunt faults. The fault simulation studies and fault location algorithm have been developed using Matlab/Simulink. Synchronized phasors of voltage and current signals of both the ends of the line have been used as input to the proposed fuzzy based fault location scheme. Percentage of error in location of series fault is within 1% and shunt fault is 5% for all the tested fault cases. Validation of percentage of error in location estimation is done using Chi square test with both 1% and 5% level of significance. PMID:26413088

  6. Tetralogy of Fallot Surgical Repair: Shunt Configurations, Ductus Arteriosus and the Circle of Willis.

    PubMed

    Piskin, Senol; Unal, Gozde; Arnaz, Ahmet; Sarioglu, Tayyar; Pekkan, Kerem

    2017-06-01

    In this study, hemodynamic performance of three novel shunt configurations that are considered for the surgical repair of tetralogy of Fallot (TOF) disease are investigated in detail. Clinical experience suggests that the shunt location, connecting angle, and its diameter can influence the post-operative physiology and the neurodevelopment of the neonatal patient. An experimentally validated second order computational fluid dynamics (CFD) solver and a parametric neonatal diseased great artery model that incorporates the ductus arteriosus (DA) and the full patient-specific circle of Willis (CoW) are employed. Standard truncated resistance CFD boundary conditions are compared with the full cerebral arterial system, which resulted 21, -13, and 37% difference in flow rate at the brachiocephalic, left carotid, and subclavian arteries, respectively. Flow splits at the aortic arch and cerebral arteries are calculated and found to change with shunt configuration significantly for TOF disease. The central direct shunt (direct shunt) has pulmonary flow 5% higher than central oblique shunt (oblique shunt) and 23% higher than modified Blalock Taussig shunt (RPA shunt) while the DA is closed. Maximum wall shear stress (WSS) in the direct shunt configuration is 9 and 60% higher than that of the oblique and RPA shunts, respectively. Patent DA, significantly eliminated the pulmonary flow control function of the shunt repair. These results suggests that, due to the higher flow rates at the pulmonary arteries, the direct shunt, rather than the central oblique, or right pulmonary artery shunts could be preferred by the surgeon. This extended model introduced new hemodynamic performance indices for the cerebral circulation that can correlate with the post-operative neurodevelopment quality of the patient.

  7. Predicting ventriculoperitoneal shunt infection in children with hydrocephalus using artificial neural network.

    PubMed

    Habibi, Zohreh; Ertiaei, Abolhasan; Nikdad, Mohammad Sadegh; Mirmohseni, Atefeh Sadat; Afarideh, Mohsen; Heidari, Vahid; Saberi, Hooshang; Rezaei, Abdolreza Sheikh; Nejat, Farideh

    2016-11-01

    The relationships between shunt infection and predictive factors have not been previously investigated using Artificial Neural Network (ANN) model. The aim of this study was to develop an ANN model to predict shunt infection in a group of children with shunted hydrocephalus. Among more than 800 ventriculoperitoneal shunt procedures which had been performed between April 2000 and April 2011, 68 patients with shunt infection and 80 controls that fulfilled a set of meticulous inclusion/exclusion criteria were consecutively enrolled. Univariate analysis was performed for a long list of risk factors, and those with p value < 0.2 were used to create ANN and logistic regression (LR) models. Five variables including birth weight, age at the first shunting, shunt revision, prematurity, and myelomeningocele were significantly associated with shunt infection via univariate analysis, and two other variables (intraventricular hemorrhage and coincided infections) had a p value of less than 0.2. Using these seven input variables, ANN and LR models predicted shunt infection with an accuracy of 83.1 % (AUC; 91.98 %, 95 % CI) and 55.7 % (AUC; 76.5, 95 % CI), respectively. The contribution of the factors in the predictive performance of ANN in descending order was history of shunt revision, low birth weight (under 2000 g), history of prematurity, the age at the first shunt procedure, history of intraventricular hemorrhage, history of myelomeningocele, and coinfection. The findings show that artificial neural networks can predict shunt infection with a high level of accuracy in children with shunted hydrocephalus. Also, the contribution of different risk factors in the prediction of shunt infection can be determined using the trained network.

  8. The orbital volume measurement in patients with ventriculoperitoneal shunt.

    PubMed

    Kim, Jong-Min; Chang, Moo-Hwan; Kyung, Sungeun E

    2015-01-01

    Enophthalmos occurs from the increased bony volume or decreased soft tissue volume in the orbit and can be caused in patients with long-term ventriculoperitoneal (VP) shunt. This study tried to find out the change of orbital volume by measuring the orbital volume before and after operation in adult patients who underwent VP shunt for hydrocephalus. The 2 evaluators measured orbital volume by using ITK-SNAP 2.4 program with double-blind test for computed tomography images before and after operation targeting 36 patients over the age of 18 who underwent VP shunt with pressure-controlled valve from 2003 to 2011. Wilcoxon matched-pairs signed-rank test of GraphPad software was used to statistically analyze the difference in orbital volume change before and after operation. In case of mean pre-op orbital volume of total 36 patients, the right was measured as 23.72 ± 4.65 cm(3), the left as 23.47 ± 4.61 cm(3), the post-op right as 24.67 ± 4.70 cm(3), and the left as 24.18 ± 4.63 cm(3), showing no statistically significant difference (P = 0.106). The mean pre-op orbital volume of 14 people (28 eyes) followed for more than 11 months was 25.06 ± 4.58 cm(3) in the right and 24.4 ± 5.02 cm(3) in the left and the mean post-op orbital volume was 27.0 ± 4.28 cm(3) in the right and 25.76 ± 3.92 cm(3) in the left, showing statistically significant differences in the change of the volume before and after shunt operation (P = 0.0057). In patients who maintain long-term shunt devices after VP shunt, remodeling of matured orbital bone may be caused due to the change in pressure gradient between cranial cavity and orbit and the possible occurrence of resulting secondary enophthalmos by increased orbital volume should be considered.

  9. Morphological studies of pulmonary arteriovenous shunting in a lamb model of superior cavopulmonary anastomosis.

    PubMed

    McMullan, David Michael; Reddy, Vadiyala Mohan; Gottliebson, William M; Silverman, Norman H; Perry, Stanton B; Chan, Frandics; Hanley, Frank Louis; Riemer, Robert Kirk

    2008-07-01

    We sought to identify and characterize the abnormal vascular structures responsible for pulmonary arteriovenous shunting following the Glenn cavopulmonary shunt. Superior cavopulmonary shunt is commonly performed as part of the staged pathway to total cavopulmonary shunt to treat univentricular forms of congenital heart disease, however, clinically significant pulmonary arteriovenous malformations develop in some patients after the procedure. The causes of pulmonary arteriovenous malformations and other pulmonary vascular changes that occur after cavopulmonary shunt are not known. Using a juvenile lamb model of superior cavopulmonary anastomosis that reliably produces pulmonary arteriovenous malformations, we performed echocardiography and morphological analyses to determine the anatomic site of shunting and to identify the vascular structures involved. Pulmonary arteriovenous shunting was identified by contrast echocardiography in all surviving animals (n = 40) following superior cavopulmonary anastomosis. Pulmonary vascular corrosion casts revealed abnormal tortuous vessels joining pulmonary arteries and veins in cavopulmonary shunt animals but not control animals. In conclusion, unusual channels that bridged pulmonary arteries and veins were identified. These may represent the vascular structures responsible for arteriovenous shunting following the classic Glenn cavopulmonary shunt. Detailed analysis of these structures may elucidate factors responsible for their development.

  10. Management of Ventriculoperitoneal Shunt Infections in Adults: Analysis of Risk Factors Associated With Treatment Failure.

    PubMed

    Pelegrín, Iván; Lora-Tamayo, Jaime; Gómez-Junyent, Joan; Sabé, Nuria; García-Somoza, Dolors; Gabarrós, Andreu; Ariza, Javier; Viladrich, Pedro Fernández; Cabellos, Carmen

    2017-04-15

    Little is known regarding the optimal treatment of ventriculoperitoneal (VP) shunt infections in adults. Our aim was to assess the efficacy of treatment strategies and to identify factors that predict failure. Retrospective, observational study of patients aged ≥12 years with VP shunt infections (1980 -2014). Therapeutic approaches were classified under 4 headings: only antibiotics (OA), one-stage shunt replacement (OSSR), two-stage shunt replacement (TSSR), and shunt removal without replacement (SR). The primary endpoint was failure of the treatment strategy, defined as the absence of definite cerebrospinal fluid (CSF) sterilization or related mortality. The parameters that predicted failure were analyzed using logistic regression. Of 108 episodes (51% male, median age 50 years), 86 were analyzed. Intravenous antibiotics were administered for a median of 19 days. Eighty episodes were treated using strategies that combined antibiotic and surgical treatment (37 TSSR, 24 SR, 19 OSSR) and 6 with OA. Failure occurred in 30% of episodes, mostly due to lack of CSF sterilization in OSSR and OA groups. Twelve percent died of related causes and 10% presented superinfection of the CSF temporary drainage/externalized peritoneal catheter. TSSR was the most effective strategy when VP shunt replacement was attempted. The only independent risk factor that predicted failure was retention of the VP shunt, regardless of the strategy. This is the largest series of VP shunt infections in adults reported to date. VP shunt removal, particularly TSSR when the patient is shunt dependent, remains the optimal choice of treatment and does not increase morbidity.

  11. Emergency portacaval shunt versus rescue portacaval shunt in a randomized controlled trial of emergency treatment of acutely bleeding esophageal varices in cirrhosis--part 3.

    PubMed

    Orloff, Marshall J; Isenberg, Jon I; Wheeler, Henry O; Haynes, Kevin S; Jinich-Brook, Horacio; Rapier, Roderick; Vaida, Florin; Hye, Robert J

    2010-11-01

    Emergency treatment of bleeding esophageal varices in cirrhosis is of singular importance because of the high mortality rate. Emergency portacaval shunt is rarely used today because of the belief, unsubstantiated by long-term randomized trials, that it causes frequent portal-systemic encephalopathy and liver failure. Consequently, portacaval shunt has been relegated solely to salvage therapy when endoscopic and pharmacologic therapies have failed. Is the regimen of endoscopic sclerotherapy with rescue portacaval shunt for failure to control bleeding varices superior to emergency portacaval shunt? A unique opportunity to answer this question was provided by a randomized controlled trial of endoscopic sclerotherapy versus emergency portacaval shunt conducted from 1988 to 2005. Unselected consecutive cirrhotic patients with acute bleeding esophageal varices were randomized to endoscopic sclerotherapy (n = 106) or emergency portacaval shunt (n = 105). Diagnostic workup was completed and treatment was initiated within 8 h. Failure of endoscopic sclerotherapy was defined by strict criteria and treated by rescue portacaval shunt (n = 50) whenever possible. Ninety-six percent of patients had more than 10 years of follow-up or until death. Comparison of emergency portacaval shunt and endoscopic sclerotherapy followed by rescue portacaval shunt showed the following differences in measurements of outcomes: (1) survival after 5 years (72% versus 22%), 10 years (46% versus 16%), and 15 years (46% versus 0%); (2) median post-shunt survival (6.18 versus 1.99 years); (3) mean requirements of packed red blood cell units (17.85 versus 27.80); (4) incidence of recurrent portal-systemic encephalopathy (15% versus 43%); (5) 5-year change in Child's class showing improvement (59% versus 19%) or worsening (8% versus 44%); (6) mean quality of life points in which lower is better (13.89 versus 27.89); and (7) mean cost of care per year ($39,200 versus $216,700). These differences were

  12. Could there be light at the end of the tunnel? Mesocaval shunting for refractory esophageal varices in patients with contraindications to transjugular intrahepatic portosystemic shunt

    PubMed Central

    Davis, Jessica; Chun, Albert K; Borum, Marie L

    2016-01-01

    Cirrhotic patients with recurrent variceal bleeds who have failed prior medical and endoscopic therapies and are not transjugular intrahepatic portosystemic shunt candidates face a grim prognosis with limited options. We propose that mesocaval shunting be offered to this group of patients as it has the potential to decrease portal pressures and thus decrease the risk of recurrent variceal bleeding. Mesocaval shunts are stent grafts placed by interventional radiologists between the mesenteric system, most often the superior mesenteric vein, and the inferior vena cava. This allows flow to bypass the congested hepatic system, reducing portal pressures. This technique avoids the general anesthesia and morbidity associated with surgical shunt placement and has been successful in several case reports. In this paper we review the technique, candidate selection, potential pitfalls and benefits of mesocaval shunt placement. PMID:27429715

  13. Pericardio-Amniotic Shunting for Incomplete Pentalogy of Cantrell.

    PubMed

    Engels, Alexander C; Debeer, Anne; Russo, Francesca M; Aertsen, Michael; Aerts, Katleen; Miserez, Marc; Deprest, Jan; Lewi, Liesbeth; Devlieger, Roland

    2017-01-01

    A 27-year-old woman, gravida 2, para 0, presented with an incomplete Pentalogy of Cantrell with an omphalocele, diaphragmatic hernia, and a pericardial defect at 32 weeks' gestation. A large pericardial effusion compressed the lungs and had led to a reduced lung growth with an observed-to-expected total lung volume of 28% as measured by MRI. The effusion disappeared completely after the insertion of a pericardio-amniotic shunt at 33 weeks. After birth, the newborn showed no signs of pulmonary hypoplasia and underwent a surgical correction of the defect. Protracted wound healing and a difficult withdrawal from opioids complicated the neonatal period. The child was discharged on postnatal day 105 in good condition. This case demonstrates that in case of Pentalogy of Cantrell with large pericardial effusion, the perinatal outcome might be improved by pericardio-amniotic shunting.

  14. Hepatic encephalomyelopathy in a calf with congenital portosystemic shunt (CPSS).

    PubMed

    Marçal, Valéria Café; Oevermann, Anna; Bley, Tim; Pfister, Patrizia; Miclard, Julien

    2008-03-01

    A 4-month-old female Holstein Friesian calf was referred to the Veterinary Teaching Hospital, University of Berne, Switzerland for evaluation of ataxia, weakness, apathy and stunted growth. Clinical examination revealed generalized ataxia, propioceptive deficits, decreased menace response and sensibility. Postmortem examination did not reveal macroscopic changes of major organs. Histologically, the brain and the spinal cord lesions were characterized by polymicrocavitation, preferentially affecting the white matter fibers at the junction of grey and white matter and by the presence of Alzheimer type II cells. The liver revealed lesions consistent with a congenital portosystemic shunt, characterized by increased numbers of arteriolar profiles and hypoplasia to absence of portal veins. The pathological investigations along with the animal history and clinical signs indicated a hepatic encephalomyelopathy due to a congenital portosystemic shunt.

  15. Failure of a Torkildsen shunt after functioning for 50 years.

    PubMed

    Zinn, Pascal O; Bozinov, Oliver; Burkhardt, Jan-Karl; Reisch, Robert; Yaşargil, M Gazi; Bertalanffy, Helmut

    2010-04-01

    Mechanical obstruction is a severe complication of ventricular catheter use. Its incidence was shown to be high in the 1960s and 1970s, with up to 41% of the catheters becoming obstructed within 10 years after surgery. The authors present what is to their knowledge the first reported case of a patient with failure of a Torkildsen shunt after 50 years of functioning. A 60-year-old woman presented with increasing gait ataxia, decline in cognitive functions (including short-term memory loss), and slight urinary incontinence. The diagnosis of hydrocephalus and thus malfunction of the Torkildsen shunt implanted 50 years previously was confirmed by MR images, which revealed a prominent triventricular hydrocephalus. The patient subsequently underwent endoscopic third ventriculostomy (ETV), the current surgical treatment of choice, resulting in total resolution of her neurological symptoms and amelioration of cerebral tissue distension. Decrease in ventricle dilation and success of the ETV were confirmed on postoperative follow-up MR images.

  16. Ateriovenous subclavia-shunt for head and neck reconstruction.

    PubMed

    Depprich, Rita A; Naujoks, Christian D; Meyer, Ulrich; Kübler, Norbert R; Handschel, Jörg G

    2008-11-24

    Reconstruction of the facial hard- and soft tissues is of special concern for the rehabilitation of patients especially after ablative tumor surgery has been performed. Impaired soft and hard tissue conditions as a sequelae of extensive surgical resection and/or radiotherapy may impede common reconstruction methods. Even free flaps may not be used without interposition of a vein graft as recipient vessels are not available as a consequence of radical neck dissection. We describe the reconstruction of the facial hard- and soft tissues with a free parasacpular flap in a patient who had received ablative tumor surgery and radical cervical lymphadenectomy as a treatment regimen for squamous cell carcinoma (SCC). To replace the missing cervical blood vessels an arteriovenous subclavia-shunt using a saphena magna graft was created. Microvascular free flap transfer was performed as a 2-stage procedure two weeks after the shunt operation. The microvascular reconstructive technique is described in detail.

  17. Discrete shunt controls in a Newton optimal power flow

    SciTech Connect

    Liu, W.H.E. ); Papa Iexopoulos, A.D. )

    1992-11-01

    Efficient and effective methods are needed for modeling discrete control actions in optimal power flow algorithms. Modeling discrete controls as continuous variables and rounding them off to the nearest steps is not satisfactory for controls with large step sizes such as shunt capacitors and reactors because it can significantly degrade optimality. Rigorous solution with discrete controls would involve a combinatorial research procedure which would be unacceptably slow for real-time applications. In this paper a penalty based discretization algorithm is proposed. The algorithm consistently provides a near optimal discrete solution for shunt controls without combinatorial search. It has been implemented in a production grade Newton optimal power flow program and tested on two actual power networks. Test results are reported.

  18. [Work condition of electricians servicing railway shunting and maneuvering yards].

    PubMed

    Talivanova, R V; Elizarov, B B; Kudrin, V A; Ovechkina, Zh V

    1995-01-01

    The article represents main occupational hazards and work conditions of such railway occupation as electromechanic and electromounter of shunting yards of railway stations. Complete hygienic evaluation of the occupational activities is given for individuals working at Moskovskaya, Oktjabrskaya and Sevemaya railroads. Health state of the workers was studied according to transitory disablement materials, the morbidity and its structure were analyzed. The authors outline some suggestions to improve the work conditions and decrease the morbidity.

  19. Development of pulmonary arteriovenous fistulae in children after cavopulmonary shunt.

    PubMed

    Bernstein, H S; Brook, M M; Silverman, N H; Bristow, J

    1995-11-01

    The cavopulmonary shunt procedure is now used for palliation of complex congenital heart lesions in infants. While pulmonary arteriovenous fistulae (PAVF) are a well-known complication of this surgery in older patients, no study of the prevalence of this condition in children and young infants has been reported. We compared 29 patients with cavopulmonary shunts or total caval exclusion with 53 control subjects evaluated by contrast echocardiography at the University of California, San Francisco. The primary cardiac lesion, age at the time of surgery, type of right heart bypass procedure, provision of auxiliary pulmonary blood flow, and changes in oxygen saturation over time were compared. The prevalence of PAVF in children after cavopulmonary anastomosis is 60%, higher than previously reported. The prevalence is significantly higher in infants < 6 months old and in those with a heterotaxy syndrome. The provision of an additional source of pulsatile, pulmonary blood flow appears to have little effect on the development of PAVF. Patients who developed PAVF had arterial oxygen saturations at the time of discharge from surgery similar to those who did not develop them. Those with PAVF had significantly lower arterial and pulmonary venous oxygen saturations at follow-up as a result of their intrapulmonary shunt. Contrast echocardiography provides a sensitive method for the detection of PAVF. While the origins, natural history, and ultimate clinical significance of PAVF in children after cavopulmonary anastomosis are unclear, surveillance by contrast echocardiography is indicated for all patients who have had this procedure because PAVF may cause significant intrapulmonary right-to-left shunting in some patients.

  20. Late systemic desaturation after total cavopulmonary shunt operations.

    PubMed Central

    Stümper, O.; Wright, J. G.; Sadiq, M.; De Giovanni, J. V.

    1995-01-01

    OBJECTIVES--To assess the medium-term results of total cavopulmonary shunt operations in children with left atrial isomerism, interrupted inferior vena cava, and complex congenital heart defects. BACKGROUND--Creation of a total cavopulmonary shunt provides very good interim palliation for children with interrupted inferior vena cava and complex congenital heart disease; however, longer term results after this operation have not been reported. METHODS--Detailed follow up of six children who underwent creation of a total cavopulmonary shunt at a tertiary referral centre. RESULTS--There were no early or late deaths. Oxygen saturations at discharge ranged from 89% to 92% (mean 90%). At last follow up (mean 4.7 years) saturations at rest ranged from 73% to 81% (mean 77%) (P < 0.05). All patients underwent exercise stress testing. At peak exercise oxygen saturations ranged from 62% to 87% (mean 71.5%) and during recovery from 68% to 85% (mean 78%). Cardiac catheterisation was performed in five patients with saturations of less than 80% at rest or peak exercise. No patient had pulmonary arteriovenous fistula. Systemic venous to hepatic venous collaterals were documented in four patients. These were localised below the diaphragm in three and above the diaphragm in one patient. The collateral vessel was successfully embolised in three of these patients, with a rise in resting oxygen saturations from 6 to 10% (mean 7%). CONCLUSIONS--The development of systemic venous to hepatic venous collaterals is a common complication in patients who undergo a total cavopulmonary shunt operation. This can lead to significant desaturation at rest and during exercise. Detailed angiographic studies of the infradiaphragmatic system veins is required for diagnosis. Transcatheter embolisation of such vessels gives good relief. Images PMID:7547023

  1. Cardiac Perforation and Tamponade During Transjugular Intrahepatic Portosystemic Shunt Placement

    SciTech Connect

    McCowan, Timothy C.; Hummel, Michael M.; Schmucker, Tracey; Goertzen, Timothy C.; Culp, William C.; Habbe, Thomas G.

    2000-07-15

    A patient developed acute severe hemodynamic compromise during a transjugular intrahepatic portosystemic shunt (TIPS) procedure for intractable ascites. Rapid clinical and radiographic evaluation of the patient disclosed pericardial blood and cardiac tamponade as the cause, probably due to right heart perforation from guidewire and catheter manipulation. The tamponade was successfully treated percutaneously, and the patient survived. Cardiac tamponade should be considered in the differential diagnosis of patients who develop hypotension during TIPS placement.

  2. A unique multipurpose damping circuit for shunt capacitor bank switching

    SciTech Connect

    Sabot, A.; Morin, C.; Guillaume, C.; Pons, A. . Les Renardieres Lab.); Taisne, J.P. . Transmission Division); Pizzo, G.L.; Morf, H.U. )

    1993-07-01

    Considerations on disturbances related to Shunt Capacitor Bank (SCB) switching are summarized and a unique damping circuit able to cope with all of them is proposed. This damping circuit consists of a reactor in parallel with a resistor which is in series with a Metal Oxide Varistor (MOV), the latter being used to switch on the resistor only during transients. The design parameter of this damping circuit are described and the main tests performed are presented.

  3. Overvoltage protection of shunt-capacitor banks using MOV arresters

    SciTech Connect

    McGranaghan, M.F.; Gresham, D.W.; Law, S.W.; Reid, W.E.

    1984-08-01

    This paper evaluates using metal-oxide-varistor (MOV) surge arresters to protect shunt-capacitor banks from overvoltages. Protection requirements and surge arrester duties are analyzed for both lightning transients and switching-surge overvoltages, using both digital and transient network analyzer (TNA) simulations. Simple analytical expressions are developed for evaluating arrester duty as a function of capacitor bank size. Guidelines and limitations for applying arresters at grounded- a

  4. Results of Trabectome Surgery Following Failed Glaucoma Tube Shunt Implantation

    PubMed Central

    Mosaed, Sameh; Chak, Garrick; Haider, Asghar; Lin, Ken Y.; Minckler, Don S.

    2015-01-01

    Abstract To evaluate the safety and efficacy of Trabectome after failed tube shunt surgery. Twenty patients with prior failed tube shunt surgery who underwent Trabectome alone were included. All patients had at least 3 months of follow-up. Outcomes measured included intraocular pressure (IOP), glaucoma medications, and secondary glaucoma surgeries. The success for Kaplan–Meier survival analysis is defined as IOP ≤21 mm Hg, IOP reduced by at least 20% from preoperative IOP, and no secondary glaucoma surgery. Mean preoperative IOP was 23.7 ± 6.4 mm Hg and mean number of glaucoma medications was 3.2 ± 1.5. At 12 months, IOP was reduced to 15.5 ± 3.2 mm Hg (P = 0.05) and number of medications was reduced to 2.4 ± 1.5 (P = 0.44). Survival rate at 12 months was 84% and 3 patients required additional glaucoma surgery with 15 patients reaching 12 months follow-up. Other than failure of IOP control and transient hypotony (IOP < 3 mm Hg) day 1 in 2 cases, there were no adverse events. Trabecular bypass procedures have traditionally been considered an approach appropriate for early-to-moderate glaucoma; however, our study indicates benefit in refractory glaucoma as well. Eyes that are prone to conjunctival scarring and hypertrophic wound healing, such as those who have failed tube shunt surgery, may benefit from procedures that avoid conjunctival incision such as Trabectome. This study indicates potential benefits in this patient population. Trabectome was safe and effective in reducing IOP at 1-year follow-up in patients with prior failed tube shunt surgery, but not effective in reducing medication reliance in these patients. PMID:26222842

  5. Switching of High-Voltage Cable Lines with Shunt Reactors

    SciTech Connect

    Sheskin, E. B.; Evdokunin, G. A.

    2016-05-15

    The problem of disconnecting high-voltage cable lines with shunt reactors by SF{sub 6} circuit breakers is discussed. In these schemes it is possible to have a significant aperiodic component of the circuit breaker current that can prevent opening of the breaker. The authors propose methods for application to cable transmission lines which they believe will be optimal for ensuring normal disconnects.

  6. Spontaneous thrombosis of a basilar tip aneurysm after ventriculoperitoneal shunting

    PubMed Central

    Pop, Raoul; Chibarro, Salvatore; Manisor, Monica; Proust, Francois; Beaujeux, Remy

    2015-01-01

    We present a case of a large unruptured basilar tip aneurysm with concomitant hydrocephalus. Complete thrombosis of the aneurysm was observed after ventriculoperitoneal shunting. Analyzing preoperative and postoperative MRI and DSA images, we identified reduced intracranial pressure and widening of the aneurysm–artery inclination angle as possible factors influencing spontaneous thrombosis. To the best of our knowledge, this is the first report of aneurysm thrombosis occurring after CSF diversion. PMID:26150627

  7. [The congenital portosystemic shunt in dogs and cats. I].

    PubMed

    Grevel, V; Schmidt, S; Lettow, E; Suter, P F; Schmidt, G U

    1987-01-01

    An overview of the circulation of the liver and of the pathogenesis of hepatic encephalopathy as a result of portal vascular anomalies is given. Clinical signs associated with portal systemic shunts are described on the basis of 16 cases, 14 dogs and 2 cats. These animals ranged in age at the time of presentation from 4 months to 7 years. The predominant abnormality observed were central nervous signs, which differed in severity. 15 animals showed a reduction in liver size. The different techniques of contrast angiography allowing demonstration of a portal systemic shunt are presented along with a discussion of the pros and cons of each. Additionally the significance of making portal venous pressure measurements prior to each angiography is also explained. In most cases mesenteric portography was chosen. Based on their location the anomalies could be categorized as intrahepatic (4 dogs) or extrahepatic (10 dogs, 2 cats). In both groups breeds of various size are represented. The extrahepatic shunts could be further described as portal-caval (n = 5), portal-phrenic (n = 4) and portal-azygos (n = 3). In five of the older animals angiography showed in addition some hepatic perfusion by the portal vein. Laboratory evaluation revealed increased resting blood ammonia concentrations (greater than 200-912 micrograms/100 ml) in all animals. Seven dogs had definitely subnormal BUN concentrations (less than 10 mg%) and ten dogs low total plasmaprotein levels (less than 5.4 g%). Free amino acids (24) were determined in four dogs and a lowered hepatic encephalopathy index (less than 1.64) was found. Medical palliative therapy to control the clinical signs is discussed. The only effective long term therapy is, however, surgery. The shunt vessel is narrowed so that a greater volume of portal blood reaches the liver. Experience gained from the surgical therapy of 14 animals is presented. Ten of these survived well without requiring further therapy at a later time. Finally the

  8. Modified Blalock-Taussig Shunt with an Umbilical Vein Graft

    PubMed Central

    Leão, Luiz Eduardo V.; Andrade, José Carlos S.; Succi, José Ernesto; Cueva, Clotario C.; Ribeiro, Expedito E.; Carvalho, Antonio Carlos C.; Buffolo, Enio

    1985-01-01

    We describe a modification of the Blalock Taussig anastomosis, with the interposition of a glutaraldehyde-tanned umbilical vein graft between the subclavian and pulmonary arteries. This operation was performed in 64 children: 11 were less than 1 month of age (17.2%), and 23 were between 1 and 6 months of age (34.9%). Hospital deaths occurred in six patients—all less than 6 months of age (9.4%). There was no instance of shunt occlusion noted. The clinical course was uneventful among survivors, except for one patient who died of endocarditis in the late postoperative follow-up. The shunt procedure may be performed very rapidly, with minimal dissection, allowing the use of a graft larger than the diameter of the subclavian artery. This modification of the Blalock Taussig operation compares favorably with our previous experience with other shunt procedures and may be considered a valuable alternative in the palliative surgical treatment of several malformations with severe pulmonary oligemia. Images PMID:15227043

  9. Extremely rare complications in cerebrospinal fluid shunt operations.

    PubMed

    Surchev, J; Georgiev, K; Enchev, Y; Avramov, R

    2002-06-01

    The cerebrospinal fluid shunt operation, from its first realization in 1908 by Kausch till our days, is still of a significant importance for the long-term treatment of the internal hydrocephalus. Well known are many complications connected with the use of the valve systems (malfunction, infectious, overdrainage, secondary craniosynostosis and etc.). For a period of 17 years (1984-2000) at the Clinic of Pediatric Neurosurgery, Department of Neurosurgery, Sofia Medical University, 414 cerebrospinal fluid shunt operations were performed on children. 216 were drained to the right atrium of the heart, 198 to the peritoneal cavity. They were followed up by catamnesis until the year 2001. The authors describe 2 extremely rare cases with post-shunt complication as a result of a malfunction of the valve system, owing to a migration of the distal catheter: 1) in the anus; 2) in the urethra. In the first case the distal catheter perforated the colon transversum and by the way of the intestines went out through the anus. In the second case the distal catheter protruded out of the body through the bladder and the urethra. Their clinical appearance, the diagnostic examinations and the operative treatment are shown.

  10. A case of giant arteriovenous shunt in a renal carcinoma.

    PubMed

    Rangel, A; Albarrán, H; Gómez-Orta, F; Soriano, M; Baduí, E

    1997-01-01

    We present the case of a 51 year-old-white male with a giant right renal arteriovenous fistula secondary to a carcinoma. Neither the aorta nor the kidneys were visualized after the injection of 60 mL of contrast media into the abdominal aorta. Moreover, the right kidney could not be visualized after 30 mL of contrast media were injected selectively into the right renal artery. This was due to a great arteriovenous shunt through the right kidney. The right renal angiogram was obtained through digital imaging, after injecting contrast media into the right renal artery, previously occluded by a balloon-catheter. The image of an hypervascularized nephroma was obtained, depicting an important arteriovenous shunt of the contrast material toward the inferior vena cava from a fistula located in the right inferior renal pole. The occlusion of the right renal artery was partially achieved by injecting 40 mL of boiling contrast media, followed by small fragments of Gelfoam suspended in the contrast substance. The balloon-catheter remained inflated in the right renal artery until a nephrectomy was performed. As far as we know, a case in which the aorta and renal circulation are unable to be seen by means of conventional angiography, because of the presence of a renal arteriovenous shunt to the fistula, has not been described.

  11. Sodium accumulation at potential-induced degradation shunted areas in polycrystalline silicon modules

    SciTech Connect

    Harvey, Steven P.; Aguiar, Jeffery A.; Hacke, Peter; Guthrey, Harvey; Johnston, Steve; Al-Jassim, Mowafak

    2016-09-19

    Here, we investigated potential-induced degradation (PID) in silicon mini-modules that were subjected to accelerated stressing to induce PID conditions. Shunted areas on the cells were identified with photoluminescence and dark lock-in thermography (DLIT) imaging. The identical shunted areas were then analyzed via time-of-flight secondary-ion mass spectrometry (TOFSIMS) imaging, 3-D tomography, and high-resolution transmission electron microscopy. The TOF-SIMS imaging indicates a high concentration of sodium in the shunted areas, and 3-D tomography reveals that the sodium extends more than 2 um from the surface below shunted regions. Transmission electron microscopy investigation reveals that a stacking fault is present at an area identified as shunted by DLIT imaging. After the removal of surface sodium, tomography reveals persistent sodium present around the junction depth of 300 nm and a drastic difference in sodium content at the junction when comparing shunted and nonshunted regions.

  12. Chemoembolic Hepatopulmonary Shunt Reduction to Allow Safe Yttrium-90 Radioembolization Lobectomy of Hepatocellular Carcinoma

    SciTech Connect

    Gaba, Ron C.; VanMiddlesworth, Kyle A.

    2012-12-15

    Yttrium-90 ({sup 90}Y) radioembolization represents an emerging transcatheter treatment option for the management of hepatocellular carcinoma (HCC). Elevation of the hepatopulmonary shunt fraction risks nontarget radiation to the lungs and may limit the use of {sup 90}Y therapy in patients with locally advanced disease with vascular invasion, who often demonstrate increased shunting. We present two cases in which patients with HCC and portal vein invasion resulting in elevated hepatopulmonary shunt fractions underwent chemoembolic shunt closure to allow safe {sup 90}Y radioembolization. Both patients demonstrated excellent tumor response and patient survival. On this basis, we propose a role for chemoembolic reduction of the lung shunt fraction before {sup 90}Y radioembolization in patients with extensive tumor-related hepatopulmonary shunting.

  13. Post Blalock-Taussig shunt mediastinal mass - a single shadow with two different destinies.

    PubMed

    Rohit, Manoj Kumar; Vadivelu, Ramalingam; Khandelwal, Niranjan; Krishna, Satheesh

    2014-01-01

    The modified Blalock-Taussig shunt is a synthetic shunt between the subclavian and pulmonary artery, used in the treatment of congenital cyanotic heart diseases with pulmonary hypoperfusion. Delayed complications include progressive failure of the shunt, serous fluid leak, and pseudoaneurysm formation. We report two different and rare mediastinal vascular complications following modified BT shunt surgery in this case report. The first one is a seroma, due to serous fluid leakage through the shunt graft, which is a relatively benign complication. The second one is a pseudoaneurysm, arising from the shunt, a frequently fatal complication. Generally, X-ray chest is used for screening in these patients. CT angiography plays a vital role in the diagnosis of both these conditions. Management in pseudoaneurysm should be aggressive, as timely intervention may be life saving, while in seroma the management is most often conservative occasionally requiring surgical intervention.

  14. Sodium Accumulation at Potential-Induced Degradation Shunted Areas in Polycrystalline Silicon Modules

    SciTech Connect

    Harvey, Steven P.; Aguiar, Jeffery A.; Hacke, Peter; Guthrey, Harvey; Johnston, Steve; Al-Jassim, Mowafak

    2016-11-01

    We investigated potential-induced degradation (PID) in silicon mini-modules that were subjected to accelerated stressing to induce PID conditions. Shunted areas on the cells were identified with photoluminescence and dark lock-in thermography (DLIT) imaging. The identical shunted areas were then analyzed via time-of-flight secondary-ion mass spectrometry (TOFSIMS) imaging, 3-D tomography, and high-resolution transmission electron microscopy. The TOF-SIMS imaging indicates a high concentration of sodium in the shunted areas, and 3-D tomography reveals that the sodium extends more than 2 um from the surface below shunted regions. Transmission electron microscopy investigation reveals that a stacking fault is present at an area identified as shunted by DLIT imaging. After the removal of surface sodium, tomography reveals persistent sodium present around the junction depth of 300 nm and a drastic difference in sodium content at the junction when comparing shunted and nonshunted regions.

  15. Depiction of ventriculoperitoneal shunt obstruction with single-photon emission computed tomography/computed tomography

    PubMed Central

    Aksoy, Sabire Yılmaz; Vatankulu, Betül; Uslu, Lebriz; Halac, Metin

    2016-01-01

    An 83-year-old male patient with ventriculoperitoneal shunt underwent radionuclide shunt study using single-photon emission computed tomography/computed tomography (SPECT/CT) to evaluate the shunt patency. The planar images showed activity at the cranial region and spinal canal but no significant activity at the peritoneal cavity. However, SPECT/CT images clearly demonstrated accumulation of activity at the superior part of bifurcation level with no activity at the distal end of shunt as well as no spilling of radiotracer into the peritoneal cavity indicating shunt obstruction. SPECT/CT makes the interpretation of radionuclide shunt study more accurate and easier as compared with traditional planar images. PMID:27385906

  16. Chemoembolic hepatopulmonary shunt reduction to allow safe yttrium-90 radioembolization lobectomy of hepatocellular carcinoma.

    PubMed

    Gaba, Ron C; Vanmiddlesworth, Kyle A

    2012-12-01

    Yttrium-90 ((90)Y) radioembolization represents an emerging transcatheter treatment option for the management of hepatocellular carcinoma (HCC). Elevation of the hepatopulmonary shunt fraction risks nontarget radiation to the lungs and may limit the use of (90)Y therapy in patients with locally advanced disease with vascular invasion, who often demonstrate increased shunting. We present two cases in which patients with HCC and portal vein invasion resulting in elevated hepatopulmonary shunt fractions underwent chemoembolic shunt closure to allow safe (90)Y radioembolization. Both patients demonstrated excellent tumor response and patient survival. On this basis, we propose a role for chemoembolic reduction of the lung shunt fraction before (90)Y radioembolization in patients with extensive tumor-related hepatopulmonary shunting.

  17. Transjugular intrahepatic portosystemic shunt combined with esophagogastric variceal embolization in the treatment of a large gastrorenal shunt

    PubMed Central

    Jiang, Qin; Wang, Ming-Quan; Zhang, Guo-Bing; Wu, Qiong; Xu, Jian-Ming; Kong, De-Run

    2016-01-01

    AIM: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with stomach and esophageal variceal embolization (SEVE) in cirrhotic patients with a large gastrorenal vessel shunt (GRVS). METHODS: Eighty-one cirrhotic patients with gastric variceal bleeding (GVB) associated with a GRVS were enrolled in the study and accepted TIPS combined with SEVE (TIPS + SEVE), by which portosystemic pressure gradient (PPG), biochemical, TIPS-related complications, shunt dysfunction, rebleeding, and death were evaluated. RESULTS: The PPGs before TIPS were greater than 12 mmHg in 81 patients. TIPS + SEVE treatment caused a significant decrease in PPG (from 37.97 ± 6.36 mmHg to 28.15 ± 6.52 mmHg, t = 19.22, P < 0.001). The percentage of reduction in PPG was greater than 20% from baseline. There were no significant differences in albumin, alanine aminotransferase, aspartate aminotransferase, bilirubin, prothrombin time, or Child-Pugh score before and after operation. In all patients, rebleeding rates were 3%, 6%, 12%, 18%, and 18% at 1, 3, 6, 12, and 18 mo, respectively. Five patients (6.2%) were diagnosed as having hepatic encephalopathy. The rates of shunt dysfunction were 0%, 4%, 9%, 26%, and 26%, at 1, 3, 6, 12, and 18 mo, respectively. The cumulative survival rates in 1, 3, 6, 12, and 18 mo were 100%, 100%, 95%, 90%, and 90%, respectively. CONCLUSION: Our preliminary results indicated that the efficacy and safety of TIPS + SEVE were satisfactory in cirrhotic patients with GVB associated with a GRVS (GVB + GRVS). PMID:27458505

  18. A Case of Discontinued Proximal Limb of a Ventriculoperitoneal Shunt With Patent Fibrous Tract.

    PubMed

    Bermo, Mohammed; Leung, Alan S; Matesan, Manuela

    2016-06-01

    Radionuclide shuntogram is important in the evaluation of cerebrospinal fluid (CSF) shunts complications such as mechanical failure, malpositioning, pseudocyst, or overdrainage. We present here a case of congenital hydrocephalus and posterior fossa cyst with multiple shunt procedures and revisions with breakage of the proximal tube of the ventriculoperitoneal shunt but preserved CSF drainage through the patent fibrous tract. Careful correlation with SPECT/CT images helped confirm the breakage and exclude CSF leak outside of the tract, which was suspected on planar images.

  19. Spontaneous peritoneal catheter knot formation: A rare cause of ventriculoperitoneal shunt malfunction.

    PubMed

    Sher, Idrees; Gambhir, Shanu; Pinto, Sarah; Mujic, Asim; Peters-Willke, Jens; Hunn, Andrew

    2017-04-01

    Ventriculoperitoneal (VP) shunting remains invaluable in the management of hydrocephalus. It is a common procedure that can be complicated by shunt malfunction due to infection, blockage and disconnection. Spontaneous peritoneal catheter knot formation causing CSF flow obstruction is a rare phenomenon. We present a case of a 12years old boy with spontaneous knot formation in the peritoneal catheter causing VP shunt obstruction and hydrocephalus.

  20. Reversibility of intrapulmonary arteriovenous shunts in liver cirrhosis documented by serial radionuclide perfusion lung scans

    SciTech Connect

    Chen, N.S.; Barnett, C.A.; Farrer, P.A.

    1984-05-01

    Using serial perfusion lung scans, the opening up and closure of right-to-left intrapulmonary arteriovenous shunts has been documented over a period of several weeks in a patient with chronic alcoholic liver disease. The presence of the shunts correlates well with the severity of hypoxemia and the presence of nodular mottling on chest radiographs. The time course of these changes with clinical status suggests lability and the functional nature of these shunts.

  1. Breast Capsular Cerebrospinal Fluid Collection from Migration of a Ventriculoperitoneal Shunt Catheter

    PubMed Central

    Knaus, William J.; Kamali, Parisa; Chun, Yoon

    2016-01-01

    Summary: In this case report we have described an unusual complication of ventriculoperitoneal shunt migration into a breast implant capsule. The patient was appropriately diagnosed with computed tomographic imaging and successfully managed with shunt revision and cerebrospinal fluid aspiration. Given the high complication profile of ventriculoperitoneal shunt catheters, this case suggests an opportunity for improved perioperative communication between plastic surgeons and neurosurgeons in patients with breast implants. Coordination regarding the subcutaneous catheter tunneling may hopefully minimize the risk of this complication. PMID:27257570

  2. Time dependent pattern of cellular characteristics causing ventriculoperitoneal shunt failure in children.

    PubMed

    Sarkiss, Christopher A; Sarkar, Rajashree; Yong, William; Lazareff, Jorge A

    2014-12-01

    Ventriculoperitoneal shunt obstruction remains a major problem in pediatric neurosurgery. We analyzed the tissue reaction to ventriculoperitoneal shunts and compared the histology versus time elapsed to shunt failure. 85 ventricular catheter tissues samples obtained from 71 patients were reviewed along with time elapsed to shunt revision. Pathology reports of all tissue samples were divided into three categories: inflammatory based on the presence of lymphocytes, macrophages, and microglial cells; reactive based on the presence of fibro-connective tissue, reactive astrocytes, and Rosenthal fibers; and normal brain tissue based on presence of choroid plexus. These categories were then grouped according to time elapsed to shunt revision. Group I had those shunts revised <6 months, group II included shunts revised between 6 months and 3 years, while group III had shunts revised after more than 3 years. The incidence of inflammatory type of histology was 44% (16/36) in group I, 22% (6/27) in group II, and 18% (4/22) in group III. The reactive histology was 42% (15/36) in group I, 67% (18/27) in group II, and 77% (17/22) in group III. There was a clear noted difference of incidence between inflammatory versus reactive histology between early shunt failure compared to late shunt failure. Incidence of normal brain tissue remained high in group I with 8%, 11% in group II, and none in group III. Early shunt obstruction arises from pathologies different from those causing late shunt obstructions. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Intraabdominal complications secondary to ventriculoperitoneal shunts: CT findings and review of the literature.

    PubMed

    Chung, Jae-Joon; Yu, Jeong-Sik; Kim, Joo Hee; Nam, Se Jin; Kim, Myeong-Jin

    2009-11-01

    The purpose of our study was to evaluate the abdominopelvic CT findings of various intraabdominal complications secondary to ventriculoperitoneal shunts for hydrocephalus and to review the literature. The CT images of 70 patients (33 men and 37 women; mean age, 48.5 years) who underwent ventriculoperitoneal shunt placement and abdominopelvic CT because of shunt-related abdominal symptoms were reviewed retrospectively. CT images were analyzed with regard to the location of the shunting catheter tip; site, size, wall, and septa of localized fluid collection; peritoneal thickening; omentomesentery infiltration; abscess; bowel perforation; abdominal wall infiltration; and thickening of the catheter track wall. The mean period between the last ventriculoperitoneal shunting operation and CT was 11 months (range, 1 week to 115 months), and the mean number of ventriculoperitoneal shunting operations undergone was 1.4 (range, 1-6). A total of 76 ventriculoperitoneal shunting catheters were introduced in 70 patients: 64 patients had a unilateral catheter inserted and six patients had bilateral catheters inserted. Sixteen patients (22.9%) were pathologically diagnosed with ventriculoperitoneal shunt-related complications: 11 cases (15.7%) of shunt infection, six cases (8.6%) of CSF pseudocyst, four cases (5.7%) of abdominal abscess, three cases (4.3%) of infected fluid collection, and one case (1.4%) of bowel perforation. Microorganisms were cultured from the tip of the shunting catheter or peritoneal fluid in 11 patients (15.7%). On abdominopelvic CT, various intraabdominal complications secondary to ventriculoperitoneal shunt were shown, of which, shunt infection was the most common, followed by CSF pseudocyst, abscess, and infected fluid collection.

  4. Evaluation of Magnetostrictive Shunt Damper Performance Using Iron (Fe)-Gallium (Ga) Alloy

    DTIC Science & Technology

    2013-09-01

    Evaluation of Magnetostrictive Shunt Damper Performance Using Iron (Fe)-Gallium (Ga) Alloy by Andrew James Murray and Dr. JinHyeong Yoo...Aberdeen Proving Ground, MD 21005 ARL-TN-0566 September 2013 Evaluation of Magnetostrictive Shunt Damper Performance Using Iron (Fe... Magnetostrictive Shunt Damper Performance Using Iron (Fe)- Gallium (Ga) Alloy 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6

  5. Shunt assistant valve: bench test investigations and clinical performance.

    PubMed

    Tokoro, Kazuhiko; Suzuki, Shin-Ichi; Chiba, Yasuhiro; Tsuda, Masako

    2002-10-01

    We tested the flow characteristics of a new siphon-reducing device, the Shunt Assistant Valve trade mark (SAV) combined with a Codman-Hakim trade mark (CH) programmable valve and studied 4 clinical cases. We discussed the efficacy of the SAV at preventing low pressure syndrome secondary to overdrainage. In the horizontal position the closing pressure (CP) of the SAV was 0. The SAV was available in five different pressure ranges for the vertical position: 15, 20, 25, 30, and 35 cmH(2)O. A bench test was performed in order to obtain pressure-flow curves for the SAV under various conditions. We investigated the simulation of the postural change of the flow performance of the new device. We implanted an SAV in 4 patients who already had an implanted CH valve. Postural changes of the shunt flow and intracranial pressure (ICP) were measured before and after the addition of the SAV. Bench test: in the horizontal position the flow increased in proportion to the pressure difference. For all SAVs it reached 14 to 16 mL/min when the pressure difference was 50 cmH(2)O. A tantalum sphere determined the CP of the SAV with a maximum in the vertical position. The flow in the vertical position was significantly decreased in comparison with the horizontal position. The external pressures did not influence the flow. Simulation: in adults shunt flow in the supine position was sufficient at both the low and the high ICP stages. When the SAV 20 and the CH valve (CP=8 cmH(2)O) was used in the sitting position we found a reduction of the flow 70-80% compared with the flow-rate found for the CH valve alone. When the CP of the CH valve was adjusted up to 20 cmH(2)O, we found a further reduction of the flow of 27-50% in the sitting position and overdrainage was effectively prevented. With this combination the flow in the sitting position significantly decreased in paediatric hydrocephalus and became zero, indicating the possibility of underdrainage in children. in 4 patients with

  6. Embolization of portal-systemic shunts in cirrhotic patients with chronic recurrent hepatic encephalopathy

    SciTech Connect

    Sakurabayashi, Shin; Sezai, Shuichi; Yamamoto, Yoshihiro; Hirano, Masanori; Oka, Hiroshi

    1997-03-15

    Purpose. To evaluate the efficacy of embolization of portal-systemic shunts in cirrhotic patients with chronic recurrent hepatic encephalopathy (CRHE). Methods. Seven cirrhotic patients with CRHE refractory to medical treatment (3 men and 4 women, mean age 66 years) were studied. Five patients had splenorenal shunts, 1 had a gastrorenal shunt, and 1 had an intrahepatic portal vein-hepatic vein shunt. Shunt embolization was performed using stainless steel coils, with a percutaneous transhepatic portal vein approach in 4 patients and a transrenal vein approach in 3 patients. Results. After embolization, the shunt disappeared in 4 patients on either ultrasound pulsed Doppler monitoring or portography. Complications observed in the 7 patients were fever, transient pleural effusion, ascites, and mild esophageal varices. For 3-6 months after embolization, the 4 patients whose shunts disappeared showed minimal or no reappearance of a shunt, and had no recurrence of encephalopathy. The serum ammonia levels decreased and electroencephalograms also improved. One of the 4 patients, who developed mild esophageal varices, required no treatment. Treatment was effective in 3 of the 4 patients (75%) who underwent embolization via a transhepatic portal vein. Conclusion. Transvascular embolization of shunts improved the outcome in 4 of 7 patients. The most effective embolization was achieved via the percutaneous transhepatic portal vein approach.

  7. Optimization of shunt placement for the Norwood surgery using multi-domain modeling.

    PubMed

    Moghadam, Mahdi Esmaily; Migliavacca, Francesco; Vignon-Clementel, Irene E; Hsia, Tain-Yen; Marsden, Alison L

    2012-05-01

    An idealized systemic-to-pulmonary shunt anatomy is parameterized and coupled to a closed loop, lumped parameter network (LPN) in a multidomain model of the Norwood surgical anatomy. The LPN approach is essential for obtaining information on global changes in cardiac output and oxygen delivery resulting from changes in local geometry and physiology. The LPN is fully coupled to a custom 3D finite element solver using a semi-implicit approach to model the heart and downstream circulation. This closed loop multidomain model is then integrated with a fully automated derivative-free optimization algorithm to obtain optimal shunt geometries with variable parameters of shunt diameter, anastomosis location, and angles. Three objective functions: (1) systemic; (2) coronary; and (3) combined systemic and coronary oxygen deliveries are maximized. Results show that a smaller shunt diameter with a distal shunt-brachiocephalic anastomosis is optimal for systemic oxygen delivery, whereas a more proximal anastomosis is optimal for coronary oxygen delivery and a shunt between these two anatomies is optimal for both systemic and coronary oxygen deliveries. Results are used to quantify the origin of blood flow going through the shunt and its relationship with shunt geometry. Results show that coronary artery flow is directly related to shunt position.

  8. Biofilm-associated infection: the hidden face of cerebrospinal fluid shunt malfunction.

    PubMed

    Mounier, Roman; Kapandji, Natacha; Birnbaum, Ron; Cook, Fabrice; Rodriguez, Cristophe; Nebbad, Bibba; Lobo, David; Dhonneur, Gilles

    2016-12-01

    Diagnosis of cerebrospinal fluid (CSF) shunt infection is difficult. Growing evidence links this pattern to biofilm-associated infections (BAI). Biofilm may explain the indolent development of the infection, and the poor efficiency of traditional microbiologic methods. We report the case of a patient admitted for hydrocephalus associated to CSF shunt malfunction. None of the clinical, serum, or CSF laboratory findings were in favor of an infectious process. Only scanning electron microscopy (SEM) revealed the presence of biofilm. Hence, despite a broad CSF shunt infection definition, some infections could remain undiagnosed by the traditional approach. This study is the first to provide some direct evidence for bacterial biofilm-associated CSF shunt infection.

  9. A rare but life-threatening complication of ventriculo-atrial shunt.

    PubMed

    Tonn, P; Gilsbach, J M; Kreitschmann-Andermahr, I; Franke, A; Blindt, R

    2005-12-01

    Insertion of ventriculoperitoneal and ventriculoatrial shunts is routinely performed. Infarction pneumonia and atrial thrombus formation are described as very rare complications of ventriculoatrial shunts. We present the case of a female patient with ventriculoatrial shunt insertion as long term treatment for aequeductal stenosis who presented with recurrent episodes of dyspnoea, chest pain, and unilateral pleural effusion. Diagnostic evaluation revealed a positive D-dimer test, bilateral basal infiltrates and pleural effusion. Transesophageal echocardiography established the diagnosis of a thrombus in the right atrium. Laboratory testing for thrombophilia revealed a homozygous factor V Leiden mutation. In the following, a shunt revision was performed.

  10. [Peritoneal pseudocysts: complications of ventriculo-peritoneal shunts. Apropos of 3 cases].

    PubMed

    Badiane, S B; Sakho, Y; Kabre, A; Ba, M C; Fall, B; Ndoye, N; Badiane, M; Gueye, E M; Gueye, M

    1997-01-01

    From 1975 to 1995, 335 patients were operated for hydrocephalus in neurosurgical clinic of CHU Fann, and got ventriculo-peritoneal shunt. 3 cases of patients presenting an uncommon complication of ventriculo-peritoneal shunt: abdominal pseudo cyst, are reported and discussed. The digestive symptoms are the first to manifest themselves for a period of time, then confusing with other forms of abdominal cysts. The suggested treatment is to remove the shunt from the peritoneal cavity and perform a ventriculo-atrial shunt, then to proceed to a laparotomy, drain the fluid and resect the cyst wall. The results are excellent.

  11. Study on the Automatic Detection Method and System of Multifunctional Hydrocephalus Shunt

    NASA Astrophysics Data System (ADS)

    Sun, Xuan; Wang, Guangzhen; Dong, Quancheng; Li, Yuzhong

    2017-07-01

    Aiming to the difficulty of micro pressure detection and the difficulty of micro flow control in the testing process of hydrocephalus shunt, the principle of the shunt performance detection was analyzed.In this study, the author analyzed the principle of several items of shunt performance detection,and used advanced micro pressure sensor and micro flow peristaltic pump to overcome the micro pressure detection and micro flow control technology.At the same time,This study also puted many common experimental projects integrated, and successfully developed the automatic detection system for a shunt performance detection function, to achieve a test with high precision, high efficiency and automation.

  12. Combined phacoemulsification with ExPRESS shunt in angle closure glaucoma.

    PubMed

    Rao, Aparna

    2015-01-01

    A 60-year-old woman diagnosed with primary angle closure glaucoma with extensive peripheral anterior synechiae (PAS) and advanced glaucomatous optic neuropathy unresponsive to maximal medical treatment, underwent clear corneal phacoemulsification and ExPRESS (Alcon Inc, Fort Worth, TX) shunt surgery in the right eye with intraoperative placement tailored to avoid areas of PAS. Postoperatively her visual acuity in the right eye was 20/20 and intraocular pressure was 13 mm Hg with the shunt in place and functioning bleb at final follow-up. The ExPRESS shunt can be used in angle closure eyes with good outcomes after proper placement of the shunt.

  13. Combined phacoemulsification with ExPRESS shunt in angle closure glaucoma

    PubMed Central

    Rao, Aparna

    2015-01-01

    Summary A 60-year-old woman diagnosed with primary angle closure glaucoma with extensive peripheral anterior synechiae (PAS) and advanced glaucomatous optic neuropathy unresponsive to maximal medical treatment, underwent clear corneal phacoemulsification and ExPRESS (Alcon Inc, Fort Worth, TX) shunt surgery in the right eye with intraoperative placement tailored to avoid areas of PAS. Postoperatively her visual acuity in the right eye was 20/20 and intraocular pressure was 13 mm Hg with the shunt in place and functioning bleb at final follow-up. The ExPRESS shunt can be used in angle closure eyes with good outcomes after proper placement of the shunt. PMID:27330457

  14. Evaluation of Mismatch Losses due to Shunts in industrial Silicon Photovoltaic Modules

    NASA Astrophysics Data System (ADS)

    Somasundaran, P.; Shilpi, M.; Gupta, R.

    2017-05-01

    In order to achieve higher efficiencies in photovoltaic module technology, it is important to characterize the shunts and other defects which degrade the performance of cells and modules as well as decrease their efficiency. These shunts also affect the reliability of cells and modules. It is important to understand how much fill factor and power loss is caused by the presence of shunts in the module. Shunts not only reduce the module power output, but also affect the I-V characteristics of the cell and hence the characteristics of the shunted cells are different from those of the shunt-free cells connected in the module leading to the mismatch effect. This is an interesting effect which has been systematically investigated in the present work. Moreover, the flow of increased shunt current will give rise to increased temperature in the region of shunt, which will affect the cell and hence module performance. In the present study, the distributed diode model has been extended to the module level and applied to evaluate the electrical mismatch losses and thermal mismatch losses due to shunts in industrial Silicon PV modules.

  15. Robert H. Pudenz (1911-1998) and Ventriculoatrial Shunt: Historical Perspective.

    PubMed

    Konar, Subhas K; Maiti, Tanmoy K; Bir, Shyamal C; Kalakoti, Piyush; Nanda, Anil

    2015-11-01

    Robert H. Pudenz was a renowned neurosurgeon in North America in the 20th century, famous for his contributions in the evolution of the shunt valve and ventriculoatrial shunt surgery. With his innovative idea and help from Heyer, in 1955, he demonstrated that a venous catheter worked best when in the right atrium and that the slit valve should be located at the most distal portion of the shunt system to prevent retrograde filling and thrombosis. He also contributed to various experimental studies on the brain, especially the electrical response of different neural structures. This historical vignette focuses on the work of Robert Pudenz and the evolution of the ventriculoatrial shunt.

  16. Migration of the Abdominal Catheter of a Ventriculoperitoneal Shunt into the Mouth: A Rare Presentation

    PubMed Central

    Low, Shiong Wen; Sein, Lwin; Yeo, Tseng Tsai; Chou, Ning

    2010-01-01

    A 1-year-old boy with a history of exomphalos and hydrocephalus had surgeries to correct these pathologies. The ventriculopleural (VPL) shunt inserted for hydrocephalus was complicated by pleural effusion, for which a ventriculoperitoneal (VP) shunt was inserted on the contralateral side. He subsequently presented with protrusion of the distal VP shunt tip from the mouth due to perforation through the gastrointestinal tract. The child also had a history of peritonitis post-exomphalos repair, which may have predisposed him to this relatively uncommon shunt complication. Probable causes and risk factors of the perforation are discussed. PMID:22135552

  17. Thrombosed Mesocaval Shunt: Salvage by Mechanical Thrombolysis. Case Report and Review of the Literature

    SciTech Connect

    Baijal, Sanjay Saran Mohan, Suyash; Singh, Jagadeesh R.; Verma, Ashish

    2008-07-15

    We report the case of a 27-year-old male who presented with acute mesocaval shunt thrombosis, which was successfully managed by mechanical thrombolysis. Shunt thrombosis was suspected when the patient showed clinical signs and symptoms of obstructive jaundice in the immediate postoperative period. Doppler sonography showed absence of flow across the shunt, suggestive of thrombosis, which was mechanically thrombolyzed by a percutaneous approach. The portocaval pressure gradient noted at the end of procedure was <5 mm Hg. The shunt remained patent at the end of 3 months' follow-up.

  18. Ohmic shunts in two-terminal dual-junction solar cells with current mismatch

    NASA Astrophysics Data System (ADS)

    Oviedo, Felipe; Liu, Zhe; Ren, Zekun; Thway, Maung; Buonassisi, Tonio; Marius Peters, Ian

    2017-08-01

    The impact of ohmic shunts on the current-voltage characteristics of single junction solar cells is well understood. Yet, for monolithic dual-junction solar cells, the effects of shunts have far less been investigated, especially if there is a current mismatch between the two sub cells. In this work, we investigate theoretically and experimentally how current-voltage characteristics of a monolithic GaAs/GaAs tandem solar cell depend on shunts in the top or the bottom sub cell, when either of this sub cells is current limiting. The open-circuit voltage of the device is observed to transition to the open-circuit voltage of the non-shunted sub cell as the shunting increases. In the same way, the fill factor is found to be more significantly affected when ohmic shunts occur in the current-limiting sub cell. Finally, as the current-limiting sub cell is shunted, the short-circuit current of the device is observed to transition to the short-circuit current of the non-current-limiting sub cell. These results allow identifying the shunted sub cell and enable characterization of ohmic shunts under current limiting conditions in dual-junction solar cells.

  19. Ventriculo-peritoneal shunt malfunction due to complete migration and subgaleal coiling of the proximal and distal catheters.

    PubMed

    Pikis, Stylianos; Cohen, José E; Shoshan, Yigal; Benifla, Mony

    2015-01-01

    Ventriculo-peritoneal (VP) shunt malfunction due to proximal and distal catheter migration has been rarely reported in the literature. Shunt migration has been proposed to occur as a result of a combination of various mechanisms, including the windlass effect, retained memory of the shunt tubing, inadequate shunt fixation, and increased intra-abdominal pressures. We describe a rare case of a 6-week-old child who presented in our department with VP shunt malfunction due to complete proximal migration and coiling of the peritoneal and ventricular VP shunt catheters within a subgaleal pocket at the left occipital area.

  20. Is there an ideal shunt? A panoramic view of 110 years in CSF diversions and shunt systems used for the treatment of hydrocephalus: from historical events to current trends.

    PubMed

    Symss, Nigel Peter; Oi, Shizuo

    2015-02-01

    The goal of this study is to evaluate whether an "ideal shunt" exists. This is a retrospective analysis based on original papers in the field of Hydrocephalus and Shunts. Patients of all age groups, who had hydrocephalus, and underwent some form of CSF diversion were included. The study has been divided into four stages: from 1900 to 1949, 1950 to 1974, 1975 to 1999, and from 2000 to 2010. In stage 1 (historical era): Saphenous vein grafts, rubber conduits, and other materials were used in CSF diversions. In 1949, the first implantable shunt tube was developed by Nulsen. In stage 2 (experimental stage): the Holter valve was developed. Newer innovations were developed in relation to the ventriculo-atrial shunt, which was the preferred CSF diversion. In stage 3 (developmental stage), a large number of different design shunt systems were developed, with the aim of reducing complications. The ventriculo-peritoneal shunt had become the preferred CSF diversion. Also, the programmable valve was born. In stage 4 (era of programmable valve, there is a preference for the use of programmable shunt systems. However, shunt failure rate at 1 year being around 25 to 40%, and shunt survival at 1 and 2 years are 50-70 and 47-53% in most series. Every shunt is an ideal shunt provided the choice of the shunt used should be made by the matching performance of the shunt system to the altered profile of CSF dynamics of a given patient. The most important factor being the opening pressure.

  1. Comparison of right ventricle-pulmonary artery shunt position in the Single Ventricle Reconstruction trial.

    PubMed

    Andersen, Nicholas D; Meza, James M; Byler, Matthew R; Lodge, Andrew J; Hill, Kevin D; Hornik, Christoph P; Jaquiss, Robert D B

    2017-06-01

    Placement of a right ventricle-pulmonary artery shunt to the left or right of the neoaorta may influence reinterventions, pulmonary artery development, and survival after the Norwood procedure because of differences in shunt and pulmonary artery geometry and blood flow. We analyzed the Pediatric Heart Network Single Ventricle Reconstruction Trial public use dataset. Comparisons were made between patients who received a left- or right-sided right ventricle-pulmonary artery shunt during the Norwood procedure in both the overall (n = 274) and the propensity score-matched (67 pairs) patient cohorts. A left-sided shunt was placed in 168 patients (61%), and a right-sided shunt was placed in 106 patients (39%). At the 12-month follow-up, there were no differences in pulmonary artery measurements, hemodynamic measurements, or pulmonary artery reinterventions between shunt groups. However, the right-sided shunt was associated with fewer surgical shunt revisions in both the overall (8.3 vs 1.9 events per 100 infants, P = .05) and the propensity score-matched (17.9 vs 0 events per 100 infants, P < .001) patient cohorts. In the propensity score-matched cohort only, right-sided shunts were further associated with fewer serious adverse events (84 vs 46 events per 100 infants, P = .01) and improved transplantation-free survival at 3 years follow-up (61% [95% confidence interval, 48-72] vs 80% [95% confidence interval, 69-88], P = .04). In the Single Ventricle Reconstruction trial, right ventricle-pulmonary artery shunt placement to the right of the neoaorta was associated with fewer shunt revisions and may contribute to improved outcomes in select patients. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  2. Persistent hydrocephalus due to postural activation of a ventricular shunt anti-gravity device.

    PubMed

    Craven, Claudia L; Toma, Ahmed K; Watkins, Laurence D

    2017-03-01

    The ever present need to balance over drainage with under drainage in hydrocephalus has required innovations including adjustable valves with antigravity devices. These are activated in the vertical position to prevent siphoning. We describe a group of bedridden patients who presented with unexplained under drainage caused by activation of antigravity shunt components produced by peculiar head/body position. Retrospective single centre case series of hydrocephalus patients, treated with ventriculo-peritoneal (VP) shunt insertion between April 2014 - February 2016. These patients presented with clinical and radiological under drainage syndrome. Medical notes were reviewed for clinical picture and outcome. Radiological studies were reviewed assessing shunt placement and ventricular size. Seven patients presented with clinical and radiological under drainage syndrome. A consistent posturing of long term hyper-flexion of the neck whilst lying supine was observed. All patients had similar shunt construct (adjustable Miethke ProGAV valve and shunt assistant anti-gravity component). In each of those patients a hypothesis was formulated that neck flexion was activating the shunt assistance anti-gravity component in supine position. Five patients underwent shunt revision surgery removing the shunt assistant device from the cranium and adding an anti-gravity component to the shunt system at the chest. One had the shunt assistant completely removed and one patient was managed conservatively with mobilisation. All patients had clinical and radiological improvement. Antigravity shunt components implanted cranially in bedridden hydrocephalus patients will produce underdrainage due to head flexion induced anti-gravity device activation. In these patients, anti-gravity devices should be placed at the chest. Alternatively, special nursing attention should be paid to head-trunk angle.

  3. Bacterial contamination of surgeons gloves during shunt insertion: a pilot study.

    PubMed

    Sørensen, P; Ejlertsen, T; Aaen, D; Poulsen, K

    2008-10-01

    Bacterial infection is a major cause of shunt dysfunction. It is well-known that the majority of pathogenic micro-organisms are low-virulent bacteria normally found on intact skin. Probably shunts become contaminated during surgery either by contact to the patient skin, or contact from contaminated gloves or instruments. This study was performed to find out to what extent gloves become contaminated during shunt surgery. Gloves used during shunt implantation were examined in 10 operations. Shunt implantation was done using recommended precautions to avoid infection, including prophylactic antibiotics and double gloving, by surgeons experienced in shunt surgery. Surgical incision, dissection and tunnelling were done. Then the surgeon, the scrub-nurse and, in three cases, the assistant made an imprint of their outer gloves on agar plates. Hereafter, they changed the outer pair of gloves before handling the shunt and completing the operation. The plates were cultured for 6 days in both aerobic and anaerobic environment. In all cases the surgeons gloves were contaminated, and in six cases also the nurses' gloves were contaminated, as well as all three assistants. Propionebacterium acnes were cultured from gloves in all 10 operations and coagulase-negative Staphylococci were found in eight operations. These results are preliminary, but nevertheless they are alarming. Despite the use of recommended precautions to avoid infections we found that a substantial numbers of gloves from surgeon, scrub nurse and assistant were contaminated with micro-organisms less than 15 min after surgery has been commenced and before the shunts were handled. This study offers a feasible, simple and logical explanation of how shunts may become contaminated and infected. A simple measure would be to change the outer pairs of gloves before handling of the shunt material during surgery, as was done in this study, where non-shunt infections were observed.

  4. Evaluation of Ventriculoperitoneal Shunt-Related Complications in Intracranial Meningioma with Hydrocephalus.

    PubMed

    Bir, Shyamal C; Sapkota, Shabal; Maiti, Tanmoy K; Konar, Subhas; Bollam, Papireddy; Nanda, Anil

    2017-02-01

    Objective Meningioma is a common intracranial tumor that predisposes patients to hydrocephalus which may require a permanent cerebrospinal fluid (CSF) diversion procedure such as ventriculoperitoneal (VP) shunts. We reviewed our long-term experience with VP shunts for the management of hydrocephalus in patients with meningioma. Methods and Materials A total of 48 Patients with meningioma who underwent VP shunt insertion for hydrocephalus from 1990 to 2013 was included in our case series. The study population was evaluated clinically and radiographically after VP shunt placement. Results Overall shunt failure was seen in 13 (27%) patients. Single and multiple shunt revisions were required in eight (16.7%) and five (10.4%) patients, respectively. The overall shunt revision within 6 months, 1 , and 5 years was 19, 23, and 27%, respectively. Male patient was significantly associated with the longer survival after shunt placement. Revisions free survival after 3, 5, 10, and 15 years of VP shunt placement were 70, 46, 30, and 20%, respectively. Finally, in regression analysis, age greater than 65 years (p = 0.02, 95% confidence interval (CI) = 0.1-0.13), tumor in posterior fossa (p < 0.0001, 95% CI = 0.1-0.23), tumor size (> 5 cm) (p = 0.3, 95% CI = 0.01-0.19), and Simpson resection grades II to IV (p = 0.04, 95% CI = 0.07-0.2) were identified as positive predictors of requirement of CSF flow diversion Conclusion The findings of the present study reveal that VP shunting is an important treatment option for the management of hydrocephalus in patients with meningioma. Further studies using less invasive techniques are warranted to compare the benefits of VP shunt for the management of hydrocephalus.

  5. Validated linear dynamic model of electrically-shunted magnetostrictive transducers with application to structural vibration control

    NASA Astrophysics Data System (ADS)

    Scheidler, Justin J.; Asnani, Vivake M.

    2017-03-01

    This paper presents a linear model of the fully-coupled electromechanical behavior of a generally-shunted magnetostrictive transducer. The impedance and admittance representations of the model are reported. The model is used to derive the effect of the shunt’s electrical impedance on the storage modulus and loss factor of the transducer without neglecting the inherent resistance of the transducer’s coil. The expressions are normalized and then shown to also represent generally-shunted piezoelectric materials that have a finite leakage resistance. The generalized expressions are simplified for three shunts: resistive, series resistive-capacitive, and inductive, which are considered for shunt damping, resonant shunt damping, and stiffness tuning, respectively. For each shunt, the storage modulus and loss factor are plotted for a wide range of the normalized parameters. Then, important trends and their impact on different applications are discussed. An experimental validation of the transducer model is presented for the case of resistive and resonant shunts. The model closely predicts the measured response for a variety of operating conditions. This paper also introduces a model for the dynamic compliance of a vibrating structure that is coupled to a magnetostrictive transducer for shunt damping and resonant shunt damping applications. This compliance is normalized and then shown to be analogous to that of a structure that is coupled to a piezoelectric material. The derived analogies allow for the observations and equations in the existing literature on structural vibration control using shunted piezoelectric materials to be directly applied to the case of shunted magnetostrictive transducers.

  6. Detection of ventricular shunt malfunction in the ED: relative utility of radiography, CT, and nuclear imaging.

    PubMed

    Lehnert, Bruce E; Rahbar, Habib; Relyea-Chew, Annemarie; Lewis, David H; Richardson, Michael L; Fink, James R

    2011-08-01

    The study objective was to determine the relative diagnostic utility of the radiographic shunt series (SS), head computed tomography (CT), and nuclear imaging performed in our Emergency Department (ED) for evaluating ventricular shunt malfunction. We retrospectively reviewed medical records, head CT (if performed), and nuclear imaging (if performed) for all ED patients with suspected shunt malfunction from 2002 to 2007 who underwent plain film shunt evaluation (296 cases/186 individuals) to determine if surgical shunt revision was performed. Logistic regression analysis was applied. Four percent (12/296) of radiographic SS were abnormal. Only 0.3% (1/296) underwent surgical revision in the absence of an abnormal head CT or nuclear imaging. Eighteen percent (51/282) of head CT exams were positive and 19% (24/128) of nuclear imaging exams were positive for shunt malfunction. Twenty-three percent (67/296) underwent surgical shunt revisions. Statistical analysis demonstrated that SS evaluation was not significantly associated with surgical shunt revision (OR 0.92; 95% CI, 0.7-1.2; p=0.47). Head CT demonstrated a significant association with surgical revision (OR 1.4; 95% CI, 1.2-1.5; p<0.001), as did nuclear imaging (OR 1.4; 95% CI, 1.2-1.6; p<0.001). Patients with suspected ventricular shunt malfunction frequently require surgical revision. Abnormal radiographic SS was not associated with progression to surgical shunt revision, whereas abnormal head CT and abnormal nuclear imaging were significantly associated with surgical revision. We conclude that radiographic SS in the ED is of low diagnostic utility and that patients with suspected shunt malfunction should instead initially undergo CT and/or nuclear imaging.

  7. Treatment of bleeding from portal hypertensive gastropathy by portacaval shunt.

    PubMed

    Orloff, M J; Orloff, M S; Orloff, S L; Haynes, K S

    1995-04-01

    Portal hypertensive gastropathy is a vascular disorder of the gastric mucosa distinguished by ectasia of the mucosal capillaries and submucosal veins without inflammation. During 1988 to 1993, 12 patients with biopsy-proven cirrhosis (10 alcoholic, 2 posthepatitic) were evaluated and treated prospectively by portacaval shunt for active bleeding from severe portal hypertensive gastropathy. Eleven patients had been hospitalized for bleeding three to nine times previously, and one was bleeding uncontrollably for the first time. Requirement for blood transfusions ranged from 11 to 39 units cumulatively, of which 8 to 30 units were required specifically to replace blood lost from portal hypertensive gastropathy. Admission findings were ascites in 9 patients, jaundice in 8, severe muscle wasting in 10, hyperdynamic state in 9. Child's risk class was C in 7, B in 4, A in 1. Ten of the 12 patients had previously received repetitive endoscopic sclerotherapy for esophageal varices, which has been reported to precipitate portal hypertensive gastropathy. Eight patients had failed propranolol therapy for bleeding. Portacaval shunt was performed emergently in 11 patients and electively in 1, and permanently stopped bleeding in all by reducing the mean portal vein-inferior vena cava pressure gradient from 251 to 16 mm saline. There were no operative deaths, and two unrelated late deaths after 13 and 24 months. During 1 to 6.75 years of follow-up, all shunts remained patent by ultrasonography, the gastric mucosa reverted to normal on serial endoscopy, and there was no gastrointestinal bleeding. Recurrent portal-systemic encephalopathy developed in only 8% of patients. Quality of life was generally good.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Exercise-induced arteriovenous intrapulmonary shunting in dogs.

    PubMed

    Stickland, Michael K; Lovering, Andrew T; Eldridge, Marlowe W

    2007-08-01

    We have previously shown, using contrast echocardiography, that intrapulmonary arteriovenous pathways are inducible in healthy humans during exercise; however, this technique does not allow for determination of arteriovenous vessel size or shunt magnitude. The purpose of this study was to determine whether large-diameter (more than 25 microm) intrapulmonary arteriovenous pathways are present in the dog, and whether exercise recruits these conduits. Through the right forelimb, 10.8 million 25-microm stable isotope-labeled microspheres (BioPAL, Inc., Worcester, MA) were injected either at rest (n = 8) or during high-intensity exercise (6- 8 mph, 10-15% grade, n = 6). Systemic arterial blood was continuously sampled during and for 3 minutes after injection. After euthanasia, tissue samples were obtained from the heart, liver, kidney, and skeletal muscle. In addition, 25- and 50-microm microspheres were infused into four isolated dog lungs that were ventilated and perfused at constant pressures similar to exercise. Blood and tissue samples were commercially analyzed for the presence of microspheres. No microspheres were detected in the arterial blood or tissue samples from resting dogs. In contrast, five of six exercising dogs showed evidence of exercise-induced intrapulmonary arteriovenous shunting, as microspheres were detected in arterial blood and/or tissue. Furthermore, shunt magnitude was calculated to be 1.4 +/- 0.8% of cardiac output (n = 3). Evidence of intrapulmonary arteriovenous anastomoses was also found in three of four isolated lungs. Consistent with previous human findings, these data demonstrate that intrapulmonary arteriovenous pathways are functional in the dog and are recruited with exercise.

  9. Exercise-induced Arteriovenous Intrapulmonary Shunting in Dogs

    PubMed Central

    Stickland, Michael K.; Lovering, Andrew T.; Eldridge, Marlowe W.

    2007-01-01

    Rationale: We have previously shown, using contrast echocardiography, that intrapulmonary arteriovenous pathways are inducible in healthy humans during exercise; however, this technique does not allow for determination of arteriovenous vessel size or shunt magnitude. Objectives: The purpose of this study was to determine whether large-diameter (more than 25 μm) intrapulmonary arteriovenous pathways are present in the dog, and whether exercise recruits these conduits. Methods: Through the right forelimb, 10.8 million 25-μm stable isotope-labeled microspheres (BioPAL, Inc., Worcester, MA) were injected either at rest (n = 8) or during high-intensity exercise (6– 8 mph, 10–15% grade, n = 6). Systemic arterial blood was continuously sampled during and for 3 minutes after injection. After euthanasia, tissue samples were obtained from the heart, liver, kidney, and skeletal muscle. In addition, 25- and 50-μm microspheres were infused into four isolated dog lungs that were ventilated and perfused at constant pressures similar to exercise. Measurements and Main Results: Blood and tissue samples were commercially analyzed for the presence of microspheres. No microspheres were detected in the arterial blood or tissue samples from resting dogs. In contrast, five of six exercising dogs showed evidence of exercise-induced intrapulmonary arteriovenous shunting, as microspheres were detected in arterial blood and/or tissue. Furthermore, shunt magnitude was calculated to be 1.4 ± 0.8% of cardiac output (n = 3). Evidence of intrapulmonary arteriovenous anastomoses was also found in three of four isolated lungs. Conclusions: Consistent with previous human findings, these data demonstrate that intrapulmonary arteriovenous pathways are functional in the dog and are recruited with exercise. PMID:17478619

  10. Neuropsychological Assessment of Adult Patients with Shunted Hydrocephalus

    PubMed Central

    Bakar, Emel Erdogan

    2010-01-01

    Objective This study is planned to determine the neurocognitive difficulties of hydrocephalic adults. Methods The research group contained healthy adults (control group, n : 15), and hydrocephalic adults (n : 15). Hydrocephalic group consisted of patients with idiopathic aquaduct stenosis and post-meningitis hydrocephalus. All patients were followed with shunted hydrocephalus and not gone to shunt revision during last two years. They were chosen from either asymptomatic or had only minor symptoms without motor and sensorineural deficit. A neuropsychological test battery (Raven Standart Progressive Matrices, Bender-Gestalt Test, Cancellation Test, Clock Drawing Test, Facial Recognition Test, Line Orientation Test, Serial Digit Learning Test, Stroop Color Word Interference Test-TBAG Form, Verbal Fluency Test, Verbal Fluency Test, Visual-Aural Digit Span Test-B) was applied to all groups. Results Neuropsychological assessment of hydrocephalic patients demonstrated that they had poor performance on visual, semantic and working memory, visuoconstructive and frontal functions, reading, attention, motor coordination and executive function of parietal lobe which related with complex and perseverative behaviour. Eventually, these patients had significant impairment on the neurocognitive functions of their frontal, parietal and temporal lobes. On the other hand, the statistical analyses performed on demographic data showed that the aetiology of the hydrocephalus, age, sex and localization of the shunt (frontal or posterior parietal) did not affect the test results. Conclusion This prospective study showed that adult patients with hydrocephalus have serious neuropsychological problems which might be directly caused by the hydrocephalus; and these problems may cause serious adaptive difficulties in their social, cultural, behavioral and academic life. PMID:20379471

  11. Time to First Shunt Failure in Pediatric Patients over 1 Year Old: A 10-Year Retrospective Study.

    PubMed

    Shannon, Chevis N; Carr, Kevin R; Tomycz, Luke; Wellons, John C; Tulipan, Noel

    2013-01-01

    Studies comparing alternatives to ventriculoperitoneal (VP) shunting for treatment of hydrocephalus have often relied upon data from an earlier era that may not be representative of contemporary shunt survival outcomes. We sought to determine the shunt survival rate of our cohort and compare our results to previously published shunt survival and endoscopic third ventriculostomy (ETV) success rates. We identified 95 patients between 1 and 18 years of age, who underwent initial VP shunt placement between January 2001 and December 2010. Our study shows a shunt survival rate of 85% at 6 months and 79% at 2 years, for initial shunts in pediatric patients over 1 year of age in this cohort. The overall infection rate was 3%. This compares favorably with published success rates of ETV at similar time points as well as with the rate of infection. This suggests that ventricular shunting remains a viable alternative to ETV in the older child.

  12. A theoretical and experimental study of coplanar waveguide shunt stubs

    NASA Technical Reports Server (NTRS)

    Dib, Nihad I.; Ponchak, George E.; Katehi, Linda P. B.

    1993-01-01

    A comprehensive theoretical and experimental study of straight and bent coplanar waveguide (CPW) shunt stubs is presented. In the theoretical analysis, the CPW is assumed to be inside a cavity while, the experiments are performed on open structures. For the analysis of CPW discontinuities with air-bridges, a hybrid technique was developed which was validated through extensive theoretical and experimental comparisons. The effect of the cavity resonances on the behavior of the stubs with and without air-bridges is investigated. In addition, the encountered radiation loss due to the discontinuities is evaluated experimentally.

  13. Shunting arc plasma source for pure carbon ion beam.

    PubMed

    Koguchi, H; Sakakita, H; Kiyama, S; Shimada, T; Sato, Y; Hirano, Y

    2012-02-01

    A plasma source is developed using a coaxial shunting arc plasma gun to extract a pure carbon ion beam. The pure carbon ion beam is a new type of deposition system for diamond and other carbon materials. Our plasma device generates pure carbon plasma from solid-state carbon material without using a hydrocarbon gas such as methane gas, and the plasma does not contain any hydrogen. The ion saturation current of the discharge measured by a double probe is about 0.2 mA∕mm(2) at the peak of the pulse.

  14. Piezoelectric vibration damping using resonant shunt circuits: an exact solution

    NASA Astrophysics Data System (ADS)

    Soltani, P.; Kerschen, G.; Tondreau, G.; Deraemaeker, A.

    2014-12-01

    The objective of this paper is to propose an exact closed-form solution to the {{H}∞ } optimization of piezoelectric materials shunted with inductive-resistive passive electrical circuits. Realizing that Den Hartog's method which imposes fixed points of equal height in the receptance transfer function is approximate, the parameters of the piezoelectric tuned vibration absorber are calculated through the direct minimization of the maxima of the receptance. The method is applied to a one-degree-of-freedom primary oscillator considering various values of the electromechanical coupling coefficients.

  15. Valproic acid-induced hyperammonaemic coma and unrecognised portosystemic shunt.

    PubMed

    Nzwalo, Hipólito; Carrapatoso, Leonor; Ferreira, Fátima; Basilio, Carlos

    2013-06-01

    Hyperammonaemic encephalopathy is a rare and potentially fatal complication of valproic acid treatment. The clinical presentation of hyperammonaemic encephalopathy is wide and includes seizures and coma. We present a case of hyperammonaemic coma precipitated by sodium valproate use for symptomatic epilepsy in a patient with unrecognised portosystemic shunt, secondary to earlier alcoholism. The absence of any stigmata of chronic liver disease and laboratory markers of liver dysfunction delayed the recognition of this alcohol-related complication. The portal vein bypass led to a refractory, valproic acid-induced hyperammonaemic coma. The patient fully recovered after dialysis treatment.

  16. RHIC INSERTION REGION, SHUNT POWER SUPPLY CURRENT ERRORS.

    SciTech Connect

    BRUNO,D.; GANETIS,G.; LAMBIASE,R.F.; SANDBERG,J.

    2001-06-18

    The Relativistic Heavy Ion Collider (RHIC) was commissioned in 1999 and 2000. RHIC requires power supplies to supply currents to highly inductive superconducting magnets. The RHIC Insertion Region contain's many shunt power supplies to trim the current of different magnet elements in a large superconducting magnet circuit. Power Supply current error measurements were performed during the commissioning of RHIC. Models of these power supply systems were produced to predict and improve these power supply current errors using the circuit analysis program MicroCap V by Spectrum Software (TM). Results of the power supply current errors are presented from the models and from the measurements performed during the commissioning of RHIC.

  17. Female gender predisposes for cerebrospinal fluid overdrainage in ventriculoperitoneal shunting.

    PubMed

    Diesner, Naïma; Freimann, Florian; Clajus, Christin; Kallenberg, Kai; Rohde, Veit; Stockhammer, Florian

    2016-07-01

    Gravitational valves (GVs) prevent overdrainage in ventriculoperitoneal shunting (VPS). However, there are no data available on the appropriate opening pressure in the shunt system when implementing a GV. We performed a retrospective analysis of hydrocephalic patients who were successfully treated with VPS which included one or more GV. In this retrospective study in adult VPS patients with GVs, we analysed all available data, including the most recent computed tomography (CT) scans, to determine the best adjustments for alleviating any symptoms of overdrainage and underdrainage. Vertical effective opening pressure (VEOP) of the entire shunt system, including the differential pressure valve, was determined. One hundred and twenty-two patients were eligible for the study. Of these, female patients revealed a higher VEOP compared with males (mean, 35.6 cmH2O [SD ± 2.46] vs 28.9 cmH2O [SD ± 0.87], respectively, p = 0.0072, t-test). In patients older than 60 years, lower VEOPs, by a mean of 6.76 cmH2O ± 2.37 (p = 0.0051), were necessary. Mean VEOP was found to be high in idiopathic intracranial hypertension (IIH; 41.6 cmH2O) and malresorptive and congenital HC (35.9 and 36.3), but low in normal pressure HC (27.5, p = 0.0229; one-way ANOVA). In the total cohort, body mass index (BMI) and height did not correlate with VEOP. Twelve patients required a VEOP of more than 40 cmH2O, and in eight of these patients this was accomplished by using multiple GVs. All but one of these eight patients were of female gender, and none of the latter were treated for normal pressure hydrocephalus (NPH) (p = 0.0044 and p = 0.0032, Fisher's exact test). In adult VPS patients, female gender increases the risk of overdrainage requiring higher VEOPs. Initial implantation of adjustable GV should be considered in female patients treated with VP shunts for pathology other than NPH.

  18. Shunting arc plasma source for pure carbon ion beama)

    NASA Astrophysics Data System (ADS)

    Koguchi, H.; Sakakita, H.; Kiyama, S.; Shimada, T.; Sato, Y.; Hirano, Y.

    2012-02-01

    A plasma source is developed using a coaxial shunting arc plasma gun to extract a pure carbon ion beam. The pure carbon ion beam is a new type of deposition system for diamond and other carbon materials. Our plasma device generates pure carbon plasma from solid-state carbon material without using a hydrocarbon gas such as methane gas, and the plasma does not contain any hydrogen. The ion saturation current of the discharge measured by a double probe is about 0.2 mA/mm2 at the peak of the pulse.

  19. Advantages of Selective Use of Intraluminal Shunt in Carotid Endarterectomy: A Study of 122 Cases

    PubMed Central

    Usman, Rashid; Ghaffar, Salma

    2016-01-01

    Objectives: To assess the advantage of selective use of shunt in carotid endarterectomy (CEA) under local anesthesia. Materials and Methods: A total of 122 consecutive patients fulfilling international guidelines were included. Shunt was used selectively only in cases of bilateral severe carotid artery occlusive disease or in those patients who developed neurological symptoms on clamping of carotid artery. Follow up was done weekly for one month; then every month for 3 months; and then every 3 months for a year. Results: Shunt was used only in 5% (n = 6) patients. Of these, 2.5% (n = 3) patients were those who developed neurological symptoms on clamping the internal carotid and deployment of shunt resulted in complete resolution of symptoms. 2.5% (n = 3) had severe bilateral carotid stenosis and shunt was deployed. One of these patients developed stroke which was permanent. There was no mortality. The mean procedure time was 170 min in patients in whom shunt was used, when compared with 100 min in patients without shunt (P = 0.003). Conclusion: Use of shunt in carotid endarterectomy under local anesthesia as selective policy has an advantage in terms of cost effectiveness, operation time and prevention of potential complications. PMID:28018499

  20. 21 CFR 882.5550 - Central nervous system fluid shunt and components.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Central nervous system fluid shunt and components. 882.5550 Section 882.5550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... shunt is a device or combination of devices used to divert fluid from the brain or other part of the...

  1. 21 CFR 882.5550 - Central nervous system fluid shunt and components.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Central nervous system fluid shunt and components. 882.5550 Section 882.5550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... shunt is a device or combination of devices used to divert fluid from the brain or other part of the...

  2. 21 CFR 882.5550 - Central nervous system fluid shunt and components.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Central nervous system fluid shunt and components. 882.5550 Section 882.5550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... shunt is a device or combination of devices used to divert fluid from the brain or other part of the...

  3. 21 CFR 882.5550 - Central nervous system fluid shunt and components.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Central nervous system fluid shunt and components. 882.5550 Section 882.5550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... shunt is a device or combination of devices used to divert fluid from the brain or other part of the...

  4. 21 CFR 882.5550 - Central nervous system fluid shunt and components.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Central nervous system fluid shunt and components. 882.5550 Section 882.5550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... shunt is a device or combination of devices used to divert fluid from the brain or other part of the...

  5. Shunt currents in vanadium flow batteries: Measurement, modelling and implications for efficiency

    NASA Astrophysics Data System (ADS)

    Fink, H.; Remy, M.

    2015-06-01

    Shunt currents are an important factor which must be considered when designing a stack for flow batteries. They lead to a reduction of the coulombic efficiency and can cause furthermore a critical warming of the electrolyte. Shunt currents inevitably appear at bypass connections of the hydraulic system between the single cells of a stack. In this work the shunt currents of a five-celled mini stack of a vanadium flow battery with external hydraulic system and their effects are investigated directly. The external hydraulic system allows the implementation of current sensors for direct measurement of the shunt currents; moreover, the single bypass channels can be interrupted by clamping the tube couplings and with it the shunt currents between the cells when the pumps are off. Thus the shares of losses by cross contamination and by shunt currents are quantified separately by charge conservation measurements. The experimentally gained data are compared to a shunt current model based on a equivalent circuit diagram and the linear equation system derived from it. Experiments and model data are in good agreement. The effects of shunt currents for different flow frame geometries and number of cells in a stack are simulated and presented in this work.

  6. Pulmonary arteriovenous fistula showing a fall in shunt fraction during exercise.

    PubMed

    Maeda, H; Monden, Y; Nakahara, K; Miyoshi, S; Kawashima, Y

    1984-04-01

    A 23-year-old man with pulmonary arteriovenous fistulas of the right middle lobe is described. During the incremental exercise test, the shunt fraction dropped from 19 percent to 12 percent as the cardiac output increased. We discuss the mechanism of this fall in shunt fraction in this patient during exercise.

  7. [Ventriculo-gallbladder shunt: An alternative for the treatment of hydrocephalus].

    PubMed

    Hasslacher-Arellano, Juan Francisco; Arellano-Aguilar, Gregorio; Funes-Rodríguez, Juan Francisco; López-Forcén, Santiago; Torres-Zapiain, Fernando; Domínguez-Carrillo, Luis Gerardo

    2016-01-01

    In the management of hydrocephalus, the ventriculo-gallbladder shunt is justified in situations where the ventriculo-peritoneal shunt is not useful due to peritoneal involvement and/or when the ventriculo-auricular and ventriculo-pleural shunts are contraindicated. A 27 year-old female with hydrocephalus at birth, managed with ventricle-peritoneal shunt, modified 3 times throughout her life due to repeated infections and other different reasons. She was admitted due to colitis caused by Clostridium difficile, presenting concomitant signs of intracranial hypertension and neurological impairment. This led to a review and change of the ventriculo-peritoneal shunt system, with distal dysfunction due to peritoneal thickening. Atrial and pleural shunts were not indicated because the risk of infection. As an alternative, it was decided to place the distal end of the catheter in the gallbladder. The patient recovered her neurological functions after the surgery. Drainage alternatives may be needed in 5% of patients with valvular shunt dysfunction. The ventriculo-gallbladder is a good and viable option because it has an absorptive capacity of 1500cc liquid daily, besides being an excellent drainage through the bile duct. The abdominal surgery is easy to perform, and it is an alternative option in the failure of the ventriculo-peritoneal shunt. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  8. Right Heart Catheterization via Dialysis Arteriovenous Shunts in End-Stage Renal Disease Patients.

    PubMed

    Hsieh, Mu-Yang; Chen, Tsung-Yan; Lin, Lin; Liao, Min-Tsun; Wang, Ren-Huei; Kuo, Ruei-Cheng; Lai, Chao-Lun; Wu, Chih-Cheng

    2016-12-01

    Right heart catheterization is an important diagnostic tool but carries risks of adverse events. Little is known about the feasibility and safety of using dialysis arteriovenous (AV) shunts. We aim to evaluate the feasibility and safety of using dialysis AV shunts for access in right heart catheterization. Hemodialysis patients who required right heart catheterization were prospectively enrolled. A 7 Fr sheath was inserted and a balloon-tipped pulmonary artery catheter was advanced for right heart catheterization. Patients were followed for 1 month, and technical success, procedure details, and complications were recorded. Thirteen patients received right heart catheterization via AV shunts. Three patients were evaluated for heart failure, and 10 were examined for pulmonary hypertension. Median patient age was 69 years (interquartile range [IQR], 58-77 years), and median shunt age was 50 months (IQR, 32-75 months). Five shunts were located in the upper arm, 2 were in the right arm, and 5 were native fistulas. All AV shunt punctures were successful on the first attempt. All right heart catheterizations were completed via AV shunts, and the technical success rate was 100%. Median fluoroscopy time was 6.9 minutes. No venous access complications or right heart catheterization-related complications occurred immediately after the procedure or during the 1-month follow-up period. AV dialysis shunts can be used for venous access for right heart catheterization with acceptable feasibility and patient tolerability. Further randomized studies are needed to confirm the benefits of this approach compared with other approaches.

  9. Chronic Leptomeningitis and Spinal Intradural Mass Secondary to Alternaria Infection in a Patient with Ventriculoperitoneal Shunt

    PubMed Central

    Thompson, Russell; Jandial, Rahul; Tegtmeier, Bernard; Chen, Mike Yue

    2016-01-01

    Fungal infection following placement of ventriculostomy or ventriculoperitoneal (VP) shunt is uncommon. We report the first case of Alternaria related central nervous system (CNS) shunt infection in a patient with CNS ependymoma manifesting as leptomeningitis and a spinal intradural mass. This case illustrates the diagnostic and management challenges. PMID:27840750

  10. Ventriculoperitoneal shunt for treatment of hydrocephalus in a French bulldog puppy

    PubMed Central

    Giacinti, Jolene A.

    2016-01-01

    A 6.5-week-old bulldog was presented with lethargy, anorexia, and stunted growth. A domed skull, ventrolateral strabismus, hypermetria, and delayed hopping were observed. Congenital hydrocephalus was diagnosed and a ventriculoperitoneal shunt was placed. After surgery, a shunt obstruction occurred but resolved with treatment. The puppy responded well and neurological deficits continued to improve after surgery. PMID:26933271

  11. Superior vena cava syndrome with retropharyngeal edema as a complication of ventriculoatrial shunt

    PubMed Central

    Al-Natour, Mohammed S; Entezami, Pouya; Nazzal, Munier M S; Casabianca, Andrew B; Assaly, Ragheb; Riley, Kalen; Gaudin, Daniel

    2015-01-01

    Key Clinical Message Thirty-seven-year old female with hydrocephalus managed by a ventriculoatrial (VA) shunt presented with upper body edema, dysphagia, and headache. Imaging demonstrated thrombosis of the superior vena cava (SVC). Direct catheter thrombolysis led to resolution of thrombus burden. Superior vena cava thrombosis is a rare consequence of VA shunting and must be managed emergently. PMID:26509004

  12. Recurrent pleural effusion without intrathoracic migration of ventriculoperitoneal shunt catheter: a case report.

    PubMed

    Chuen-im, Piyaporn; Smyth, Matthew D; Segura, Bradley; Ferkol, Thomas; Rivera-Spoljaric, Katherine

    2012-01-01

    Pleural effusion is a rare complication of ventriculoperitoneal (VP) shunting, usually due to the migration of the VP shunt catheter into the thorax. Herein we report a neurologically disadvantaged child with a lobar holoprosencephaly and hydrocephalus, initially treated with a VP shunt, who years later developed recurrent right-sided pleural effusion ultimately confirmed to be a cerebrospinal fluid (CSF) hydrothorax without intra-thoracic migration of the distal shunt catheter. Thoracentesis was compatible with a transudative effusion. Given the presence of a persistent pleural effusion, beta-2 transferrin concentrations were measured, which yielded a positive result. Plain radiographs and head computed tomography (CT) showed a normally positioned, functional VP shunt. A spine CT myelogram to look for a spinal dural-thoracic CSF fistula was negative. A radionuclide CSF shunt study demonstrated normal functioning VP shunt with radiotracer accumulation within the peritoneum, with subsequent tracer rapidly accumulating in the right hemithorax. Video-assisted thoracoscopic (VATS) exploration with drainage of the pleural effusion and pleurodesis was then performed. No diaphragmatic defect or shunt tubing within the thorax was found and the procedure failed to resolve the effusion. The patient's recurrent effusion was ultimately resolved with intracranial endoscopic choroid plexus coagulation to decrease CSF output.

  13. Shunt Devices for the Treatment of Adult Hydrocephalus: Recent Progress and Characteristics

    PubMed Central

    MIYAKE, Hiroji

    2016-01-01

    Various types of shunt valves have been developed during the past 50 years, most of which can be classified into the following categories: (1) fixed differential pressure valves; (2) fixed differential pressure (DP) valves with an antisiphon mechanism; (3) programmable DP valves; (4) programmable DP valves with an antisiphon mechanism; and (5) programmable antisiphon valves. When considering the myriad of possible postoperative condition changes, such as the onset of accidental non-related diseases or trauma in adults, and changes in normal physiological development or anticipation of future shunt removal in children, it has become standard to use the programmable valve as a first choice for cerebrospinal fluid shunting. However, it is still unclear what type of shunt valve is suitable for each individual case. Based on the results of SINPHONI and more recently SINPHONI 2 trials, the programmable DP valve is recommended as the first line shunt valve. The programmable DP valve with an antisiphon mechanism is thought to be beneficial for tall, slender patients, who have a tendency for easily developing complications of overdrainage, however, this type of valve must be used cautiously in obese patients because of the increased risk of underdrainage. Although the current evidence is still insufficient, the programmable antisiphon valve, which costs the same as the programmable DP valve, is also thought to be the first line shunt valve. The quick reference table is applicable for most shunt valves, and for patients with either the ventriculoperitoneal or the lumboperitoneal shunt. PMID:27041631

  14. Management of cardiac migration of a distal shunt catheter: the radiological pitfalls.

    PubMed

    Aboukais, R; Zairi, F; Marinho, P; Lejeune, J-P

    2015-02-01

    Cardiac migration is a rare complication of the ventriculoperitoneal shunt. We report a case of a late migration of the distal shunt into the pulmonary arteries. The authors underline the radiological features that suggested the presence of a knot. Preoperative planning and the assistance of a vascular surgeon were required due to the presence of a knot.

  15. Intervening for RPA stenosis following Waterston shunt: Importance of anatomical definition of the coronary arteries.

    PubMed

    Hovis, Ian W; Sutton, Nicole J; Pass, Robert H

    2014-03-01

    Right pulmonary artery (RPA) stenosis following Waterston shunt is common. We report a case of RPA stenosis many years following tetralogy of Fallot repair with take-down of a Waterston shunt and demonstrate an unusual and important anatomic variant of proximity of the left coronary artery to the mid-portion of the RPA. Copyright © 2013 Wiley Periodicals, Inc.

  16. Minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal shunt*

    PubMed Central

    Jia, Lu; Zhao, Zhong-xin; You, Chao; Liu, Jia-gang; Huang, Si-qing; He, Min; Ji, Pei-gang; Duan, Jie; Zeng, Yi-jun; Li, Guo-ping

    2011-01-01

    Objective: To investigate the clinical value of a minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal (LP) shunt. Method: The clinical and long-term follow-up data of 256 patients suffering from communicating hydrocephalus and undergoing percutaneous LP shunt during 1998 to 2008 were retrospectively analyzed. Results: After the follow-up, which lasted 6 months to 10 years, 219 cases of communicating hydrocephalus recovered well (ventricular size returned to normal and symptoms completely disappeared), 25 cases were brought under control (ventricle size reduced by 50% and symptoms partially abated), and 12 cases showed no obvious changes. Fifteen obese subjects needed modifications of the shunt due to the obstruction of the abdominal end following wrapping, and one subject underwent extubation as the subject was unable to tolerate stimulation of the cauda equina. The effectiveness of shunting was 91.40% and the probability of shunt-tube obstruction, which occurs predominantly in the abdominal end, was only 5.85%, far lower than that of ventriculoperitoneal (VP) shunt. Three subjects had a history of infection following VP shunting. Conclusion: LP shunting is minimally invasive and effective in treating communicating hydrocephalus, with fewer complications. PMID:21462385

  17. Transient right-to-left shunting through a patent foramen ovale secondary to unilateral diaphragmatic paralysis.

    PubMed Central

    Cordero, P. J.; Morales, P.; Mora, V.; Cebrian, J.; Vallterra, J.; Gudin, J.; Benlloch, E.; Marco, V.

    1994-01-01

    A 57 year old patient presented with unilateral diaphragmatic paralysis and severe hypoxaemia secondary to transient right-to-left interatrial shunting through a patent foramen ovale. The final diagnosis was made because of the initial detection of a shunt while the patient was breathing 100% oxygen. Images PMID:7940438

  18. Creation of transcatheter aortopulmonary and cavopulmonary shunts using magnetic catheters: feasibility study in swine.

    PubMed

    Levi, Daniel S; Danon, Saar; Gordon, Brent; Virdone, Nicky; Vinuela, Fernando; Shah, Sanjay; Carman, Greg; Moore, John W

    2009-05-01

    Surgical shunts are the basic form of palliation for many types of congenital heart disease. The Glenn shunt (superior cavopulmonary connection) and central shunt (aortopulmonary connection) represent surgical interventions that could potentially be accomplished by transcatheter techniques. We sought to investigate the efficacy of using neodymium iron boron (NdFeB) magnetic catheters to create transcatheter cavopulmonary and aortopulmonary shunts. NdFeB magnets were machined and integrated into catheters. "Target" catheters were placed in the pulmonary arteries (PAs), and radiofrequency "perforation" catheters were placed in either the descending aorta (DAo) for central shunts or the superior vena cava (SVC) for Glenn shunts. The magnet technique or "balloon target" method was used to pass wires from the DAo or the SVC into the PA. Aortopulmonary and cavopulmonary connections were then created using Atrium iCAST covered stents. Magnet catheters were used to perforate the left pulmonary artery from the DAo, thereby establishing a transcatheter central shunt. Given the orientation of the vasculature, magnetic catheters could not be used for SVC-to-PA connections; however, perforation from the SVC to the right pulmonary artery was accomplished with a trans-septal needle and balloon target. Transcatheter Glenn or central shunts were successfully created in four swine.

  19. Delayed spontaneous pneumocephalus in ventriculoperitoneal shunting: two case reports and literature review.

    PubMed

    Najera Aguilar, Edinson; Castle Ramirez, Maria; Bollar Zabala, Alicia; Urculo Bareño, Enrique

    2014-01-01

    Spontaneous pneumocephalus following cerebrospinal fluid shunt is a rare complication. In most cases, the air enters in the intracranial cavity via a skull base defect. We report 2 cases of delayed tension pneumocephalus, secondary to ventriculoperitoneal shunt, and review the etiopathogenesis, prevention and treatment of this condition.

  20. Intrapulmonary shunting in primary pulmonary hypertension: an observation in two patients treated with epoprostenol sodium.

    PubMed

    Castro, P F; Bourge, R C; McGiffin, D C; Benza, R L; Fan, P; Pinkard, N B; McGoon, M D

    1998-07-01

    Continuous intravenous infusion of epoprostenol sodium in selected patients with primary pulmonary hypertension improves symptoms and survival. This report describes two patients with primary pulmonary hypertension treated with epoprostenol in whom intrapulmonary shunting and severe hypoxemia occurred. Intrapulmonary shunting was confirmed by contrast echocardiography showing delayed appearance of bubbles in the left cardiac chambers after peripheral venous injection of agitated saline solution.

  1. Normal-pressure hydrocephalus: current understanding of diagnostic tests and shunting

    SciTech Connect

    Black, P.M.

    1982-02-01

    Normal-pressure hydrocephalus is no longer difficult to diagnose or treat-cranial computed tomographic scanning has made the diagnosis of ventricular enlargement straightforward, and shunt placement often helps the patient whose condition can be traced to a specific cause. Predicting accurately whether a patient will benefit from a shunt, however, is still problematic.

  2. [Diagnosis of left-to-right shunt. Dye dilution curves in patients with left-to-right shunt during physical exertion and after beta-receptor blockade].

    PubMed

    Klempt, H W

    1976-04-08

    In 79 patients, suffering from central left-to-right shunts, dye-dilution curves were recorded partially using a peripheral venous injection site during reactive hyperaemia. 47 investigations were carried out during ergometer exercise in supine position. 32 patients received injections of 1-2 mg Propranolol or 0,4-0,8 mg Pindolol. During exercise dye-dilution curves showed characteristic alterations, indicating a decrease of the relative shunt-flow, whereas beta-receptor blocking agents increased the relative shunt-flow. Dye-dilution curves written during exercise may be helpful in evaluating the indication for operative closure in patients with small atrial or ventricular septal defects. beta-receptor blocking agents can facilitate diagnosis of left-to-right shunt as a screening test.

  3. Prevention of Arteriovenous Shunt Occlusion Using Microbubble and Ultrasound Mediated Thromboprophylaxis

    PubMed Central

    Kutty, Shelby; Wu, Juefei; Hammel, James M.; Abraham, Joseph R.; Venkataraman, Jeeva; Abdullah, Ibrahim; Danford, David A.; Radio, Stanley J.; Lof, John; Porter, Thomas R.

    2014-01-01

    Background Palliative shunts in congenital heart disease patients are vulnerable to thrombotic occlusion. High mechanical index (MI) impulses from a modified diagnostic ultrasound (US) transducer during a systemic microbubble (MB) infusion have been used to dissolve intravascular thrombi without anticoagulation, and we sought to determine whether this technique could be used prophylactically to reduce thrombus burden and prevent occlusion of surgically placed extracardiac shunts. Methods and Results Heparin‐bonded ePTFE tubular vascular shunts of 4 mm×2.5 cm (Propaten; W.L Gore) were surgically placed in 18 pigs: a right‐sided side‐to‐side arteriovenous (AV, carotid‐jugular) shunt, and a left‐sided arterio‐arterial (AA, carotid‐carotid) interposition shunt in each animal. After shunt implantation, animals were randomly assigned to one of 3 groups. Transcutaneous, weekly 30‐minute treatments (total of 4 treatments) of either guided high MI US+MB (Group 1; n=6) using a 3% MRX‐801 MB infusion, or US alone (Group 2; n=6) were given separately to each shunt. The third group of 6 pigs received no treatments. The shunts were explanted after 4 weeks and analyzed by histopathology to quantify luminal thrombus area (mm2) for the length of each shunt. No pigs received antiplatelet agents or anticoagulants during the treatment period. The median overall thrombus burden in the 3 groups for AV shunts was 5.10 mm2 compared with 4.05 mm2 in AA (P=0.199). Group 1 pigs had significantly less thrombus burden in the AV shunts (median 2.5 mm2) compared with Group 2 (median 5.6 mm2) and Group 3 (median 7.5 mm2) pigs (P=0.006). No difference in thrombus burden was seen between groups for AA shunts. Conclusion Transcutaneous US with intravenous MB is capable of preventing thrombus accumulation in arteriovenous shunts without the need for antiplatelet agents, and may be a method of preventing progressive occlusion of palliative shunts. PMID:24518555

  4. Multiple Liver Abscesses Associated with Ventriculoperitoneal Shunt Infection: Case Report and Review of the Literature

    PubMed Central

    Yang, Tae Ki

    2013-01-01

    Liver abscess following ventriculoperitoneal (VP) shunting occurs very rarely. We report an unusual case of multiple liver abscesses caused by Staphylococcus capitis in a 50-year-old compromised woman due to a complicating VP shunt infection. We reviewed the nine cases of VP shunt complications reported in the English literature, and speculated that the most likely pathogenetic mechanism in our case is an infected peritoneal tip that migrated to and penetrated the liver, which subsequently caused the formation of multiple liver abscesses. The patient was successfully treated with percutaneous aspiration, drainage of the abscesses, intravenous antibiotics, and shunt revision. Awareness and vigilance of the possibility of liver abscess formation caused by VP shunt infection will help establish an early accurate diagnosis and therapeutic strategy. PMID:24379956

  5. A noninvasive approach to quantitative measurement of flow through CSF shunts. Technical note.

    PubMed

    Stein, S C; Apfel, S

    1981-04-01

    A method of measuring flow rate through cerebrospinal fluid (CSF) shunts is reported. It consists of two thermistors in series applied to the skin over the shunt tubing. The thermistors respond by a drop in measured temperature following application of an ice cube placed on the skin overlying the proximal shunt tube. The time required for the thermal response to travel between the two thermistors is related to the velocity of flow through the shunt tubing. Flow rate can then be calculated using the internal diameter of the tubing. A series of animal experiments employing a constant infusion of mock CSF through subcutaneously implanted shunt tubing showed excellent correlation between calculated flow rates and actual infusion rates. The device is noninvasive and easily adapted to use in patients. The measurements are readily repeatable.

  6. Pleural effusion in a child with a ventriculoperitoneal shunt and congenital heart disease.

    PubMed

    Henningfeld, Jennifer; Loomba, Rohit S; Encalada, Santiago; Magner, Kristin; Pfister, Jennifer; Matthews, Anne; Foy, Andrew; Mikhailov, Theresa

    2016-01-01

    We present the unique case of an 8 month old infant who required extracorporeal membrane oxygenation (ECMO) after neonatal repair of tetralogy of Fallot. While on ECMO, he developed grade 3 intraventricular hemorrhage resulting in hydrocephalus requiring ventriculoperitoneal (VP) shunt placement at 5 months of life. He presented to cardiology clinic with a 2-month history of poor weight gain, tachypnea, and grunting and was found to have a large right sided pleural effusion. This was proven to be cerebrospinal fluid (CSF) accumulation secondary to poor peritoneal absorption with subsequent extravasation of CSF into the thoracic cavity via a diaphragmatic defect. After diaphragm repair, worsening ascites from peritoneal malabsorption led to shunt externalization and ultimate conversion to a ventriculoatrial (VA) shunt. This is the second reported case of VA shunt placement in a child with congenital heart disease and highlights the need to consider CSF extravasation as the cause of pleural effusions in children with VP shunts.

  7. CSF hydrothorax after ventriculoperitoneal shunt without catheter migration: a case report.

    PubMed

    Kocaogullar, Yalcin; Güney, Onder; Kaya, Bülent; Erdi, Fatih

    2011-10-01

    Ventriculoperitoneal (VP) shunting is the most common procedure performed for the management of hydrocephalus. VP shunt related complications remain a persistent problem in current clinical practice. Five-year-old female patient was admitted to our hospital with persistent dyspnea complaint. The patient was operated at the age of 3 months and a VP shunt established in a different clinic due to hydrocephalus associated with Dandy-Walker malformation. The patient's chest X-ray revealed right sided pleural effusion. Thorasentesis was performed and the effusion was drained with a chest tube. The discharged liquid was consistent with CSF. Scintigraphic radionuclide shunt analyses were performed and CSF passage from abdomen to chest and lower mediastinal region was determined in the late static images. The patient was operated and the incorporated ventriculoperitoneal shunt was removed. Hydrothorax was completely resolved after early postoperative stage. CSF hydrothorax especially without catheter migration is an unusual but potentially serious-clinical complication.

  8. [Recurrent Hiccups Caused by Malposition of the Peritoneal Catheter of a Lumboperitoneal Shunt: A Case Report].

    PubMed

    Yoshida, Yuya; Nakajima, Yoshio; Tokuda, Kazuhiko; Kidani, Ryuichi

    2016-02-01

    A number of rare and unpredictable shunt-related complications after shunt placement to treat hydrocephalus have been described. Here a 78-year-old man who underwent lumboperitoneal (LP) shunt placement presented postoperatively with recurrent hiccups. Abdominal radiography and computed tomography performed at 7 days postoperative revealed that a peritoneal catheter had migrated into the upper abdominal cavity and contacted the diaphragm. The patient underwent LP shunt revision, during which the catheter was pulled back and repositioned within the lower abdominal cavity. The hiccups ceased completely. To our knowledge, the only other report of a similar complication was published in the 1980s. Here we describe a case in which a peritoneal catheter from an LP shunt migrated into the upper abdominal cavity and irritated the diaphragm, causing recurrent hiccups.

  9. Fetal surgery for hydrocephalus: successful in utero ventriculoamniotic shunt for Dandy-Walker syndrome.

    PubMed

    Depp, R; Sabbagha, R E; Brown, J T; Tamura, R K; Reedy, N J

    1983-06-01

    The diagnosis of fetal hydrocephalus based on dilation of the ventricular system presents a broad range of management decisions. The options are presented and a case of Dandy-Walker syndrome managed by fetal ventriculoamniotic shunt placement is presented as an example. Under ultrasonic guidance, a shunt was placed at 30 weeks' gestation by later newborn Dubowitz examination. Delivery was delayed for five weeks, one to two weeks following probable shunt malfunction, after achieving fetal lung maturation. Follow-up six months after definitive neonatal ventricular shunting and three weeks after shunt revision revealed a socially active male infant with a motor development index of 87 and a psychomotor development index of 95. Potential advantages of fetal surgery including achievement of term gestation are presented. Proposed guidelines for determining the benefit of such procedures are also presented.

  10. The shunt-LDO regulator to power the upgraded ATLAS pixel detector

    NASA Astrophysics Data System (ADS)

    Gonella, L.; Barbero, M.; Hügging, F.; Krüger, H.; Wermes, N.

    2012-01-01

    The shunt-LDO regulator is a new regulator concept which combines a shunt and a Low Drop-Out (LDO) regulator. Designed as an improved shunt regulator to match the needs of serially powered detector systems, it can also be used as a pure LDO regulator for general application in powering schemes requiring linear regulation. The flexibility of the design makes the shunt-LDO regulator a good candidate for use in the powering schemes envisaged for the upgrades of the ATLAS pixel detector. Two shunt-LDO regulators integrated in the prototype of the next ATLAS pixel front-end chip, the FE-I4A, are used to demonstrate the feasibility of the proposed powering solutions.

  11. An Unusual Complication of Ventriculoperitoneal Shunt: Urinary Bladder Stone Case Report and Literature Review.

    PubMed

    Xu, Songtao; Sheng, Weixin; Qiu, Yufa; Wang, Jianguo

    2016-01-01

    Ventriculoperitoneal (V-P) shunt surgery is the most common technique used for the treatment of hydrocephalus. The migration of ventriculoperitoneal shunt to the bladder is rare. Only two cases have been previously reported in the literature. We report on a 38-year-old male who had hydrocephalus and V-P shunt for 12 years. Two years ago, he found himself with recurrent urinary tract infections, haematuria and urges incontinence, and then he was diagnosed with bladder perforation and merge stones. The patient had an abdominal operation to cut off and take out the shunt catheter, as well as a transurethral holmium laser lithotripsy. Bladder perforation and stones are rare examples of complications in V-P surgical procedures. Controlling the effective length of the terminal V-P shunt and modifying it appropriately can effectively reduce these complications.

  12. Sound absorption of a finite micro-perforated panel backed by a shunted loudspeaker.

    PubMed

    Tao, Jiancheng; Jing, Ruixiang; Qiu, Xiaojun

    2014-01-01

    Deep back cavities are usually required for micro-perforated panel (MPP) constructions to achieve good low frequency absorption. To overcome the problem, a close-box loudspeaker with a shunted circuit is proposed to substitute the back wall of the cavity of the MPP constructions to constitute a composite absorber. Based on the equivalent circuit model, the acoustic impedance of the shunted loudspeaker is formulated first, then a prediction model of the sound absorption of the MPP backed by shunted loudspeaker is developed by employing the mode solution of a finite size MPP coupled by an air cavity with an impendence back wall. The MPP absorbs mid to high frequency sound, and with properly adjusted electrical parameters of its shunted circuit, the shunted loudspeaker absorbs low frequency sound, so the composite absorber provides a compact solution to broadband sound control. Numerical simulations and experiments are carried out to validate the model.

  13. Laparoscopic Cholecystectomy for Acute Calcular Cholecystitis in a Patient with Ventriculoperitoneal Shunt: A Case Report and Literature Review.

    PubMed

    Albarrak, Abdullah A; Khairy, Sami; Ahmed, Alzahrani Mohammed

    2015-01-01

    Management of patients who have ventriculoperitoneal shunt presenting with acute calcular cholecystitis has remained a clinical challenge. In this paper, the hospital course and the follow-up of a patient presenting with acute calcular cholecystitis and ventriculoperitoneal shunt managed with laparoscopic cholecystectomy are presented followed by literature review on the management of acute calcular cholecystitis in patients who have ventriculoperitoneal shunts.

  14. Hepatic Arterial Infusion Chemotherapy Combined with Venous Embolization in a Patient with Hepatic Metastases with an Arteriovenous Shunt

    SciTech Connect

    Nishiofuku, Hideyuki; Tanaka, Toshihiro; Sakaguchi, Hiroshi; Yamamoto, Kiyosei; Inoue, Masayoshi; Sueyoshi, Satoru; Shinnkai, Takayuki; Hasegawa, Masatoshi; Kichikawa, Kimihiko

    2009-07-15

    We describe herein a patient who had hepatic metastases with an arteriovenous shunt and was treated by hepatic arterial infusion chemotherapy. The arteriovenous shunt was diagnosed by {sup 99m}Tc-macroaggregated albumin scintigraphy and hepatic venous embolization was performed to reduce shunt flow.

  15. Elective minimally invasive coronary artery bypass: Shunt or tournique occlusion? Assessment of a protective role of perioperative left anterior descending shunting on myocardial damage. A prospective randomized study

    PubMed Central

    2012-01-01

    Background To determine impact of intraluminal-left anterior descending shunt to prevent myocardial damage in minimally invasive coronary artery bypass. Methods 38 patients were randomly assigned to external tournique occlusion (n = 19) or intraluminal-left anterior descending shunt group (n = 19). Blood samples for cardiac troponin T were collected at 30 minutes prior to, 6 and 24 hours after surgery. Results One patient in external tournique occlusion and two patients in intraluminal-left anterior descending shunt group were excluded from futher analysis due to preoperative cardiac troponin T level above the 99th-percentile. Postoperatively, each six patients in external tournique occlusion (33.3%) and intraluminal-left anterior descending shunt (35.3%) group were above the 99th-percentile. Two patients from each group (external tournique occlusion group 11.1% vs. intraluminal-left anterior descending shunt group 11.8%) had peak values above 10-% coeficient of variation cutoff (p = 1). There were no significant differences in between both groups at all studied timepoints. Conclusion There was no protective effect of intraluminal shunting on myocardial damage compared to short-term tournique occlusion. It is upon the surgeon's discretion which method may preferrably be used to achieve a bloodless field in grafting of the non-occluded left anterior descending in minimally invasive coronary artery bypass. PMID:22809563

  16. Ventriculo-ureteral shunt insertion using percutaneous nephrostomy: a novel minimally invasive option in a patient with chronic hydrocephalus complicated by multiple distal ventriculoperitoneal shunt failures.

    PubMed

    Pillai, Ashok; Mathew, Georgie; Nachimuthu, Sivasankaran; Kalavampara, Sanjeevan Vasudevan

    2017-03-17

    The management of ventriculoperitoneal (VP) shunt failure is a common problem in neurosurgical practice. On occasion, extraperitoneal sites for CSF diversion are required when shunting to the peritoneal cavity has failed after multiple attempts. The authors report a novel minimally invasive procedure allowing cannulation of the ureter for the purpose of ventriculo-ureteral (VU) shunting. Sixteen years prior to presentation, this 46-year-old woman had contracted tuberculous meningitis and had chronic hydrocephalus, with multiple distal shunt failures in recent months. A percutaneous nephrostomy was used to pass the distal catheter based on intraoperative retrograde pyelography. Following successful placement of the VU shunt, the patient's hydrocephalus stabilized and she returned to her regular functional status. The only long-term complication noted within 36 months of follow-up was a transient episode of electrolyte disturbance and dehydration associated with a diarrheal illness that responded to adequate hydration and salt supplementation. By its minimally invasive nature, this approach offers a reasonable extraperitoneal alternative after multiple distal shunt catheter failures have occurred.

  17. Ventriculo-ureteral shunt insertion using percutaneous nephrostomy: a novel minimally invasive option in a patient with chronic hydrocephalus complicated by multiple distal ventriculoperitoneal shunt failures.

    PubMed

    Pillai, Ashok; Mathew, Georgie; Nachimuthu, Sivasankaran; Kalavampara, Sanjeevan Vasudevan

    2017-08-01

    The management of ventriculoperitoneal (VP) shunt failure is a common problem in neurosurgical practice. On occasion, extraperitoneal sites for CSF diversion are required when shunting to the peritoneal cavity has failed after multiple attempts. The authors report a novel minimally invasive procedure allowing cannulation of the ureter for the purpose of ventriculo-ureteral (VU) shunting. Sixteen years prior to presentation, this 46-year-old woman had contracted tuberculous meningitis and had chronic hydrocephalus, with multiple distal shunt failures in recent months. A percutaneous nephrostomy was used to pass the distal catheter based on intraoperative retrograde pyelography. Following successful placement of the VU shunt, the patient's hydrocephalus stabilized and she returned to her regular functional status. The only long-term complication noted within 36 months of follow-up was a transient episode of electrolyte disturbance and dehydration associated with a diarrheal illness that responded to adequate hydration and salt supplementation. By its minimally invasive nature, this approach offers a reasonable extraperitoneal alternative after multiple distal shunt catheter failures have occurred.

  18. Design and measurement of improved capacitively-shunted flux qubits

    NASA Astrophysics Data System (ADS)

    Sears, Adam; Birenbaum, Jeffrey; Hover, David; Gudmundsen, Theodore; Kerman, Andrew; Welander, Paul; Yoder, Jonilyn L.; Gustavsson, Simon; Jin, Xiaoyue; Kamal, Archana; Clarke, John; Oliver, William

    2014-03-01

    The addition of a capacitive or inductive shunt across one of the junctions can alter the coherence properties of a classic flux or RF-SQUID qubit. We have studied the performance of capacitively shunted flux qubits fabricated with MBE aluminum, starting from a 2D coplanar waveguide geometry used in similar high-performance transmon qubits, and measured dispersively. We will detail the importance of design parameters that preserve the flux qubit's anharmonicity and discuss conclusions about materials quality based on calculations of the participation of junction, dielectric, and superconductor components. This research was funded in part by the Office of the Director of National Intelligence (ODNI), Intelligence Advanced Research Projects Activity (IARPA); and by the Assistant Secretary of Defense for Research & Engineering under Air Force Contract number FA8721-05-C-0002. All statements of fact, opinion or conclusions contained herein are those of the authors and should not be construed as representing the official views or policies of IARPA, the ODNI, or the U.S. Government Present address: SLAC National Accelerator Laboratory, Menlo Park, CA.

  19. A High Isolation Series-Shunt RF MEMS Switch

    PubMed Central

    Yu, Yuan-Wei; Zhu, Jian; Jia, Shi-Xing; Shi, Yi

    2009-01-01

    This paper presents a wide band compact high isolation microelectromechanical systems (MEMS) switch implemented on a coplanar waveguide (CPW) with three ohmic switch cells, which is based on the series-shunt switch design. The ohmic switch shows a low intrinsic loss of 0.1 dB and an isolation of 24.8 dB at 6 GHz. The measured average pull-in voltage is 28 V and switching time is 47 μs. In order to shorten design period of the high isolation switch, a structure-based small-signal model for the 3-port ohmic MEMS switch is developed and parameters are extracted from the measured results. Then a high isolation switch has been developed where each 3-port ohmic MEMS switch is closely located. The agreement of the measured and modeled radio frequency (RF) performance demonstrates the validity of the electrical equivalent model. Measurements of the series-shunt switch indicate an outstanding isolation of more than 40 dB and a low insertion loss of 0.35 dB from DC to 12 GHz with total chip size of 1 mm × 1.2 mm. PMID:22408535

  20. Fabrication and characterization of shunted μ-SQUID

    SciTech Connect

    Kumar, Nikhil; Fournier, T.; Courtois, H.; Gupta, Anjan K.

    2014-04-24

    In order to eliminate hysteresis, we have fabricated and characterized niobium based shunted micron size superconducting quantum interference devices (μ-SQUIDs). We find a wide temperature range where these μ-SQUIDs are non-hysteretic in nature and show a very good I{sub c} vs. B oscillations in hysteretic regime and V vs. B oscillations in non-hysteretic regime. Here we report the characteristics of a shunted- μ-SQUID (Wf38LS72D5). In this device we have achieved a large voltage modulation, in non-hysteretic regime, at various temperatures including such as 1.1 mV at 6.62 K with a transfer function V{sub Φ} = 7.2mV/Φ{sub 0}. The figures within the original article PDF file, as supplied to AIP Publishing, were affected by a PDF-processing error. Consequently, the article re-flowed and pagination increased from 3 to 4 pages. This article was updated on 14 May 2014 to correct the PDF-processing error, with the scientific content remaining unchanged. Readers are advised that the replacement article PDF file contains an additional blank page to preserve the original pagination.

  1. [Arteriovenous shunting in obesity, its relation to lung volume].

    PubMed

    Martínez Guerra, M L; Fernández Bonetti, P; Sandoval Zárate, J; Lupi Herrera, E

    1981-01-01

    Thirty-five patients with an average overweight of 67.1% were studied. Pulmonary restriction of a variable degree was found in 68.6/; in 60% due to reduction of respiratory reserve volume. Bronchial obstruction was detected in 57% as measured by forced midexpiratory flow (25-75%). In addition, 14% showed a decrease of 75-85% in forced expiratory flow, which suggested that the pathology was located in the small respiratory airways. The PaO2 while breathing room air and in a resting state was of 52.6 +/- 9.42 mmHg, and after breathing it increased to 69.07 +/- 11.01 mmHg. The PaO2 breathing inspiratory fractions of 99.6% O2 in a resting condition was 309.34 +/- 70.07 mmHg, and after deep breathing it rose to 354.0 +/- 64.27 mmHg. The mechanisms which produce hypoxemia in the obese were analysed and it was concluded that they were due fundamentally to alterations of the ventilation perfusion ratio and to an increase of the venous-arterial shunt. In some cases, alveolar hypoventilation contributed (Pickwick syndrome). By increasing the pulmonary volume with deep breathing, the ventilation perfusion ratio improves or becomes normal, likewise, the venous-arterial shunt can improve or persist as the only cause of hypoxemia.

  2. Transjugular Intrahepatic Portosystemic Shunt (TIPS): Current Status and Future Possibilities

    SciTech Connect

    Bilbao, Jose Ignacio; Quiroga, Jorge; Herrero, Jose Ignacio; Benito, Alberto

    2002-08-15

    Since the insertion of the first TIPS in 1989 much has been learned about this therapeutic procedure. It has an established role for the treatment of some complications of portal hypertension: prevention of recurrent variceal bleeding and rescue of patients with acute uncontrollable variceal bleeding. In addition TIPS is useful for Budd-Chiari syndrome, refractory ascites and hepatorenal syndrome, although its specific role in these indications remains to be definitively established. However, the decrease in sinusoidal blood flow induced by TIPS can lead to the patient developing hepatic encephalopathy and liver failure in some cases. Therefore, TIPS should be used with caution in patients with very poor liver function. From a technical point of view, successful placement of TIPS is achieved in more than 98% of cases by experienced groups. At present, evaluation of TIPS dysfunction based on morphology probably leads to an overdiagnosis of this complication since most of these cases are not associated with clinical manifestations (recurrent bleeding or refractory ascites). The major disadvantage of TIPS remains its poor long-term patency requiring a mandatory surveillance program. The indicator for shunt function/malfunction should be the portosystemic pressure gradient, which is best assessed by intravascular measurements. Shunt obstructions may be prevented or reduced by the use of stent-grafts in the future.

  3. Instantiating a mechatronic valve schedule for a hydrocephalus shunt.

    PubMed

    Momani, Lina; Alkharabsheh, Abdel Rahman; Al-Zuibi, Nayel; Al-Nuaimy, Waleed

    2009-01-01

    Hydrocephalus is caused by blockage or reabsorption difficulty that upsets the natural balance of production and absorption of cerebrospinal fluid in the brain, resulting in a build-up of the fluid in the ventricles of the brain. One of the recent advances in the treatment of hydrocephalus is the invention of a mechatronic valve. The desirability of such valve lies in the potential of having shunt that not only control hydrocephalus but also seeks to treat it. In contrast to current valves, such a valve is regulated based on a time based schedule not on the differential pressure across the valve. Thus the effectiveness of such valve is highly dependant on selecting an appropriate valve schedule that delivers personal dynamic treatment for every individual patient. Providing such a schedule is likely to be one of the obstacles facing the implementation of the mechatronic valve. In this paper, an algorithm is proposed to help in developing such a schedule that dynamically change based on the patients' own intracranial pressure data and a novel figure of merit, thus providing the physician with an easy tool that facilitate the use of the mechatronic valve. The algorithm was implemented in M ATLAB and Simulink. Real ICP data for three hydrocephalus patients (before shunting) were used to test this algorithm and the resulted schedules along with the resulted intracranial pressure data have illustrated the effectiveness of the algorithm in providing schedule that maintain ICP within the normal limits.

  4. Transjugular Intrahepatic Portosystemic Shunts in Children with Biliary Atresia

    SciTech Connect

    Huppert, Peter E.; Goffette, Pierre; Sokal, Emil M.; Schweizer, Paul; Claussen, Claus D.

    2002-12-15

    Purpose: We retrospectively evaluated the technical and long-term clinical results of transjugularintrahepatic portosystemic shunts (TIPS) in children with portal hypertension and biliary atresia (BA). Methods: Nine children with BA and recurrent bleeding from esophagogastric and/or intestinal varices were treated by TIPS at the age of 34-156 months and followed-up in two centers. Different types of stents were used. Results: Shunt insertion succeeded in all patients, but in two a second procedure was necessary. Seven procedures lasted more than 3 hr, mainly due to difficult portal vein puncture.Variceal bleeding ceased in all patients; however, 16 reinterventions were performed in eight patients for clinical reasons (n =11) and sonographically suspected restenosis (n =5). Four patients underwent successful liver transplantation 4-51 months after TIPS and five are in good clinical conditions 64-75 months after TIPS. Conclusions: TIPS in children with BA is technically difficult, mainly due to periportal fibrosis and small portal veins. Frequency of reinterventions seems to be higher compared with adults.

  5. Use of lumboperitoneal shunts with the Strata NSC valve: a single-center experience.

    PubMed

    Toma, Ahmed K; Dherijha, Muhammad; Kitchen, Neil D; Watkins, Laurence D

    2010-12-01

    The lumboperitoneal (LP) shunt with the adjustable PS Medical Strata NSC LP valve and small lumen peritoneal catheter was introduced in the authors' unit in 2007. The object of this study was to audit the unit's experience with this new shunt system. The authors performed a retrospective review of the clinical records of patients who underwent Strata NSC LP shunt insertion. Demographic and clinical data as well as information about complications and revisions were reported. Between August 2007 and November 2009, 20 patients underwent placement of an LP shunt with an adjustable Strata NSC valve and small lumen peritoneal catheter at the authors' institution. Their mean age was 40.3 years and the mean duration of follow-up was 12 months. Preoperatively, 18 patients had headache and 15 patients had visual signs and symptoms. Fourteen of the 18 patients with preoperative headache did not complain of headache postoperatively, and 4 had headache that was found not to be related to shunt function. Two of the patients with preoperative visual complaints had ongoing visual problems postoperatively. None of the patients had infection or subdural hematoma. The only overdrainage symptoms occurred in association with spontaneous readjustment of the valve and resolved when the valve was reset. Thirteen patients (65%) did not require shunt revision. Seven patients (35%) required 13 shunt exploration or revision procedures, mainly due to distal obstruction. Placement of an LP shunt failed to completely resolve the raised intracranial pressure problem in 2 patients. The use of the Strata NSC valve and small lumen peritoneal catheter is effective in treating pseudotumor cerebri and is beneficial in terms of markedly reducing overdrainage complications compared with other reported series of cases in which an LP shunt has been placed. However, the use of the Strata NSC valve and small lumen peritoneal catheter did not have a marked impact on other causes of shunt failure, particularly

  6. Shunt-dependent hydrocephalus: management style among members of the American Society of Pediatric Neurosurgeons.

    PubMed

    Kraemer, Mark R; Sandoval-Garcia, Carolina; Bragg, Taryn; Iskandar, Bermans J

    2017-09-01

    OBJECTIVE The authors conducted a survey to evaluate differences in the understanding and management of shunt-dependent hydrocephalus among members of the American Society of Pediatric Neurosurgeons (ASPN). METHODS Surveys were sent to all 204 active ASPN members in September 2014. One hundred thirty responses were received, representing a 64% response rate. Respondents were asked 13 multiple-choice and free-response questions regarding 4 fundamental problems encountered in shunted-hydrocephalus management: shunt malfunction, chronic cerebrospinal fluid (CSF) overdrainage, chronic headaches, and slit ventricle syndrome (SVS). RESULTS Respondents agreed that shunt malfunction occurs most often as the result of ventricular catheter obstruction. Despite contrary evidence in the literature, most respondents (66%) also believed that choroid plexus is the tissue most often found in obstructed proximal catheters. However, free-text responses revealed that the respondents' understanding of the underlying pathophysiology of shunt obstruction was highly variable and included growth, migration, or adherence of choroid plexus, CSF debris, catheter position, inflammatory processes, and CSF overdrainage. Most respondents considered chronic CSF overdrainage to be a rare complication of shunting in their practice and reported wide variation in treatment protocols. Moreover, despite a lack of evidence in the literature, most respondents attributed chronic headaches in shunt patients to medical reasons (for example, migraines, tension). Accordingly, most respondents managed headaches with reassurance and/or referral to pain clinics. Lastly, there were variable opinions on the etiology of slit ventricle syndrome (SVS), which included early shunting, chronic overdrainage, and/or loss of brain compliance. Beyond shunt revision, respondents reported divergent SVS treatment preferences. CONCLUSIONS The survey shows that there is wide variability in the understanding and management of

  7. Left ventricular to right atrial shunt (Gerbode defect): congenital versus acquired

    PubMed Central

    2014-01-01

    Introduction Congenital left ventricular to right atrial (LV-RA) shunt (Gerbode defect) is rare, while acquired LV-RA shunt has been increasingly reported. As yet, systematically incorporated data of the LV-RA shunt have not been presented. Aim To present the clinical features, diagnostic challenge and management strategies of congenital and acquired LV-RA shunts. Material and methods The data source was based on a comprehensive literature retrieval of the LV-RA shunt in the period 1990–2013. Results In comparison with the acquired Gerbode defect, the congenital Gerbode defect group of patients were younger and were associated more often with additional congenital disorders. Previous cardiac surgery and infective endocarditis were the two major aetiologies of the occurrence of the acquired shunts. Paravalvular abscess was associated in 10.2% and atrioventricular block in 13.6% of the acquired group patients. Transoesophageal echocardiography showed a higher diagnostic accuracy, lower missed diagnosis and lower inclusive diagnosis rates, in comparison to transthoracic echocardiography, but the misdiagnosis rates of the two modalities did not differ from each other. Four (4.5%) of the acquired group patients were complicated by atrioventricular block following surgical or interventional closure of the shunt. Eight (9.1%) patients died in the acquired group, but no patient died in the congenital group. Conclusions The diagnosis of an LV-RA shunt is quite challenging, especially in the context of coexisting abnormalities including an additional intracardiac shunt, tricuspid regurgitation, pulmonary artery hypertension and infective endocarditis, which have to be carefully differentiated from the shunt by further investigations. A better control of infective complications and careful manoeuvres during surgery may help to keep the LV-RA-sensitive septum intact. PMID:25489305

  8. Choice of valve type and poor ventricular catheter placement: Modifiable factors associated with ventriculoperitoneal shunt failure.

    PubMed

    Jeremiah, Kealeboga Josephine; Cherry, Catherine Louise; Wan, Kai Rui; Toy, Jennifer Ah; Wolfe, Rory; Danks, Robert Andrew

    2016-05-01

    Ventriculoperitoneal (VP) shunt insertion is a common neurosurgical procedure, essentially unchanged in recent years, with high revision rates. We aimed to identify potentially modifiable associations with shunt failure. One hundred and forty patients who underwent insertion of a VP shunt from 2005-2009 were followed for 5-9years. Age at shunt insertion ranged from 0 to 91years (median 44, 26% <18years). The main causes of hydrocephalus were congenital (26%), tumour-related (25%), post-haemorrhagic (24%) or normal pressure hydrocephalus (19%). Fifty-eight (42%) patients required ⩾1 shunt revision. Of these, 50 (88%) were for proximal catheter blockage. The median time to first revision was 108days. Early post-operative CT scans were available in 105 patients. Using a formal grading system, catheter placement was considered excellent in 49 (47%) but poor (extraventricular) in 13 (12%). On univariate analysis, younger age, poor ventricular catheter placement and use of a non-programmable valve were associated with shunt failure. On logistic regression modelling, the independent associations with VP shunt failure were poor catheter placement (odds ratio [OR] 4.9, 95% confidence interval [CI] 1.3-18.9, p=0.02) and use of a non-programmable valve (OR 0.4, 95% CI 0.2-1.0, p=0.04). In conclusion, poor catheter placement (revision rate 77%) was found to be the strongest predictor of shunt failure, with no difference in revisions between excellent (43%) and moderate (43%) catheter placement. Avoiding poor placement in those with mild or moderate ventriculomegaly may best reduce VP shunt failures. There may also be an influence of valve choice on VP shunt survival.

  9. Relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt.

    PubMed

    Yamada, Shoko Merrit; Kitagawa, Ryo; Teramoto, Akira

    2013-01-01

    The long-term maintenance of ventriculoperitoneal (VP) shunt function depends on the correct placement of the catheter tip in the lateral ventricle. The relationship between the location of the ventricular catheter tip and VP shunt function was analyzed in 52 patients. The location of the ventricular catheter tip was classified into one of the following five groups: (i) Group A--superior to the foramen of Monro; (ii) Group B--in the center of the lateral ventricle body; (iii) Group C--in the third ventricle; (iv) Group D--contacting the ventricle wall; and (v) Group E--in the septum pellucidum. VP shunt function was defined as well controlled hydrocephalus when the Evan's ratio of the ventricular size was < 0.3. The VP shunt functioned well in 14 of 52 patients (26.9%), the shunt valve pressure was incorrectly set in 21 (40.4%), and irreversible shunt malfunction was identified in 17 (32.7%). Among the 14 patients with a well-functioning shunt, 13 were in Groups A or B with an odds ratio (OR) of 17.875 (p<0.05). In the 17 irreversible shunt malfunctions, 13 were identified in Groups C, D, or E with an OR of 0.123 (p<0.05). Long term VP shunt function or failure due to irreversible malfunction is directly influenced by the position of the ventricular catheter tip. Ideal points for positioning the ventricular catheter tip are superior to the foramen of Monro and in the center of the lateral ventricle body. Early shunt revision may be required for patients in whom the catheter tip contacts the ventricle wall or is located in the septum pellucidum.

  10. Ventricular peritoneal shunt malfunction after operative correction of scoliosis: report of three cases.

    PubMed

    Lai, Lawrence P; Egnor, Michael R; Carrion, Wesley V; Haralabatos, Susan S; Wingate, Michael T

    2014-11-01

    Two of the most common disease processes associated with hydrocephalus in children are spina bifida and intraventricular hemorrhage of prematurity, both of which are known to be also associated with spinal deformity in later childhood. The occurrence of shunt malfunction after mechanical injury or stress to the hardware has been well documented. Newer techniques in the treatment of neuromuscular scoliosis, including anterior release with segmental fixation, have resulted in more powerful corrections of these large spinal deformities. A new potential cause of shunt malfunction is the aggressive correction of scoliosis. To report patients with neuromuscular curves averaging 100° who were subsequently recognized to have perioperative shunt malfunction. Three case studies from a university hospital setting were included. All three children were young adolescents and had-long term shunts. Two of the children had spina bifida and a third had cerebral palsy. All children underwent anterior release of their scoliosis with posterior segmental instrumentation, with unit rods and sublaminar wires. All had significant correction of their scoliosis. Malfunctioning of the ventriculoperitoneal shunts were recorded. Chart reviews of three cases were analyzed. Two children had shunt malfunctions within a month of their surgery, and one child had intraoperative recognition and externalization of the shunt. Older children undergoing repair of neuromuscular scoliosis are often preadolescents or adolescents who have the same indwelling shunt systems originally implanted in early infancy. The shunt may be brittle and calcified, and the peritoneal catheter may be short. The correction of scoliosis often results in an almost instantaneous growth of a few inches. Because of the potential difficulty in recognizing shunt malfunction in the perioperative period, consideration should be given for elective revision of the peritoneal catheter in children at risk. Copyright © 2014 Elsevier Inc

  11. Ventricular-subcutaneous shunt for the treatment of experimental hydrocephalus in young rats: technical note.

    PubMed

    Santos, Marcelo Volpon; Garcia, Camila Araujo Bernardino; Jardini, Evelise Oliveira; Romeiro, Thais Helena; da Silva Lopes, Luiza; Machado, Hélio Rubens; de Oliveira, Ricardo Santos

    2016-08-01

    Hydrocephalus is a complex disease that affects cerebrospinal fluid (CSF) dynamics and is very common in children. To this date, CSF shunting is still the standard treatment for childhood hydrocephalus, but, nevertheless, the effects of such an operation on the developing brain are widely unknown. To help overcome this, experimental models of CSF shunts are surely very useful tools. The objective of this study was to describe a feasible and reliable technique of an adapted ventricular-subcutaneous shunt for the treatment of kaolin-induced hydrocephalus in young rats. We developed a ventricular-subcutaneous shunt (VSCS) technique which was used in 31 Wistar young rats with kaolin-induced hydrocephalus. Hydrocephalus was induced at 7 days of age, and shunt implantation was performed 7 days later. Our technique used a 0.7-mm gauge polypropylene catheter tunneled to a subcutaneous pocket created over the animal's back and inserted into the right lateral ventricle. All animals were sacrificed 14 days after shunt insertion. Twenty-four rats survived and remained well until the study was ended. No major complications were seen. Their weight gain went back to normal. They all underwent ambulatory behavioral testing prior and after VSCS, which showed improvement in their motor skills. We have also obtained magnetic resonance (MR) scans of 16 pups confirming reduction of ventricular size after shunting and indicating effective treatment. Histopathological analysis of brain samples before and after shunting showed reversion of ependymal and corpus callosum disruption, as well as fewer reactive astrocytes in shunted animals. An experimental CSF shunt technique was devised. Excessive CSF of hydrocephalic rats is diverted into the subcutaneous space where it can be resorbed. This technique has a low complication rate and is effective. It might be applied to various types of experimental studies involving induction and treatment of hydrocephalus.

  12. Impact of ventriculoperitoneal shunting on chronic normal pressure hydrocephalus in consciousness rehabilitation.

    PubMed

    Chen, Zhen; Yang, Yanhui; Chen, Ge; Wang, Maobin; Song, Weiqun

    2014-10-01

    To investigate the impact of ventriculoperitoneal shunting during clinical rehabilitation of chronic normal pressure hydrocephalus patients with disorders of consciousness following aneurysmal subarachnoid haemorrhage. Cross-sectional study. Thirty-five patients with disorders of consciousness following aneurysmal subarachnoid haemorrhage who had undergone ventriculoperitoneal shunting for chronic normal pressure hydrocephalus were compared with 16 matched controls with no ventriculoperitoneal shunting. Data from clinical examinations, rehabilitation assessments and computed tomography scans (to exclude other diseases that can cause ventricular enlargement) were analysed. All the patients with disorders of consciousness underwent neurorehabilitation. Consciousness was measured on the Glasgow Coma Scale. The cella media index was calculated as the change in size of the lateral ventricles (prior to ventriculoperitoneal shunting and/or rehabilitation, and 1 and 3 months after shunting and/or rehabilitation). The short-term outcome of treatment was assessed at 3 months using the Glasgow Outcome Scale. Twenty-four out of 35 patients with disorders of consciousness recovered gradually after ventriculoperitoneal shunting and rehabilitation. There was a significant difference in the Glasgow Coma Scale between ventriculoperitoneal shunting and control groups at both 1 and 3 months (F = 19.29, p < 0.01). Significant differences were also observed between the 2 groups in the cella media index at 1 and 3 months (F = 15.03, p < 0.01). The Glasgow Outcome Scale of the ventriculoperitoneal shunting group was significantly higher than that of the control group (p < 0.01, r = 0.55) 3 months after shunting and/or rehabilitation. Chronic normal pressure hydrocephalus during rehabilitation is a serious and previously unrecognized medical condition, which influences consciousness in patients following an aneurysmal subarachnoid haemorrhage. However, the

  13. [Semiology of ventriculoperitoneal shunting dysfunction in children - a review].

    PubMed

    Neiter, E; Guarneri, C; Pretat, P-H; Joud, A; Marchal, J-C; Klein, O

    2016-02-01

    Ventriculoperitoneal shunting (VPS) is a treatment of the hydrocephalus that may dysfunction. The clinical presentation of shunt dysfunction is variable. We therefore decided to focus on the clinical presentation of VPS malfunction in children, as this condition requires immediate emergency treatment and because of the sometimes confusing signs of intracranial hypertension in a shunted child. We searched PubMed with the following groups of keywords: (dysfunction OR blockage) AND shunting AND hydrocephalus; shunt complications AND hydrocephalus; hydrocephalus AND shunt AND malfunction. Articles dealing with ventriculo-atrial shunt were excluded. A total of 79 articles were retained for analysis (English and French). Case reports were excluded. The clinical presentation varies by age: vomiting and alterated level of consciousness are the most frequent signs in older children, whereas infants present more often with raised intracranial pressure symptoms such as nausea, vomiting, irritability and bulging fontanel. Drowsiness is a good predictor of VPS dysfunction. An asymptomatic presentation is rare but possible. Abdominal presentation is also possible, ranging from abdominal discomfort to peritonitis. Fever, occurring a short time after the last intervention, and irritability are good predictors of shunt infection. Pumping the chamber of the VPS has a weak positive predictive value (12%). Shunt dysfunction can lead to death, with an estimated mortality rate at 1% per year during the first years. It is essential to be aware of the variability of the clinical presentation of VPS dysfunction, because of the potential severity of this condition. Also it is important to pay attention to the comments of the parents, especially if the child experienced a previous shunt malfunction. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease.

    PubMed

    O'Connor, Matthew J; Ravishankar, Chitra; Ballweg, Jean A; Gillespie, Matthew J; Gaynor, J William; Tabbutt, Sarah; Dominguez, Troy E

    2011-07-01

    To determine the incidence, risk factors, and outcomes after early, unplanned intervention on systemic-to-pulmonary artery shunts in neonates. We retrospectively studied all neonates undergoing systemic-to-pulmonary artery shunt placement at The Children's Hospital of Philadelphia between September 1, 2002, and May 1, 2005. Patients requiring transcatheter or surgical systemic-to-pulmonary artery shunt intervention before discharge were compared with those not undergoing shunt intervention. A total of 206 patients underwent shunt placement. Diagnoses included hypoplastic left heart syndrome (62.1%), pulmonary atresia (15%), tricuspid atresia (4.9%), tetralogy of Fallot (2.4%), and other lesions with obstruction to systemic (10.7%) or pulmonary blood flow (4.9%). Twenty-one interventions occurred in 20 patients (9.7%). Risk factors for intervention included heterotaxy syndrome (P = .04), congenital abnormality (P = .04), and a trend toward lower birthweight. In patients with a modified Blalock-Taussig shunt, similar risk factors were identified and the incidence of intervention decreased with increasing shunt size. In-hospital mortality was 30% (6/20) for the cases and 8.1% (15/186) for the nonintervention group (P = .02). Long-term survival was significantly lower in patients requiring intervention (P = .002). This group also had a higher incidence of infections (P < .001) and extracorporeal membrane oxygenation (P < .001), and longer hospital stay (P = .001). In neonates undergoing systemic-to-pulmonary artery shunt placement, approximately 10% underwent shunt intervention before discharge. Some factors, such as low birthweight, shunt size, noncardiac congenital abnormalities, and heterotaxy syndrome, may help identify patients at risk. Patients undergoing intervention experienced increased morbidity and mortality. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  15. Scintigraphic diagnosis of a right to left shunt in end-stage lung disease.

    PubMed

    Graves, M W; Kiratli, P O; Mozley, D; Palevsky, H; Zukerberg, B; Alavi, A

    2003-05-01

    The presence of a right to left shunt influences the surgical approach to lung transplantation in patients with end-stage pulmonary disease. The purposes of this study included comparing contemporaneous lung scintigraphy with cardiac catheterization in the detection of intracardiac shunts in patients with end-stage lung disease and the point prevalence of right to left shunting was determined in patients with several different types of end-stage lung disease. Hundred and twenty six patients with end-stage lung disease who were candidates for lung transplantation underwent perfusion images of the lungs with Tc-99m-labeled macro-aggregated albumin (MAA). Planar scans of the brain and the kidneys were performed contemporaneously. Statistical analyses included correlation ofthe clinical, laboratory and scintigraphic variables. Group means were compared with the students t-test (two-tailed P-value). There were 21 patients with primary pulmonary hypertension (PPH), 72 with emphysematous lung disease (COPD), 22 with pulmonary fibrotic disease (PF) and 11 with congenital heart disease (CHD) leading to pulmonary hypertension. Only 13 patients (10.3%) were found to have a right to left shunt. Of these, 4 had PPH, 2 had PF, and 7 had CHD. No shunts were found in patients with emphysema. All the positive studies had abnormally increased activity in both the brain and the kidneys. However, there were 25 cases with renal activity and none of these patients had brain activity or clinical evidence of a shunt. Increased pulmonary artery pressure was associated with scintigraphic presence of a shunt. There were no cases of a right to left shunt with a mean pulmonary artery pressure less than 50 mm Hg. In the subset of patients with a pulmonary pressure greater than 50 mm Hg, approximately 40% of the patients had a right to a left shunt. There were no measurable differences in the spirometry results, right ventricular ejection fraction (RVEF) or left ventricular ejection fraction

  16. Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States

    PubMed Central

    Simon, Tamara D.; Hall, Matthew; Riva-Cambrin, Jay; Albert, J. Elaine; Jeffries, Howard E.; LaFleur, Bonnie; Dean, J. Michael; Kestle, John R. W.

    2010-01-01

    Object Reported rates of CSF shunt infection vary widely across studies. The study objective was to determine the CSF shunt infection rates after initial shunt placement at multiple US pediatric hospitals. The authors hypothesized that infection rates between hospitals would vary widely even after adjustment for patient, hospital, and surgeon factors. Methods This retrospective cohort study included children 0–18 years of age with uncomplicated initial CSF shunt placement performed between January 1, 2001, and December 31, 2005, and recorded in the Pediatric Health Information System (PHIS) longitudinal administrative database from 41 children's hospitals. For each child with 24 months of follow-up, subsequent CSF shunt infections and procedures were determined. Results The PHIS database included 7071 children with uncomplicated initial CSF shunt placement during this time period. During the 24 months of follow-up, these patients had a total of 825 shunt infections and 4434 subsequent shunt procedures. Overall unadjusted 24-month CSF shunt infection rates were 11.7% per patient and 7.2% per procedure. Unadjusted 24-month cumulative incidence rates for each hospital ranged from 4.1 to 20.5% per patient and 2.5–12.3% per procedure. Factors significantly associated with infection (p < 0.05) included young age, female sex, African-American race, public insurance, etiology of intraventricular hemorrhage, respiratory complex chronic condition, subsequent revision procedures, hospital volume, and surgeon case volume. Malignant lesions and trauma as etiologies were protective. Infection rates for each hospital adjusted for these factors decreased to 8.8–12.8% per patient and 1.4–5.3% per procedure. Conclusions Infections developed in > 11% of children who underwent uncomplicated initial CSF shunt placements within 24 months. Patient, hospital, and surgeon factors contributed somewhat to the wide variation in CSF shunt infection rates across hospitals. Additional

  17. Bilateral abducens and facial nerve palsies as a localizing sign due to reduction in intracranial pressure after fourth ventriculoperitoneal shunting

    PubMed Central

    Maramattom, Boby Varkey; Panikar, Dilip

    2016-01-01

    A trapped fourth ventricle often requires fourth ventriculoperitoneal shunting (4VP). Complications of this procedure include shunt blockage, infection, shunt migration, and overdrainage. Cranial nerve palsies are very rare after 4VP shunting and have been described with over drainage and brainstem distortion. We present an unusual case of bilateral abducens and facial nerve palsies after 4VP shunting after normalization of 4th ventricular parameters. Measurement of various brainstem angles presented us with a plausible hypothesis to explain the cranial nerve dysfunction. PMID:27994363

  18. Ventriculoperitoneal Shunt Tip as a Rare Cause for Recurrent Pain Episodes in a Child: Think Irritable Peritoneum.

    PubMed

    Poryo, Martin; Eymann, Regina; Meyer, Sascha

    2015-01-01

    Ventriculoperitoneal (VP) shunting is an established treatment to regulate the drainage of cerebrospinal fluid (CSF) in posthaemorrhagic hydrocephalus. Several complications (e.g. blockage of CSF shunting, overdrainage, but also catheter-related perforation of abdominal organs, etc.) may occur and may lead to painful episodes, mostly headache, in these children. Here, we report on a 7-year-old child with recurrent painful episodes after revision of a VP shunt that subsided only after repositioning of the abdominal tip of the VP shunt. Visceral irritation by a malpositioned VP shunt should be considered as a cause for recurrent pain in non-verbal children without other relevant clinical findings.

  19. Laparoscopic distal splenoadrenal shunt for the treatment of portal hypertension in children with congenital hepatic fibrosis

    PubMed Central

    Zhang, Jin-Shan; Cheng, Wei; Li, Long

    2017-01-01

    Abstract Background: The distal splenorenal shunt is an effective procedure for the treatment of portal hypertension in children. However, there has been no report about laparoscopic distal splenorenal shunt in the treatment of portal hypertension in children. Methods: From December 2015 to August 2016, 4 children with upper gastrointestinal bleeding underwent laparoscopic distal splenoadrenal shunt. Portal hypertension and splenomegaly were demonstrated on the preoperative computed tomography (CT) and sonography. The distal splenic vein was mobilized and anastomosed to the left adrenal vein laparoscopically. All patients were followed-up postoperatively. Results: The laparoscopic distal splenoadrenal shunt was successfully performed in all patients. The liver fibrosis was diagnosed by postoperative liver pathology. The operative time ranged from 180 to 360 minutes. The blood loss was minimal. The length of hospital stay was 6 to 13 days. The duration of following-up was 1 to 9 months (median: 3 months). The portal pressure and splenic size were decreased postoperatively. The complete blood count normalized and the biochemistry tests were within normal range after surgery. Postoperative ultrasound and CT confirmed shunt patency and satisfactory flow in the splenoadrenal shunt in all patients. No patient developed recurrence of variceal bleeding. Conclusions: The laparoscopic splenoadrenal shunt is a feasible treatment of portal hypertension in children. PMID:28099341

  20. Diagnosis of ventriculoperitoneal shunt infection using [F-18]-FDG PET: a case report.

    PubMed

    Rehman, T; Chohan, M O; Yonas, H

    2011-06-01

    Infection of cerebrospinal fluid (CSF) shunts is a common occurrence and can often be difficult to diagnose using standard analysis of shunt fluid. This article presents the first case report on the diagnosis of a CSF shunt infection on FDG PET scan. A 26-year-old female underwent ventriculoperitoneal shunt placement after developing a pseudomeningocele subsequent to a suboccipital craniectomy for Chiari malformation. Two months later, the patient presented with abdominal pain and non-specific symptoms and was found to have a perisplenic abscess for which she was adequately treated. Failure of her symptoms to solve and an initial negative shunt CSF analysis prompted the search for other sources of infection. An FDG PET scan performed a week later found evidence of increase tracer uptake around the distal tip of the catheter and a repeat shunt CSF analysis showed evidence of CSF infection. FDG PET may be useful in diagnosing shunt related infections in case of high clinical suspicion when standard diagnostic modalities fail to diagnose hardware infection.