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Sample records for portosystemic shunt histologic

  1. Transjugular Intrahepatic Portosystemic Shunt: Histologic and Immunohistochemical Study of Autopsy Cases

    SciTech Connect

    Terayama, Noboru; Matsui, Osamu; Kadoya, Masumi; Yoshikawa, Jun; Gabata, Toshifumi; Miyayama, Shiro; Takashima, Tsutomu; Kobayashi, Kenichi; Nakanishi, Isao; Nakanuma, Yasuni

    1997-11-15

    Purpose: To assess the histologic findings associated with stenosed and occluded transjugular intrahepatic portosystemic shunt (TIPS) tracts. Methods: Four TIPS tracts within three autopsy livers were histologically studied for vascular components by routine staining and immunohistochemical staining. TIPS had been performed for bleeding from esophageal varices in patients with cirrhosis of the liver. Results: Two TIPS, examined on days 4 and 53, showed occlusion by fibrin thrombus. In the former, no endothelial cells were detected, but coagulative necrosis of hepatocytes was found in the surrounding liver. In the latter, bile pigments were seen on the luminal surface. In the two other TIPS without tract occlusion, examined on days 49 and 293, a layer of endothelial cells, proliferation of smooth muscle cells, and deposition of an extracellular matrix such as collagen were confirmed. In the tract examined on day 293, there was protrusion of hepatocytes into the lumen through the stent wires. Conclusion: Short- and midterm TIPS occlusions were caused by thrombus forming after necrosis of hepatocytes and bile leakage, respectively. Long-term TIPS stenosis was associated with a combination of pseudointimal hyperplasia and ingrowth of hepatocytes.

  2. 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

  3. 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, ...

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. [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

  10. 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.

  11. 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

  12. [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.

  13. Emphysematous pyonephrosis associated with extrahepatic portosystemic shunt in a dog

    PubMed Central

    LIM, Jongsu; YOON, Youngmin; JUNG, Dongin; YEON, Seongchan; LEE, Heechun

    2015-01-01

    A 16-month-old intact female Maltese dog was referred for examination of depression and vomiting. Ultrasonography revealed dilated right renal pelvis containing echogenic fluid with free gas. A hyperechoic material suspected of urolith was identified in the right ureter. Computed tomography revealed emphysematous change of the right kidney associated with ureteral obstruction and extrahepatic portosystemic shunt (EHPSS). Ureteronephrectomy and surgical correction were performed for the EHPSS. Escherichia coli was isolated from pus from the right kidney. Quantitative analysis revealed that the urolith was an ammonium urate stone. After 5 months follow-up, no complication was observed. This is the first report of emphysematous pyonephrosis associated with EHPSS in a dog. PMID:26668166

  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. 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.

  16. 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

  17. Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy.

    PubMed

    Pereira, Keith; Carrion, Andres F; Martin, Paul; Vaheesan, Kirubahara; Salsamendi, Jason; Doshi, Mehul; Yrizarry, Jose M

    2015-12-01

    Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure-related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. Conservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is, however, the ultimate treatment.

  18. Surgical attenuation of spontaneous congenital portosystemic shunts in dogs resolves hepatic encephalopathy but not hypermanganesemia.

    PubMed

    Gow, Adam G; Frowde, Polly E; Elwood, Clive M; Burton, Carolyn A; Powell, Roger M; Tappin, Simon W; Foale, Rob D; Duncan, Andrew; Mellanby, Richard J

    2015-10-01

    Hypermanganesemia is commonly recognized in human patients with hepatic insufficiency and portosystemic shunting. Since manganese is neurotoxic, increases in brain manganese concentrations have been implicated in the development of hepatic encephalopathy although a direct causative role has yet to be demonstrated. Evaluate manganese concentrations in dogs with a naturally occurring congenital shunt before and after attenuation as well as longitudinally following the changes in hepatic encephalopathy grade. Our study demonstrated that attenuation of the shunt resolved encephalopathy, significantly reduced postprandial bile acids, yet a hypermanganasemic state persisted. This study demonstrates that resolution of hepatic encephalopathy can occur without the correction of hypermanganesemia, indicating that increased manganese concentrations alone do not play a causative role in encephalopathy. Our study further demonstrates the value of the canine congenital portosystemic shunt as a naturally occurring spontaneous model of human hepatic encephalopathy.

  19. Three-dimensional multislice helical computed tomography techniques for canine extra-hepatic portosystemic shunt assessment.

    PubMed

    Bertolini, Giovanna; Rolla, Edoardo C; Zotti, Alessandro; Caldin, Marco

    2006-01-01

    The purpose of the present study was to investigate the feasibility and usefulness of three-dimensional (3D) multislice computed tomography (CT) angiography with maximum intensity projection (MIP) and volume rendering (VR) in six dogs with clinical and sonographic findings suggestive of portosystemic shunt. Furthermore, we aimed to estimate the diameter of the portal vein and shunt vessels. MIP and VR reconstructions were performed for each patient and the origin and insertion of all shunt vessels were detected. In addition, 3D reconstructions allowed excellent depiction of vascular morphology and topography. All diagnoses and vessel measurements were confirmed by surgery. 3D multidetector CT angiography is a promising, noninvasive, and accurate method of evaluating dogs with suspected portosystemic shunts.

  20. Rheolytic Thrombectomy of an Acutely Thrombosed Transjugular Intrahepatic Portosystemic Stent Shunt

    SciTech Connect

    Mueller-Huelsbeck, Stefan; Link, Johann; Hoepfner, Michael; Loeser, Christian; Heller, Martin

    1996-04-15

    As an alternative to chemical thrombolysis, an acutely occluded transjugular intrahepatic portosystemic stent shunt in a 72-year-old woman was successfully recanalized using a 5 Fr rheolytic catheter system. No adjunctive thrombectomy treatment was necessary. The underlying stenotic leason was treated with percutaneous transluminal angioplasty and a Palmaz stent. Immediately after the intervention optimal shunt flow was achieved. Ascites vanished within a few days and no further bleeding complications appeared.

  1. Acute Budd-Chiari syndrome: Treatment with transjugular intrahepatic portosystemic shunt

    SciTech Connect

    Strunk, Holger M.; Textor, Jochen; Brensing, Karl-August; Schild, Hans H.

    1997-07-15

    The case of a 28-year-old man with acute Budd-Chiari syndrome due to veno-occlusive disease is reported. Transjugular intrahepatic portosystemic shunt (TIPS) was performed after upper gastrointestinal endoscopy, duplex sonographic and abdominal computed tomographic examination, inferior cavogram with hepatic venous catheterization, and transvenous biopsy. A 10-mm parenchymal tract was created. The patient did well after the procedure; ascites resolved and liver function improved markedly. The shunt has remained patent up to now for 6 months.

  2. Radiation Exposure in Transjugular Intrahepatic Portosystemic Shunt Creation

    SciTech Connect

    Miraglia, Roberto Maruzzelli, Luigi Cortis, Kelvin; D’Amico, Mario; Floridia, Gaetano Gallo, Giuseppe Tafaro, Corrado Luca, Angelo

    2016-02-15

    PurposeTransjugular intrahepatic portosystemic shunt (TIPS) creation is considered as being one of the most complex procedures in abdominal interventional radiology. Our aim was twofold: quantification of TIPS-related patient radiation exposure in our center and identification of factors leading to reduced radiation exposure.Materials and methodsThree hundred and forty seven consecutive patients underwent TIPS in our center between 2007 and 2014. Three main procedure categories were identified: Group I (n = 88)—fluoroscopic-guided portal vein targeting, procedure done in an image intensifier-based angiographic system (IIDS); Group II (n = 48)—ultrasound-guided portal vein puncture, procedure done in an IIDS; and Group III (n = 211)—ultrasound-guided portal vein puncture, procedure done in a flat panel detector-based system (FPDS). Radiation exposure (dose-area product [DAP], in Gy cm{sup 2} and fluoroscopy time [FT] in minutes) was retrospectively analyzed.ResultsDAP was significantly higher in Group I (mean ± SD 360 ± 298; median 287; 75th percentile 389 Gy cm{sup 2}) as compared to Group II (217 ± 130; 178; 276 Gy cm{sup 2}; p = 0.002) and Group III (129 ± 117; 70; 150 Gy cm{sup 2}p < 0.001). The difference in DAP between Groups II and III was also significant (p < 0.001). Group I had significantly longer FT (25.78 ± 13.52 min) as compared to Group II (20.45 ± 10.87 min; p = 0.02) and Group III (19.76 ± 13.34; p < 0.001). FT was not significantly different between Groups II and III (p = 0.73).ConclusionsReal-time ultrasound-guided targeting of the portal venous system during TIPS creation results in a significantly lower radiation exposure and reduced FT. Further reduction in radiation exposure can be achieved through the use of modern angiographic units with FPDS.

  3. Portosplenic blood flow separation in a patient with portosystemic encephalopathy and a spontaneous splenorenal shunt.

    PubMed

    Zamora, Carlos Armando; Sugimoto, Koji; Tsurusaki, Masakatsu; Yamaguchi, Masato; Izaki, Kenta; Taniguchi, Takanori; Iwama, Yuki; Mimura, Fumitoshi; Sugimura, Kazuro

    2004-08-01

    A patient with portosystemic encephalopathy, hyperammonemia, and a spontaneous splenorenal shunt was admitted to the authors' institution after a failed attempt at transvenous retrograde shunt obliteration. As an alternative approach, the authors separated splenic and portal flows by embolizing only the proximal splenic vein while leaving the shunt intact. Thus, the splenic flow could escape into the systemic circulation and an extreme increase in portal pressure was avoided. The procedure could provide rapid decreases in blood ammonia levels and a fast resolution of symptoms, but repeated interventions were required.

  4. T1-201 per rectum: A noninvasive method for evaluating portosystemic shunt

    SciTech Connect

    Verdickt, X.; Reding, P.; Tshiamala, P.; Ham, H.R.

    1984-01-01

    Portosystemic shunt is one of the most important complications of liver cirrhosis. Unfortunately, current methods for detecting and quantifying this shunt are either non-specific or associated with significant morbidity. The aim of this work was to evaluate the clinical value of a new non-traumatic method which consisted of administrating T1-201 per rectum and monitoring the absorbed activity using a camera and a computer system. The method assumes that in the absence of portosystemic shunt, most of the absorbed activity will be fixed in the liver while in the presence of this shunt, some of the activity will be fixed in the myocardium. The ratio of heart to liver activity can therefore be used to evaluate the importance of the portosystemic shunt. 34 subjects have been studied. The ratio of heart to liver activity at the 25th minute after the tracer administration is higher in patients with liver cirrhosis (n=22, m=.9, s.d.=.37) than in patients with steatosis (n=10, m=.28, s.d.=.03). In two healthy subjects investigated the H/L ratio was .27 and .30. The reproducibility of the test was evaluated in 8 subjects and showed a good reproducibility (mean of difference =.03, range=.01 to .07). Patients with esophageal varices had always a high H/L ratio while some patients with liver cirrhosis without esophageal varices had also high H/L ratio, probably due to the presence of intrahepatic shunt. The authors' results showed the value of this new non-traumatic test for detecting and quantifying extra- as well as intrahepatic portosystematic shunt.

  5. Portosystemic shunting in portal hypertension: evaluation with portal scintigraphy with transrectally administered I-123 IMP

    SciTech Connect

    Kashiwagi, T.; Azuma, M.; Ikawa, T.; Takehara, T.; Matsuda, H.; Yoshioka, H.; Mitsutani, N.; Koizumi, T.; Kimura, K.

    1988-10-01

    Portosystemic shunting was evaluated with rectal administration of iodine-123 iodoamphetamine (IMP) in seven patients without liver disease and 53 patients with liver cirrhosis. IMP (2-3 mCi (74-111 MBq)) was administered to the rectum through a catheter. Images of the chest and abdomen were obtained for up to 60 minutes with a scintillation camera interfaced with a computer. In all patients, images of the liver and/or lungs were observed within 5-10 minutes and became clear with time. In patients without liver disease, only liver images could be obtained, whereas the lung was visualized with or without the liver in all patients with liver cirrhosis. The portosystemic shunt index was calculated by dividing counts of lungs by counts of liver and lung. These values were significantly higher in liver cirrhosis, especially in the decompensated stage. Transrectal portal scintigraphy with IMP appears to be a useful method for noninvasive and quantitative evaluation of portosystemic shunting in portal hypertension.

  6. Pancreaticoportal Fistula and Disseminated Fat Necrosis After Revision of a Transjugular Intrahepatic Portosystemic Shunt

    SciTech Connect

    Klein, Seth J. Saad, Nael; Korenblat, Kevin; Darcy, Michael D.

    2013-04-15

    A 59-year old man with alcohol related cirrhosis and portal hypertension was referred for transjugular intrahepatic portosystemic shunt (TIPS) to treat his refractory ascites. Ten years later, two sequential TIPS revisions were performed for shunt stenosis and recurrent ascites. After these revisions, he returned with increased serum pancreatic enzyme levels and disseminated superficial fat necrosis; an iatrogenic pancreaticoportal vein fistula caused by disruption of the pancreatic duct was suspected. The bare area of the TIPS was subsequently lined with a covered stent-graft, and serum enzyme levels returned to baseline. In the interval follow-up period, the patient has clinically improved.

  7. A comparison of the Ameroid constrictor versus ligation in the surgical management of single extrahepatic portosystemic shunts.

    PubMed

    Murphy, S T; Ellison, G W; Long, M; Van Gilder, J

    2001-01-01

    Twenty-two dogs were managed surgically for a single extrahepatic portosystemic shunt; 12 with surgical ligation and 10 with an Ameroid constrictor. Utilization of the Ameroid constrictor significantly decreased surgery time to approximately half that of the ligation technique. A decreased intraoperative and postoperative complication rate was noted with the Ameroid constrictor group. Follow-up evaluation demonstrated comparable efficacy when comparing surgical techniques. The Ameroid constrictor offered a surgical occlusion technique for management of a single extra-hepatic portosystemic shunt that was equally effective to ligation while shortening surgical time and minimizing the risks that are commonly associated with ligation of the shunting vessel.

  8. Staging of portal hypertension and portosystemic shunts using dynamic nuclear medicine investigations

    PubMed Central

    Dragoteanu, Mircea; Balea, Ioan A; Dina, Liliana A; Piglesan, Cecilia D; Grigorescu, Ioana; Tamas, Stefan; Cotul, Sabin O

    2008-01-01

    AIM: To explore portal hypertension and portosystemic shunts and to stage chronic liver disease (CLD) based on the pathophysiology of portal hemodynamics. METHODS: Per-rectal portal scintigraphy (PRPS) was performed on 312 patients with CLD and liver angioscintigraphy (LAS) on 231 of them. The control group included 25 healthy subjects. We developed a new model of PRPS interpretation by introducing two new parameters, the liver transit time (LTT) and the circulation time between right heart and liver (RHLT). LTT for each lobe was used to evaluate the early portal hypertension. RHLT is useful in cirrhosis to detect liver areas missing portal inflow. We calculated the classical per-rectal portal shunt index (PRSI) at PRPS and the hepatic perfusion index (HPI) at LAS. RESULTS: The normal LTT value was 24 ± 1 s. Abnormal LTT had PPV = 100% for CLD. Twenty-seven non-cirrhotic patients had LTT increased up to 35 s (median 27 s). RHLT (42 ± 1 s) was not related to liver disease. Cirrhosis could be excluded in all patients with PRSI < 5% (P < 0.01). PRSI > 30% had PPV = 100% for cirrhosis. Based on PRPS and LAS we propose the classification of CLD in 5 hemodynamic stages. Stage 0 is normal (LTT = 24 s, PRSI < 5%). In stage 1, LTT is increased, while PRSI remains normal. In stage 2, LTT is decreased between 16 s and 23 s, whereas PRSI is increased between 5% and 10%. In stage 3, PRSI is increased to 10%-30%, and LTT becomes undetectable by PRPS due to the portosystemic shunts. Stage 4 includes the patients with PRSI > 30%. RHLT and HPI were used to subtype stage 4. In our study stage 0 had NPV = 100% for CLD, stage 1 had PPV = 100% for non-cirrhotic CLD, stages 2 and 3 represented the transition from chronic hepatitis to cirrhosis, stage 4 had PPV = 100% for cirrhosis. CONCLUSION: LTT allows the detection of early portal hypertension and of opening of transhepatic shunts. PRSI is useful in CLD with extrahepatic portosystemic shunts. Our hemodynamic model stages the

  9. Histopathological and immunohistochemical investigations of hepatic lesions associated with congenital portosystemic shunt in dogs.

    PubMed

    Baade, S; Aupperle, H; Grevel, V; Schoon, H-A

    2006-01-01

    Canine livers with congenital portosystemic shunt were investigated histopathologically and immunohistochemically before and 8-272 days after partial ligation of the shunt. Lesions included hypoplasia of portal veins, arteriolar and ductular proliferation, lymphangiectasis, mild to moderate fibrosis, fatty cysts, and mostly mild hepatocellular damage with frequent atrophy and steatosis, regardless of the location of the shunting vessel. Perisinusoidal hepatic stellate cells (HSCs) in normal canine liver expressed alpha-smooth muscle actin (alpha-SMA), but no desmin. In altered livers, however, raised expression of alpha-SMA was detected, together with expression of desmin, in varying numbers of HSCs. This was interpreted as a sign of cellular proliferation and transformation to myofibroblast-like cells. Additionally, there was an obvious perisinusoidal increase of several extracellular matrix components. Postoperative biopsy samples showed basically the same lesions as those of pre-operative samples, except that signs of resolution of hepatic changes were apparent.

  10. [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.

  11. 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

  12. Percutaneous hydrodynamic thrombectomy of acute thrombosis in transjugular intrahepatic portosystemic shunt (TIPS): A feasibility study in five patients

    SciTech Connect

    Raat, Henricus; Stockx, Luc; Ranschaert, Eric; Nevens, Frederik; Wilms, Guy; Baert, Albert L.

    1997-05-15

    Purpose. To evaluate the feasibility of percutaneous hydrodynamic thrombectomy in restoring patency of acutely thrombosed stent-shunts after transjugular intrahepatic portosystemic shunt (TIPS).MethodsPercutaneous hydrodynamic thrombectomy was performed in five consecutive patients with angiographically documented complete thrombosis of the stent-shunt which developed within 2 weeks after the TIPS procedure. Thrombectomy was performed with a hydrolytic suction thrombectomy catheter, introduced via a transjugular approach.ResultsIn all patients, immediate restoration of patency of the stent-shunt was achieved after deploying additional stent(s) to cover residual adherent mural thrombus. In two patients early reocclusion occurred.ConclusionPercutaneous hydrolytic suction thrombectomy in acutely thrombosed intrahepatic portosystemic shunts is technically feasible.

  13. [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

  14. Clinical Results of the Transjugular Intrahepatic Portosystemic Shunt (TIPS) for the Treatment of Variceal Bleeding

    PubMed Central

    Han, Sang-Woo; Joo, Young-Eun; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun; Kim, Jae-Kyu; Kim, Sei-Jong

    2000-01-01

    Background Transjugular intrahepatic portosystemic shunt (TIPS) has been popularized for the treatment of refractory variceal bleeding. The aim of this study was to assess the safety and long-term effect of TIPS in the treatment of variceal bleeding that is not controlled with pharmacological and endoscopic treatment. Methods Thirty-six patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) due to refractory variceal bleeding were included in the study. The effectiveness of portal decompression and bleeding control was evaluated. Upper gastrointestinal endoscopy was performed to analyse the degree of varices and portal hypertensive gastropathy (PHG) before TIPS procedure and one to three weeks after TIPS. Angiography was performed in surviving patients, if bleeding recurred, or if ultrasonography or endoscopy suggested stent dysfunction. Results TIPS were successfully placed in 36 of 38 patients (94.6%). TIPS achieved hemostasis of variceal bleeding in 34 patients (94.4%). Portal venous pressure decreased from an initial average of 28.7±7.9 to 23.2±9.4 mmHg after TIPS (p < 0.05). The portosystemic pressure gradient was significantly decreased from 15.5±6.3 to 7.8±4.1 mmHg (p < 0.01). The degree of esophagogastric varices and PHG was significantly improved after TIPS. The total length of follow-up was from one day to 54 months (mean: 355 days). The actuarial probability of survival was 83% at one year and 74% at two years. Overall, 16 episodes of stent dysfunction were diagnosed during follow-up. Stent revision by means of angioplasty was successfully performed in 14 of these episodes. Conclusion TIPS is an effective and reliable nonoperative means of lowering portal pressure. This procedure has proved useful in the management of acute variceal bleeding refractory to endoscopic treatment. Surveillance by ultrasonography, endoscopy, and angiographic intervention is useful for the maintenance of shunt patency. PMID:11242805

  15. Staged Transcatheter Treatment of Portal Hypoplasia and Congenital Portosystemic Shunts in Children

    SciTech Connect

    Bruckheimer, Elchanan Dagan, Tamir; Atar, Eli; Schwartz, Michael; Kachko, Ludmila; Superina, Riccardo; Amir, Gabriel; Shapiro, Rivka; Birk, Einat

    2013-12-15

    Purpose: Congenital portosystemic shunts (CPSS) with portal venous hypoplasia cause hyperammonemia. Acute shunt closure results in portal hypertension. A transcatheter method of staged shunt reduction to afford growth of portal vessels followed by shunt closure is reported. Methods: Pressure measurements and angiography in the CPSS or superior mesenteric artery (SMA) during temporary occlusion of the shunt were performed. If vessels were diminutive and the pressure was above 18 mmHg, a staged approach was performed, which included implantation of a tailored reducing stent to reduce shunt diameter by {approx}50 %. Recatheterization was performed approximately 3 months later. If the portal pressure was below 18 mmHg and vessels had developed, the shunt was closed with a device. Results: Six patients (5 boys, 1 girl) with a median age of 3.3 (range 0.5-13) years had CPSS portal venous hypoplasia and hyperammonemia. Five patients underwent staged closure. One patient tolerated acute closure. One patient required surgical shunt banding because a reducing stent could not be positioned. At median follow-up of 3.8 (range 2.2-8.4) years, a total of 21 procedures (20 transcatheter, 1 surgical) were performed. In all patients, the shunt was closed with a significant reduction in portal pressure (27.7 {+-} 11.3 to 10.8 {+-} 1.8 mmHg; p = 0.016), significant growth of the portal vessels (0.8 {+-} 0.5 to 4.0 {+-} 2.4 mm; p = 0.037), and normalization of ammonia levels (202.1 {+-} 53.6 to 65.7 {+-} 9.6 {mu}mol/L; p = 0.002) with no complications. Conclusion: Staged CPSS closure is effective in causing portal vessel growth and treating hyperammonemia.

  16. Hepatic Veins and Inferior Vena Cava Thrombosis in a Child Treated by Transjugular Intrahepatic Portosystemic Shunt

    SciTech Connect

    Carnevale, Francisco Cesar Santos, Aline Cristine Barbosa; Tannuri, Uenis; Cerri, Giovanni Guido

    2010-06-15

    We report the case of a 9-year-old boy with portal hypertension, due to Budd-Chiari syndrome, and retrohepatic inferior vena cava thrombosis, submitted to a transjugular intrahepatic portosystemic shunt (TIPS) by connecting the suprahepatic segment of the inferior vena cava directly to the portal vein. After 3 months, the withdrawal of anticoagulants promoted the thrombosis of the TIPS. At TIPS revision, thrombosis of the TIPS and the main portal vein and clots at the splenic and the superior mesenteric veins were found. Successful angiography treatment was performed by thrombolysis and balloon angioplasty of a severe stenosis at the distal edge of the stent.

  17. Novel Image Guidance Techniques for Portal Vein Targeting During Transjugular Intrahepatic Portosystemic Shunt Creation.

    PubMed

    Farsad, Khashayar; Kaufman, John A

    2016-03-01

    The most challenging part of transjugular intrahepatic portosystemic shunt creation is arguably the transvenous access from the hepatic vein to the portal vein. As experience and technology have evolved, the image guidance aspect of this critical step in the procedure has become more robust. Improved means to target the portal vein include both direct and indirect methods of portal vein opacification, cross-sectional imaging for both targeting and access, and novel use of transabdominal and intravascular ultrasound guidance. These techniques are described herein.

  18. Transient Hemolytic Anemia after Transjugular Intrahepatic Portosystemic Stent Shunt

    PubMed Central

    Garcia-Rebollo, Sagrario; Santolaria-Fernández, Francisco; Diaz-Romero, Francisco; Rodriguez-Moreno, Fermin; Martinez-Riera, Antonio

    1996-01-01

    Management of variceal bleeding secondary to portal hypertension constitutes a challenging issue, particularly in child's C cirrhotic patients. Recently, transjugular placement of self-expanding metallic stents in the liver (TIPS), creating a shunt between the portal and hepatic branches has provided a safe and promising therapeutic approach in this clinical situation. We report here the case of a 66-year-old male cirrhotic patient who developed a moderately severe clinical picture of a Coombsnegative hemolytic anemia (serum hemoglobin, 93 g/l, serum bilirubin 160.74 umol/L (9.4 mg/dl), indirect 6.3 mg/dl (107.73 umol/L); serum LDH 1220 u/l, reticulocytes, 5.1%. serum ferritin, 1221 ug/1, schistocytes in peripheral blood smear) the week after undergoing a TIPS, suggesting the development ofa microangiopathic hemolytic anaemia secondary to red blood cell disruption by passing through the metallic network of the stent. PMID:8809588

  19. Congenital Extrahepatic Portosystemic Shunts: Spectrum of Findings on Ultrasound, Computed Tomography, and Magnetic Resonance Imaging

    PubMed Central

    Gupta, Pankaj; Sinha, Anindita; Sodhi, Kushaljit Singh; Lal, Anupam; Debi, Uma; Thapa, Babu R.; Khandelwal, Niranjan

    2015-01-01

    Congenital extrahepatic portosystemic shunt (CEPS) is a rare disorder characterised by partial or complete diversion of portomesenteric blood into systemic veins via congenital shunts. Type I is characterised by complete lack of intrahepatic portal venous blood flow due to an end to side fistula between main portal vein and the inferior vena cava. Type II on the other hand is characterised by partial preservation of portal blood supply to liver and side to side fistula between main portal vein or its branches and mesenteric, splenic, gastric, and systemic veins. The presentation of these patients is variable. Focal liver lesions, most commonly nodular regenerative hyperplasia, are an important clue to the underlying condition. This pictorial essay covers imaging characteristics in abdominopelvic region. PMID:26858845

  20. Hepatic Encephalopathy due to Congenital Multiple Intrahepatic Portosystemic Venous Shunts Successfully Treated by Percutaneous Transhepatic Obliteration

    PubMed Central

    Takenaga, Shinsuke; Narita, Kenichi; Matsui, Yo; Fukuda, Kunihiko

    2016-01-01

    Hepatic encephalopathy due to intrahepatic portosystemic venous shunts (IPSVS) in a non-cirrhotic condition is rare. Here we report a rare case of a patient with congenital multiple IPSVS successfully treated by percutaneous transhepatic obliteration. The patient was a 67-year-old woman who presented to our hospital with progressive episodes of consciousness disorder and vomiting. Laboratory tests revealed hyperammonemia (192.0 μg/dL), and computed tomography revealed multiple IPSVS in both lobes. There was no evidence of underlying liver disease or hepatic trauma. Transcatheter embolization for IPSVS was performed because conservative therapy was not sufficiently effective. After endovascular shunt closure, hepatic encephalopathy improved. The serum ammonia level normalized during the 5-year follow-up period. Thus, transcatheter embolization may be an effective therapy for patients with symptomatic and refractory IPSVS. Careful follow-up is necessary for portal hypertension-related complications after transcatheter embolization for IPSVS. PMID:27990104

  1. The transjugular intrahepatic portosystemic shunt for the management of cirrhotic refractory ascites.

    PubMed

    Garcia-Tsao, Guadalupe

    2006-07-01

    Cirrhotic ascites results from sinusoidal hypertension and sodium retention, which is secondary to a decreased effective arterial blood volume. Transjugular intrahepatic portosystemic shunt (TIPS) placement is currently indicated in cirrhotic patients with refractory ascites who require large-volume paracentesis (LVP) more than two or three times per month. TIPS placement is associated with normalization of sinusoidal pressure and a significant improvement in urinary sodium excretion that correlates with suppression of plasma renin activity, which is, itself, indicative of an improvement in effective arterial blood volume. Compared with serial LVP, placement of an uncovered TIPS stent is more effective at preventing ascites from recurring; however, increased incidence of hepatic encephalopathy and shunt dysfunction rates after TIPS placement are important issues that increase its cost. Although evidence suggests that TIPS placement might result in better patient survival, this needs to be confirmed, particularly in light of the development of polytetrafluoroethylene-covered stents. Favorable results apply to centers experienced in placing the TIPS, with the aim being to decrease the portosystemic gradient to <12 mmHg but >5 mmHg. This article reviews the pathophysiologic basis for the use of a TIPS in patients with refractory ascites, the results of controlled trials comparing TIPS placement (using uncovered stents) versus LVP, and a systematic review of predictors of death after TIPS placement for refractory ascites.

  2. Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Cirrhosis and Concomitant Portal Vein Thrombosis

    SciTech Connect

    Ha, Thuong G. Van Hodge, Justin; Funaki, Brian; Lorenz, Jonathan; Rosenblum, Jordan; Straus, Christopher; Leef, Jeff

    2006-10-15

    Purpose. To determine the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with liver cirrhosis complicated by thrombosed portal vein. Methods. This study reviewed 15 cases of TIPS creation in 15 cirrhotic patients with portal vein thrombosis at our institution over an 8-year period. There were 2 women and 13 men with a mean age of 53 years. Indications were refractory ascites, variceal hemorrhage, and refractory pleural effusion. Clinical follow-up was performed in all patients. Results. The technical success rate was 75% (3/4) in patients with chronic portal vein thrombosis associated with cavernomatous transformation and 91% (10/11) in patients with acute thrombosis or partial thrombosis, giving an overall success rate of 87%. Complications included postprocedural encephalopathy and localized hematoma at the access site. In patients with successful shunt placement, the total follow-up time was 223 months. The 30-day mortality rate was 13%. Two patients underwent liver transplantation at 35 days and 7 months, respectively, after TIPS insertion. One patient had an occluded shunt at 4 months with an unsuccessful revision. The remaining patients had functioning shunts at follow-up. Conclusion. TIPS creation in thrombosed portal vein is possible and might be a treatment option in certain patients.

  3. Hepatic Encephalopathy Secondary to Intrahepatic Portosystemic Venous Shunt: Balloon-Occluded Retrograde Transvenous Embolization with n-Butyl Cyanoacrylate and Microcoils

    SciTech Connect

    Yamagami, Takuji; Nakamura, Toshiyuki; Iida, Shigeharu; Kato, Takeharu; Tanaka, Osamu; Matsushima, Shigenori; Ito, Hirotoshi; Okuyama, Chio; Ushijima, Yo; Shiga, Kensuke; Nishimura, Tsunehiko

    2002-06-15

    We report a 70-year-old woman with hepatic encephalopathy due to an intrahepatic portosystemic venous shunt that was successfully occluded by percutaneous transcatheter embolization with n-butyl cyanoacrylate and microcoils.

  4. Transjugular Intrahepatic Portosystemic Shunt: Indications, Contraindications, and Patient Work-Up

    PubMed Central

    Copelan, Alexander; Kapoor, Baljendra; Sands, Mark

    2014-01-01

    The transjugular intrahepatic portosystemic shunt (TIPS) procedure is effective in achieving portal decompression and in managing some of the major complications of portal hypertension. While many clinicians are familiar with the two most common indications for TIPS placement, secondary prophylaxis of esophageal variceal hemorrhage and treatment of refractory ascites, evidence for its usefulness is growing in other entities, where it has been less extensively studied but demonstrates promising results. Newer indications include early utilization in the treatment of esophageal variceal hemorrhage, Budd–Chiari syndrome, ectopic varices, and portal vein thrombosis. The referring clinician and interventionist must remain cognizant of the contraindications to the procedure to avoid complications and potential harm to the patient. This review is designed to provide an in-depth analysis of the most common as well as less typical indications for TIPS placement, and to discuss the contraindications and appropriate patient evaluation for this procedure. PMID:25177083

  5. 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.

  6. Understanding the Pathophysiology of Portosystemic Shunt by Simulation Using an Electric Circuit

    PubMed Central

    Kim, Moonhwan

    2016-01-01

    Portosystemic shunt (PSS) without a definable cause is a rare condition, and most of the studies on this topic are small series or based on case reports. Moreover, no firm agreement has been reached on the definition and classification of various forms of PSS, which makes it difficult to compare and analyze the management. The blood flow can be seen very similar to an electric current, governed by Ohm's law. The simulation of PSS using an electric circuit, combined with the interpretation of reported management results, can provide intuitive insights into the underlying mechanism of PSS development. In this article, we have built a model of PSS using electric circuit symbols and explained clinical manifestations as well as the possible mechanisms underlying a PSS formation. PMID:27868061

  7. Transjugular intrahepatic portosystemic shunt in refractory chylothorax due to liver cirrhosis.

    PubMed

    Lutz, Philipp; Strunk, Holger; Schild, Hans Heinz; Sauerbruch, Tilman

    2013-02-21

    A pleural effusion containing chylomicrons is termed chylothorax and results from leakage of lymph fluid into the pleural cavity. We report on the case of a 59-year-old woman with severe dyspnea due to a large chylothorax. She was known to have liver cirrhosis but no ascites. There was no history of trauma, cardiac function was normal and thorough diagnostic work-up did not reveal any signs of malignancy. In summary, no other etiology of the chylothorax than portal hypertension could be found. Therapy with diuretics as well as parenteral feeding failed to relieve symptoms. After a transjugular intrahepatic portosystemic shunt (TIPS) had successfully been placed, pleural effusion decreased considerably. Eight months later, TIPS revision had to be performed because of stenosis, resulting in remission from chylothorax. This case shows that even in the absence of ascites, chylothorax might be caused by portal hypertension and that TIPS can be an effective treatment option.

  8. Transjugular Intrahepatic Portosystemic Shunt in a Patient with Cavernomatous Portal Vein Occlusion

    SciTech Connect

    Kawamata, Hiroshi; Kumazaki, Tatsuo; Kanazawa, Hidenori; Takahashi, Shuji; Tajima, Hiroyuki; Hayashi, Hiromitsu

    2000-03-15

    A 23-year-old woman with liver cirrhosis secondary to primary sclerosing cholangitis was referred to us for the treatment of recurrent bleeding from esophageal varices that had been refractory to endoscopic sclerotherapy. Her portal vein was occluded, associated with cavernous transformation. A transjugular intrahepatic portosystemic shunt (TIPS) was performed after a preprocedural three-dimensional computed tomographic angiography evaluation to determine feasibility. The portal vein system was recanalized and portal blood flow increased markedly after TIPS. Esophageal varices disappeared 3 weeks after TIPS. Re-bleeding and hepatic encephalopathy were absent for 3 years after the procedure. We conclude that with adequate preprocedural evaluation, TIPS can be performed safely even in patients with portal vein occlusion associated with cavernous transformation.

  9. Understanding the Pathophysiology of Portosystemic Shunt by Simulation Using an Electric Circuit.

    PubMed

    Kim, Moonhwan; Lee, Keon-Young

    2016-01-01

    Portosystemic shunt (PSS) without a definable cause is a rare condition, and most of the studies on this topic are small series or based on case reports. Moreover, no firm agreement has been reached on the definition and classification of various forms of PSS, which makes it difficult to compare and analyze the management. The blood flow can be seen very similar to an electric current, governed by Ohm's law. The simulation of PSS using an electric circuit, combined with the interpretation of reported management results, can provide intuitive insights into the underlying mechanism of PSS development. In this article, we have built a model of PSS using electric circuit symbols and explained clinical manifestations as well as the possible mechanisms underlying a PSS formation.

  10. Congenital portosystemic shunts and hepatic encephalopathy in goat kids in California: 11 cases (1999-2012).

    PubMed

    Kinde, Hailu; Pesavento, Patricia A; Loretti, Alexandre P; Adaska, John M; Barr, Bradd C; Moore, Janet D; Anderson, Mark L; Rimoldi, Guillermo; Hill, Ashley E; Jones, Megan E B

    2014-01-01

    Between 1999 and 2012, 11 cases of congenital portosystemic shunts (cPSS) resulting in hepatic encephalopathy were diagnosed in goat kids necropsied at the California Animal Health and Food Safety Laboratory System and at the Department of Pathology, Immunology & Microbiology, School of Veterinary Medicine, University of California-Davis. Affected animals included 6 females and 5 males of various breeds including Boer (5/11), Nigerian Dwarf (1/11), Saanen (1/11), Toggenburg (1/11), and mixed-breed (3/11) aged between 1.5 months and 11 months, submitted live (2/11) or dead (9/11) for necropsy. The most frequent clinical signs in these goats were ataxia, blindness, tremors, head bobbing, head pressing, seizures, circling, weakness, and ill thrift. Bile acids were measured in 2 animals, and were elevated in both cases (134 and 209 µmol/l, reference interval = 0-50 µmol/l). Necropsy findings were poor to fair body condition. Grossly, the livers of 4 animals were subjectively small. Microscopic lesions included portal spaces with increased numbers of arteriolar profiles and hypoplastic or absent portal veins, diffuse atrophy of the hepatic parenchyma with the presence of small hepatocytes and, in some cases, multifocal hepatocellular macrovesicular vacuolation. In the brain and spinal cord of all animals, there was bilateral and symmetric spongy degeneration affecting the cerebrum, mesencephalon, cerebellum, brainstem, and cervical spinal cord. In all cases, the brain lesions were consistent with hepatic encephalopathy. Congenital portosystemic shunts should be considered in the differential diagnosis of young goats with a history of ill thrift, and nonspecific neurological signs.

  11. 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

  12. Usefulness of Transjugular Intrahepatic Portosystemic Shunt in the Management of Bleeding Ectopic Varices in Cirrhotic Patients

    SciTech Connect

    Vidal, V.; Joly, L.; Perreault, P.; Bouchard, L.; Lafortune, M.; Pomier-Layrargues, G.

    2006-04-15

    Purpose. To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the control of bleeding from ectopic varices. Methods. From 1995 to 2004, 24 cirrhotic patients, bleeding from ectopic varices, mean age 54.5 years (range 15-76 years), were treated by TIPS. The etiology of cirrhosis was alcoholic in 13 patients and nonalcoholic in 11 patients. The location of the varices was duodenal (n = 5), stomal (n = 8), ileocolic (n = 6), anorectal (n = 3), umbilical (n = 1), and peritoneal (n 1). Results. TIPS controlled the bleeding in all patients and induced a decrease in the portacaval gradient from 19.7 {+-} 5.4 to 6.4 {+-} 3.1 mmHg. Postoperative complications included self-limited intra-abdominal bleeding (n = 2), self-limited hemobilia (n = 1), acute thrombosis of the shunt (n = 1), and bile leak treated by a covered stent (n = 1). Median follow-up was 592 days (range 28-2482 days). Rebleeding occurred in 6 patients. In 2 cases rebleeding was observed despite a post-TIPS portacaval gradient lower than 12 mmHg and was controlled by variceal embolization; 1 patient underwent surgical portacaval shunt and never rebled; in 3 patients rebleeding was related to TIPS stenosis and treated with shunt dilatation with addition of a new stent. The cumulative rate of rebleeding was 23% and 31% at 1 and 2 years, respectively. One- and 2-year survival rates were 80% and 76%, respectively. Conclusion. The present series demonstrates that bleeding from ectopic varices, a challenging clinical problem, can be managed safely by TIPS placement with low rebleeding and good survival rates.

  13. A simple method for the quantification of portosystemic shunting (PSS) in patients with portal hypertension.

    PubMed

    Bödvarsson, A; Verdegaal, W P; Slaats, E H; Geraedts, A A; Kehrer, D F; Silberbusch, J

    1993-12-01

    Portosystemic shunting (PSS) was evaluated in 32 patients with chronic liver disease by the rectal administration of iodine-123 I-amphetamine (IMP method), a radionuclide which is rapidly absorbed from the sigmoid and extracted by liver and lungs. Simultaneous measurement of pulmonary and hepatic uptake supplies a shunt fraction (SF) as an index of PSS. The IMP method was compared with the ammonia tolerance test (NH3TT), and there proved to be a significant correlation between these two methods (r = 0.75, p < 0.001). Assuming that an increase of > 7 mumol/l in arterial ammonia concentration after NH3TT represents PSS, the IMP method had a sensitivity of 0.93. When fasting (NH3) was > 50 mumol/l, all patients showed pathological PSS with either method, but this was also the case in 50% of patients with normal basal arterial ammonia. There was also a significant correlation between the IMP method and the Child-Pugh classification (r = 0.75, p < 0.001). Endoscopy in 28 patients revealed absence of varices in 11, of whom, however, 7 (64%) had an increased SF and although all 15 patients with ascites had increased SF, this was also the case in 12 of the 17 patients without ascites. In conclusion, PSS evaluation using IMP is a non-invasive, sensitive method without patient discomfort which might be used in the staging and follow-up of chronic liver disease.

  14. Combined transjugular intrahepatic portosystemic shunt and other interventions for hepatocellular carcinoma with portal hypertension

    PubMed Central

    Qiu, Bin; Zhao, Meng-Fei; Yue, Zhen-Dong; Zhao, Hong-Wei; Wang, Lei; Fan, Zhen-Hua; He, Fu-Liang; Dai, Shan; Yao, Jian-Nan; Liu, Fu-Quan

    2015-01-01

    AIM: To evaluate combination transjugular intrahepatic portosystemic shunt (TIPS) and other interventions for hepatocellular carcinoma (HCC) and portal hypertension. METHODS: Two hundred and sixty-one patients with HCC and portal hypertension underwent TIPS combined with other interventional treatments (transarterial chemoembolization/transarterial embolization, radiofrequency ablation, hepatic arterio-portal fistulas embolization, and splenic artery embolization) from January 1997 to January 2010 at Beijing Shijitan Hospital. Two hundred and nine patients (121 male and 88 female, aged 25-69 years, mean 48.3 ± 12.5 years) with complete clinical data were recruited. We evaluated the safety of the procedure (procedure-related death and serious complications), change of portal vein pressure before and after TIPS, symptom relief [e.g., ascites, hydrothorax, esophageal gastric-fundus variceal bleeding (EGVB)], cumulative rates of survival, and distributary channel restenosis. The characteristics of the patients surviving ≥ 5 and < 5 years were also analyzed. RESULTS: The portosystemic pressure was decreased from 29.0 ± 4.1 mmHg before TIPS to 18.1 ± 2.9 mmHg after TIPS (t = 69.32, P < 0.05). Portosystemic pressure was decreased and portal hypertension symptoms were ameliorated. During the 5 year follow-up, the total recurrence rate of resistant ascites or hydrothorax was 7.2% (15/209); 36.8% (77/209) for EGVB; and 39.2% (82/209) for hepatic encephalopathy. The cumulative rates of distributary channel restenosis at 1, 2, 3, 4, and 5 years were 17.2% (36/209), 29.7% (62/209), 36.8% (77/209), 45.5% (95/209) and 58.4% (122/209), respectively. No procedure-related deaths and serious complications (e.g., abdominal bleeding, hepatic failure, and distant metastasis) occurred. Moreover, Child-Pugh score, portal vein tumor thrombosis, lesion diameter, hepatic arterio-portal fistulas, HCC diagnosed before or after TIPS, stent type, hepatic encephalopathy, and type of other

  15. Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

    SciTech Connect

    Ingraham, Christopher R. Padia, Siddharth A. Johnson, Guy E.; Easterling, Thomas R.; Liou, Iris W.; Kanal, Kalpana M.; Valji, Karim

    2015-10-15

    Background and AimsComplications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.MethodsFive pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.ResultsAll five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.ConclusionsThis series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus.

  16. Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage

    PubMed Central

    Loffroy, Romaric; Estivalet, Louis; Cherblanc, Violaine; Favelier, Sylvain; Pottecher, Pierre; Hamza, Samia; Minello, Anne; Hillon, Patrick; Thouant, Pierre; Lefevre, Pierre-Henri; Krausé, Denis; Cercueil, Jean-Pierre

    2013-01-01

    Acute variceal hemorrhage, a life-threatening condition that requires a multidisciplinary approach for effective therapy, is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy, the presence of large esophageal varices with recent stigmata of bleeding, or fresh blood visible in the stomach with no other source of bleeding identified. Transfusion of blood products, pharmacological treatments and early endoscopic therapy are often effective; however, if primary hemostasis cannot be obtained or if uncontrollable early rebleeding occurs, transjugular intrahepatic portosystemic shunt (TIPS) is recommended as rescue treatment. The TIPS represents a major advance in the treatment of complications of portal hypertension. Acute variceal hemorrhage that is poorly controlled with endoscopic therapy is generally well controlled with TIPS, which has a 90% to 100% success rate. However, TIPS is associated with a mortality of 30% to 50% in such a setting. Emergency TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy failure, before the clinical condition worsens. Furthermore, admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized effectively. This review article discusses initial management and then focuses on the specific role of TIPS as a primary therapy to control acute variceal hemorrhage, particularly as a rescue therapy following failure of endoscopic approaches. PMID:24115809

  17. Splenophrenic portosystemic shunt in dogs with and without portal hypertension: can acquired and congenital porto-caval connections coexist?

    PubMed Central

    Ricciardi, M.

    2016-01-01

    The possible existence of the same pattern of porto-caval connection in dogs having a single congenital portosystemic shunt (CPSS) and in dogs having multiple acquired portosystemic shunt (MAPSS) secondary to portal hypertension (PH) was evaluated. Retrospective evaluation of all CT examinations of patients having portosystemic shunt (PSS) was performed in a 4-year time period. All anomalous porto-caval connections were assessed for anatomical pattern and compared with published veterinary literature. Records of 25 dogs were reviewed. 16 dogs had a single CPSS (CPSS group), and 9 dogs had multiple acquired PSS secondary to PH (APSS group). The splenophrenic shunt pattern was found in 3 dogs of the CPSS group as a single congenital anomaly without PH and in 2 dogs of the APSS group associated with MAPSS and ascites due to different hepatic diseases causing PH. These findings corroborate two hypotheses: 1) Splenophrenic PSS should be considered as a classical CPSS but if this is not sufficient to alleviate a PH developed after birth because of eventual hepatic or portal diseases, in this case ascites and acquired portal collaterals may develop. In this case, MAPSS and CPSS may coexist. 2) The pattern of splenophrenic PSS, classically described among CPSS, may develop as acquired portal collateral in dogs with PH and it should also be included in the category of APSS. These preliminary findings may be helpful in reconsidering the classical haemodynamics of porto-caval diseases, enrich the classification of APSS in dogs and refine the imaging evaluation of patients with PH. PMID:27882305

  18. Combination therapy using PSE and TIO ameliorates hepatic encephalopathy due to intrahepatic portosystemic venous shunt in idiopathic portal hypertension

    PubMed Central

    Kojima, Seiichiro; Ito, Hiroyuki; Takashimizu, Shinji; Ichikawa, Hitoshi; Matsumoto, Tomohiro; Hasebe, Terumitsu

    2016-01-01

    A 64-year-old woman treated for anemia and ascites exhibited hepatic encephalopathy. Abdominal ultrasonography and computed tomography (CT) showed communication between the portal vein and the middle hepatic vein, indicating an intrahepatic portosystemic venous shunt (PSS). Since hepatic encephalopathy of the patient was resistant to medical treatment, interventional radiology was performed for the treatment of shunt obliteration. Hepatic venography showed anastomosis between the hepatic vein branches, supporting the diagnosis of idiopathic portal hypertension (IPH). To minimize the increase in portal vein pressure after shunt obliteration, partial splenic artery embolization (PSE) was first performed to reduce portal vein blood flow. Transileocolic venous obliteration (TIO) was then performed, and intrahepatic PSS was successfully obliterated using coils with n-butyl-2-cyanoacrylate (NBCA). In the present case, hepatic encephalopathy due to intrahepatic PSS in the patient with IPH was successfully treated by combination therapy using PSE and TIO. PMID:27651930

  19. Is color-Doppler US a reliable method in the follow-up of transjugular intrahepatic portosystemic shunt (TIPS)?

    PubMed Central

    Ricci, P.; Cantisani, V.; Lombardi, V.; Alfano, G.; D'Ambrosio, U.; Menichini, G.; Marotta, E.; Drudi, F.M.

    2007-01-01

    Transjugular intrahepatic portosystemic shunt (TIPS) has become a widely accepted treatment for complications of portal hypertension. Shunt or hepatic vein stenoses or occlusions are common short- and mid-term complications of the procedure, with a one-year primary patency ranging from 25% to 66%. When promptly identified, shunt stenosis or occlusion may be treated before the recurrence of gastrointestinal bleeding or ascites. The revision is usually successful and the primary-assisted patency of TIPS is approximately 85% at one year. Doppler sonography is a widely accepted screening modality for TIPS patients, both as a routine follow-up in asymptomatic patients and in those cases with clinically suspected TIPS malfunction. In a routine US follow-up, a TIPS patient is scheduled for a control 24 h after the procedure, and then after one week, 1 month, 3 months, and at 3-month intervals thereafter. Venography is at present performed solely on the basis of a suspected shunt dysfunction during the sonographic examination. Color-Doppler sonography is the most reliable method for monitoring the shunt function after TIPS implantation. Several studies have shown that Doppler sonography is a sensitive and relatively specific way to detect shunt malfunction, particularly when multiple parameters are examined. Achieving high sensitivity is optimal so that malfunctioning shunts can be identified and shunt revision can be performed before symptomatic deterioration. Venous angiography is at present indicated only on the basis of US suspicion of shunt compromise. Power-Doppler US and US contrast media can be useful in particular conditions, but are not really fundamental. PMID:23396711

  20. Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts

    SciTech Connect

    Park, Jonathan K.; Al-Tariq, Quazi Z.; Zaw, Taryar M. Raman, Steven S. Lu, David S.K.

    2015-10-15

    PurposeTo assess radiofrequency (RF) ablation efficacy, as well as the patency of transjugular intrahepatic portosystemic shunts (TIPSs), in patients with hepatocellular carcinoma (HCC).Materials and MethodsRetrospective database review of patients with pre-existing TIPS undergoing RF ablation of HCC was conducted over a 159-month period ending in November 2013. TIPS patency pre- and post-RF ablation was assessed by ultrasound, angiography, and/or contrast-enhanced CT or MRI. Patient demographics and immediate post-RF ablation outcomes and complications were also reviewed.Results19 patients with 21 lesions undergoing 25 RF ablation sessions were included. Child-Pugh class A, B, and C scores were seen in 1, 13, and 5 patients, respectively. Eleven patients (58 %) ultimately underwent liver transplantation. Immediate technical success was seen in all ablation sessions without residual tumor enhancement (100 %). No patients (0 %) suffered liver failure within 1 month of ablation. Pre-ablation TIPS patency was demonstrated in 22/25 sessions (88 %). Of 22 cases with patent TIPS prior to ablation, post-ablation patency was demonstrated in 22/22 (100 %) at immediate post-ablation imaging and in 21/22 (95 %) at last follow-up (1 patient was incidentally noted to have occlusion 31 months later). No immediate complications were observed.ConclusionAblation efficacy was similar to the cited literature values for patients without TIPS. Furthermore, TIPS patency was preserved in the majority of cases. Patients with both portal hypertension and HCC are not uncommonly encountered, and a pre-existing TIPS does not appear to be a definite contraindication for RF ablation.

  1. Lipopolysaccharide and toll-like receptor 4 in dogs with congenital portosystemic shunts.

    PubMed

    Tivers, M S; Lipscomb, V J; Smith, K C; Wheeler-Jones, C P D; House, A K

    2015-12-01

    Surgical attenuation of a congenital portosystemic shunt (CPSS) results in increased portal vein perfusion, liver growth and clinical improvement. Portal lipopolysaccharide (LPS) is implicated in liver regeneration via toll-like receptor (TLR) 4 mediated cytokine activation. The aim of this study was to investigate factors associated with LPS in dogs with CPSS. Plasma LPS concentrations were measured in the peripheral and portal blood using a limulus amoebocyte lysate (LAL) assay. LPS concentration was significantly greater in the portal blood compared to peripheral blood in dogs with CPSS (P = 0.046) and control dogs (P = 0.002). LPS concentrations in the peripheral (P = 0.012) and portal (P = 0.005) blood of dogs with CPSS were significantly greater than those of control dogs. The relative mRNA expression of cytokines and TLRs was measured in liver biopsies from dogs with CPSS using quantitative PCR. TLR4 expression significantly increased following partial CPSS attenuation (P = 0.020). TLR4 expression was significantly greater in dogs that tolerated complete CPSS attenuation (P = 0.011) and those with good portal blood flow on pre-attenuation (P = 0.004) and post-attenuation (P = 0.015) portovenography. Serum interleukin (IL)-6 concentration was measured using a canine specific ELISA and significantly increased 24 h following CPSS attenuation (P < 0.001). Portal LPS was increased in dogs with CPSS, consistent with decreased hepatic clearance. TLR4 mRNA expression was significantly associated with portal blood flow and increased following surgery. These findings support the concept that portal LPS delivery is important in the hepatic response to surgical attenuation. Serum IL-6 significantly increased following surgery, consistent with LPS stimulation via TLR4, although this increase might be non-specific.

  2. Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

    SciTech Connect

    Padia, Siddharth A. Chewning, Rush H. Kogut, Matthew J. Ingraham, Christopher R. Johnson, Guy E.; Bhattacharya, Renuka; Kwan, Sharon W. Monsky, Wayne L. Vaidya, Sandeep; Hippe, Daniel S.; Valji, Karim

    2015-08-15

    PurposeLocoregional therapy for hepatocellular carcinoma (HCC) can be challenging in patients with a transjugular intrahepatic portosystemic shunt (TIPS). This study compares safety and imaging response of ablation, chemoembolization, radioembolization, and supportive care in patients with both TIPS and HCC.MethodsThis retrospective study included 48 patients who had both a TIPS and a diagnosis of HCC. Twenty-nine of 48 (60 %) underwent treatment for HCC, and 19/48 (40 %) received best supportive care (i.e., symptomatic management only). While etiology of cirrhosis and indication for TIPS were similar between the two groups, treated patients had better baseline liver function (34 vs. 67 % Child-Pugh class C). Tumor characteristics were similar between the two groups. A total of 39 ablations, 17 chemoembolizations, and 10 yttrium-90 radioembolizations were performed on 29 patients.ResultsAblation procedures resulted in low rates of hepatotoxicity and clinical toxicity. Post-embolization/ablation syndrome occurred more frequently in patients undergoing chemoembolization than ablation (47 vs. 15 %). Significant hepatic dysfunction occurred more frequently in the chemoembolization group than the ablation group. Follow-up imaging response showed objective response in 100 % of ablation procedures, 67 % of radioembolization procedures, and 50 % of chemoembolization procedures (p = 0.001). When censored for OLT, patients undergoing treatment survived longer than patients receiving supportive care (2273 v. 439 days, p = 0.001).ConclusionsAblation appears to be safe and efficacious for HCC in patients with TIPS. Catheter-based approaches are associated with potential increased toxicity in this patient population. Chemoembolization appears to be associated with increased toxicity compared to radioembolization.

  3. Three-Dimensional Path Planning Software-Assisted Transjugular Intrahepatic Portosystemic Shunt: A Technical Modification

    SciTech Connect

    Tsauo, Jiaywei Luo, Xuefeng; Ye, Linchao; Li, Xiao

    2015-06-15

    PurposeThis study was designed to report our results with a modified technique of three-dimensional (3D) path planning software assisted transjugular intrahepatic portosystemic shunt (TIPS).Methods3D path planning software was recently developed to facilitate TIPS creation by using two carbon dioxide portograms acquired at least 20° apart to generate a 3D path for overlay needle guidance. However, one shortcoming is that puncturing along the overlay would be technically impossible if the angle of the liver access set and the angle of the 3D path are not the same. To solve this problem, a prototype 3D path planning software was fitted with a utility to calculate the angle of the 3D path. Using this, we modified the angle of the liver access set accordingly during the procedure in ten patients.ResultsFailure for technical reasons occurred in three patients (unsuccessful wedged hepatic venography in two cases, software technical failure in one case). The procedure was successful in the remaining seven patients, and only one needle pass was required to obtain portal vein access in each case. The course of puncture was comparable to the 3D path in all patients. No procedure-related complication occurred following the procedures.ConclusionsAdjusting the angle of the liver access set to match the angle of the 3D path determined by the software appears to be a favorable modification to the technique of 3D path planning software assisted TIPS.

  4. Percutaneous Treatment of Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts

    SciTech Connect

    Tesdal, I. Kaare Wikstroem, Mats; Flechtenmacher, Christa; Filser, Thomas; Dueber, Christoph

    2006-10-15

    Purpose. To assess the role of transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in patients with hepatocellular carcinoma (HCC) and transjugular intrahepatic portosystemic shunts (TIPS). Methods. Between January 1999 and September 2004, 6 patients with HCC and TIPS were treated with either TACE (n = 3) or TACE in combination with PEI (n = 3). One patient had a known advanced, untreated HCC prior to TIPS. In the remaining 5 patients HCC was diagnosed 14, 17, 51, 69, and 76 months respectively after elective TIPS. TACE was performed using a mixture of 30-60 mg of epirubicin and 10 ml of lipiodol following superselective catheterization of tumor-feeding vessels. PEI was performed under CT guidance. Methods. The mean follow-up time after treatment of HCC was 26.2 months (range 7-46 months). During follow-up, all patients were free of rebleeding. Two patients died 7 and 38 months after one session of TACE and PEI (77 months after TIPS) and three sessions of TACE (91 months after TIPS), respectively. The cause of death was liver failure (Child-Pugh class C) and peritonitis, respectively. A third patient underwent liver transplantation 24 months after TIPS and several sessions of TACE. In the remaining 3 patients, the HCC is well controlled 13, 30, and 46 months after repetitive percutaneous treatment without signs of hepatic deterioration or metastasis. Conclusion. Transcatheter arterial superselective chemoembolization and percutaneous ethanol injection seems to be beneficial even in HCC patients treated with TIPS, provided that the liver function is adequate.

  5. Management of Transjugular Intrahepatic Portosystemic Shunt (TIPS)-associated Refractory Hepatic Encephalopathy by Shunt Reduction Using the Parallel Technique: Outcomes of a Retrospective Case Series

    SciTech Connect

    Cookson, Daniel T. Zaman, Zubayr; Gordon-Smith, James; Ireland, Hamish M.; Hayes, Peter C.

    2011-02-15

    Purpose: To investigate the reproducibility and technical and clinical success of the parallel technique of transjugular intrahepatic portosystemic shunt (TIPS) reduction in the management of refractory hepatic encephalopathy (HE). Materials and Methods: A 10-mm-diameter self-expanding stent graft and a 5-6-mm-diameter balloon-expandable stent were placed in parallel inside the existing TIPS in 8 patients via a dual unilateral transjugular approach. Changes in portosystemic pressure gradient and HE grade were used as primary end points. Results: TIPS reduction was technically successful in all patients. Mean {+-} standard deviation portosystemic pressure gradient before and after shunt reduction was 4.9 {+-} 3.6 mmHg (range, 0-12 mmHg) and 10.5 {+-} 3.9 mmHg (range, 6-18 mmHg). Duration of follow-up was 137 {+-} 117.8 days (range, 18-326 days). Clinical improvement of HE occurred in 5 patients (62.5%) with resolution of HE in 4 patients (50%). Single episodes of recurrent gastrointestinal hemorrhage occurred in 3 patients (37.5%). These were self-limiting in 2 cases and successfully managed in 1 case by correction of coagulopathy and blood transfusion. Two of these patients (25%) died, one each of renal failure and hepatorenal failure. Conclusion: The parallel technique of TIPS reduction is reproducible and has a high technical success rate. A dual unilateral transjugular approach is advantageous when performing this procedure. The parallel technique allows repeat bidirectional TIPS adjustment and may be of significant clinical benefit in the management of refractory HE.

  6. 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.

  7. Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt

    PubMed Central

    Lee, Edward Wolfgang; Kuei, Andrew; Saab, Sammy; Busuttil, Ronald W; Durazo, Francisco; Han, Steven-Huy; El-Kabany, Mohamed M; McWilliams, Justin P; Kee, Stephen T

    2016-01-01

    AIM: To evaluate and validate the national trends and predictors of in-patient mortality of transjugular intrahepatic portosystemic shunt (TIPS) in 15 years. METHODS: Using the National Inpatient Sample which is a part of Health Cost and Utilization Project, we identified a discharge-weighted national estimate of 83884 TIPS procedures performed in the United States from 1998 to 2012 using international classification of diseases-9 procedural code 39.1. The demographic, hospital and co-morbility data were analyzed using a multivariant analysis. Using multi-nominal logistic regression analysis, we determined predictive factors related to increases in-hospital mortality. Comorbidity measures are in accordance to the Comorbidity Software designed by the Agency for Healthcare Research and Quality. RESULTS: Overall, 12.3% of patients died during hospitalization with downward trend in-hospital mortality with the mean length of stay of 10.8 ± 13.1 d. Notable, African American patients (OR = 1.809 vs Caucasian patients, P < 0.001), transferred patients (OR = 1.347 vs non-transferred, P < 0.001), emergency admissions (OR = 3.032 vs elective cases, P < 0.001), patients in the Northeast region (OR = 1.449 vs West, P < 0.001) had significantly higher odds of in-hospital mortality. Number of diagnoses and number of procedures showed positive correlations with in-hospital death (OR = 1.249 per one increase in number of procedures). Patients diagnosed with acute respiratory failure (OR = 8.246), acute kidney failure (OR = 4.359), hepatic encephalopathy (OR = 2.217) and esophageal variceal bleeding (OR = 2.187) were at considerably higher odds of in-hospital death compared with ascites (OR = 0.136, P < 0.001). Comorbidity measures with the highest odds of in-hospital death were fluid and electrolyte disorders (OR = 2.823), coagulopathy (OR = 2.016), and lymphoma (OR = 1.842). CONCLUSION: The overall mortality of the TIPS procedure is steadily decreasing, though the length of stay

  8. Effect of technical parameters on transjugular intrahepatic portosystemic shunts utilizing stent grafts

    PubMed Central

    Andring, Brice; Kalva, Sanjeeva P; Sutphin, Patrick; Srinivasa, Rajiv; Anene, Alvin; Burrell, Marc; Xi, Yin; Pillai, Anil K

    2015-01-01

    AIM: To assess the effect of technical parameters on outcomes of transjugular intrahepatic portosystemic shunt (TIPS) created using a stent graft. METHODS: The medical records of 68 patients who underwent TIPS placement with a stent graft from 2008 to 2014 were reviewed by two radiologists blinded to the patient outcomes. Digital Subtraction Angiographic images with a measuring catheter in two orthogonal planes was used to determine the TIPS stent-to-inferior vena cava distance (SIVCD), hepatic vein to parenchymal tract angle (HVTA), portal vein to parenchymal tract angle (PVTA), and the accessed portal vein. The length and diameter of the TIPS stent and the use of concurrent variceal embolization were recorded by review of the patient’s procedure note. Data on re-intervention within 30 d of TIPS placement, recurrence of symptoms, and survival were collected through the patient’s chart. Cox proportional regression analysis was performed to assess the effect of these technical parameters on primary patency of TIPS, time to recurrence of symptoms, and all-cause mortality. RESULTS: There was no significant association between the SIVCD and primary patency (P = 0.23), time to recurrence of symptoms (P = 0.83), or all-cause mortality (P = 0.18). The 3, 6, and 12-mo primary patency rates for a SIVCD ≥ 1.5 cm were 82.4%, 64.7%, and 50.3% compared to 89.3%, 83.8%, and 60.6% for a SIVCD of < 1.5 cm (P = 0.29). The median time to stenosis for a SIVCD of ≥ 1.5 cm was 19.1 mo vs 15.1 mo for a SIVCD of < 1.5 cm (P = 0.48). There was no significant association between the following factors and primary patency: HVTA (P = 0.99), PVTA (P = 0.65), accessed portal vein (P = 0.35), TIPS stent diameter (P = 0.93), TIPS stent length (P = 0.48), concurrent variceal embolization (P = 0.13) and reinterventions within 30 d (P = 0.24). Furthermore, there was no correlation between these technical parameters and time to recurrence of symptoms or all-cause mortality. Recurrence of

  9. Acquired portosystemic collaterals: anatomy and imaging.

    PubMed

    Leite, Andréa Farias de Melo; Mota, Américo; Chagas-Neto, Francisco Abaeté; Teixeira, Sara Reis; Elias Junior, Jorge; Muglia, Valdair Francisco

    2016-01-01

    Portosystemic shunts are enlarged vessels that form collateral pathological pathways between the splanchnic circulation and the systemic circulation. Although their causes are multifactorial, portosystemic shunts all have one mechanism in common-increased portal venous pressure, which diverts the blood flow from the gastrointestinal tract to the systemic circulation. Congenital and acquired collateral pathways have both been described in the literature. The aim of this pictorial essay was to discuss the distinct anatomic and imaging features of portosystemic shunts, as well as to provide a robust method of differentiating between acquired portosystemic shunts and similar pathologies, through the use of illustrations and schematic drawings. Imaging of portosystemic shunts provides subclinical markers of increased portal venous pressure. Therefore, radiologists play a crucial role in the identification of portosystemic shunts. Early detection of portosystemic shunts can allow ample time to perform endovascular shunt operations, which can relieve portal hypertension and prevent acute or chronic complications in at-risk patient populations.

  10. Acquired portosystemic collaterals: anatomy and imaging*

    PubMed Central

    Leite, Andréa Farias de Melo; Mota Jr., Américo; Chagas-Neto, Francisco Abaeté; Teixeira, Sara Reis; Elias Junior, Jorge; Muglia, Valdair Francisco

    2016-01-01

    Portosystemic shunts are enlarged vessels that form collateral pathological pathways between the splanchnic circulation and the systemic circulation. Although their causes are multifactorial, portosystemic shunts all have one mechanism in common-increased portal venous pressure, which diverts the blood flow from the gastrointestinal tract to the systemic circulation. Congenital and acquired collateral pathways have both been described in the literature. The aim of this pictorial essay was to discuss the distinct anatomic and imaging features of portosystemic shunts, as well as to provide a robust method of differentiating between acquired portosystemic shunts and similar pathologies, through the use of illustrations and schematic drawings. Imaging of portosystemic shunts provides subclinical markers of increased portal venous pressure. Therefore, radiologists play a crucial role in the identification of portosystemic shunts. Early detection of portosystemic shunts can allow ample time to perform endovascular shunt operations, which can relieve portal hypertension and prevent acute or chronic complications in at-risk patient populations. PMID:27777479

  11. Pull-Through Technique for Recanalization of Occluded Portosystemic Shunts (TIPS): Technical Note and Review of the Literature

    SciTech Connect

    Tanaka, Toshihiro Guenther, Rolf W. Isfort, Peter; Kichikawa, Kimihiko; Mahnken, Andreas H.

    2011-04-15

    Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction is an important problem after creation of shunts. Most commonly, TIPS recanalization is performed via the jugular vein approach. Occasionally it is difficult to cross the occlusion. We describe a hybrid technique for TIPS revision via a direct transhepatic access combined with a transjugular approach. In two cases, bare metal stents or polytetrafluoroethylene (PTFE)-covered stent grafts had been placed in TIPS tract previously, and they were completely obstructed. The tracts were inaccessible via the jugular vein route alone. In each case, after fluoroscopy or computed tomography-guided transhepatic puncture of the stented segment of the TIPS, a wire was threaded through the shunt and snared into the right jugular vein. The TIPS was revised by balloon angioplasty and additional in-stent placement of PTFE-covered stent grafts. The patients were discharged without any complications. Doppler sonography 6 weeks after TIPS revision confirmed patency in the TIPS tract and the disappearance of ascites. We conclude that this technique is feasible and useful, even in patients with previous PTFE-covered stent graft placement.

  12. Endovascular Management of Refractory Hepatic Encephalopathy Complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS): Comprehensive Review and Clinical Practice Algorithm.

    PubMed

    Pereira, Keith; Carrion, Andres F; Salsamendi, Jason; Doshi, Mehul; Baker, Reginald; Kably, Issam

    2016-02-01

    Transjugular intrahepatic portosystemic shunt (TIPS) has evolved as an effective intervention for treatment of complications of portal hypertension. The use of polytetrafluoroethylene-covered stents have improved the patency of the shunts and diminished the incidence of TIPS dysfunction. However, TIPS-related refractory hepatic encephalopathy (rHE) poses a significant challenge. Approximately 3-7 % of patients with TIPS develop rHE. Refractory hepatic encephalopathy is defined as a recurrent or persistent encephalopathy despite appropriate medical treatment. Hepatic encephalopathy can be an extremely debilitating complication that profoundly affects quality of life. The approach to management of patients with rHE is complex and typically requires collaboration between different specialties. Liver transplantation is the ultimate treatment for rHE; however, the ongoing shortage of organ donation markedly limits this treatment option. Alternative therapies such as shunt occlusion or reduction can control symptoms and serve as a 'bridge' therapy to liver transplantation. Therefore, interventional radiologists play a key role in the management of these patients by offering a variety of endovascular techniques. The purpose of this review is to highlight some of these endovascular techniques and to develop a therapeutic algorithm that can be applied in clinical practice for the management of rHE.

  13. Endovascular Management of Refractory Hepatic Encephalopathy Complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS): Comprehensive Review and Clinical Practice Algorithm

    SciTech Connect

    Pereira, Keith

    2016-02-15

    Transjugular intrahepatic portosystemic shunt (TIPS) has evolved as an effective intervention for treatment of complications of portal hypertension. The use of polytetrafluoroethylene-covered stents have improved the patency of the shunts and diminished the incidence of TIPS dysfunction. However, TIPS-related refractory hepatic encephalopathy (rHE) poses a significant challenge. Approximately 3–7 % of patients with TIPS develop rHE. Refractory hepatic encephalopathy is defined as a recurrent or persistent encephalopathy despite appropriate medical treatment. Hepatic encephalopathy can be an extremely debilitating complication that profoundly affects quality of life. The approach to management of patients with rHE is complex and typically requires collaboration between different specialties. Liver transplantation is the ultimate treatment for rHE; however, the ongoing shortage of organ donation markedly limits this treatment option. Alternative therapies such as shunt occlusion or reduction can control symptoms and serve as a ‘bridge’ therapy to liver transplantation. Therefore, interventional radiologists play a key role in the management of these patients by offering a variety of endovascular techniques. The purpose of this review is to highlight some of these endovascular techniques and to develop a therapeutic algorithm that can be applied in clinical practice for the management of rHE.

  14. Primary Implantation of Polyester-Covered Stent-Grafts for Transjugular Intrahepatic Portosystemic Stent Shunts (TIPSS): A Pilot Study

    SciTech Connect

    Cejna, Manfred; Thurnher, Siegfried; Pidlich, Johann; Kaserer, Klaus; Schoder, Maria; Lammer, Johannes

    1999-07-15

    Purpose: To investigate whether placement of a polyester-covered stent-graft increases the primary patency of transjugular intrahepatic portosystemic stent shunts (TIPSS). Methods: Between 1995 and 1997 Cragg Endopro or Passager MIBS stent-grafts were used for the creation of TIPSS in eight male patients, 35-59 years of age (mean 48 years). All patients suffered from recurrent variceal bleeding and/or refractory ascites due to liver cirrhosis. Seven stent-grafts were dilated to a diameter of 10 mm, one to 12 mm. Follow-up was performed with duplex ultrasound, clinical assessment, and angiography. Results: The technical success rate for creation of a TIPSS was 100%. The mean portosystemic pressure gradient decreased from 25 mmHg to 12 mmHg. In seven of eight patients TIPSS dysfunction occurred between 2 days and 3 years after stent-graft placement. In one patient the TIPSS is still primarily patent (224 days after creation). The secondary patency rates are 31 days to 3 years. Conclusion: The primary use of polyester-covered stent-grafts for TIPSS did not increase primary patency rates in our small series.

  15. A multimodality imaging approach for guiding a modified endovascular coil embolization of a single intrahepatic portosystemic shunt in dogs.

    PubMed

    Knapp, Teja; Navalòn, Iolanda; Medda, Massimo; Pradelli, Danitza; Borgonovo, Simone; Crosta, Cristina; Bussadori, Claudio Maria

    2015-12-01

    Intrahepatic portosystemic shunts (IHPSS) in dogs are aberrant vascular anomalies that connect the portal and the systemic venous vessels. In most of the patients, the surgical approach is unfavourable due to the difficulties in isolating the IHPSS, making the option of a percutaneous transvenous coil embolization (PTCE) one of the safer occlusive procedures. This study describes the treatment of eight dogs with a single IHPSS using a multimodality imaging approach to guide the modified PTCE procedure. This new technique results in a decrease of 71% of the time of the entire procedure with the reduction of 91% in the time required involved the IHPSS identification and in the fluoroscopy exposure time avoiding the need for iodinated contrast agents during the procedure. Moreover, the placement of the catheter before the caval stent ensures its greater stability, enhancing the procedural safety in the phase when the coils are released and avoiding the risk of their dislocation.

  16. Transjugular Intrahepatic Portosystemic Shunt for Treatment of Cirrhosis-related Chylothorax and Chylous Ascites: Single-institution Retrospective Experience

    SciTech Connect

    Kikolski, Steven G. Aryafar, Hamed Rose, Steven C.; Roberts, Anne C.; Kinney, Thomas B.

    2013-08-01

    PurposeTo investigate the efficacy and safety of the use of transjugular intrahepatic portosystemic shunt (TIPS) creation to treat cirrhosis-related chylous collections (chylothorax and chylous ascites).MethodsWe retrospectively reviewed data from four patients treated for refractory cirrhosis-related chylous collections with TIPS at our institution over an 8 year period.ResultsOne patient had chylothorax, and three patients had concomitant chylothorax and chylous ascites. There were no major complications, and the only procedure-related complications occurred in two patients who had mild, treatable hepatic encephalopathy. All patients had improvement as defined by decreased need for thoracentesis or paracentesis, with postprocedure follow-up ranging from 19 to 491 days.ConclusionTIPS is a safe procedure that is effective in the treatment of cirrhosis-related chylous collections.

  17. Covered versus bare stents for transjugular intrahepatic portosystemic shunt: an updated meta-analysis of randomized controlled trials

    PubMed Central

    Qi, Xingshun; Tian, Yulong; Zhang, Wei; Yang, Zhiping; Guo, Xiaozhong

    2016-01-01

    Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a standard treatment option for the management of portal hypertension in liver cirrhosis. Since the introduction of covered stents, shunt patency has been greatly improved. However, it remains uncertain about whether covered stents could improve survival. A meta-analysis of randomized controlled trials has been performed to compare the outcomes of covered versus bare stents for TIPS. Methods: PubMed, EMBASE, and Cochrane Library databases were searched to identify the relevant randomized controlled trials. Overall survival, shunt patency, and hepatic encephalopathy were the major endpoints. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was calculated. Cochrane risk of bias tool was employed. Results: Overall, 119 papers were identified. Among them, four randomized controlled trials were eligible. Viatorr covered stents alone, Fluency covered stents alone, and Viatorr plus Fluency covered stents were employed in one, two, and one randomized controlled trials, respectively. Risk of bias was relatively low. Meta-analyses demonstrated that the covered-stents group had significantly higher probabilities of overall survival (HR = 0.67, 95% CI = 0.50–0.90, p = 0.008) and shunt patency (HR = 0.42, 95% CI = 0.29–0.62, p < 0.0001) than the bare-stents group. Additionally, the covered-stents group might have a lower risk of hepatic encephalopathy than the bare-stents group (HR = 0.70, 95% CI = 0.49–1.00, p = 0.05). The heterogeneity among studies was not statistically significant in the meta-analyses. Conclusions: Compared with bare stents, covered stents for TIPS may improve the overall survival. In the era of covered stents, the indications for TIPS may be further expanded. PMID:28286557

  18. Transjugular Intrahepatic Portosystemic Shunt, Mechanical Aspiration Thrombectomy, and Direct Thrombolysis in the Treatment of Acute Portal and Superior Mesenteric Vein Thrombosis

    SciTech Connect

    Ferro, Carlo; Rossi, Umberto G. Bovio, Giulio; Dahamane, M'Hamed; Centanaro, Monica

    2007-09-15

    A patient was admitted because of severe abdominal pain, anorexia, and intestinal bleeding. Contrast-enhanced multidetector computed tomography demonstrated acute portal and superior mesenteric vein thrombosis (PSMVT). The patient was treated percutaneously with transjugular intrahepatic portosystemic shunt (TIPS), mechanical aspiration thrombectomy, and direct thrombolysis, and 1 week after the procedure, complete patency of the portal and superior mesenteric veins was demonstrated. TIPS, mechanical aspiration thrombectomy, and direct thrombolysis together are promising endovascular techniques for the treatment of symptomatic acute PSMVT.

  19. The transhepatic endotoxin gradient is present despite liver cirrhosis and is attenuated after transjugular portosystemic shunt (TIPS).

    PubMed Central

    2011-01-01

    Background Translocation of gut-derived bacterial products such as endotoxin is a major problem in liver cirrhosis. Methods To assess the hepatic clearance of bacterial products in individuals with cirrhosis, we tested concentrations of Gram-negative bacterial lipopolysaccharide (LPS), LPS-binding protein (LBP), and the precursor of nitric oxide (NO), L-arginine, in a cohort of 8 stable patients with liver cirrhosis before and after elective transjugular portosystemic shunt (TIPS) implantation, including central venous, hepatic venous, and portal venous measurements. Results Using an adapted LPS assay, we detected high portal venous LPS concentrations (mean 1743 ± 819 pg/mL). High concentrations of LPS were detectable in the central venous blood (931 ± 551 pg/mL), as expected in persons with cirrhosis. The transhepatic LPS gradient was found to be 438 ± 287 pg/mL, and 25 ± 12% of portal LPS was cleared by the cirrhotic liver. After TIPS, central venous LPS concentrations increased in the hepatic and central veins, indicating shunting of LPS with the portal blood through the stent. This paralleled a systemic increase of L-arginine, whereas the NO synthase inhibitor asymmetric dimethylarginine (ADMA) remained unchanged, suggesting that bacterial translocation may contribute to the pathogenesis of circulatory dysfunction post-TIPS. Conclusions This study provides quantitative estimates of the role of the liver in the pathophysiology of bacterial translocation. The data indicate that the cirrhotic liver retains the capacity for clearance of bacterial endotoxin from the portal venous blood and that TIPS implantation attenuates this clearance. Thus, increased endotoxin concentrations in the systemic circulation provide a possible link to the increased encephalopathy in TIPS patients. PMID:21978390

  20. Diagnostic value of the rectal ammonia tolerance test, fasting plasma ammonia and fasting plasma bile acids for canine portosystemic shunting.

    PubMed

    van Straten, G; Spee, B; Rothuizen, J; van Straten, M; Favier, R P

    2015-06-01

    Portosystemic shunting (PSS) often results in hyperammonaemia and, consequently, hepatic encephalopathy. This retrospective study evaluated the sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) and other test performance metrics for the ammonia tolerance test (ATT), serum fasting bile acids (FBA), serum fasting ammonia concentration (FA), and combinations of these tests for their association with PSS in dogs. Medical records of 271 dogs suspect for PSS (symptomatic group) and 53 dogs returning for evaluation after surgical closure of a congenital PSS (CPSS post-surgical control group) were analysed. In the symptomatic group, ATT at 40 min (T40), and the FBA had the highest sensitivity (100% and 98%, respectively) and NPV (100% and 96%, respectively) for PSS. The combination of increased FBA and FA had the highest specificity (97%), with a PPV of 97%, and a positive likelihood ratio of 29. In the CPSS post-surgical control group, the specificity and PPV of FA and the combination of increased FBA/FA were both 100%. In purebred populations, the NPV of all tests was 100%. Consequently, PSS would be ruled out in a symptomatic dog with normal FBA or ATT (T40) and would be highly probable when both FBA and FA are increased. Increased FA was conclusive for PSS in dogs evaluated for post-surgical closure of a CPSS. FBA was the most suitable test for screening purposes.

  1. Portal vein aneurysm associated with Budd-Chiari syndrome treated with transjugular intrahepatic portosystemic shunt: A case report

    PubMed Central

    Tsauo, Jiaywei; Li, Xiao

    2015-01-01

    A 65-year-old woman with Budd-Chiari syndrome (BCS) presented with right upper quadrant pain. A computed tomography (CT) scan showed a saccular aneurysm located at the extrahepatic portal vein main branch measuring 3.2 cm in height and 2.5 cm × 2.4 cm in diameter. The aneurysm was thought to be associated with BCS as there was no preceding history of trauma and it had not been present on Doppler ultrasound examination performed 3 years previously. Because of increasing pain and concern for complications due to aneurysm size, the decision was made to relieve the hepatic venous outflow obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) was created without complications. She had complete resolution of her abdominal pain within 2 d and remained asymptomatic after 1 year of follow-up. CT scans obtained after TIPS showed that the aneurysm had decreased in size to 2.4 cm in height and 2.0 cm × 1.9 cm in diameter at 3 mo, and had further decreased to 1.9 cm in height and 1.6 cm × 1.5 cm in diameter at 1 year. PMID:25759562

  2. Acute Effects of Liver Vein Occlusion by Stent-Graft Placed in Transjugular Intrahepatic Portosystemic Shunt Channel: An Experimental Study

    SciTech Connect

    Keussen, Inger Bergqvist, Lennart; Rissler, Pehr; Cwikiel, Wojciech

    2006-02-15

    The purpose of this study was to evaluate the effects of hepatic vein occlusion by stent-graft used in transjugular intrahepatic portosystemic shunt (TIPS). The experiments were performed in six healthy pigs under general anesthesia. Following percutaneous transhepatic implantation of a port-a-cath in the right hepatic vein, TIPS was created with a stent-graft (Viatorr; W L Gore, Flagstaff, AZ, USA). The outflow from the hepatic vein, blocked by the stent-graft was documented by injection of contrast medium and repeated injections of {sup 99}Tc{sup m}-labeled human serum albumin through the port-a-cath. After 2 weeks, the outflow was re-evaluated, the pigs were sacrificed, and histopathologic examination of the liver was performed. Occlusion of the hepatic vein by a stent-graft had a short and temporary effect on the outflow. Histopathological examination from the affected liver segment showed no divergent pattern. Stent-grafts used in TIPS block the outflow from the liver vein, but do not have a prolonged circulatory effect and do not affect the liver parenchyma.

  3. Selective alterations of cerebrospinal fluid amino acids in dogs with congenital portosystemic shunts.

    PubMed

    Butterworth, J; Gregory, C R; Aronson, L R

    1997-12-01

    Numerous studies suggest that modifications in concentrations of both excitatory and inhibitory amino acids are implicated in the pathophysiology of portal-systemic encephalopathy (PSE), a neuropsychiatric disorder associated with chronic liver disease in humans. In this study, amino acid levels were measured by High Performance Liquid Chromatography (HPLC) in Cerebrospinal Fluid (CSF) of 10 dogs (age range: 3 mo.- 3 yr 4 mo.) exhibiting a congenital portal-systemic shunt, either intra or extra-hepatic, and 8 age-matched control dogs who showed no signs of hepatic or neurologic disorders. Dogs with congenital shunts manifested signs of encephalopathy such as disorientation, head pressing, vocalization, depression, seizures and coma. CSF from dogs with congenital shunts contained significantly increased amounts of glutamate (2 to 3-fold increase, p<0.01), glutamine (6-fold increase, p<0.05) and aromatic amino acids (phenylalanine, tyrosine and tryptophan) compared to CSF of control dogs. Concentrations of GABA and branched chain amino acids (valine, leucine, isoleucine) were within normal limits. Modifications of brain glutamate (an excitatory amino acid) as well as tryptophan (the precursor of serotonin) could contribute to the neurological syndrome characteristic of congenital PSE in dogs.

  4. [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.

  5. Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation for Chronic Portal Vein Thrombosis: Technical Considerations.

    PubMed

    Thornburg, Bartley; Desai, Kush; Hickey, Ryan; Kulik, Laura; Ganger, Daniel; Baker, Talia; Abecassis, Michael; Lewandowski, Robert J; Salem, Riad

    2016-03-01

    Portal vein thrombosis (PVT) is common in cirrhotic patients and presents a challenge at the time of transplant. Owing to the increased posttransplant morbidity and mortality associated with complete PVT, the presence of PVT is a relative contraindication to liver transplantation at many centers. Our group began performing portal vein (PV) recanalization and transjugular intrahepatic portostystemic shunt placement (PVR-TIPS) several years ago to optimize the transplant candidacy of patients with PVT. The procedure has evolved to include transsplenic access to assist with recanalization, which is now our preferred method due to its technical success without significant added morbidity. Here, we describe in detail our approach to PVR-TIPS with a focus on the transsplenic method. The procedure was attempted in 61 patients and was technically successful in 60 patients (98%). After transitioning to transsplenic access to assist with recanalization, the technical success rate has improved to 100%. The recanalized portal vein and TIPS have maintained patency during follow-up, or to the time of transplant, in 55 patients (92%) with a mean follow-up of 16.7 months. In total, 23 patients (38%) have undergone transplant, all of whom received a physiologic anastomosis (end-to-end anastomosis in 22 of 23 patients, 96%). PVR-TIPS placement should be considered as an option for patients with chronic PVT in need of transplantation. Transsplenic access makes the procedure technically straightforward and should be considered as the primary method for recanalization.

  6. Evaluation of surgical outcome, complications, and mortality in dogs undergoing preoperative computed tomography angiography for diagnosis of an extrahepatic portosystemic shunt: 124 cases (2005–2014)

    PubMed Central

    Brunson, Benjamin W.; Case, J. Brad; Ellison, Gary W.; Fox-Alvarez, W. Alexander; Kim, Stanley E.; Winter, Matthew; Garcia-Pereira, Fernando L.; Farina, Lisa L.

    2016-01-01

    This study evaluated the safety of preoperative computed tomography angiography (CTA) and its effect on surgical time and clinical outcomes in dogs that underwent surgical correction of a single congenital extrahepatic portosystemic shunt (CEPSS). Patient data were retrospectively collected from medical records and owner communications for 124 dogs with single CEPSS, undergoing preoperative CTA (n = 43) or not (n = 81) which were surgically treated from 2005 to 2014. The frequency of major postoperative complications was 4.7% and 9.9% for the CTA and no CTA groups, respectively (P = 0.49). Mean ± standard deviation (SD) surgical time for the preoperative CTA group was 84 ± 40 min and 81 ± 31 min for the no CTA group (P = 0.28). We conclude that anesthetized preoperative CTA appears to be a safe method for diagnosis and surgical planning in dogs with single CEPSS, and does not appear to affect surgical procedure time, complication rate, or clinical outcome. PMID:26740699

  7. Regional cerebral blood flow assessed by single photon emission computed tomography (SPECT) in dogs with congenital portosystemic shunt and hepatic encephalopathy.

    PubMed

    Or, Matan; Peremans, Kathelijne; Martlé, Valentine; Vandermeulen, Eva; Bosmans, Tim; Devriendt, Nausikaa; de Rooster, Hilde

    2017-02-01

    Regional cerebral blood flow (rCBF) in eight dogs with congenital portosystemic shunt (PSS) and hepatic encephalopathy (HE) was compared with rCBF in eight healthy control dogs using single photon emission computed tomography (SPECT) with a (99m)technetium-hexamethylpropylene amine oxime ((99m)Tc-HMPAO) tracer. SPECT scans were abnormal in all PSS dogs. Compared to the control group, rCBF in PSS dogs was significantly decreased in the temporal lobes and increased in the subcortical (thalamic and striatal) area. Brain perfusion imaging alterations observed in the dogs with PSS and HE are similar to those in human patients with HE. These findings suggest that dogs with HE and PSS have altered perfusion of mainly the subcortical and the temporal regions of the brain.

  8. Multidetector-Row Computed Tomography in the Evaluation of Transjugular Intrahepatic Portosystemic Shunt Performed with Expanded-Polytetrafluoroethylene-Covered Stent-Graft

    SciTech Connect

    Fanelli, Fabrizio Bezzi, Mario; Bruni, Antonio; Corona, Mario; Boatta, Emanuele; Lucatelli, Pierleone; Passariello, Roberto

    2011-02-15

    We assessed, in a prospective study, the efficacy of multidetector spiral computed tomography (MDCT) in the evaluation of transjugular intrahepatic portosystemic shunt (TIPS) patency in patients treated with the Viatorr (Gore, Flagstaff, AZ) expanded-polytetrafluoroethylene (e-PTFE)-covered stent-graft. Eighty patients who underwent TIPS procedure using the Viatorr self-expanding e-PTFE stent-graft were evaluated at follow-up of 1, 3, 6, and 12 months with clinical and laboratory tests as well as ultrasound-color Doppler (USCD) imaging. In case of varices, upper gastrointestinal endoscopy was also performed. In addition, the shunt was evaluated using MDCT at 6 and 12 months. In all cases of abnormal findings and discrepancy between MDCT and USCD, invasive control venography was performed. MDCT images were acquired before and after injection of intravenous contrast media on the axial plane and after three-dimensional reconstruction using different algorithms. MDCT was successfully performed in all patients. No artefacts correlated to the Viatorr stent-graft were observed. A missing correlation between UCSD and MDCT was noticed in 20 of 80 (25%) patients. Invasive control venography confirmed shunt patency in 16 (80%) cases and shunt malfunction in 4 (20%) cases. According to these data, MDCT sensitivity was 95.2%; specificity was 96.6%; and positive (PPV) and negative predictive values (NPV) were 90.9 and 98.2%, respectively. USCD sensitivity was 90%; specificity was 75%; and PPV and NPV were 54.5 and 95.7%, respectively. A high correlation (K value = 0.85) between MDCT and invasive control venography was observed. On the basis of these results, MDCT shows superior sensitivity and specificity compared with USCD in those patients in whom TIPS was performed with the Viatorr stent-graft. MDCT can be considered a valid tool in the follow-up of these patients.

  9. Cost analysis for the prevention of variceal rebleeding: a comparison between transjugular intrahepatic portosystemic shunt and endoscopic sclerotherapy in a selected group of Italian cirrhotic patients.

    PubMed

    Meddi, P; Merli, M; Lionetti, R; De Santis, A; Valeriano, V; Masini, A; Rossi, P; Salvatori, F; Salerno, F; de Franchis, R; Capocaccia, L; Riggio, O

    1999-04-01

    The aim of the present study was to compare the cumulative cost of the first 18-month period in a selected group of Italian cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic sclerotherapy (ES) to prevent variceal rebleeding. Thirty-eight patients enrolled in a controlled trial were considered (18 TIPS and 20 sclerotherapy). The number of days spent in the hospital for the initial treatment and during the follow-up period were defined as the costs of hospitalization. ES sessions, TIPS procedures, angioplasty or addition of a second stent to maintain the shunt patency, were defined as the costs of therapeutic procedures. The two groups were comparable for age, sex, and Child-Pugh score. During the observation period 4 patients died in the TIPS group, and 2 died and 1 was transplanted in the sclerotherapy group. The rebleeding rate was significantly higher in the sclerotherapy group. Despite this, the number of days spent in the hospital was similar in the two groups. This was because of a higher number of hospital admissions for the treatment of hepatic encephalopathy and shunt insufficiency in the TIPS group. The therapeutic procedures were more expensive for TIPS. Consequently, the cumulative cost was higher for patients treated with TIPS than for those treated with sclerotherapy. The extra cost was because of the initial higher cost of the procedure and the difference was still maintained at the end of the 18-month follow-up. When the cumulative costs were expressed per month free of rebleeding, the disadvantage of TIPS disappeared. In conclusion, a program of prevention of variceal rebleeding with TIPS, despite the longer interval free of rebleeding, is not a cost-saving strategy in comparison with sclerotherapy.

  10. Aberrant expression and distribution of enzymes of the urea cycle and other ammonia metabolizing pathways in dogs with congenital portosystemic shunts.

    PubMed

    van Straten, Giora; van Steenbeek, Frank G; Grinwis, Guy C M; Favier, Robert P; Kummeling, Anne; van Gils, Ingrid H; Fieten, Hille; Groot Koerkamp, Marian J A; Holstege, Frank C P; Rothuizen, Jan; Spee, Bart

    2014-01-01

    The detoxification of ammonia occurs mainly through conversion of ammonia to urea in the liver via the urea cycle and glutamine synthesis. Congenital portosystemic shunts (CPSS) in dogs cause hyperammonemia eventually leading to hepatic encephalopathy. In this study, the gene expression of urea cycle enzymes (carbamoylphosphate synthetase (CPS1), ornithine carbamoyltransferase (OTC), argininosuccinate synthetase (ASS1), argininosuccinate lyase (ASL), and arginase (ARG1)), N-acetylglutamate synthase (NAGS), Glutamate dehydrogenase (GLUD1), and glutamate-ammonia ligase (GLUL) was evaluated in dogs with CPSS before and after surgical closure of the shunt. Additionally, immunohistochemistry was performed on urea cycle enzymes and GLUL on liver samples of healthy dogs and dogs with CPSS to investigate a possible zonal distribution of these enzymes within the liver lobule and to investigate possible differences in distribution in dogs with CPSS compared to healthy dogs. Furthermore, the effect of increasing ammonia concentrations on the expression of the urea cycle enzymes was investigated in primary hepatocytes in vitro. Gene-expression of CPS1, OTC, ASL, GLUD1 and NAGS was down regulated in dogs with CPSS and did not normalize after surgical closure of the shunt. In all dogs GLUL distribution was localized pericentrally. CPS1, OTC and ASS1 were localized periportally in healthy dogs, whereas in CPSS dogs, these enzymes lacked a clear zonal distribution. In primary hepatocytes higher ammonia concentrations induced mRNA levels of CPS1. We hypothesize that the reduction in expression of urea cycle enzymes, NAGS and GLUD1 as well as the alterations in zonal distribution in dogs with CPSS may be caused by a developmental arrest of these enzymes during the embryonic or early postnatal phase.

  11. Implantability, Complications, and Follow-Up After Transjugular Intrahepatic Portosystemic Stent-Shunt Creation With the 6F Self-Expanding Sinus-SuperFlex-Visual Stent

    PubMed Central

    Spira, Daniel; Wiskirchen, Jakub; Lauer, Ulrich; Ketelsen, Dominik; Nikolaou, Konstantin; Wiesinger, Benjamin

    2016-01-01

    Background The transjugular intrahepatic portosystemic stent-shunt (TIPSS) builds a shortcut between the portal vein and a liver vein, and represents a sophisticated alternative to open surgery in the management of portal hypertension or its complications. Objectives To describe clinical experiences with a low-profile nitinol stent system in TIPSS creation, and to assess primary and long-term success. Patients and Methods Twenty-six patients (5 females, 21 males; mean age 54.6 years) were treated using a low-profile 6F self-expanding sinus-SuperFlex-Visual stent system. The indication for TIPSS creation was refractory bleeding in 9 of the 26 patients, refractory ascites in 18 patients, and acute thrombosis of the portal vein confluence in one patient. Portosystemic pressure gradients before and after TIPSS, periprocedural and long-term complications, and the time to orthotopic liver transplantation (OLT) or death were recorded. Results The portosystemic pressure gradient was significantly reduced, from 20.9 ± 6.3 mmHg before to 8.2 ± 2.3 mmHg after TIPSS creation (P < 0.001). Procedure-related complications included acute tract occlusion (n = 2), liver hematoma (n = 1), hepatic encephalopathy (n = 1), and cardiac failure (n = 1). Three of the 26 patients had late-onset TIPSS occlusion (at 12, 12, and 39 months after TIPSS creation). Three patients died within one week after the procedure due to their poor general condition (multiorgan failure, acute respiratory distress syndrome, necrotizing pancreatitis, and aspiration pneumonia). Another four patients succumbed to their underlying advanced liver disease within one year after TIPSS insertion. Seven patients underwent OLT at a mean time of 9.4 months after TIPSS creation. Conclusion The sinus-SuperFlex-Visual stent system can be safely deployed as a TIPSS device. The pressure gradient reduction was clinically sufficient to treat the patients’ symptoms, and periprocedural complications were due to the TIPSS

  12. MELD Score as a Predictor of Early Death in Patients Undergoing Elective Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedures

    SciTech Connect

    Montgomery, Aaron; Ferral, Hector Vasan, Rajiv; Postoak, Darren W.

    2005-04-15

    Purpose. To Evaluate the MELD score as a predictor of 30-day mortality in patients undergoing elective TIPS procedures. Methods. This was a retrospective, IRB-approved study. The medical records of all patients who underwent a TIPS procedure between May 1, 1999 and June 1, 2003 in a single institution were reviewed. Patients who underwent elective TIPS were selected. Elective TIPS was performed in 119 patients with a mean age of 55.1 ({+-} 9.6) years. The MELD and Child-Pugh scores before TIPS, etiology of cirrhosis, portosystemic gradients before and after TIPS, procedure time, and procedural complications were obtained from the medical records. The MELD and Child-Pugh scores before TIPS were compared between the survivor group (SG) and the early death (EDG) group. The early death rate was calculated for MELD score subgroups (1-10, 11-17, 18-24, and >24). Data were analyzed using the Fisher exact test, chi-square test and independent-sample t-test. A p value of less than 0.05 was considered significant. Results. Technical success rate was 100%. The early death rate was 10.9% (13/119). The mean MELD scores before TIPS were 19.4 ({+-} 5.9) (EDG) and 14 ({+-} 4.2) (SG) (p = 0.025). The early death rate was highest in the pre-TIPS MELD > 24 subgroup. The Child-Pugh scores were 9.0 ({+-} 1.6) (SG) and 9.8 {+-} 1.06 (EDG) (p 0.08). The mean portosystemic gradients before TIPS were 20.5 ({+-} 7.7) mmHg (EDG) and 22.7 ({+-} 7.3) (SG) (p > 1) and the mean portosystemic gradients after TIPS were 6.5 ({+-} 3.5) (EDG) and 6.9 ({+-} 2.4) (SG) (p > 1). The mean procedural times were 95.6 ({+-} 8.4) min (EDG) and 89.2 ({+-} 7.5) min (SG) (p > 1). No early death was attributed to a fatal complication during TIPS. Conclusion. The MELD score is useful in identifying patients at a higher risk of early death after an elective TIPS. On the basis of our results, we do not endorse elective TIPS in patients with MELD scores > 24.

  13. Successful Treatment of Small Intestinal Bleeding in a Crohn's Patient with Noncirrhotic Portal Hypertension by Transjugular Portosystemic Shunt Placement and Infliximab Treatment.

    PubMed

    Heimgartner, Benjamin; Dawson, Heather; De Gottardi, Andrea; Wiest, Reiner; Niess, Jan Hendrik

    2016-01-01

    Small intestinal bleeding in Crohn's disease patients with noncirrhotic portal hypertension and partial portal and superior mesenteric vein thrombosis is a life-threatening event. Here, a case is reported in which treatment with azathioprine may have resulted in nodular regenerative hyperplasia, portal hypertension and portal vein thrombosis. The 56-year-old patient with Crohn's disease developed nodular regenerative hyperplasia under treatment with azathioprine. He was admitted with severe bleeding. Gastroscopy showed small esophageal varices without bleeding stigmata. Blood was detected in the terminal ileum. CT scan revealed a partial portal vein thrombosis with extension to the superior mesenteric vein, thickening of the jejunal wall and splenomegaly. Because intestinal bleeding could not be controlled by conservative treatment, the thrombus was aspirated and a transjugular intrahepatic portosystemic shunt (TIPS) was placed. Switching the immunosuppressive medication to infliximab controlled Crohn's disease activity. Bleeding was stopped, hemoglobin normalized, and thrombocytopenia and bowel movements improved. In summary, small intestinal bleeding in a Crohn's patient with nodular regenerative hyperplasia, portal hypertension and portal vein thrombosis can be efficiently treated by TIPS. TIPS placement together with infliximab treatment led to the improvement of the blood panel and remission in this patient.

  14. Safety and efficacy of 2-octyl-cyanoacrylate in the management of patients with gastric and duodenal varices who are not candidates for transjugular intrahepatic portosystemic shunts

    PubMed Central

    Burdick, James; Trotter, James F.

    2016-01-01

    Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension and cirrhosis. Options are limited for patients who are not candidates for transjugular intrahepatic portosystemic shunts (TIPS). Cyanoacrylate injections have been reported to be efficacious in previous case series. The aim of this retrospective study was to report our single-center experience with the safety and efficacy of 2-octyl-cyanoacrylate in patients who were not TIPS candidates. Electronic medical records were reviewed for 16 patients who underwent a total of 18 esophagogastroduodenoscopies for acute gastric or duodenal variceal bleeding and secondary prophylaxis of gastric varices; 14 patients had cirrhosis with an average Model for End-Stage Liver Disease score of 16, and 2 patients had noncirrhotic portal hypertension. Primary endpoints of the study included early and delayed rebleeding rate, complications, and death or liver transplantation. The rebleeding rate (early or delayed) was 7%, and no complications were found. One death was reported (unrelated to the procedure). In conclusion, 2-octyl-cyanoacrylate is a safe and effective alternative for non-TIPS candidates who present with acute gastric variceal bleeding given its low rebleeding and complication rate. PMID:27695164

  15. Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Intractable Ascites in a Patient with Polycystic Liver Disease

    SciTech Connect

    Bahramipour, Phillip F.; Festa, Steven; Biswal, Rajiv; Wachsberg, Ronald H.

    2000-03-15

    Though polycystic liver disease (PCLD) has historically been considered a contraindication to TIPS, we present a case where technically successful shunt creation was achieved without the need for modification of the standard TIPS procedure, as was required in a previous report.

  16. MELD-Na as a prognostic indicator of 30- and 90-day mortality in patients with end-stage liver disease after creation of transjugular intrahepatic portosystemic shunt.

    PubMed

    Ahmed, Rezwan; Santhanam, Prasanna; Rayyan, Yaser

    2015-10-01

    Previous studies have shown that the Model for End-Stage Liver Disease (MELD) score is superior to other liver disease scoring systems to establish optimal candidates for transjugular intrahepatic portosystemic shunt (TIPS) procedure and liver transplantation. Our aim was to compare MELD-Na score with MELD score as a predictor of 30-day as well as 90-day mortality for individuals with end-stage liver disease (ESLD) after creation of TIPS. We performed a chart review on cirrhotic patients who underwent TIPS procedure and documented presence and severity of ascites and hepatic encephalopathy, patient laboratory values, and results from TIPS procedures. We compared continuous variables by Student's t-test for independent samples and categorical variables by χ-test(s). In non-normal distributions, a nonparametric test was used. We performed a logistic regression to determine the effects of several variables and analyzed variable predictors of likelihood of death within 30 and 90 days of TIPS procedure. Of the six predictor variables, only MELD-Na score was a statistically significant predictor of 30- and 90-day mortality following TIPS procedure for ESLD (P=0.028). For each one point increase in MELD-Na score, the odds of death increased by 1.15 times [95% confidence interval (1.02-1.30), P=0.28]. Since hyponatremia may be associated with poor prognostic features of overall health, its incorporation into the MELD scoring system to predict mortality in ESLD after creation of TIPS serves a useful purpose. Our single-center experience suggests that the MELD-Na score is the most effective predictor of survival after TIPS creation.

  17. Comparison of Transjugular Intrahepatic Portosystemic Shunt with Covered Stent and Balloon-Occluded Retrograde Transvenous Obliteration in Managing Isolated Gastric Varices

    PubMed Central

    Lee, Kristen A.; Sauk, Steven; Korenblat, Kevin

    2017-01-01

    Objective Although a transjugular intrahepatic portosystemic shunt (TIPS) is commonly placed to manage isolated gastric varices, balloon-occluded retrograde transvenous obliteration (BRTO) has also been used. We compare the long-term outcomes from these procedures based on our institutional experience. Materials and Methods We conducted a retrospective review of patients with isolated gastric varices who underwent either TIPS with a covered stent or BRTO between January 2000 and July 2013. We identified 52 consecutive patients, 27 who had received TIPS with a covered stent and 25 who had received BRTO. We compared procedural complications, re-bleeding rates, and clinical outcomes between the two groups. Results There were no significant differences in procedural complications between patients who underwent TIPS (7%) and those who underwent BRTO (12%) (p = 0.57). There were also no statistically significant differences in re-bleeding rates from gastric varices between the two groups (TIPS, 7% [2/27]; BRTO, 8% [2/25]; p = 0.94) or in developing new ascites following either procedure (TIPS, 4%; BRTO, 4%; p = 0.96); significantly more patients who underwent TIPS developed hepatic encephalopathy (22%) than did those who underwent BRTO (0%, p = 0.01). There was no statistically significant difference in mean survival between the two groups (TIPS, 30 months; BRTO, 24 months; p = 0.16); median survival for the patients who received TIPS was 16.6 months, and for those who underwent BRTO, it was 26.6 months. Conclusion BRTO is an effective method of treating isolated gastric varices with similar outcomes and complication rates to those of TIPS with a covered stent but with a lower rate of hepatic encephalopathy. PMID:28246514

  18. Efficacy of TACE in TIPS Patients: Comparison of Treatment Response to Chemoembolization for Hepatocellular Carcinoma in Patients With and Without a Transjugular Intrahepatic Portosystemic Shunt

    SciTech Connect

    Kuo, Yuo-Chen Kohi, Maureen P. Naeger, David M. Tong, Ricky T. Kolli, K. Pallav Taylor, Andrew G. Laberge, Jeanne M. Kerlan, Robert K. Fidelman, Nicholas

    2013-10-15

    Purpose: To compare treatment response after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in patients with and without a transjugular intrahepatic portosystemic shunt (TIPS). Materials and Methods: A retrospective review of patients who underwent conventional TACE for HCC between January 2005 and December 2009 identified 10 patients with patent TIPS. From the same time period, 23 patients without TIPS were selected to control for comparable Model for End-Stage Liver Disease and Child-Pugh-Turcotte scores. The two groups showed similar distribution of Barcelona Clinic Liver Cancer and United Network of Organ Sharing stages. Target HCC lesions were evaluated according to the modified response evaluation criteria in solid tumors (mRECIST) guidelines. Transplantation rate, time to tumor progression, and overall survival (OS) were documented. Results: After TACE, the rate of complete response was significantly greater in non-TIPS patients compared with TIPS patients (74 vs. 30 %, p = 0.03). Objective response rate (complete and partial response) trended greater in the non-TIPS group (83 vs. 50 %, p = 0.09). The liver transplantation rate was 80 and 74 % in the TIPS and non-TIPS groups, respectively (p = 1.0). Time to tumor progression was similar (p = 0.47) between the two groups. OS favored the non-TIPS group (p = 0.01) when censored for liver transplantation. Conclusion: TACE is less effective in achieving complete or partial response using mRECIST criteria in TIPS patients compared with those without a TIPS. Nevertheless, similar clinical outcomes may be achieved, particularly in TIPS patients who are liver-transplantation candidates.

  19. Long-term Outcome and Analysis of Dysfunction of Transjugular Intrahepatic Portosystemic Shunt Placement in Chronic Primary Budd-Chiari Syndrome.

    PubMed

    Hayek, Georges; Ronot, Maxime; Plessier, Aurélie; Sibert, Annie; Abdel-Rehim, Mohamed; Zappa, Magaly; Rautou, Pierre-Emmanuel; Valla, Dominique; Vilgrain, Valérie

    2016-10-31

    Purpose To evaluate the long-term safety, technical success, and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in a series of patients with Budd-Chiari syndrome (BCS), and to determine the predictors of shunt dysfunction. Materials and Methods From 2004 to 2013, all patients with primary BCS referred for TIPS placement were included in the study. The primary and secondary technical success rates and the number and types of early (ie, before day 7) complications were noted. Factors associated with dysfunction were analyzed with uni- and multivariate analyses. Survival was analyzed with Kaplan-Meier curves. Results Fifty-four patients (34 women [63%]; mean age, 36 years ± 12 [standard deviation]) were included. Twenty-eight patients (52%) had myeloproliferative neoplasms. The mean Model for End-Stage Liver Disease score was 14.5 ± 4. The most frequent indication for TIPS was refractory ascites (50 of 54; 93%). Primary and secondary technical success rates were 93% and 98%, respectively. Early complications occurred in 17 patients (32%). After a mean follow-up of 56 months ± 41 (interquartile range, 22-92), 22 patients (42%) experienced at least one episode of TIPS dysfunction (median delay between administration of TIPS and first episode of dysfunction, 10.8 months). Cumulative 1-, 2-, 3-, 5-, and 10-year primary patency rates were 64%, 59%, 54%, 45%, and 45%, respectively. Dysfunction was associated with a myeloproliferative neoplasm (hazard ratio, 8.18; 95% confidence interval: 1.45, 46.18; P = .017), more than two initial stents (hazard ratio, 3.90; 95% confidence interval:1.16, 13.10; P = .027), and the occurrence of early complications (hazard ratio, 11.34; 95% confidence interval: 1.82, 70.69; P = .009). The 10-year survival rate was 76%. Conclusion TIPS placement in patients with chronic primary BCS was associated with a nonnegligible rate of early complications and required endovascular revision or revisions in 42% of patients

  20. Impact of Anatomical, Procedural, and Operator Skill Factors on the Success and Duration of Fluoroscopy-Guided Transjugular Intrahepatic Portosystemic Shunt

    SciTech Connect

    Marquardt, Steffen Rodt, Thomas Rosenthal, Herbert Wacker, Frank Meyer, Bernhard C.

    2015-08-15

    PurposeTo assess the impact of anatomical, procedural, and operator skill factors on the success and duration of fluoroscopy-guided transjugular intrahepatic portoystemic shunt following standard operating procedure (SOP).Material and MethodsDuring a 32-month period, 102 patients underwent transjugular intrahepatic portosystemic shunt creation (TIPS) by two interventional radiologists (IR) following our institutional SOP based on fluoroscopy guidance. Both demographic and procedural data were assessed. The duration of the intervention (D{sub Int}) and of the portal vein puncture (D{sub Punct}) was analyzed depending on the skill level of the IR as well as the anatomic or procedural factors.ResultsIn 99 of the 102 patients, successful TIPS without peri-procedural complications was performed. The mean D{sub Int} (IR1: 77 min; IR2: 51 min, P < 0.005) and the mean D{sub Punct} (IR1: 19 min; IR2: 13 min, P < 0.005) were significantly higher in TIPS performed by IR1 (with 2 years of clinical experience performing TIPS, n = 38) than by IR2 (>10 years of clinical experience performing TIPS, n = 61), (P < 0.005 both, Mann–Whitney U test). D{sub Int} showed a higher correlation with D{sub Punct} for IR2 (R{sup 2} = 0.63) than for IR1 (R{sup 2} = 0.13). There was no significant difference in the D{sub Punct} for both IRs with regard to the success of the wedged portography (P = 0.90), diameter of the portal vein (P = 0.60), central right portal vein length (P = 0.49), or liver function (MELD-Score before the TIPS procedure; P = 0.14).ConclusionTIPS following SOP is safe, fast, and reliable. The only significant factor for shorter D{sub Punct} and D{sub Int} was the clinical experience of the IR. Anatomic variability, successful portography, or liver function did not alter the duration or technical success of TIPS.

  1. 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

  2. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

    MedlinePlus

    ... ray or ultrasound equipment, a stent, and a balloon-tipped catheter are used. The equipment typically used ... the stent is in the correct position, the balloon is inflated, expanding the stent into place. The ...

  3. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

    MedlinePlus Videos and Cool Tools

    ... advised to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to ... you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period ...

  4. Improved Patency of Transjugular Intrahepatic Portosystemic Shunt: The Efficacy of Cilostazol for the Prevention of Pseudointimal Hyperplasia in Swine TIPS Models

    SciTech Connect

    Park, Sang Woo Cha, In Ho; Kim, Chul Hwan; Jeon, Hae Jeong; Park, Jeong Hee; Hong, Suk Joo; Lee, In Sik

    2007-07-15

    Purpose. To investigate the efficacy of oral administration of cilostazol to inhibit pseudointimal/intimal hyperplasia in swine TIPS models. Methods. Successful TIPS creation was carried out in 11 of 12 healthy young pigs (20-25 kg). In the treatment group (n = 6), both cilostazol and aspirin were administered daily, from the first day of TIPS creation. The control group (n = 5) was administered only aspirin. The animals were followed-up for 2 weeks and then killed. The specimen (including portal vein, hepatic parenchymal tract, hepatic vein, and inferior vena cava) and stents were carefully bisected in a longitudinal fashion. The control group was compared with the treatment group by means of a gross and histologic evaluation of the degree of pseudointimal/intimal hyperplasia in the shunt. Results. At the gross evaluation, the control group showed considerably more pseudointimal/intimal hyperplasia than the treatment group. Using microscopic evaluation, there was a statistically significant difference (p < 0.05) in the mean maximum pseudointimal/intimal hyperplasia thickness between the control group (2.97 {+-} 0.33 mm) and treatment group (0.73 {+-} 0.27 mm). Conclusion. Oral administration of cilostazol may have been effective in reducing pseudointimal/intimal hyperplasia in swine TIPS models.

  5. Canine congenital portosystemic encephalopathy.

    PubMed

    Maddison, J E

    1988-08-01

    The case records of 21 dogs with congenital portosystemic encephalopathy are reviewed. The disorder was most common in Australian cattledogs (blue heelers; 8 cases), Old English sheepdogs (3 cases) and Maltese terriers (3 cases). Extra-hepatic shunts occurred in small breeds, with the exception of 1 cattledog, while intra-hepatic shunts occurred in the medium to large breeds. The most common clinical pathology abnormalities were abnormal ammonia tolerance, mild to moderate increases in plasma alanine aminotransferase or alkaline phosphatase concentrations, decreased total serum protein concentrations, increased fasting ammonia concentrations and ammonium biurate crystalluria. Radiological examination revealed that all the dogs had a small liver. The kidneys were enlarged in 5 of 10 dogs in which kidney size could be estimated. Surgical ligation of an extra-hepatic shunt was successful in 2 of 4 dogs in which it was attempted. Medical management resulted in alleviation of clinical signs in 5 of 8 dogs. The period of successful treatment ranged from a few months to over a year.

  6. Construction of Transjugular Intrahepatic Portosystemic Shunt: Bare Metal Stent/Stent-graft Combination versus Single Stent-graft, a Prospective Randomized Controlled Study with Long-term Patency and Clinical Analysis

    PubMed Central

    Wang, Chang-Ming; Li, Xuan; Fu, Jun; Luan, Jing-Yuan; Li, Tian-Run; Zhao, Jun; Dong, Guo-Xiang

    2016-01-01

    Background: Balanced adjustment of the portal vein shunt volume during a transjugular intrahepatic portosystemic shunt (TIPS) is critical for maintaining liver perfusion and decreasing the incidence of liver insufficiency. A stent-graft is proved to be superior to a bare metal stent (BMS) for the construction of a TIPS. However, the clinical results of the combination application of stents and stent-grafts have not been determined. This study aimed to compare the technique of using a combination of stents and stent-grafts with using a single stent-graft to construct a TIPS. Methods: From April 2011 to November 2014, a total of fifty patients were randomly assigned to a stents-combination group (Group I, n = 28) or a stent-graft group (Group II, n = 22). Primary patency rates were calculated. Clinical data, including the technical success rate, bleeding control results, incidence of encephalopathy, liver function preservation, and survival rate, were assessed. Results: Technically, the success rate was 100% for both groups. The primary patency rates at 1, 2, and 3 years for Group I were 96%, 84%, and 77%, respectively; for Group II, they were 90%, 90%, and 78%, respectively. The survival rates at 1, 2, and 3 years for Group I were 79%, 74%, and 68%, respectively; for Group II, they were 82%, 82%, and 74%, respectively. The incidence of hepatic encephalopathy was 14.3% for Group I and 13.6% for Group II. The Child-Pugh score in Group I was stable at the end of the follow-up but had significantly increased in Group II (t = −2.474, P = 0.022). Conclusions: The construction of a TIPS with either the single stent-graft or BMS/stent-graft combination is effective for controlling variceal bleeding. The BMS/stent-graft combination technique is superior to the stent-graft technique in terms of hepatic function preservation indicated by the Child-Pugh score. However, considering the clinical results of the TIPS, the two techniques are comparable in their primary shunt

  7. 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

  8. Early Liver Failure after Transjugular Intrahepatic Portosystemic Shunt in Patients with Cirrhosis with Model for End-Stage Liver Disease Score of 12 or Less: Incidence, Outcome, and Prognostic Factors.

    PubMed

    Luca, Angelo; Miraglia, Roberto; Maruzzelli, Luigi; D'Amico, Mario; Tuzzolino, Fabio

    2016-08-01

    Purpose To evaluate the incidence, outcomes, and prognostic factors of early liver failure (ELF) after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with cirrhosis with Model for End-Stage Liver Disease (MELD) score of 12 or less. Materials and Methods Institutional review board approved this retrospective study, with waiver of written informed consent. Two-hundred sixteen consecutive patients with cirrhosis (140 men, 76 women; mean age, 55.9 years; virus-related cirrhosis, 67.6% [146 of 216 patients]) with baseline MELD score of 12 or less who underwent TIPS placement between September 1999 and July 2012 were followed until last clinical evaluation, liver transplantation, or death. The Kaplan-Meier method, log-rank test, area under the receiver operating characteristic curve, and univariate and multivariate analyses were used, as appropriate. Results Twenty of 216 patients (9.2%) developed ELF within 3 months of TIPS (10 patients died, one required liver transplantation, and nine increased the MELD score to >18). ELF was associated with lower survival, 37% versus 95% at 6 months, and 24% versus 86% at 12 months (P < .001) compared with patients without ELF. ELF occurred in 16 of 95 (16.8%) patients with refractory ascites and in four of 121 (3.3%) patients with other indications for TIPS. Multivariate analysis confirmed MELD scores of 11 or 12 (odds ratio, 3.96 [95% confidence interval: 1.07, 14.67]; P = .040), decreased hemoglobin level (odds ratio, 0.68 [95% confidence interval: 0.49, 0.95]; P = .022), and decreased platelet count (odds ratio, 0.99 [95% confidence interval: 0.99, 0.99]; P = .024) as predictors for ELF in patients with refractory ascites. Conclusion ELF is not uncommon in cirrhotic patients with a MELD score of 12 or less who undergo TIPS placement for refractory ascites (especially in patients with MELD of 11 or 12) and decreased hemoglobin level and platelet count. (©) RSNA, 2016.

  9. Post-TIPS Hepatic Encephalopathy Treated by Occlusion Balloon-Assisted Retrograde Embolization of a Coexisting Spontaneous Splenorenal Shunt

    SciTech Connect

    Shioyama, Yasukazu; Matsueda, Kiyoshi; Horihata, Koushi; Kimura, Masashi; Nishida, Norifumi; Kishi, Kazushi; Terada, Masaki; Sato, Morio; Yamada, Ryusaku

    1996-11-15

    A 51-year-old man with posthepatitis cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for bleeding of recurrent esophageal varices. The patient had a coexisting, spontaneous, splenorenal shunt. He subsequently developed hepatic encephalopathy, presumably due to excessive portosystemic shunting. Since medical management resulted in no significant improvement, the splenorenal shunt was embolized from the jugular vein approach via renal vein access during temporary balloon occlusion. Within a few days, the patient's hepatic encephalopathy resolved. Twelve months later the patient showed no recurrence of encephalopathy and had maintained a patent TIPS.

  10. Restoration of Liver Function and Portosystemic Pressure Gradient after TIPSS and Late TIPSS Occlusion

    SciTech Connect

    Maedler, U.; Hansmann, J.; Duex, M.; Noeldge, G.; Sauer, P.; Richter, G.M.

    2002-03-15

    TIPSS (transjugular intrahepatic portosystemic shunt) may be indicated to control bleeding from esophageal and gastric varicose veins, to reduce ascites, and to treat patients with Budd-Chiari syndrome and veno-occlusive disease. Numerous measures to improve the safety and methodology of the procedure have helped to increase the technical and clinical success. Follow-up of TIPSS patients has revealed shunt stenosis to occur more often in patients with preserved liver function (Child A, Child B). In addition, the extent of liver cirrhosis is the main factor that determines prognosis in the long term. Little is known about the effects of TIPSS with respect to portosystemic hemodynamics. This report deals with a cirrhotic patient who stopped drinking 7 months prior to admission. He received TIPSS to control ascites and recurrent esophageal bleeding. Two years later remarkable hypertrophy of the left liver lobe and shunt occlusion was observed. The portosystemic pressure gradient dropped from 24 mmHg before TIPSS to 11 mmHg and remained stable after shunt occlusion. The Child's B cirrhosis prior to TIPSS turned into Child's A cirrhosis and remained stable during the follow-up period of 32 months. This indicates that liver function of TIPSS patients may recover due to hypertrophy of the remaining non-cirrhotic liver tissue. In addition the hepatic hemodynamics may return to normal. In conclusion, TIPSS cannot cure cirrhosis but its progress may be halted if the cause can be removed. This may result in a normal portosystemic gradient, leading consequently to shunt occlusion.

  11. [Early transjugular intrahepatic portosystemic shunt: When, how and in whom?].

    PubMed

    Ruiz-Blard, Esteban; Baiges, Anna; Turon, Fanny; Hernández-Gea, Virginia; García-Pagán, Juan Carlos

    2016-01-01

    Early TIPS is basically a new application of an old concept. This intervention used to be a useful rescue therapy when other interventions failed but has now become a primary intervention in patients with variceal bleeding and risk factors for poor prognosis. This technique has also been proven to control bleeding and has a definite survival advantage at 6 weeks and 1 year over standard therapy with vasoactive drugs and endoscopy, without increasing the rate of adverse events. In well-trained hands and with appropriate candidate selection, early TIPS is a safe, life-saving and evidenced-based procedure.

  12. Green tea polyphenol decreases the severity of portosystemic collaterals and mesenteric angiogenesis in rats with liver cirrhosis.

    PubMed

    Hsu, Shao-Jung; Wang, Sun-Sang; Hsin, I-Fang; Lee, Fa-Yauh; Huang, Hui-Chun; Huo, Teh-Ia; Lee, Wen-Shin; Lin, Han-Chieh; Lee, Shou-Dong

    2014-05-01

    Abnormal angiogenesis in liver cirrhosis often leads to severe complications such as variceal haemorrhage and encephalopathy. Furthermore, splanchnic angiogenesis elevates portal pressure, in which angiogenic factors play pivotal roles. GTP (green tea polyphenol) extracted from Camellia sinensis has anti-angiogenic properties, but the effects on the parameters described above in cirrhosis have not been investigated. The aim of the present study was to determine the effects of GTP in cirrhosis and to investigate the underlying mechanism. Liver cirrhosis was induced in Spraque-Dawley rats by common BDL (bile duct ligation). They randomly received GTP or DW (distilled water, vehicle) for 28 days, then haemodynamic parameters, portosystemic shunting, mesenteric window vascular density, intrahepatic angiogenesis, liver fibrosis, plasma VEGF (vascular endothelial growth factor) concentration, mesenteric angiogenic factor and receptor protein expression, and serum and mesenteric oxidative stress parameters were assessed. Compared with the DW group, GTP significantly decreased portosystemic shunting, liver fibrosis, intrahepatic angiogenesis, mesenteric window vascular density, VEGF concentration and down-regulated the mesenteric HIF (hypoxia-inducible factor)-1α, VEGF and phospho-Akt expression. In conclusion, GTP ameliorates the severity of portosystemic shunting and mesenteric angiogenesis via the suppression of HIF-1α, Akt activation and VEGF. GTP appears to be an appropriate agent in controlling portal hypertension-related complications via anti-angiogenesis.

  13. Comparison of shunt fraction estimation using transcolonic iodine-123-iodoamphetamine and technetium-99m-pertechnetate in a group of dogs with experimentally-induced chronic biliary cirrhosis

    SciTech Connect

    Koblik, P.D.; Hornof, W.J.; Yen, C.K.; Komtebedde, J.; Breznock, E.; Fisher, P. )

    1991-01-01

    Portosystemic shunt fraction estimation using transcolonic iodine-123-iodoamphetamine (IMP) has been previously validated relative to portal vein macroaggregated albumin injections using an experimental model of cirrhosis. Transcolonic technetium-99m-pertechnetate (TcO4-) has been proposed as an alternative tracer to IMP to study portal circulation in cirrhotic patients. We compared shunt fraction estimates from paired transcolonic IMP and TcO4- studies performed on a group of dogs before and after common bile duct ligation surgery. Pertechnetate over-estimated shunt fraction in 6/7 postoperative studies relative to IMP. A good correlation between the two methods was demonstrated, however, the slope of the regression line was substantially less than 1.0 with TcO4- values reaching 100% at IMP shunt values of approximately 60%. This apparent inability to accurately assess high shunt flows may limit the quantitative aspects of TcO4- studies on patients with severe portosystemic shunting.

  14. 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 ...

  15. 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 ...

  16. Preservation of portal pressure improves growth and metabolic profile in the male portacaval-shunted rat.

    PubMed

    Dasarathy, Srinivasan; Mullen, Kevin D; Conjeevaram, Hari S; Kaminsky-Russ, Kristine; Wills, Laurie A; McCullough, Arthur J

    2002-09-01

    The portacaval anastomosis (PCA) rat model and human cirrhosis have many metabolic and nutritional abnormalities in common, such as growth retardation, hepatic and gonadal atrophy, and hyperammonemia. The severity of these abnormalities is variable and may be related to a number of factors, including portal pressure, portosystemic shunting, dietary intake, and how efficiently food is used. Therefore, this rat model was used to study these variables with the intent of gaining insights for improving the management of portal hypertension and malnutrition in human cirrhosis. A nonsuture end-to-side PCA (N = 100) or sham surgery (N = 71) was performed in 100 male rats. Four weeks after surgery, body and organ weights, food intake, serum ammonia, and serum amino acids were measured at death. In a subgroup of rats, (sham 7; PCA 34) portal venous pressure, degree of portosystemic shunting, and organ and body weights were obtained at death. Growth, liver weight, and testes weight were decreased, ammonia levels were higher, and the ratios of branched chain to aromatic amino acid (BCAA/AAA) were lower in the PCA group compared to the sham animals (P < 0.05). Since spleen weights correlated with portal pressure (P = 0.01), the PCA animals were then divided into those with preserved and those with low portal pressures based on spleen weight. The PCA group with preserved portal pressure had better growth, larger livers and testes, lower serum ammonia, and higher BCAA/AAA levels than the PCA group with low portal pressure; improvements associated with normal amounts of food intake and better food efficiency than the low pressure animals (P < 0.05 or better). Sham animals had no portosystemic shunting, while 100% shunting occurred in both PCA groups regardless of the portal pressure. In conclusion, preservation of portal pressure after portacaval anastomosis provides metabolic and nutritional benefits, which are independent of portosystemic shunting and associated with normal

  17. Percutaneous Mesocaval Shunt Creation in a Patient with Chronic Portal and Superior Mesenteric Vein Thrombosis

    SciTech Connect

    Bercu, Zachary L. Sheth, Sachin B.; Noor, Amir; Lookstein, Robert A. Fischman, Aaron M. Nowakowski, F. Scott Kim, Edward Patel, Rahul S.

    2015-10-15

    The creation of a transjugular intrahepatic portosystemic shunt (TIPS) is a critical procedure for the treatment of recurrent variceal bleeding and refractory ascites in the setting of portal hypertension. Chronic portal vein thrombosis remains a relative contraindication to conventional TIPS and options are limited in this scenario. Presented is a novel technique for management of refractory ascites in a patient with hepatitis C cirrhosis and chronic portal and superior mesenteric vein thrombosis secondary to schistosomiasis and lupus anticoagulant utilizing fluoroscopically guided percutaneous mesocaval shunt creation.

  18. 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.

  19. 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.

  20. Distal splenorenal shunt

    MedlinePlus

    ... shunt; Cirrhosis - distal splenorenal; Liver failure - distal splenorenal; Portal vein pressure - distal splenorenal shunt ... vein from your spleen is removed from the portal vein. The vein is then attached to the ...

  1. Percutaneous Retroperitoneal Splenorenal Shunt for Symptomatic Portal Vein Thrombosis After Liver Transplantation.

    PubMed

    Pulitano, C; Rogan, C; Sandroussi, C; Verran, D; McCaughan, G W; Waugh, R; Crawford, M

    2015-08-01

    Acute or recurrent bleeding from ectopic varices is a potentially life-threatening condition in rare patients with extrahepatic complete portal vein thrombosis (PVT) after liver transplantation (LT). In this setting, the role of interventional radiology is very limited and surgical shunts, in particular splenorenal shunts are usually used, despite the high associated mortality. We present the first reports of the clinical use of a new minimally invasive technique, percutaneous retroperitoneal splenorenal shunt (PRESS), in two LT recipients with life-threatening variceal hemorrhage secondary to PVT. Both patients had a successful PRESS using a transplenic approach with resolution of bleeding, avoiding the need for a potentially complicated laparotomy. The PRESS procedure is a useful addition to the interventional armamentarium that can be used in cases unsuitable for surgical shunt, and refractory to endoscopic management. In the future, this technique may be an alternative to surgical shunts as the standard procedure in patients with extra-hepatic PVT, just as the transjugular intrahepatic portosystemic shunt (TIPS) procedure has become for the management of portal hypertension in the absence of PVT. Longer-term follow-up will be needed to establish the long-term success of this procedure.

  2. Glomerular filtration rate and renal volume in dogs with congenital portosystemic vascular anomalies before and after surgical ligation.

    PubMed

    Deppe, T A; Center, S A; Simpson, K W; Erb, H N; Randolph, J F; Dykes, N L; Yeager, A E; Reynolds, A J

    1999-01-01

    Glomerular filtration rate (GFR) and renal volume were evaluated in dogs with confirmed portosystemic vascular anomalies (PSVA) before and after surgical ligation of their PSVA. Pre- and postligation CBC, serum biochemistry, urinalysis, abdominal ultrasonography with measurement of renal volume, and per rectal scintigraphy were performed to document resolution of abnormalities consistent with portosystemic shunting. GFR was estimated by plasma 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) clearance before (n = 21) and after (n = 12) surgical correction of PSVA. Preligation 99mTc-DTPA GFR was increased (median, 5.64 mL/minute/kg; range, 3.53-8.49 mL/minute/kg; reference range, 2.83-4.47 mL/minute/kg) in 81% (17/21) of dogs. Postligation 99mTc-DTPA GFR decreased in all 12 evaluated dogs (median change = -42%; P < .001). Preligation renal volume was above the reference range for the left and right kidneys in 71% (10/14) and 69% (11/16) of dogs evaluated, respectively. Right renal volume decreased significantly (n = 5; median change, -45%; P = .03) after surgical ligation of PSVA. These findings document increased GFR and renal volume in dogs with PSVA, which may explain in part the low blood urea nitrogen and serum creatinine concentrations encountered in these dogs. Knowledge of changes in GFR associated with PSVA ligation may prove helpful in the anesthetic, drug, and dietary management of affected dogs.

  3. Reversal learning impairment and alterations in the prefrontal cortex and the hippocampus in a model of portosystemic hepatic encephalopathy.

    PubMed

    Méndez, Marta; Méndez-López, Magdalena; López, Laudino; Begega, Azucena; Aller, María Angeles; Arias, Jaime; Arias, Jorge L

    2010-09-01

    Patients with liver dysfunction often suffer from hepatic encephalopathy (HE), a neurological complication that affects attention and memory. Various experimental animal models have been used to study HE, the most frequently used being the portocaval shunt (PCS). In order to determine brain substrates of cognitive impairment in this model, we assessed reversal learning and c-Fos expression in a rat model of portosystemic derivation. PCS and sham-operated rats (SHAM) were tested for reversal learning. Brains were processed for c-Fos immunocytochemistry. The total number of c-Fos positive nuclei was quantified in the prefrontal cortex and hippocampus. The spatial reference memory task showed no differences between groups in escape latencies. The no-platform probe test showed that both the PCS and the SHAM learned the location of platform. However, the PCS group perseverated in the old target during reversal. The PCS group presented less c-Fos- positive cells in prelimbic cortex, CA1 and dentate gyrus of the dorsal hippocampus than SHAM. Overall, these results suggest that this specific model of portosystemic hepatic encephalopathy produces reversal learning impairment that could be linked to dysfunction in neuronal activity in the prefrontal cortex and hippocampus.

  4. Hydrocephalus and Shunts

    MedlinePlus

    ... or anesthesia. When ventricles start to get too big, it is a strong sign that the shunt is not working right. It is important to know that some people (between 5 and 15 percent) with Spina Bilda may have ...

  5. 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: ...

  6. 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

  7. 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.

  8. Adrenal pseudotumors on CT due to dilated portosystemic veins

    SciTech Connect

    Mitty, H.M.; Cohen, B.A.; Sprayregen, S.; Schwartz, K.

    1983-10-01

    The adrenal and periadrenal venous systems are part of the portosystemic collateral pathways that may enlarge in portal hypertension. The cross-sectional image of the resulting enlarged venous channels may simulate an adrenal msss. Three examples of such computed tomographic (CT) scans are presented with selective venographic correlation. Patients with portal hypertension and suspected adrenal pathology may require enhanced or dynamic CT scans.

  9. 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.

  10. Anatomy of the Portal Vein Bifurcation: Implication for Transjugular Intrahepatic Portal Systemic Shunts

    SciTech Connect

    Kwok, Philip Chong-hei Ng, Wai Fu; Lam, Christine Suk-yee; Tsui, Polly Po; Faruqi, Asma

    2003-06-15

    Purpose: The relationship of the portalvein bifurcation to the liver capsule in Asians, which is an important landmark for transjugular intrahepatic portosystemic shunt, has not previously been described. Methods: The anatomy of the portal vein bifurcation was studied in 70 adult Chinese cadavers; it was characterized as intrahepatic or extrahepatic. The length of the exposed portion of the right and left portal veins was measured when the bifurcation was extrahepatic. Results: The portal vein bifurcation was intrahepatic in 37 cadavers (53%) and extrahepatic in 33 cadavers (47%). The mean length of the right and left extrahepatic portal veins was 0.96 cm and 0.85 cm respectively.Both were less than or equal to 2 cm in 94% of the cadavers with extrahepatic bifurcation. There was no correlation between the presence of cirrhosis and the location of the portal vein bifurcation(p 1.0). There was no statistically significant difference in liver mass in cadavers with either extrahepatic or intrahepatic bifurcation (p =0.40). Conclusions: These findings suggest that fortransjugular intrahepatic portosystemic shunt placement, a portal vein puncture 2 cm from the bifurcation will be safe in most cases.

  11. 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.

  12. Portosystemic hepatic encephalopathy model shows reversal learning impairment and dysfunction of neural activity in the prefrontal cortex and regions involved in motivated behavior.

    PubMed

    Méndez, M; Méndez-López, M; López, L; Aller, M A; Arias, J; Arias, J L

    2011-05-01

    Hepatic encephalopathy (HE) is a neurological complication that affects attention and memory. Experimental animal models have been used to study HE, the most frequent being the portacaval shunt (PCS). In order to investigate learning impairment and brain functional alterations in this model, we assessed reversal learning and neural metabolic activity in a PCS rat model. PCS and sham-operated rats were tested for reversal learning in the Morris water maze. Brains were then processed for cytochrome oxidase (CO) histochemistry. The PCS group had reversal learning impairment and a reduction in CO activity in the prefrontal cortex, ventral tegmental area and accumbens shell nucleus. These results suggest that this model of portosystemic HE shows learning impairments that could be linked to dysfunction in neural activity in the prefrontal cortex and regions involved in motivated behavior.

  13. 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

  14. 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.

  15. [Portal hypertension in children. Follow-up after portal systemic shunts (author's transl)].

    PubMed

    Bernard, O; Alvarez, F; Alagille, D

    1982-01-01

    The retrospective study of 115 children in whom a successful portosystemic shunt was carried out for portal hypertension, provides the following conclusions: 1) Patency of the shunt must be checked by esophageal endoscopy, six months postoperatively. A patent shunt can be expected when the size of the spleen and/or thrombocytopenia improve in the early post-operative period. Early ultrasound examination is also very useful in that respect. 2) None of the children with extrahepatic portal vein obstruction or congenital hepatic fibrosis presented with clinical signs of portal systemic encephalopathy (PSE). 3) Eight of 30 children with cirrhosis presented with one or more clinical episodes of PSE. Some were transient allowing for a normal diet to be resumed later on. 4) It is thus advisable to give children with cirrhosis a low protein diet in the months after surgery. Protein content of the diet can usually be increased progressively over a period of one to two years. 5) Whenever splenectomy is necessary, it is mandatory to prevent pneumococcal infections with the pneumococcal vaccine and daily treatment with oral penicillin.

  16. Effects of mesocaval shunt on the pharmacokinetics of metronidazole in young rats.

    PubMed

    Guillé, Beatriz E Perez; Alvarez, Fernando Villegas; Toledo López, Alejandra R; Bravo-Luna, Miguel A Jiménez; Soriano-Rosales, Rosa E; Lares-Asseff, Ismael; Arrellin, Gerardo; Guillé, Maria G Pérez

    2005-01-01

    Prophylactic and therapeutic management of portosystemic encephalopathies is based on protein restriction in the diet, and the use of lactulose and antibiotics such as metronidazole. These actions intend to reduce the main source of intestinal ammonia production and release into the systemic circulation. The aim of this study was to evaluate the medium-term effects of mesocaval shunt on the pharmacokinetics of metronidazole in rats with healthy livers. Male Lewis rats were divided into two groups. The first group was subjected to mesocaval shunt (MCS) and the other employed as a control. The following tests were carried out in both groups: metronidazole pharmacokinetics, determination of ALT, AST, albumin, urea and ammonium, liver weight and histomorphology. A loss in body and liver weight was registered in rats subjected to MCS. AST levels also increased compared to controls. Significant differences in almost all pharmacokinetic parameters were detected between MCS and control rats, especially in Kel, AUC and Cmax. Modifications in metronidazole pharmacokinetics and liver weight changes without microstructural modification secondary to MCS were found. We suggest that individual drug-monitoring and pharmacokinetic analysis must be carried out in metronidazole medicated patients with modifications in portal circulation with or with out macro or micro liver structural alterations.

  17. Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Treatment of Venous Symptomatic Chronic Portal Thrombosis in Non-cirrhotic Patients

    SciTech Connect

    Bilbao, Jose I. Elorz, Mariana; Vivas, Isabel; Martinez-Cuesta, Antonio; Bastarrika, Gorka; Benito, Alberto

    2004-09-15

    Purpose: To present a series of cases of non-cirrhotic patients with symptomatic massive portal thrombosis treated by percutaneous techniques. All patients underwent a TIPS procedure in order to maintain the patency of the portal vein by facilitating the outflow. Methods: A total of six patients were treated for thrombosis of the main portal vein (6/6); the main right and left branches (3/6) and the splenic vein (5/6) and superior mesenteric vein (6/6). Two patients had a pancreatic malignancy; one patient with an orthotopic liver transplant had been surgically treated for a pancreatic carcinoma. Two patients had idiopathic thrombocytosis, and in the remaining patient no cause for the portal thrombosis was identified. During the initial procedure in each patient one or more approaches were tried: transhepatic (5/6), transileocolic (1/6), trans-splenic (1/6) or transjugular (1/6). In all cases the procedure was completed with a TIPS with either ultrasound guidance (3/6), 'gun-shot' technique (2/6) or fluoroscopic guidance (1/6).Results: No complications were observed during the procedures. One patient had a repeat episode of variceal bleeding at 30 months, one patient remained asymptomatic and was lost to follow-up at 24 months, two patients were successfully treated surgically (cephalic duodenopancreatectomy) and are alive at 4 and 36 months. One patient remains asymptomatic (without new episodes of abdominal pain) at 16 months of follow-up. One patient died because of tumor progression at 10 months. Conclusion: Percutaneous techniques for portal recanalization are an interesting alternative even in non-acute thrombosis. Once flow has been restored in the portal vein TIPS may be necessary to obtain an adequate outflow, hence facilitating and maintaining the portal flow.

  18. Lipopolysaccharide-Induced Neutrophil Dysfunction Following Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS) Insertion is Associated with Organ Failure and Mortality

    PubMed Central

    Macnaughtan, Jane; Mookerjee, Rajeshwar P.; Jalan, Rajiv

    2017-01-01

    Systemic lipopolysaccharide (LPS) is implicated in increasing mortality in patients with alcoholic hepatitis but the underlying mechanisms are not well characterised. The objective of this study was to characterise neutrophil function, LPS and cytokine concentrations within the splanchnic circulation of alcoholic cirrhotic patients undergoing TIPSS insertion for variceal haemorrhage and correlate this with outcome. 26 patients with alcoholic cirrhosis and variceal haemorrhage were studied prior to and 1-hour after TIPSS insertion. Neutrophil function, LPS and cytokine concentrations were determined in arterial, hepatic venous (HV) and portal venous blood (PV). Significantly higher LPS concentrations and neutrophil reactive oxidant species (ROS) production were observed in PV vs HV blood. Cross-incubation of HV plasma with PV neutrophils resulted in reduced ROS production. Insertion of TIPSS was associated with a significant increase in arterial LPS concentrations and deterioration in neutrophil phagocytosis. Number of organ failures and arterial IL-6 concentrations at presentation were associated with increased mortality. The portal circulation has a distinct immunological milieu characterised by a pathological neutrophil phenotype and an anti-inflammatory cytokine profile associated with heightened LPS levels. TIPSS insertion renders this neutrophil functional defect systemic, associated with an increase in arterial LPS and a susceptibility to sepsis. PMID:28051160

  19. 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....

  20. 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....

  1. 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....

  2. 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....

  3. 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....

  4. 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.

  5. 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.

  6. 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…

  7. Experimental Percutaneous Extrahepatic Portacaval Shunt Creation by Transjugular Approach in Swine

    SciTech Connect

    Seong, Chang Kyu; Pavcnik, Dusan Uchida, Barry T.; Anai, Hiroshi; Timmermans, Hans; Niyyati, Mahtab; Corless, Christopher L.; Correa, Luiz O.; Keller, Frederick S.; Roesch, Josef

    2005-06-15

    The purpose of the study was to evaluate the feasibility of the creation of a percutaneous extrahepatic portacaval shunt (PEPS) in swine by a transjugular approach and to find a suitable stent-graft to use in PEPS. In 12 swine, the extrahepatic portal vein (PV) was entered from the inferior vena cava (IVC) by a needle system introduced from the transjugular approach. A catheter introduced through the transhepatic approach served as a target. Five types of stent-graft consisting of homemade Z stents and a polytetrafluoethylene cover were explored for PEPS creation. Eight animals had follow-up venograms up to 6 weeks or until the shunt became severely stenotic. Gross and histologic examinations were performed after the final follow-up venography. The PV punctures and stent-graft placement were difficult, but the PEPS was established in all animals. In four animals, the stent-graft failed to adequately cover the tract, causing severe hemorrhage. Only two shunts remained patent up to 6 weeks. The other shunts exhibited severe stenosis or occlusion. At gross examination, all shunts traversed the liver parenchyma of the caudate lobe surrounding the IVC. The extravascular PEPS portion was 4 mm to 2 cm long. All shunts entered the PV close to the splenomesenteric junction and exhibited neointimal formation. Shunt stenoses were caused by neointimal hyperplasia and occlusions by a superimposed thrombus. PEPS can be created by the transjugular approach in swine, but only the PV shunt entrance is extrahepatic. None of the tested rigid stent-grafts were suitable for PEPS creation. A short flexible stent-graft with flanged ends is suggested for further exploration.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  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. 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.

  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. [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.

  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. The Budd-Chiari syndrome. Treatment by mesenteric-systemic venous shunts.

    PubMed Central

    Cameron, J L; Herlong, H F; Sanfey, H; Boitnott, J; Kaufman, S L; Gott, V L; Maddrey, W C

    1983-01-01

    Twelve patients with the Budd-Chiari syndrome have been managed surgically. Ten of the patients were female, two were male, with a mean age of 40 years. Three of the patients had polycythemia vera, two had pre-existing cirrhosis, one had ingested estrogens, one had an occult tumor, and in four there were no associated factors. Ten patients presented with ascites and two with bleeding esophageal varices. The diagnosis was confirmed in all 12 patients by liver biopsy and hepatic vein catheterization. Inferior vena cavography revealed the abdominal vena cava to be thrombosed in six patients. The superior mesenteric vein was used to decompress the congested liver in all 12 patients. In five patients, a mesocaval shunt (MCS) was performed and in seven patients, a mesoatrial shunt (MAS) was carried out. There were four hospital deaths (two MCS, two MAS). One late death (MAS) occurred from liver failure following shunt thrombosis. Two additional patients (one MCS, one MAS) re-developed ascites immediately following surgery and angiography revealed a thrombosed shunt. Ascites has been controlled with a LeVeen shunt in these two patients, but liver biopsies showed progression to cirrhosis. The remaining five patients (three MAS, two MCS) did well, and angiography revealed patent shunts. Two of these patients, however, re-developed ascites at 4 and 10 months following MAS and required a second MAS. Follow-up ranges from 6 to 68 months. In three of the patients (two MCS, one MAS) with patent shunts, liver biopsy shows a remarkable return toward normal liver architecture and histology. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. PMID:6615056

  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, 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...

  20. 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...

  1. 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...

  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...

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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....

  9. 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....

  10. 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....

  11. A Comprehensive Review of Portosystemic Collaterals in Cirrhosis: Historical Aspects, Anatomy, and Classifications

    PubMed Central

    Shetty, Rajesh; Kasana, Vivek

    2016-01-01

    Portosystemic collateral formation in cirrhosis plays an important part in events that define the natural history in affected patients. A detailed understanding of collateral anatomy and hemodynamics in cirrhotics is essential to envisage diagnosis, management, and outcomes of portal hypertension. In this review, we provide detailed insights into the historical, anatomical, and hemodynamic aspects to portal hypertension and collateral pathways in cirrhosis with emphasis on the various classification systems. PMID:28074159

  12. A Comprehensive Review of Portosystemic Collaterals in Cirrhosis: Historical Aspects, Anatomy, and Classifications.

    PubMed

    Philips, Cyriac Abby; Arora, Ankur; Shetty, Rajesh; Kasana, Vivek

    2016-01-01

    Portosystemic collateral formation in cirrhosis plays an important part in events that define the natural history in affected patients. A detailed understanding of collateral anatomy and hemodynamics in cirrhotics is essential to envisage diagnosis, management, and outcomes of portal hypertension. In this review, we provide detailed insights into the historical, anatomical, and hemodynamic aspects to portal hypertension and collateral pathways in cirrhosis with emphasis on the various classification systems.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. Arne Torkildsen and the ventriculocisternal shunt: the first clinically successful shunt for hydrocephalus.

    PubMed

    Eide, Per Kristian; Lundar, Tryggve

    2016-05-01

    Arne Torkildsen was a pioneering Norwegian neurosurgeon who introduced the ventriculocisternal shunt, the first clinically successful shunt for CSF diversion in hydrocephalus. The procedure, usually referred to as ventriculocisternostomy (VCS), Torkildsen's operation, orTorkildsen's shunt, became internationally recognized as an efficient operation for the treatment of noncommunicating hydrocephalus. The operation gained widespread use in the 1940s and 1950s before the introduction of extracranial shunts. In this paper, the authors look more closely at Torkildsen's development of the VCS and examine how this surgical approach differed from other procedures for treating hydrocephalus before World War II. Long-term results of the VCS are presented.

  18. 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.

  19. 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.

  20. 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.

  1. Clinico-histologic conferences: histology and disease.

    PubMed

    Shaw, Phyllis A; Friedman, Erica S

    2012-01-01

    Providing a context for learning information and requiring learners to teach specific content has been demonstrated to enhance knowledge retention. To enhance students' appreciation of the role of science and specifically histology in clinical reasoning, disease diagnosis, and treatment, a new teaching format was created to provide clinical context, promote integration and application of science knowledge, and to foster peer teaching and learning: the Clinico-Histologic Conference (CHC) for the Mount Sinai School of Medicine Histology course. Teams of six students were each assigned specific disease processes and were charged with creating oral presentations and handouts that taught their classmates about the clinical manifestations, etiopathogeneses, diagnoses, and treatments of the assigned processes, along with comparisons of normal histology to the pathology of the disease. Each team also created four questions, some of which were used on Histology written examinations. The physician facilitator evaluated the presentation and handouts. About two-thirds of students agreed the CHC enhanced appreciation of the importance of histology, provided a context for integration and application of basic science to patient care and enhanced their ability to teach their peers. Student feedback demonstrated that the CHCs were successful in promoting teamwork, peer teaching, and the application of histology to diagnose diseases. The authors believe that teaching basic science content in this new format enhanced student learning and application of medical knowledge, and that this new teaching format can be adopted by other medical school courses.

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. Anatomy and histology of Virchow's node.

    PubMed

    Mizutani, Masaomi; Nawata, Shin-ichi; Hirai, Ichiro; Murakami, Gen; Kimura, Wataru

    2005-12-01

    A regional lymphatic system is composed of the first, second, third and even fourth or much more intercalated nodes along the lymptatic route from the periphery to the venous angle or the thoracic duct. The third or fourth node is usually termed the last-intercalated node or end node along the route. Similarly, one of the supraclavicular nodes is known to correspond to the end node along the thoracic duct. It is generally called 'Virchow's node', in which the famous 'Virchow's metastasis' of advanced gastric cancer occurs. The histology of this node has not been investigated, although region-specific differences in histology are evident in human lymph nodes. We found macroscopically the end node in five of 30 donated cadavers. Serial sections were prepared for these five nodes and sections stained with hematoxylin and eosin. Histological investigation revealed that, on the inferior or distal side of the end node, the thoracic duct divided into three to 10 collateral ducts and these ducts surrounded the node. The node communicated with the thoracic duct and its collaterals at multiple sites in two to three hilus-like portions, as well as along the subcapsular sinus. Thus, the end node was aligned parallel to the thoracic duct. Moreover, the superficial and deep cortex areas of the end node were fragmented to make an island-like arrangement, which may cause the short-cut intranodal shunt. Consequenly, the filtration function of most of Virchow's node seemed to be quite limited.

  7. 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.

  8. Intrapulmonary vascular shunt pathways in alveolar capillary dysplasia with misalignment of pulmonary veins.

    PubMed

    Galambos, Csaba; Sims-Lucas, Sunder; Ali, Noorjahan; Gien, Jason; Dishop, Megan K; Abman, Steven H

    2015-01-01

    Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a lethal neonatal lung disease characterised by severe pulmonary hypertension, abnormal vasculature and intractable hypoxaemia. Mechanisms linking abnormal lung vasculature with severe hypoxaemia in ACD/MPV are unknown. We investigated whether bronchopulmonary anastomoses form right-to-left shunt pathways in ACD/MVP. We studied 2 infants who died of ACD/MPV postmortem with direct injections of coloured ink into the pulmonary artery, bronchial artery and pulmonary veins. Extensive histological evaluations included serial sectioning, immunostaining and 3-dimensional reconstruction demonstrated striking intrapulmonary vascular pathways linking the systemic and pulmonary circulations that bypass the alveolar capillary bed. These data support the role of prominent right-to-left intrapulmonary vascular shunt pathways in the pathophysiology of ACD/MPV.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. Clinico-Histologic Conferences: Histology and Disease

    ERIC Educational Resources Information Center

    Shaw, Phyllis A.; Friedman, Erica S.

    2012-01-01

    Providing a context for learning information and requiring learners to teach specific content has been demonstrated to enhance knowledge retention. To enhance students' appreciation of the role of science and specifically histology in clinical reasoning, disease diagnosis, and treatment, a new teaching format was created to provide clinical…

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. [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.

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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....

  14. 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....

  15. 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....

  16. 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....

  17. 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....

  18. The inferior mesenteric vein to the left gonadal vein shunt for gastroesophageal varices and extrahepatic portal vein thrombosis after living donor liver transplantation: a case report.

    PubMed

    Kobayashi, T; Sato, Y; Yamamoto, S; Oya, H; Kokai, H; Hatakeyama, K

    2012-03-01

    This 59-year-old woman underwent living donor liver transplantation using a left lobe graft as an aid for autoimmune hepatitis in 2003. Splenectomy was also performed because of blood type incompatibility. Follow-up endoscopic and computed tomography examinations showed gastroesophageal varices with extra hepatic portal vein thrombosis in 2007 that increased (esophageal varices [EV]: locus superior [Ls], moderately enlarged, beady varices [F2], Blue varices [Cb], presence of small in number and localized red color sign [RC1] and telangiectasia [TE+], gastric varices [GV]: extension from the cardiac orifice to the fornix [Lg-cf], moderately enlarged, beady varices [F2], white varices [Cw], absence of red color sign [RC-]). Portal venous flow to the gastroesophageal varices was also confirmed from a large right gastric vein. The splenic vein was thrombosed. Blood flow to the liver graft was totally supplied from the hepatic artery. The graft was functioning well. Because these gastroesophageal varices had a high risk of variceal bleeding, we decided to proceed with a portal reconstruction of a surgical portosystemic shunt in 2008. Severe adhesions were observed around the portal vein. It was impossible to perform portal reconstruction. There were relatively fewes adhesious in the left lower side of the abdominal cavity. We decided to create an inferior mesenteric vein to left gonadal vein shunt. The portal vein pressure decreased from 31.0 to 21.5 cm H2O thereafter. The postoperative course was smooth without any complication. This patient was discharged on the postoperative day 15. Follow-up endoscopic study showed the improvement in the gastroesophageal varices (EV: Ls, F2, Cb, RC(-), GV: Lg-c, F2, Cw, RC-) at 3 months after the operation. We also comfirmed the patency of the shunt by serial computed tomography examinations.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy.

    PubMed

    Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam

    2017-03-14

    Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

  6. Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

    PubMed Central

    Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam

    2017-01-01

    Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management. PMID:28348478

  7. Early diet intervention to reduce the incidence of hepatic encephalopathy in cirrhosis patients: post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) findings.

    PubMed

    Luo, Ling; Fu, Shiying; Zhang, Yunzhi; Wang, Jingxiang

    2016-01-01

    背景与目的:肝性脑病是肝硬化患者经颈静脉肝内门体分流术(TIPS)术后 常见的并发症。本研究目的是通过积极的饮食干预降低TIPS 术后肝性脑病的 发病率。方法与研究设计:选择2011 年8 月至2013 年2 月的99 例接受TIPS 术治疗的肝硬化患者作为对照组。 其中,术后28 例并发肝性脑病。采用回顾 性研究分析肝性脑病发生的可能原因和诱因,饮食不当为主要诱因,占 85.7%。2013 年5 月至2014 年9 月的83 例肝硬化TIPS 术后患者作为实验 组,针对饮食不当这一主要问题采取相应的干预措施:制定TIPS 术后护理常 规,培训护士关于营养和常见食物中蛋白质含量的知识,定制低蛋白膳食,培 训护士沟通技巧以提高对患者的营养知识教育,帮助建立家庭-社会支持系 统。结果:实验组中有10 例发生肝性脑病,发病率为12.1%,与对照组 (28.3%)相比发病率显著降低(p<0.01)。结论:早期积极的饮食干预能显 著提高肝硬化患者TIPS 术后低蛋白饮食的依从性,降低肝性脑病的发生率。.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. Pre- and post-shunting observations in adult sheep with kaolin-induced hydrocephalus

    PubMed Central

    2013-01-01

    Background The objective of this study was to examine host-shunt interactions in sheep with kaolin-induced hydrocephalus. Methods Forty-two sheep (29–40 kg) were utilized for this study. In 20 animals, various kaolin doses were injected into the cisterna magna including 10 and 50 mg/kg as well as 2–4 ml of a 25% kaolin suspension. Based on animal health and hydrocephalus development, 3 ml of a 25% kaolin suspension was chosen. In 16 animals, kaolin was administered and 6–8 days later, the animals received a custom made ventriculo-peritoneal shunt. In 8 animals ventricular CSF pressures were measured with a water manometer before kaolin administration and 7–8 days later. The sheep were allowed to survive for up to 9–12 weeks post-kaolin or until clinical status required euthanasia. Brains were assessed for morphological and histological changes. Ventricle/cerebrum cross sectional area ratios (V/C) were calculated from photographs of the sliced coronal planes immediately anterior to the interventricular foramina. Results Intraventricular pressures increased from 12.4±1.1 cm H2O to 41.3±3.5 cm H2O following kaolin injection (p < 0.0001, n = 8). In all animals, we observed kaolin on the basal surface of the brain and mild (V/C 0.03-0.10) to moderate (V/C >0.10) ventricular expansion. The animals lost weight between kaolin administration and shunting (33.7±1.2 kg versus 31.0±1.7 kg) with weights after shunting remaining stable up to sacrifice (31.6±2.2 kg). Of 16 shunted animals, 5 did well and were sacrificed 9–12 weeks post-kaolin. In the remainder, the study was terminated at various times due to deteriorating health. Hydrocephalus was associated with thinning of the corpus callosum, but no obvious loss of myelin staining, along with reactive astroglial (glial fibrillary acidic immunoreactive) and microglial (Iba1 immunoreactive) changes in the white matter. Ventricular shunts revealed choroid plexus ingrowth in 5/16, brain

  14. Enzyme activities and morphological appearance in functioning and excluded segments of the small intestine after shunt operation for obesity.

    PubMed Central

    Asp, N G; Gudmand-Høyer, E; Andersen, B; Berg, N O

    1979-01-01

    Five patients in whom small-intestinal bypass was performed for severe obesity had a second operation 11-19 months later because of insufficient weight loss. Mucosal enzyme activities and histological appearance were investigated in biopsies from different parts of the functioning and excluded small intestine. These were compared with biopsies form corresponding sites obtained at the first operation. In addition to a prominent increase in length, circumference, and mucosal thickness in the functioning shunt, the disaccharidases and two intracellular beta-galactosidases increased in specific activity,, especially in the distal ileal part of the shunt. In the excluded segment of the small intestine different enzymes showed a different response: trehalase increased and alkaline phosphate decreased significantly. Other enzymes that were measured showed a varied pattern. The results indicated that not only the luminal content but also other, presumably hormonal, factors regulated the enzyme activities, and that different regulating factors influenced the various enzymes differently. The marked adaptive increase in mucosal surface of the functioning shunt could be one factor in explaining the weight stabilisation and, in some cases, weight increase after the initial rapid weight loss after the operation for small-intestinal bypass. The increase in specific enzyme activities would further increase the digestive capacity of the shunt. Images Fig. 1 PMID:488750

  15. [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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. Salaries in histology.

    PubMed

    Buesa, René J

    2008-04-01

    An analysis of histology salaries from the last 4 national surveys conducted by the American Society of Clinical Pathologists is presented. The regional variations within and between years for histology salaries presented in the last 4 national surveys of medical laboratory specialties are not statistically significant. Local variations greater than the national variations reflect the preponderant effect of local supply and demand over regional characteristics. Salaries by hospitals are significantly different only between 2 size categories and the supervisors' salary. There is no correlation between the salary increase for any histology position in any one year and the vacancy level in the previous year. On the other hand, the correlation between histotechnicians' salaries and both the cost of living and the median income are significant, as well as between the latter and the supervisors' salary. The histotechnologists' salaries are significantly correlated with the consumer price index but not with the inflation rate. A survey of histology salaries in foreign countries was also undertaken and compared with salaries in the United States. National salaries rank close to the general average for 10 foreign countries when expressed as ratios with the personal gross domestic product or with the countries' minimum wage. For the midpoint salary ranges, the United States ranks fourth after Canada, the United Kingdom, and Australia, the latter 3 countries with structured pay rates adjusted to local costs of living in contrast with United States' salary characteristics. Histology salaries rest on negotiations within each employer's salary structure and fluctuate according to license level, documented studies, special training(s), years of experience, references, and the ability to negotiate, where each side tries to take advantage of the other. The result is a heterogeneous and chaotic salary situation driven by personal and local needs, where the histology worker usually

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. Gastritis: the histology report.

    PubMed

    Rugge, Massimo; Pennelli, Gianmaria; Pilozzi, Emanuela; Fassan, Matteo; Ingravallo, Giuseppe; Russo, Valentina M; Di Mario, Francesco

    2011-03-01

    Gastritis is defined as inflammation of the gastric mucosa. In histological terms, it is distinguishable into two main categories, i.e. non-atrophic and atrophic. In the gastric mucosa, atrophy is defined as the loss of appropriate glands. There are several etiological types of gastritis, their different etiology being related to different clinical manifestations and pathological features. Atrophic gastritis (resulting mainly from long-standing Helicobacter pylori infection) is a major risk factor for the onset of (intestinal type) gastric cancer. The extent and site of the atrophic changes correlate significantly with the cancer risk. The current format for histology reporting in cases of gastritis fails to establish an immediate link between gastritis phenotype and risk of malignancy. Building on current knowledge of the biology of gastritis, an international group of pathologists [Operative Link for Gastritis Assessment (OLGA)] has proposed a system for reporting gastritis in terms of its stage (the OLGA Staging System): this system places the histological phenotypes of gastritis on a scale of progressively increasing gastric cancer risk, from the lowest (Stage 0) to the highest (Stage IV). The aim of this tutorial is to provide unequivocal information on how to standardize histology reports on gastritis in diagnostic practice.

  9. Histologic classification of gliomas.

    PubMed

    Perry, Arie; Wesseling, Pieter

    2016-01-01

    Gliomas form a heterogeneous group of tumors of the central nervous system (CNS) and are traditionally classified based on histologic type and malignancy grade. Most gliomas, the diffuse gliomas, show extensive infiltration in the CNS parenchyma. Diffuse gliomas can be further typed as astrocytic, oligodendroglial, or rare mixed oligodendroglial-astrocytic of World Health Organization (WHO) grade II (low grade), III (anaplastic), or IV (glioblastoma). Other gliomas generally have a more circumscribed growth pattern, with pilocytic astrocytomas (WHO grade I) and ependymal tumors (WHO grade I, II, or III) as the most frequent representatives. This chapter provides an overview of the histology of all glial neoplasms listed in the WHO 2016 classification, including the less frequent "nondiffuse" gliomas and mixed neuronal-glial tumors. For multiple decades the histologic diagnosis of these tumors formed a useful basis for assessment of prognosis and therapeutic management. However, it is now fully clear that information on the molecular underpinnings often allows for a more robust classification of (glial) neoplasms. Indeed, in the WHO 2016 classification, histologic and molecular findings are integrated in the definition of several gliomas. As such, this chapter and Chapter 6 are highly interrelated and neither should be considered in isolation.

  10. 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

  11. 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.

  12. Intrapulmonary and intracardiac shunting with exercise at altitude.

    PubMed

    Imray, Chris H E; Pattinson, Kyle T S; Myers, Steve; Chan, Colin W; Hoar, Helen; Brearey, Steve; Collins, Phil; Wright, Alex D

    2008-01-01

    Recent studies in normal participants have shown that right to left shunt blood vessels in the lung open up during exercise. We describe the first field study to investigate this phenomenon at altitude. This study aimed to assess the effect of altitude and partial acclimatization on inducible right to left shunting at rest and with exercise. A contrast-enhanced transcranial Doppler imaging technique to detect microbubbles after injection of blood and saline agitated with air was used to measure right to left shunting in 10 normal participants at rest and immediately after exercising to maximum oxygen consumption (VO(2max)) at 80 m, on acute exposure to 3450 m, and finally after a week above 3450 m. At 80 m, exercising resulted in right to left shunting via patent foramen ovale in 2 participants, but there was no evidence of shunting in the remaining 8 participants. Cerebral microbubbles were detected at rest in the 2 participants with patent foramen ovale on acute exposure to 3450 m, and the shunting increased on exercise (P = .04). In 5 of the remaining 8 participants without patent foramen ovale, cerebral microbubbles were detected on exercise (P = .04) but not at rest. Partial acclimatization had minimal effect on the prevalence or magnitude of the intrapulmonary or intracardiac shunts. Oxygenation was similar in those with shunts compared with those without shunts. Intrapulmonary shunting occurs on exercise at altitude, but the clinical and physiologic significances have yet to be determined. Despite the occurrence of shunting in most participants, our results suggest that this phenomenon is not a significant factor in altitude and exercise-induced hypoxia.

  13. 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.

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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 Section 236.60 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD... Instructions: All Systems Track Circuits § 236.60 Switch shunting circuit; use restricted. Switch...

  19. 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 Section 236.60 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD... Instructions: All Systems Track Circuits § 236.60 Switch shunting circuit; use restricted. Switch...

  20. 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 Section 236.60 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD... Instructions: All Systems Track Circuits § 236.60 Switch shunting circuit; use restricted. Switch...

  1. 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... Circuit, shunt fouling. The track circuit in the fouling section of a turnout, connected in multiple with the track circuit in the main track....

  2. 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...

  3. 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 (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4545 Shunt...

  4. 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...

  5. 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...

  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. 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 Section 236.60 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD... Instructions: All Systems Track Circuits § 236.60 Switch shunting circuit; use restricted. Switch...

  10. 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 Section 236.60 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD... Instructions: All Systems Track Circuits § 236.60 Switch shunting circuit; use restricted. Switch...

  11. 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...

  12. 21 CFR 874.3850 - Endolymphatic shunt tube with valve.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 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...

  13. 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...

  14. 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...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 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. Changes in body composition after transjugular intrahepatic portosystemic stent in cirrhosis: a critical review of literature.

    PubMed

    Dasarathy, Jaividhya; Alkhouri, Naim; Dasarathy, Srinivasan

    2011-10-01

    Change in body composition with reduced muscle mass with or without loss of fat mass occurs in 60-90% of patients with cirrhosis. This has an adverse impact on the outcome of these patients and is an understudied area. Transjugular intrahepatic portosystemic stent (TIPS) is now a standard therapy for portal hypertension but its beneficial impact on nutritional indices is not well recognized. We included all publications on TIPS that had any nutritional index as an outcome measure or end point. Given the heterogeneity of the patient population, differences in study design and outcome measures, a meta-analysis was not feasible. Data were summarized and interpreted. A total of eight studies have been published on the changes in body composition after TIPS in cirrhosis in a total of 152 patients followed for 3-12 months. Improvement in fat-free mass and fluid-free or ascites-free body weight was reported in all studies. Plasma leptin, IGF1, insulin sensitivity, rate of glucose disposal and growth hormone did not change after TIPS. One study measured muscle strength that improved. Direct measurement of skeletal muscle mass was not performed in any study. TIPS resulted in an improvement in body composition. Given the clinical significance of skeletal muscle and fat mass in cirrhosis, nutritional indices should be considered to be an important outcome measure in patients with TIPS. The mechanism of these is unclear, but its clinical implication is that this may contribute to the improved survival after TIPS.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  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. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. [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.

  9. 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

  10. [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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. Validation of histology image registration

    NASA Astrophysics Data System (ADS)

    Shojaii, Rushin; Karavardanyan, Tigran; Yaffe, Martin; Martel, Anne L.

    2011-03-01

    The aim of this paper is to validate an image registration pipeline used for histology image alignment. In this work a set of histology images are registered to their correspondent optical blockface images to make a histology volume. Then multi-modality fiducial markers are used to validate the alignment of histology images. The fiducial markers are catheters perfused with a mixture of cuttlefish ink and flour. Based on our previous investigations this fiducial marker is visible in medical images, optical blockface images and it can also be localized in histology images. The properties of this fiducial marker make it suitable for validation of the registration techniques used for histology image alignment. This paper reports on the accuracy of a histology image registration approach by calculation of target registration error using these fiducial markers.

  18. Histology without xylene.

    PubMed

    Buesa, René J; Peshkov, Maxim V

    2009-08-01

    After the hazardous effects of xylene became indisputable in the 1970s, many potential substitutes became available, some with as many if not more hazards. This article discusses the inadequacy of 5 vegetable oils as substitutes, as well as the characteristics of 22 D-limonene-based substitutes, all less effective in their chemical role, some capable of inducing health problems, and costing more than twice as much as xylene. Some of the 35 alkane-based substitutes discussed are effective for tissue processing, less toxic, with a cost about the same as xylene, but are not very effective for dewaxing and other staining tasks. Isopropanol (2-propanol) alone or mixed with molten paraffin is a technically acceptable and cost-effective substitute for xylene for tissue processing, but in this study, we demonstrate that the best clearing agents from the sectioning quality and diagnostic value point of view, with automated or manual protocols, are mixtures of 5:1 and 2:1 isopropanol and mineral oil, followed by undiluted mineral oil, all at 50 degrees C, making them a safer and cheaper substitute than xylene. Using a 1.7% dishwasher soap aqueous solution at 90 degrees C to dewax before staining and oven drying the stained sections before coverslipping will eliminate xylene from the staining tasks. Tissue processors retorts and conduits can be dewaxed with a 2% solution of a strong glassware laboratory detergent. These 4 methodologies will make the histology laboratory xylene-free but, due to the natural resistance to change, many histotechs will be reluctant to adopt them if they think that their technical expertise could be jeopardized, and the only way these changes will succeed is if the pathologists, as stewards of the histology laboratory, commit to their implementation.

  19. 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.

  20. 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

  1. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) Identification. A peritoneo-venous shunt is an implanted device that consists of a catheter and a pressure activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in...

  2. 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)

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. Hearing Loss in Patients with Shunt-Treated Hydrocephalus.

    PubMed

    Panova, Margarita V; Geneva, Ina E; Madjarova, Kalina I; Bosheva, Miroslava N

    2015-01-01

    Hearing loss is a common manifestation of the long-term complications in patients with shunt treated hydrocephalus along with motor development disturbance, cognitive and visual impairment, epilepsy and endocrine disorders. The aim of the present study was to investigate the alterations of hearing in patients with shunt treated hydrocephalus of non-tumor etiology and at least one year after implantation of ventriculo-peritoneal shunt, as well as their impact on the quality of life of patients. The study included 70 patients (age range 1.25 years - 21.25 years) with shunted non-tumor hydrocephalus and at least one year after placement of the shunt system. Hearing alterations were proved by measuring the brainstem auditory evoked potentials (BAEP) for children up to 5 years of age and children with mental retardation; audiograms was used for children older than 5 years with normal neuro-psychological development (NPD). Of the 70 studied patients 17 (24%) had hearing loss (10 bilateral and 7-unilateral) and all of them had sensorineural hearing loss, which is associated with low weight at birth, posthemorrhagic hydrocephalus and brainstem symptoms at the time of diagnosis of hydrocephalus. Hearing pathology was found more often in shunt-treated patients with NPD retardation, poor functional status and low quality of life. Children with shunt-treated hydrocephalus have hearing loss of sensorineural type. Children with brain stem symptomatology at diagnosing hydrocephalus and children with post-hemorrhagic hydrocephalus show higher risk of hearing loss. Children with shunted hydrocephalus and hearing loss show lower NPD, lower quality of life and lower functional status.

  8. 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.

  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. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. 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.

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

    DTIC Science & Technology

    2013-10-01

    TITLE: Prediction of Susceptibility to Acute Mountain Sickness Using Hypoxia-Induced Intrapulmonary Arteriovenous Shunt and Intracardiac Shunt...01October2012-30September2013 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Prediction of Susceptibility to Acute Mountain Sickness Using...following organizations have approved our protocol: a) Sacred Heart Medical Center IRB, the review board for Oregon Heart and Vascular Institute; b) Oregon

  18. [Histologic studies on otomycosis].

    PubMed

    Vennewald, Irina; Schönlebe, J; Klemm, E

    2002-01-01

    Fungal infections of the ear are mostly described as mycoses of the auditory canal. The aim of our investigations was to find out how fungi colonize the ear in immunocompetent patients. In the years from 1993 to 2000, 128 patients suspected of having otomycosis were examined. Of these 115 patients suffered from chronic otitis media with persisting tympanum perforation and otorrhea. A further 13 patients had clinical signs of otitis externa only. In 54 out of 139 samples, fungi were found in the auditory canal, in five on the tympanic membrane, and in five in the middle ear. Two-thirds were isolated as moulds and one-third as yeasts. Dominating species were Aspergillus niger and Candida parapsilosis. Samples of 15 patients suspected of having mastoiditis or cholesteatoma were examined histologically. Fungal hyphae were observed in the middle ear cavity and/or between horny lamellae of cholesteatoma in 4 patients. In the middle ear of immunocompetent patients chronic-hyperplastic (polypous) inflammation was detected with increased production of mucus, which probably promotes the colonization with pathogenic fungi as in the middle ear just like in the auditory canal.

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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.

  4. 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.

  5. [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.

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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

  11. 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.

  12. [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.

  13. 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.

  14. [Extraneural metastases of malignant brain tumors through ventriculoperitoneal shunt--report of two autopsy cases and a review of the literature (author's transl)].

    PubMed

    Shibasaki, T; Takeda, F; Kawafuchi, J

    1977-01-01

    Internal drainage of cerebrospinal fluid utilizing a mechanical tube has been an increasingly common and effective procedure for the relief of non-communicating hydrocephalus with intracranial tumor. However, several cases have recently been reported in which extraneural metastases of the tumor were initiated through the shunt tube implanted. The purpose of this paper is to present two cases with malignant brain tumor metastasizing extraneurally through ventriculoperitoneal shunt, and to review the reported cases in the literature. Case 1 The patient, a 9-year-old boy, had been suffering from headache and vomiting for 3 months prior to admission to the Neurosurgical Clinic, Gumma University Hospital. On admission, he had choked discs and cerebellar dysfunction with a staggering gait. The clinical diagnosis was a 4th ventricle tumor. On November 29, 1971, a suboccipital craniectomy was performed. A medullary tumor in the 4th ventricle was partially removed, and ventriculoperitoneal shunt was also performed. Subsequently postoperative irradiation was given, and the symptoms were abated. Histological diagnosis was ependymoblastoma. Thirteen months later, he was again admitted because of visual disturbance, psychic change and pituitary hypofunction. Bilateral frontal craniotomy revealed a large mass over the midline of the anterior skull base, accompanied by numerous meningeal neoplastic deposits. The tumor was partially removed and histologically proven to be meningeal metastases of ependymoblastoma. Irradiation was again given and the symptoms improved. But the 4th ventricle tumor recurred 5 months after the 2nd operation, and then a massive intraperitoneal effusion appeared. Cytological examination revealed clusters of tumor cells in the ascites. The patient died on September 8, 1974, namely 22 months after the ventriculoperitoneal shunt was implanted. Postmortem examination showed a solid tumor in the 4th ventricle which was accompanied by diffuse meningeal

  15. 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

  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. Colorectal tumors: the histology report.

    PubMed

    Lanza, Giovanni; Messerini, Luca; Gafà, Roberta; Risio, Mauro

    2011-03-01

    Epithelial colorectal tumors are common pathologic entities. Their histology report should be comprehensive of a series of pathologic parameters essential for the correct clinical management of the patients. Diagnostic histologic criteria of adenomatous, serrated, inflammatory, and hamartomatous polyps and of polyposis syndromes are discussed. In addition, the pathologic features of early and advanced colorectal cancer are described and a checklist is given. Finally, molecular prognostic and predictive factors currently employed in the treatment of colorectal cancer are discussed.

  19. 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

  20. 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.

  1. 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.

  2. Rapid progression of intrapulmonary arteriovenous shunting in polysplenia syndrome associated with biliary atresia.

    PubMed

    Kimura, Takuya; Hasegawa, Toshimichi; Sasaki, Takashi; Okada, Akira; Mushiake, Sotarou

    2003-06-01

    This report describes a patient with biliary atresia (BA) associated with polysplenia syndrome who showed a rapid progression of intrapulmonary arteriovenous shunting (IPS), resulting in a fatal outcome. Intrauterine ultrasonography at 36 weeks of gestation revealed fetal abnormalities, including situs inversus, absent retrohepatic inferior vena cava, and azygous connection. She was diagnosed postnatally as BA because of persistent acholic stool and neonatal jaundice. She underwent hepatic portoenterostomy at age 158 days. The gallbladder and the hepatic ducts were hypoplastic, and the common bile duct was absent. Magnetic resonance image and operative findings also identified polysplenia and an absent portal trunk. Liver histology showed cirrhotic changes and bile duct proliferation. Postoperatively, she achieved good bile secretion, with gradual decrease of total bilirubin. However, she had repeated febrile episodes, and computerized tomography at age 7 months showed multiple liver cysts. Thereafter, she presented with exertional dyspnea. Contrast-enhanced echocardiography showed IPS with a degree of 2/III at age 8 months and 3/III at 10 months. (99m)Technetium-labeled macroaggregated albumin ((99m)Tc-MAA) scintigraphy revealed a shunt ratio of 25.5% at 9 months and 39.7% at 10 months. Percutaneous transhepatic drainage of the bile cysts was performed without success. Sludged bile was obtained. However, respiratory distress rapidly progressed, and she died at age 11 months. In the present patient, the association of polysplenia syndrome and absent portal vein with BA, as well as liver cirrhosis, seemed to be contributing factors to rapid progression of IPS in early life.

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. [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.

  10. 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.

  11. Pitfalls in the Performance and Interpretation of Scintigraphic Imaging for Pleuroperitoneal Shunt.

    PubMed

    Covington, Matthew F; Choudhary, Gagandeep; Avery, Ryan J; Kuo, Phillip H

    2016-11-01

    Ascites can cause pleural effusions when the peritoneal fluid crosses the diaphragm through a pleuroperitoneal shunt in the setting of hepatic cirrhosis (hepatic hydrothorax) or malignant ascites. Scintigraphic imaging for pleuroperitoneal shunt requires intraperitoneal injection of Tc-SC or Tc-macroaggregated albumin followed by planar imaging of the chest and abdomen. Pleuroperitoneal shunt is confirmed by identifying radiotracer crossing the diaphragm from the peritoneal to pleural space. An atlas of pleuroperitoneal shunt imaging pitfalls is presented to facilitate optimal performance and interpretation of nuclear pleuroperitoneal shunt examinations. Examples include cases of nondiagnostic radiotracer injections, processing errors, and nontarget uptake.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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)

  17. 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

  18. 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.

  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. 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.

  1. 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

  2. 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.

  3. Reordering Histology to Enhance Engagement

    ERIC Educational Resources Information Center

    Amerongen, Helen

    2011-01-01

    In redesigning the preclinical curriculum and shifting from a discipline-based approach to an organ system-based approach, faculty at the University of Arizona College of Medicine in Tucson took the opportunity to restructure the sequence of introductory histology content to make it more engaging and relevant. In this article, the author describes…

  4. [Histology of keratoglobus (author's transl)].

    PubMed

    Knieper, P; Rochels, R; Nover, A

    1980-07-01

    The authors examined four cases of keratoglobus and report here on the histological changes found: degenerative alterations of the epithelium, characteristic changes of Bowman's membrane, such as thinning, detachment and wrinkling, alterations of the stroma and secondary alterations of the Descemet's membrane. These results indicate that keratoglobus is nearly an extreme variant of keratoconus.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. [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.

  11. Anal anatomy and normal histology.

    PubMed

    Pandey, Priti

    2012-12-01

    The focus of this article is the anatomy and histology of the anal canal, and its clinical relevance to anal cancers. The article also highlights the recent histological and anatomical changes to the traditional terminology of the anal canal. The terminology has been adopted by the American Joint Committee on Cancer, separating the anal region into the anal canal, the perianal region and the skin. This paper describes the gross anatomy of the anal canal, along with its associated blood supply, venous and lymphatic drainage, and nerve supply. The new terminology referred to in this article may assist clinicians and health care providers to identify lesions more precisely through naked eye observation and without the need for instrumentation. Knowledge of the regional anatomy of the anus will also assist in management decisions.

  12. 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.

  13. 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

  14. Adapting lean to histology laboratories.

    PubMed

    Buesa, René J

    2009-10-01

    Histology laboratories (histolabs) can increase productivity and reduce turnaround time and errors by using any one of several available management tools. After a few years of operation, all histolabs develop workflow problems. Histology laboratories handling more than 20,000 cases per year benefit the most from implementing management tools, as occurred in the 25 facilities summarized in this article. Discontinuous workflow, lack of "pulling" between steps, accepting unavoidable waiting times while working with small batches within work cells, and a workflow with an uneven rate of completion, are some of the adaptations required by the Lean system when it is used in histology because 70% of the tasks are manual and the flow has to be interrupted to add value to the pieces of tissue during tissue processing, no matter how short that step is. After all these adaptations are incorporated, the histolab becomes as "Lean" as it can be, and the qualifier is also a recognition of the effort and personnel involvement in the implementation. Given its service nature, productivity increments do not expand the histolab customer base and could lead to staffing reductions. This is one of the causes of reluctance by some employees for implementing these techniques which are mostly driven by cost reductions sought by insurance companies and administrators, and not necessarily because of a real medical need to reduce the turnaround time. Finally, any histolab wanting to improve its workflow can follow some easy steps presented here as a guide to accomplish that objective. These steps stress the need for the supervisors to insure that the personnel in the histology laboratory are being paid at a comparable rate as other histolabs in the area.

  15. 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.

  16. Causative role of infection in chronic non-thromboembolic pulmonary hypertension following ventriculo-atrial shunt.

    PubMed

    Amelot, Aymeric; Bouazza, Schaharazad; George, Bernard; Bresson, Damien

    2014-08-01

    A severe complication of ventriculo-atrial (VA) shunt placement for treatment of hydrocephalus is chronic thromboembolic pulmonary hypertension (CTEPH). We report here a patient with a VA shunt for treatment of hydrocephalus who presented two consecutive episodes of VA shunt-induced infection by Staphylococcus epidermidis and who rapidly developed chronic PH. Extensive radiological investigations and normal ventilation/perfusion lung scan allowed us to rule out CTEPH. To our knowledge, no other case of chronic pulmonary hypertension (PH) related to VA shunt insertion has been reported so far. PH in this patient with VA shunt is clinically distinct from CTEPH and has been caused by VA shunt-induced S. epidermidis infection per se.

  17. 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.

  18. 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.

  19. 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.

  20. 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

  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. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. [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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Coeliac disease: the histology report.

    PubMed

    Villanacci, Vincenzo; Ceppa, Paola; Tavani, Enrico; Vindigni, Carla; Volta, Umberto

    2011-03-01

    To this day intestinal biopsy is justly considered the "gold standard" for the diagnosis of coeliac disease (CD). The aim of the authors in setting up these guidelines was to assist pathologists in formulating a more precise morphological evaluation of a duodenal biopsy in the light of clinical and laboratory data, to prepare histological samples with correctly oriented biopsies and in the differential diagnosis with other pathological entities and complications of the disease. A further intention was to promote the conviction for the need of a close collaborative relationship between different specialists namely the concept of a "multidisciplinary team".

  13. Gastric lymphoma: the histology report.

    PubMed

    Doglioni, Claudio; Ponzoni, Maurilio; Ferreri, Andrés J M; Savio, Antonella

    2011-03-01

    The diagnosis of gastric MALT lymphoma is frequently difficult for the general histopathologist. During recent years there have been relevant changes in the therapeutic approach to gastric MALT lymphoma and our knowledge about its pathogenesis has greatly improved. The management of this disease actually requires a close cooperation between the histopathologist and the clinicians. The histology report of biopsies of a newly diagnosed or of an already treated case implies information of clinical and therapeutical relevance. This paper aims at giving the histopathologist a general knowledge about the state of art of this disease and its management. The diagnostic process leading to a complete and competent report is then described step by step.

  14. Histology of the first fish

    USGS Publications Warehouse

    Smith, M.P.; Sansom, I.J.; Repetski, J.E.

    1996-01-01

    THE first description of Anatolepis Bockelie & Fortey was from early Ordovician sediments of Ny Friesland, Spitsbergen1,2, but the genus is now known from many localities in North America and Greenland, ranging in age from the Late Cambrian period to the Early Ordovician3-6. Although initially interpreted as an agnathan fish2,3 that predated other representatives7, this has been widely disputed because the available histological data were unconvincing6,8-10 and the scales fell outside the known morphological range of other accepted early vertebrates9-11. Further doubt was cast upon the vertebrate affinity of Anatolepis when specimens from East Greenland were interpreted as the cuticular fragments of aglaspid arthropods6, although this interpretation has also been refuted12. Here we report on the morphology and histology of large collections of Anatolepis, and demonstrate the presence of dentine, a tissue unique to vertebrates, confirming that the taxon is both a vertebrate and the oldest known fish.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  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. 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

  16. 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

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. Acute modified Blalock-Taussing shunt obstruction successfully treated with urokinase and heparin.

    PubMed

    Mizzi, J; Grech, V

    2005-07-01

    Acute modified Blalock-Tuassig shunt obstruction due to thrombosis may be life-threatening. We report non-invasive relief of shunt obstruction with thrombolysis and heparinisation, a potentially life-saving intervention that is applicable in all settings, including outside tertiary paediatric cardiology centres.

  2. Acute modified Blalock-Taussing shunt obstruction successfully treated with urokinase and heparin

    PubMed Central

    Mizzi, J; Grech, V

    2005-01-01

    Acute modified Blalock-Tuassig shunt obstruction due to thrombosis may be life-threatening. We report non-invasive relief of shunt obstruction with thrombolysis and heparinisation, a potentially life-saving intervention that is applicable in all settings, including outside tertiary paediatric cardiology centres. PMID:22368653

  3. 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

  4. Histologic effects of resurfacing lasers.

    PubMed

    Freedman, Joshua R; Greene, Ryan M; Green, Jeremy B

    2014-02-01

    By utilizing resurfacing lasers, physicians can significantly improve the appearance of sun-damaged skin, scars, and more. The carbon dioxide and erbium:yttrium-aluminum-garnet lasers were the first ablative resurfacing lasers to offer impressive results although these earlier treatments were associated with significant downtime. Later, nonablative resurfacing lasers such as the neodymium:yttrium-aluminum-garnet laser proved effective, after a series of treatments with less downtime, but with more modest results. The theory of fractional photothermolysis has revolutionized resurfacing laser technology by increasing the safety profile of the devices while delivering clinical efficacy. A review of the histologic and molecular consequences of the resurfacing laser-tissue interaction allows for a better understanding of the devices and their clinical effects.

  5. 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.

  6. 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.

  7. [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.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. Tc-99m MAA total-body imaging to detect intrapulmonary right-to-left shunts and to evaluate the therapeutic effect in pulmonary arteriovenous shunts.

    PubMed

    Lu, G; Shih, W J; Chou, C; Xu, J Y

    1996-03-01

    The appearance of radiotracer in the systemic circulation to document the visualization of the brain, kidneys, and spleen after intravenous administration of Tc-99m MAA indicates right-to-left shunts because MAA particles (20-60 microns) are supposedly trapped in the pulmonary bed (less than 15 microns). Six hypoxemia patients (1 male, 5 females; age range, 12-52 years) with intrapulmonary right-to-left shunts were evaluated by Tc-99m MAA dynamic perfusion imaging and total-body scans. Tc-99m MAA total-body imaging of the six patients with intrapulmonary right-to-left shunts (3 patients with chronic liver disease/cirrhosis of the liver and 3 patients with pulmonary arteriovenous fistulae) revealed significant radiotracer uptake in extrapulmonary organs such as the brain, kidneys, and spleen; a shunt ratio, estimated by a semiquantitative method, ranged from 17.8% to 52%. All dynamic pulmonary perfusion scans showed a normal sequence of cardiopulmonary flow without intracardiac shunts. Three patients with pulmonary arteriovenous fistulae underwent a second Tc-99m MAA total-body imaging after embolization therapy (2 patients) or lobectomy (1 patient). The result in lobectomized patients were negative for uptake in extrapulmonary organs; the two patients who underwent embolization therapy demonstrated only mild improvement. As a consequence of these findings, the authors conclude that Tc-99m MAA total-body imaging can be used for the diagnosis of intrapulmonary right-to-left shunts, as well as for the evaluation of postshunt therapy.

  16. 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.

  17. 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

  18. [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.

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 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

  4. Histologic analysis of postmeniscectomy osteonecrosis.

    PubMed

    Higuchi, Hiroshi; Kobayashi, Yasukazu; Kobayashi, Atsushi; Hatayama, Kazuhisa; Kimura, Masashi

    2013-05-01

    Bone marrow signal changes on magnetic resonance imaging (MRI) after meniscectomy have been reported as evidence of postmeniscectomy osteonecrosis, but this pathology is unclear. We conducted a study to follow-up cases with bone marrow signal changes on MRI after meniscectomy and investigate the pathology of underlying lesions. Of 136 patients with no presurgical evidence of osteonecrosis, 29 had juxta-articular bone marrow signal changes on MRI after arthroscopic meniscectomy and subsequently underwent conservative therapy. In 6 of these 29 patients, clinical symptoms and radiographic changes began deteriorating. Based on the Koshino classification, 4 of the 6 patients had Stage-2 knee osteonecrosis and 2 had Stage-3. Arthroscopic and pathologic examinations were performed. Arthroscopic findings were fibrillation (all 6 cases), fissuring (4), ulceration (2), and eburnation (2). Histologic analysis confirmed subchondral bone fractures in all 6 cases, but osteonecrotic lesions were detected only in 2 cases with obvious radiologic deterioration. Postmeniscectomy osteonecrosis might result from subchondral bone fractures. Fracture healing is worse in patients with comorbidities than in those without it; comorbidities might be a risk factor for osteonecrosis.

  5. 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

  6. 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.

  7. 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

  8. Syringo-Subarachnoid-Peritoneal Shunt Using T-Tube for Treatment of Post-Traumatic Syringomyelia

    PubMed Central

    Kim, Seon-Hwan; Youm, Jin-Young; Kwon, Hyon-Jo

    2012-01-01

    Various surgical procedures for the treatment of post-traumatic syringomyelia have been introduced recently, but most surgical strategies have been unreliable. We introduce the concept and technique of a new shunting procedure, syringo-subarachnoid-peritoneal shunt. A 54-year-old patient presented to our hospital with a progressive impairment of motion and position sense on the right side. Sixteen years before this admission, he had been treated by decompressive laminectomy for a burst fracture of L1. On his recent admission, magnetic resonance (MR) imaging studies of the whole spine revealed the presence of a huge syrinx extending from the medulla to the L1 vertebral level. We performed a syringo-subarachnoid-peritoneal shunt, including insertion of a T-tube into the syrinx, subarachnoid space and peritoneal cavity. Clinical manifestations and radiological findings improved after the operation. The syringo-subarachnoid-peritoneal shunt has several advantages. First, fluid can communicate freely between the syrinx, the subarachnoid space, and the peritoneal cavity. Secondly, we can prevent shunt catheter from migrating because dural anchoring of the T-tube is easy. Finally, we can perform shunt revision easily, because only one arm of the T-tube is inserted into the intraspinal syringx cavity. We think that this procedure is the most beneficial method among the various shunting procedures. PMID:22993681

  9. Shunting normal pressure hydrocephalus: the predictive value of combined clinical and CT data.

    PubMed Central

    Vanneste, J; Augustijn, P; Tan, W F; Dirven, C

    1993-01-01

    The value of an ordinal global scale derived from combined clinical and CT data (clin/CT scale) to predict the clinical outcome in 112 patients shunted for presumed normal pressure hydrocephalus (NPH) was analysed. The clinical data were retrospectively collected, all CT scans were re-evaluated, and the clin/CT scale was determined blind to the results of further ancillary tests and to the post-surgical outcome. The scale ranked three classes of prediction: on the basis of clinical and CT characteristics, improvement after shunting was probable, possible, or improbable. The predictive value of the clin/CT scale for the subgroup of communicating NPH was established for two different strategies, depending on the strictness of selection criteria for shunting. In the subgroup of patients with presumed communicating NPH, the prevalence of shunt responsiveness was 29%; the best strategy was to shunt only patients with probable shunt-responsive NPH: the sensitivity was 0.54, the specificity 0.84, and the predictive accuracy 0.75, with a limited number of ineffective shunts (11%) and missed improvements (13%). The study illustrates its need to assess the pre-test probability of NPH based on combined clinical and CT data, before establishing the clinical usefulness of an ancillary test. PMID:8459240

  10. Are Shunt Revisions Associated with IQ in Congenital Hydrocephalus? A Meta -Analysis.

    PubMed

    Arrington, C Nikki; Ware, Ashley L; Ahmed, Yusra; Kulesz, Paulina A; Dennis, Maureen; Fletcher, Jack M

    2016-12-01

    Although it is generally acknowledged that shunt revisions are associated with reductions in cognitive functions in individuals with congenital hydrocephalus, the literature yields mixed results and is inconclusive. The current study used meta-analytic methods to empirically synthesize studies addressing the association of shunt revisions and IQ in individuals with congenital hydrocephalus. Six studies and three in-house datasets yielded 11 independent samples for meta-analysis. Groups representing lower and higher numbers of shunt revisions were coded to generate effect sizes for differences in IQ scores. Mean effect size across studies was statistically significant, but small (Hedges' g = 0.25, p < 0.001, 95 % CI [0.08, 0.43]) with more shunt revisions associated with lower IQ scores. Results show an association of lower IQ and more shunt revisions of about 3 IQ points, a small effect, but within the error of measurement associated with IQ tests. Although clinical significance of this effect is not clear, results suggest that repeated shunt revisions because of shunt failure is associated with a reduction in cognitive functions.

  11. 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.

  12. The Bohr Effect Is Not a Likely Promoter of Renal Preglomerular Oxygen Shunting

    PubMed Central

    Olgac, Ufuk; Kurtcuoglu, Vartan

    2016-01-01

    The aim of this study was to evaluate whether possible preglomerular arterial-to-venous oxygen shunting is affected by the interaction between renal preglomerular carbon dioxide and oxygen transport. We hypothesized that a reverse (venous-to-arterial) shunting of carbon dioxide will increase partial pressure of carbon dioxide and decrease pH in the arteries and thereby lead to increased oxygen offloading and consequent oxygen shunting. To test this hypothesis, we employed a segment-wise three-dimensional computational model of coupled renal oxygen and carbon dioxide transport, wherein coupling is achieved by shifting the oxygen-hemoglobin dissociation curve in dependence of local changes in partial pressure of carbon dioxide and pH. The model suggests that primarily due to the high buffering capacity of blood, there is only marginally increased acidity in the preglomerular vasculature compared to systemic arterial blood caused by carbon dioxide shunting. Furthermore, effects of carbon dioxide transport do not promote but rather impair preglomerular oxygen shunting, as the increase in acidity is higher in the veins compared to that in the arteries. We conclude that while substantial arterial-to-venous oxygen shunting might take place in the postglomerular vasculature, the net amount of oxygen shunted at the preglomerular vasculature appears to be marginal. PMID:27833564

  13. Effect of cerebrospinal fluid shunts on intracranial pressure and on cerebrospinal fluid dynamics

    PubMed Central

    Fox, John L.; McCullough, David C.; Green, Robert C.

    1973-01-01

    Part 2 describes measurements of intracranial cerebrospinal fluid (CSF) pressure in 18 adult patients with CSF shunts, all pressure measurements being referred to a horizontal plane close to the foramina of Monro. All 18 patients had normal CSF pressure by lumbar puncture; however, in one patient an intracranial pressure of +280 mm was subsequently measured after pneumoencephalography. Twelve patients had pre-shunt CSF pressures measured intracranially: 11 ranged from +20 to +180 mm H2O and one was +280 mm H2O in the supine position. In the upright posture nine patients had values of −10 to −140 mm H2O, while three others were +60, +70, and +280 mm H2O. After CSF shunting in these 18 patients the pressures were −30 to +30 mm H2O in the supine position and −210 to −370 mm in the upright position. The effect of posture on the siphoning action of these longer shunts in the erect, adult patient is a major uncontrollable variable in maintenance of intracranial pressure after shunting. Other significant variables are reviewed. In Part 3 a concept of the hydrocephalus phenomenon is described. Emphasis is placed on the pressure differential (Pd) and force differential (Fd) causing pre-shunt ventricular enlargement and post-shunt ventricular size reduction. The site of Pd, which must be very small and not to be confused with measured ventricular pressure, P, must be at the ventricular wall. Images PMID:4541079

  14. Pediatric hydrocephalus: Does the shunt device pressure selection affect the outcome?

    PubMed Central

    Sinha, Arvind; Sharma, Anuj; Gupta, Charitesh

    2012-01-01

    Aim: To compare the efficacy of low- versus medium-pressure shunts in pediatric hydrocephalus in a randomized controlled trial. Materials and Methods: Forty patients of pediatric hydrocephalus were randomized into two groups. The Chhabra differential pressure VP shunt (low or medium) was inserted in every patient. Postoperative follow-up was performed for symptomatic improvement and radiological evaluation (by sonography or computed tomography scan) for ventricle hemispheric ratio (VHR). Comparative analysis of pre- and postoperative VHR and need of redo surgery for shunt malformation were carried out to establish outcomes. Results: Nineteen patients had a low-pressure and 21 patients had a medium-pressure shunt inserted. The age of the patients ranged from 1 day to 10 years. The average preoperative VHR in group A was 55.37%, which reduced to 40% postoperatively (P = 0.00005); likewise, the pre- and postoperative VHR in group B were 61.57% and 42%, respectively, which was statistically significant (P = 0.0006). The complications of shunts and incidence of redo shunt surgery in both groups were not found to be statistically significant (P = 0.5614). Conclusions: The study found no significant difference in the outcome of patients with low- or medium-pressure shunt placement in pediatric hydrocephalus. PMID:22529548

  15. Management of pregnancy and delivery of a patient with malfunctioning ventriculoperitoneal shunt.

    PubMed

    Schiza, S; Stamatakis, E; Panagopoulou, A; Valsamidis, D

    2012-01-01

    The use of ventriculoperitoneal shunts increased the life expectancy of many women with hydrocephalus who are able to reach childbearing age. It is believed that pregnancy may be associated with shunt malfunction and the management of pregnant women with a malfunctioning ventriculoperitoneal shunt is a challenging medical condition for the anaesthetist, the obstetrician and the neurosurgeon. We report on a case of a 35-year-old primiparous woman who underwent a scheduled caesarean delivery at 30 weeks' gestation due to deteriorating neurological condition during pregnancy. The patient had a history of astrocytoma resection in the past and placement of a ventriculoperitoneal shunt due to obstructive hydrocephalus. She had a normal life without neurological deficits until the 18th week of gestation, when the first neurological symptoms appeared. An MRI was done that showed significant dilatation of the fourth ventricle and it was believed that the shunt was not functioning properly so the patient's symptoms were present because of raised intracranial pressure. In the 30th week of gestation, she had a caesarean delivery under epidural anaesthesia and she gave birth to a live female infant. Her neurological condition started improving 48 h after delivery and the symptoms gradually regressed. At 20 days after surgery she was discharged from hospital. The presence of a ventriculoperitoneal shunt is not a contraindication for pregnancy. Maternal shunt dependency carries a relatively high incidence of complications for some patients, e.g. shunt malfunction due to raised intraabdominal pressure caused by the gravid uterus. The results of pregnancies and deliveries in women with pre-existing ventriculoperitoneal shunts are favourable if there is proper management.

  16. Passively minimizing structural sound radiation using shunted piezoelectric materials

    NASA Astrophysics Data System (ADS)

    Bulent Ozer, M.; Royston, Thomas J.

    2003-10-01

    Two methods are presented to determine optimal inductance and resistance values of the shunt circuit across a piezoceramic material, which is bonded to a simply supported plate in order to minimize sound radiation from the plate. The first method (DH) makes use of den Hartog's damped vibration absorber principle. The second method (SM) uses the Sherman Morrison matrix inversion theorem. The effectiveness of each method is compared with regard to minimizing total acoustic sound-power radiation and acoustic pressure at a point. Optimization algorithms and case studies are presented using a linearized model for the piezoceramic and using a nonlinear model for the piezoceramic that accounts for the inherent dielectric hysteresis. Case studies demonstrate that the second method (SM) results in superior performance, under both linear and nonlinear system assumptions. Studies also illustrate that, if the nonlinearity in the system is significant, it must be incorporated in the optimization process.

  17. Cross-limb vascular shunting for major limb replantation.

    PubMed

    Lee, Yao-Chou; Lee, Jing-Wei

    2009-02-01

    In the management of traumatic major limb amputation, rapid re-establishment of circulation to the amputated part is imperative so as to prevent complications related to reperfusion injury, especially for those already suffering from prolonged ischemia. A temporary, extra-anatomic cross limb shunting with infusion lines can be used to perfuse the amputated part almost instantaneously. This allows the surgeon to carry out skeletal fixation and other reparative works in an unhurried manner. The cannulation site is targeted at intact vessels far away from the injury zone, obviating the need to explore and handle traumatized vessels at the mangled stump ends, thus greatly simplifying and expediting the revascularization process. Such a method had been successfully applied in 2 young people suffering traumatic arm amputation and thigh amputation, respectively. We suggested that such a procedure could be a useful adjunct in the field of major limb replantation.

  18. Shunt Diode Designs in Li/cf Shuttle Batteries

    NASA Technical Reports Server (NTRS)

    Miller, D.; Higgins, R.

    1984-01-01

    Although Li/CF cells and batteries have an excellent safety record, they are included with other battery systems that require additional safety precautions. One precaution suggested is the inclusion of shunt diodes into these batteries. The benefits of this addition are examined. All cells tested at elevated temperatures vent regardless of length of time between being fully discharged and reversed or inclusion of the diode in the system. Cells discharged at ambient temperatures all show a relatively quick reversal, but stabilize at voltages that are high enough that the diodes are not functioning. Cells tested at depressed temperatures reverse the deepest of all cells tested, with the deepest reversal occurring very early in the test and voltages recovering to above -0.60 volts near the end of the tests. Anode limited cells will eliminate the venting during hot reversal.

  19. Statistics of voltage fluctuations in resistively shunted Josephson junctions

    NASA Astrophysics Data System (ADS)

    Marthaler, Michael; Golubev, Dmitry; Utsumi, Yasuhiro; Schön, Gerd

    2011-03-01

    The intrinsic nonlinearity of Josephson junctions converts Gaussian current noise in the input into non-Gaussian voltage noise in the output. For a resistively shunted Josephson junction with white input noise we determine numerically exactly the properties of the few lowest cumulants of the voltage fluctuations, and we derive analytical expressions for these cumulants in several important limits. The statistics of the voltage fluctuations is found to be Gaussian at bias currents well above the Josephson critical current, but Poissonian at currents below the critical value. In the transition region close to the critical current the higher-order cumulants oscillate and the voltage noise is strongly non-Gaussian. For coloured input noise we determine the third cumulant of the voltage.

  20. Statistics of voltage fluctuations in resistively shunted Josephson junctions

    NASA Astrophysics Data System (ADS)

    Golubev, D. S.; Marthaler, M.; Utsumi, Y.; Schön, Gerd

    2010-05-01

    The intrinsic nonlinearity of Josephson junctions converts Gaussian current noise in the input into non-Gaussian voltage noise in the output. For a resistively shunted Josephson junction with white input noise we determine numerically exactly the properties of the few lowest cumulants of the voltage fluctuations, and we derive analytical expressions for these cumulants in several important limits. The statistics of the voltage fluctuations is found to be Gaussian at bias currents well above the Josephson critical current but Poissonian at currents below the critical value. In the transition region close to the critical current the higher-order cumulants oscillate and the voltage noise is strongly non-Gaussian. For colored input noise we determine the third cumulant of the voltage.

  1. A SQUID gradiometer module with large junction shunt resistors

    NASA Astrophysics Data System (ADS)

    Qiu, Yang; Liu, Chao; Zhang, Shu-Lin; Zhang, Guo-Feng; Wang, Yong-Liang; Li, Hua; Zeng, Jia; Kong, Xiang-Yan; Xie, Xiao-Ming

    2014-08-01

    A dual-washer superconducting quantum interference device (SQUID) with a loop inductance of 350 pH and two on-washer integrated input coils is designed according to conventional niobium technology. In order to obtain a large SQUID flux-to-voltage transfer coefficient, the junction shunt resistance is selected to be 33 Ω. A vertical SQUID gradiometer module with a baseline of 100 mm is constructed by utilizing such a SQUID and a first-order niobium wire-wound antenna. The sensitivity of this module reaches about 0.2 fT/(cm·Hz1/2) in the white noise range using a direct readout scheme, i.e., the SQUID is directly connected to an operational amplifier, in a magnetically shielded room. Some magnetocardiography (MCG) measurements with a sufficiently high signal-to-noise ratio (SNR) are demonstrated.

  2. Inframammary fold: a histologic reappraisal.

    PubMed

    Muntan, C D; Sundine, M J; Rink, R D; Acland, R D

    2000-02-01

    The inframammary fold is a defining element in the shape and structure of the female breast. It should be preserved whenever possible in ablative procedures and recreated accurately when the breast is reconstructed after mastectomy. To date, no accurate anatomic description of this essential structure exists. Previous studies have suggested that the fold is produced by a supporting ligament running from the dermis in the fold region to a variety of locations on the rib cage. This clinic's experience with mastectomy, augmentation mammaplasty, and breast reconstruction does not support the existence of a ligamentous structure. To define the structure of the inframammary fold, 10 female and 2 male cadavers were studied. The anterior chest wall was removed en bloc and frozen in orthostatic position. Parasagittal sections were made of the inframammary fold with the chest wall intact. After decalcification of the ribs and routine histologic preparation, thin sections were stained with Gomori's trichrome. On light microscopic examination, no demonstrable ligamentous structure of dense regular connective tissue could be identified in the fold region in any of the 12 specimens. Superficial and deep fascial layers were uniformly observed anterior to the pectoralis major and serratus anterior muscles. The superficial fascia was connected to the dermis in the fold region in a variety of configurations. In some cases, the deep fascia fused with the superficial fascia and dermis at the fold level. In other cases, bundles of collagen fibers arising from the superficial fascial layer were found to insert into the dermis at the inframammary fold, slightly inferior to it, or both. These bundles were observed consistently in sections from the sternum to the middle axillary line. They were distinct from Cooper's suspensory ligaments, which are seen more superiorly in the glandular tissue.

  3. Lack of shunt response in suspected idiopathic normal pressure hydrocephalus with Alzheimer disease pathology.

    PubMed

    Hamilton, Roy; Patel, Sunil; Lee, Edward B; Jackson, Eric M; Lopinto, Joanna; Arnold, Steven E; Clark, Christopher M; Basil, Anuj; Shaw, Leslie M; Xie, Sharon X; Grady, M Sean; Trojanowski, John Q

    2010-10-01

    To determine the impact of cortical Alzheimer disease pathology on shunt responsiveness in individuals treated for idiopathic normal pressure hydrocephalus (iNPH), 37 patients clinically diagnosed with iNPH participated in a prospective study in which performance on neurologic, psychometric, and gait measures before and 4 months after shunting was correlated with amyloid β plaques, neuritic plaques, and neurofibrillary tangles observed in cortical biopsies obtained during shunt insertion. No complications resulted from biopsy acquisition. Moderate to severe pathology was associated with worse baseline cognitive performance and diminished postoperative improvement on NPH symptom severity scales, gait measures, and cognitive instruments compared to patients lacking pathology.

  4. Tunable acoustic waveguide based on vibro-acoustic metamaterials with shunted piezoelectric unit cells

    NASA Astrophysics Data System (ADS)

    Kwon, Byung-Jin; Jung, Jin-Young; Lee, Dooho; Park, Kwang-Chun; Oh, Il-Kwon

    2015-10-01

    We propose a new class of acoustic waveguides with tunable bandgaps (TBs) by using vibro-acoustic metamaterials with shunted periodic piezoelectric unit cells. The unit metamaterial cells that consist of a single crystal piezoelectric transducer and an electrical shunt circuit are designed to induce a strong vibro-acousto-electrical coupling, resulting in a tunable acoustic bandgap as well as local structural resonance and Bragg scattering bandgaps. The present results show that the TB frequency can be actively controlled and the transmission loss of the acoustic wave can be greatly improved by simply changing the inductance values in the shunt circuit.

  5. An interesting case of screen-detected breast cancer encasing a ventriculoperitoneal shunt.

    PubMed

    Jain, Yogesh Kumar; Kokan, Jalal S

    2013-01-23

    A 67-year-old woman was diagnosed with a breast cancer via screening encasing the ventriculoperitoneal shunt. Triple assessment including MRI scan of the breast confirmed the presence of a breast mass and the tubing of the ventriculoperitoneal shunt was running directly through the mass. She underwent wide local excision of the breast cancer as well as rerouting of VP shunt as a joint procedure with the neurosurgery team and recovered uneventfully. This is a very rare and an interesting case and required management involving a different specialty.

  6. Brain abscesses associated with right-to-left shunts in adults.

    PubMed

    Memon, Kashif A; Cleveland, Kerry O; Gelfand, Michael S

    2012-04-01

    Although brain abscesses are frequently cryptogenic in origin, bacteria must reach the brain either by direct or hematogenous spread. Right-to-left shunts, caused either by intrapulmonary vascular malformations or congenital heart defects, may allow microorganisms to evade the normal host defenses in the lungs and lead to development of brain abscesses. Two patients recently presented with brain abscesses and were found to have conditions associated with right-to-left shunts. The diagnosis of brain abscess should prompt the clinician to consider right-to-left shunts as a possible predisposing condition for brain abscess.

  7. Testing of cerebrospinal compensatory reserve in shunted and non-shunted patients: a guide to interpretation based on an observational study.

    PubMed Central

    Czosnyka, M; Whitehouse, H; Smielewski, P; Simac, S; Pickard, J D

    1996-01-01

    OBJECTIVE--To design a computerised infusion test to compensate for the disadvantages of Katzman's lumbar infusion method: inadequate accuracy of estimation of the resistance to cerebrospinal fluid outflow and poor predictive value in normal pressure hydrocephalus. METHODS--Accuracy was improved by intracranial pressure signal processing and model analysis for measurement of cerebrospinal compensatory variable. These include the CSF outflow resistance, brain compliance, pressure-volume index, estimated sagittal sinus pressure, CSF formation rate, and other variables. Infusion may be made into the lumbar space, ventricles, or, when assessing shunt function in vivo, the shunt chamber. RESULTS AND CONCLUSIONS--The computerised test has been used for five years in a multicentre study in 350 hydrocephalic patients of various ages, aetiologies, and states of cerebrospinal compensation. The principles of using the test to characterise different types of CSF circulatory disorders in patients presenting with ventricular dilatation, including brain atrophy and normal and high pressure hydrocephalus, are presented and illustrated. Previous studies showed a positive correlation between cerebrospinal compensatory variables and the results of shunting, but such a prediction remains difficult in idiopathic normal pressure hydrocephalus, particularly in elderly patients. The technique is helpful in the assessment of shunt malfunction, including posture-related overdrainage, over-drainage related to the nocturnal B wave activity, and proximal or distal shunt obstruction. The appendix presents an introduction of the mathematical modelling of CSF pressure volume-compensation included in computerised infusion test software. Images PMID:8778261

  8. Extracervical fibrosclerosis causing obstruction of a ventriculo-peritoneal shunt in a patient with hydrocephalus and invasive fibrous thyroiditis (Riedel's struma).

    PubMed

    Natt, N; Heufelder, A E; Hay, I D; Grant, C S; Goellner, J R

    1997-07-01

    The association of invasive fibrous thyroiditis (IFT) with foci of extracervical fibrosclerosis is well recognized. Affected sites include the retroperitoneum, the mediastinum, the biliary tract, and the orbit. The development of subcutaneous fibrosclerosis, however, is extremely rare. We report a patient with known invasive fibrous thyroiditis and hypoparathyroidism who presented with localized subcutaneous fibrosclerosis of the anterior chest wall resulting in compression of his ventriculoperitoneal shunt. The aetiology of IFT has remained unclear. Several histological and serological features, including the presence of mononuclear cells within the fibrosclerotic process, the occurrence of microscopic vasculitis, and the detection of autoantibodies directed against thyroid-specific antigens in a large proportion of patients with IFT, currently support the notion of autoimmune mechanisms playing a role in the pathogenesis of this rare disease.

  9. Use of acetazolamide to decrease cerebrospinal fluid production in chronically ventilated patients with ventriculopleural shunts

    PubMed Central

    Carrion, E; Hertzog, J; Medlock, M; Hauser, G; Dalton, H

    2001-01-01

    Acetazolamide (ACTZ), a carbonic anhydrase inhibitor, has been shown to decrease cerebrospinal fluid (CSF) production in both in vivo and in vitro animal models. We report two children with hydrocephalus who experienced multiple shunt failures, and who had externalised ventriculostomy drains (EVD) prior to ventriculopleural shunt placement. The effects of increasing doses of ACTZ on CSF production and subsequent tolerance to ventriculopleural shunts were evaluated. The patients had a 48% and a 39% decrease in their EVD CSF output when compared to baseline with maximum ACTZ dose of 75 mg/kg/day and 50 mg/kg/day, respectively (p < 0.05). This is the first report of change in CSF volume in children after extended treatment with ACTZ. ACTZ treatment in mechanically ventilated paediatric patients with hydrocephalus may improve tolerance of ventriculopleural shunts and minimise respiratory compromise. Potassium and bicarbonate supplements are required to correct metabolic disturbances.

 PMID:11124792

  10. Optimizing the Shunting Schedule of Electric Multiple Units Depot Using an Enhanced Particle Swarm Optimization Algorithm

    PubMed Central

    Jin, Junchen

    2016-01-01

    The shunting schedule of electric multiple units depot (SSED) is one of the essential plans for high-speed train maintenance activities. This paper presents a 0-1 programming model to address the problem of determining an optimal SSED through automatic computing. The objective of the model is to minimize the number of shunting movements and the constraints include track occupation conflicts, shunting routes conflicts, time durations of maintenance processes, and shunting running time. An enhanced particle swarm optimization (EPSO) algorithm is proposed to solve the optimization problem. Finally, an empirical study from Shanghai South EMU Depot is carried out to illustrate the model and EPSO algorithm. The optimization results indicate that the proposed method is valid for the SSED problem and that the EPSO algorithm outperforms the traditional PSO algorithm on the aspect of optimality. PMID:27436998

  11. Optimizing the Shunting Schedule of Electric Multiple Units Depot Using an Enhanced Particle Swarm Optimization Algorithm.

    PubMed

    Wang, Jiaxi; Lin, Boliang; Jin, Junchen

    2016-01-01

    The shunting schedule of electric multiple units depot (SSED) is one of the essential plans for high-speed train maintenance activities. This paper presents a 0-1 programming model to address the problem of determining an optimal SSED through automatic computing. The objective of the model is to minimize the number of shunting movements and the constraints include track occupation conflicts, shunting routes conflicts, time durations of maintenance processes, and shunting running time. An enhanced particle swarm optimization (EPSO) algorithm is proposed to solve the optimization problem. Finally, an empirical study from Shanghai South EMU Depot is carried out to illustrate the model and EPSO algorithm. The optimization results indicate that the proposed method is valid for the SSED problem and that the EPSO algorithm outperforms the traditional PSO algorithm on the aspect of optimality.

  12. [Hydrothorax as a complication of a ventricle peritoneal shunt. A case report].

    PubMed

    Yéboles, Raúl M; Vázquez, Lorena; Seoane, Marta; Castro, Susana; Ruiz, Beatriz

    2017-02-24

    The ventricle peritoneal (VP) shunt is commonly used in the treatment of hydrocephalus. It is a relatively simple and effective technique, but around 70% of the patients with a VP shunt have a complication in their lifetime. Most of these complications are due to infection or mechanical dysfunction. The thoracic complications are rare. The present case is one of the small number of them found in the literature, describing hydrothorax as a complication of a VP shunt without catheter migration and without ascites. The case is presented of a 2 year-old girl with VP shunt. The patient was diagnosed with pleural effusion compatible with hydrothorax. After finding beta-2-transferrin in the pleural fluid, it was it was shown to be from cerebrospinal fluid. Cranial CT showed the catheter in a proper position, and the Xray and ultrasound showed the catheter correctly positioned in the peritoneum.

  13. Ultrasound characterization of interface oscillation as a proxy for ventriculoperitoneal shunt function.

    PubMed

    Aralar, April Joy C; Bird, Matthew D; Graham, Robert D; Beomseo Koo; Shenai, Mahesh B; Chitnis, Parag V; Sikdar, Siddhartha

    2016-08-01

    Hydrocephalus, where cerebrospinal fluid (CSF) production rate is greater than reabsorption rate, leads to impaired neurological function if left untreated. Ventriculoperitoneal shunts (VPS) are implanted in the brain ventricles to route CSF. VPS systems have a high failure rate, and failure symptoms resemble symptoms of common maladies. The current gold standard for shunt diagnosis, surgical intervention, poses high risk and requires an expensive procedure for patients. Current non-invasive methods lack proper insight to assist physicians. We propose a noninvasive method of characterizing the oscillation of the shunt's pressure-relief valve to assist physicians in shunt diagnosis. Brightness-mode and motion-mode ultrasound images can be used to determine fluid flow. Blockage in the system could be detected by observing the phase change of the ultrasound signal in different flow cases with or without perturbation. Future testing and implementation can allow for the use of this method in localizing and identifying the modality of failure.

  14. Urethral protrusion of the abdominal catheter of ventriculoperitoneal shunt: Case report of extremely rare complication.

    PubMed

    Yazar, Ugur; Kanat, Ayhan; Akca, Nezih; Gazioglu, Gurkan; Arda, Irfan S; Kazdal, Hizir

    2012-05-01

    Hydrocephalus in its various forms constitutes one of the major problems in pediatric neurosurgical practice. The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus, so that all neurosurgeons struggle with shunt malfunctions and their complications. Well-known complications are connected with the use of the valve systems (malfunction, infectious, overdrainage, secondary craniosynostosis, etc.). We report an unusual case of protruding abdominal catheter from the urethra. This girl had received a VP shunt for hydrocephalus following surgery of posterior fossa medulloblastoma 4 years ago. After admission, the entire system was removed, antibiotic treatment was administered for 2 weeks, and a new VP shunt was placed. The postoperative course was uneventful. This complication is extremely rare.

  15. Assessment of FGPM shunt damping for vibration reduction of laminated composite beams

    NASA Astrophysics Data System (ADS)

    Lezgy-Nazargah, M.; Divandar, S. M.; Vidal, P.; Polit, O.

    2017-02-01

    This work addresses theoretical and finite element investigations of functionally graded piezoelectric materials (FGPMs) for shunted passive vibration damping of laminated composite beams. The properties of piezoelectric patches are assumed to vary through the thickness direction following the exponent or power law distribution in terms of the volume fractions of the constituent materials. By employing Hamilton's principle, the governing differential equations of motion are derived. The resulting system of equations of vibration is solved by employing an efficient three-nodded beam element which is based on a refined sinus piezoelectric model. The effects of effective electromechanical coupling coefficients (EEMCCs), different electric shunt circuits and different material compositions on the shunted damping performance are investigated. The optimal values of the electric components belonging to each shunt circuit are numerically determined.

  16. [The development of extrahepatic portacaval shunt device based on magnetic compression technique through the interventional procedure].

    PubMed

    Yan, Xiaopeng; Lv, Yi; Ma, Jia; Liu, Wenyan; Li, Jianhui; Ma, Feng; Wang, Haohua

    2013-11-01

    A device of extrahepatic portacaval shunt is introduced. This device is composed of the daughter and parent magnets and the vascular interventional operation equipment. It is based on the principle of magnetic compression technology, through the intervention approach the daughter and mother magnet are moved to the portal vein and inferior vena cava, respectively. Then the two magnets attract and compress the vessel walls of portal vein and inferior vena cava. Two weeks later, the magnets are detached from the vessel wall with a RUPS-set and the portacaval shunt is established. It is mainly used for the treatment of portal hypertension. It belongs to the interventional operation, there is no any foreign body remaining after the portacaval shunt is established, which can maintain long-term patency. Futhermore the portacaval shunt will not be expanded, therefore it can significantly reduce the incidence of hepatic encephalopathy.

  17. Vibration and wave propagation attenuation for metamaterials by periodic piezoelectric arrays with high-order resonant circuit shunts

    NASA Astrophysics Data System (ADS)

    Zhou, Wanlu; Wu, You; Zuo, Lei

    2015-06-01

    Beam or plate metamaterials with periodic piezoelectric arrays have attracted more and more attention in recent years for wave propagation attenuation and the corresponding vibration reduction. Conventional designs use resistive shunt (R-shunt) and resistor-inductor shunt (RL-shunt). An innovative metamaterial with a high-order resonant shunt circuit is proposed and investigated for vibration and wave propagation attenuation in this paper. The proposed high-order resonant shunt circuit can introduce two local resonances in series around the tuning frequency to broaden the attenuation bandwidth, or can create two separate resonances to achieve two separate bandgaps. Finite element modeling of the beam metamaterial with wave propagation and vibration in the transverse direction is established. Simulations have been conducted to compare the vibration attenuation performances among R-shunt, RL-shunt, and the proposed high-order shunt. An impedance-based method has been presented for the parameter design of electrical components in the proposed high-order shunt for bandgaps at two desired frequencies.

  18. Evaluation of Microbial Bacterial and Fungal Diversity in Cerebrospinal Fluid Shunt Infection

    PubMed Central

    Simon, Tamara D.; Pope, Christopher E.; Browd, Samuel R.; Ojemann, Jeffrey G.; Riva-Cambrin, Jay; Mayer-Hamblett, Nicole; Rosenfeld, Margaret; Zerr, Danielle M.; Hoffman, Lucas

    2014-01-01

    Background Cerebrospinal fluid shunt infection can be recalcitrant. Recurrence is common despite appropriate therapy for the pathogens identified by culture. Improved diagnostic and therapeutic approaches are required, and culture-independent molecular approaches to cerebrospinal fluid shunt infections have not been described. Objectives To identify the bacteria and fungi present in cerebrospinal fluid from children with cerebrospinal fluid shunt infection using a high-throughput sequencing approach, and to compare those results to those from negative controls and conventional culture. Methods This descriptive study included eight children ≤18 years old undergoing treatment for culture-identified cerebrospinal fluid shunt infection. After routine aerobic culture of each cerebrospinal fluid sample, deoxyribonucleic acid (DNA) extraction was followed by amplification of the bacterial 16S rRNA gene and the fungal ITS DNA region tag-encoded FLX-Titanium amplicon pyrosequencing and microbial phylogenetic analysis. Results The microbiota analyses for the initial cerebrospinal fluid samples from all eight infections identified a variety of bacteria and fungi, many of which did not grow in conventional culture. Detection by conventional culture did not predict the relative abundance of an organism by pyrosequencing, but in all cases, at least one bacterial taxon was detected by both conventional culture and pyrosequencing. Individual bacterial species fluctuated in relative abundance but remained above the limits of detection during infection treatment. Conclusions Numerous bacterial and fungal organisms were detected in these cerebrospinal fluid shunt infections, even during and after treatment, indicating diverse and recalcitrant shunt microbiota. In evaluating cerebrospinal fluid shunt infection, fungal and anaerobic bacterial cultures should be considered in addition to aerobic bacterial cultures, and culture-independent approaches offer a promising alternative

  19. [Syringomyelia secondary to adhesive arachnoiditis: clinical profiles and efficacy of shunt operations].

    PubMed

    Kamada, K; Iwasaki, Y; Hida, K; Abe, H; Isu, T

    1993-02-01

    The authors report nine cases of syringomyelia secondary to adhesive arachnoiditis treated in our institute from 1982 to 1991. Neurological signs, radiological features, and results of surgical treatment were reviewed. Common initial manifestations in association with syringomyelia were spastic paraparesis in 8 patients (88.9%), regional sensory loss in 4 (44.4%), neurogenic bladder in 4 (44.4%), and somatic pain in 2 (22.2%). All the neurological symptoms or signs progressed gradually for years. All the patients were treated with various modes of shunt operations, including syringo-peritoneal shunt in seven patients, syringo-subarachnoid shunt in one, and ventriculo-peritoneal shunt in one, respectively. Three patients who failed to resolve their major complaints after the first surgery further received syringo-peritoneal shunts. Postsurgical follow-up periods ranged from 18 months to 10 years. Serial MR imaging revealed a significant reduction of the size of syringomyelia in 8 of 9 patients. However only 6 patients showed certain improvement of neurological deficits. Three patients who failed to improve clearly had a long (beyond 15 years) history of syringomyelia before the first surgical treatment. A total of 11 syringo-peritoneal shunts were done in 8 patients of whom 5 patients improved neurologically. It was noticed that 4 of 5 successful syringo-peritoneal shunts were placed in the caudal level of the syrinx. In conclusion, syringo-peritoneal shunt may be at present an optimal mode of surgical management for syringomyelia secondary to adhesive arachnoiditis. In addition, we would like to recommend that follow-up serial MR imaging be done for patients having adhesive arachnoiditis in order to detect syringomyelia as early as possible.

  20. Superconducting FCL using a combined inducted magnetic field trigger and shunt coil

    DOEpatents

    Tekletsadik, Kasegn D.

    2007-10-16

    A single trigger/shunt coil is utilized for combined induced magnetic field triggering and shunt impedance. The single coil connected in parallel with the high temperature superconducting element, is designed to generate a circulating current in the parallel circuit during normal operation to aid triggering the high temperature superconducting element to quench in the event of a fault. The circulating current is generated by an induced voltage in the coil, when the system current flows through the high temperature superconducting element.

  1. Functional magnetic resonance imaging before and after ventriculoperitoneal shunting for hydrocephalus--case report.

    PubMed

    Fukuhara, T; Luciano, M G; Liu, J Z; Yue, G H

    2001-12-01

    A 70-year-old man with hydrocephalus was examined with functional magnetic resonance (fMR) imaging before and after ventriculoperitoneal shunting. Preoperatively, activation by right hand exercise revealed only a slight signal increase in the peri-rolandic area. However, 3 months after ventriculoperitoneal shunting, a significant signal increase was observed. fMR imaging may detect activity-related improvement of cerebral blood flow responses in patients with hydrocephalus after surgical treatment.

  2. Deletion of Rbpj from postnatal endothelium leads to abnormal arteriovenous shunting in mice

    PubMed Central

    Nielsen, Corinne M.; Cuervo, Henar; Ding, Vivianne W.; Kong, Yupeng; Huang, Eric J.; Wang, Rong A.

    2014-01-01

    Arteriovenous malformations (AVMs) are tortuous vessels characterized by arteriovenous (AV) shunts, which displace capillaries and shunt blood directly from artery to vein. Notch signaling regulates embryonic AV specification by promoting arterial, as opposed to venous, endothelial cell (EC) fate. To understand the essential role of endothelial Notch signaling in postnatal AV organization, we used inducible Cre-loxP recombination to delete Rbpj, a mediator of canonical Notch signaling, from postnatal ECs in mice. Deletion of endothelial Rbpj from birth resulted in features of AVMs by P14, including abnormal AV shunting and tortuous vessels in the brain, intestine and heart. We further analyzed brain AVMs, as they pose particular health risks. Consistent with AVM pathology, we found cerebral hemorrhage, hypoxia and necrosis, and neurological deficits. AV shunts originated from capillaries (and possibly venules), with the earliest detectable morphological abnormalities in AV connections by P8. Prior to AV shunt formation, alterations in EC gene expression were detected, including decreased Efnb2 and increased Pai1, which encodes a downstream effector of TGFβ signaling. After AV shunts had formed, whole-mount immunostaining showed decreased Efnb2 and increased Ephb4 expression within AV shunts, suggesting that ECs were reprogrammed from arterial to venous identity. Deletion of Rbpj from adult ECs led to tortuosities in gastrointestinal, uterine and skin vascular beds, but had mild effects in the brain. Our results demonstrate a temporal requirement for Rbpj in postnatal ECs to maintain proper artery, capillary and vein organization and to prevent abnormal AV shunting and AVM pathogenesis. PMID:25209249

  3. PI and fuzzy logic controllers for shunt Active Power Filter--a report.

    PubMed

    Karuppanan, P; Mahapatra, Kamala Kanta

    2012-09-01

    The authors acknowledge certain errors in their recently published paper titled "PI and fuzzy logic controllers for shunt active power filter--A report.The ambiguity in band width calculation of adaptive hysteresis controller and control aspects of dc-link voltage issues are addressed. The shunt APF system is validated through extensive simulation and the results are support features of the proposed technique.

  4. Bilateral papilledema as the first sign of ventriculoperitoneal shunt dysfunction§.

    PubMed

    Serna-Ojeda, Juan Carlos; Aguirre-Mireles, Montserrat; Camargo-Suarez, Mayra Fabiola

    2015-01-01

    A 12 year-old girl patient with a history of ventriculoperitoneal shunt placement at the age of 6 months presented with progressive bilateral decrease in visual acuity. Ophthalmologic examination was consistent with bilateral papilledema. No other systemic manifestations of increased intracranial pressure were evident and laboratory work-up excluded other inflammatory or infectious processes. We present here an interesting case of a patient with ophthalmologic manifestations as the initial finding of ventriculoperitoneal shunt dysfunction.

  5. Soluble membrane attack complex is diagnostic for intraventricular shunt infection in children

    PubMed Central

    Ramos, Theresa N.; Arynchyna, Anastasia A.; Blackburn, Tessa E.; Johnston, James M.

    2016-01-01

    BACKGROUND. Children treated with cerebrospinal fluid (CSF) shunts to manage hydrocephalus frequently develop shunt failure and/or infections, conditions that present with overlapping symptoms. The potential life-threatening nature of shunt infections requires rapid diagnosis; however, traditional microbiology is time consuming, expensive, and potentially unreliable. We set out to identify a biomarker that would identify shunt infection. METHODS. CSF was assayed for the soluble membrane attack complex (sMAC) by ELISA in patients with suspected shunt failure or infection. CSF was obtained at the time of initial surgical intervention. Statistical analysis was performed to assess the diagnostic potential of sMAC in pyogenic-infected versus noninfected patients. RESULTS. Children with pyogenic shunt infection had significantly increased sMAC levels compared with noninfected patients (3,211 ± 1,111 ng/ml vs. 26 ± 3.8 ng/ml, P = 0.0001). In infected patients undergoing serial CSF draws, sMAC levels were prognostic for both positive and negative clinical outcomes. Children with delayed, broth-only growth of commensal organisms (P. acnes, S. epidermidis, etc.) had the lowest sMAC levels (7.96 ± 1.7 ng/ml), suggesting contamination rather than shunt infection. CONCLUSION. Elevated CSF sMAC levels are both sensitive and specific for diagnosing pyogenic shunt infection and may serve as a useful prognostic biomarker during recovery from infection. FUNDING. This work was supported in part by the Impact Fund of Children’s of Alabama. PMID:27699221

  6. The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery.

    PubMed

    Jain, Gaurav; Mukerji, Gaurav; Dixit, Anupam; Manshani, Novin; Yadav, Y R

    2007-11-01

    Undernutrition is common in surgical patients, is frequently unrecognised and is strongly associated with adverse outcomes such as high rates of complications and mortality, worsening functional status and prolonged hospitalisation. Owing to the associated infection and symptoms such as repeated vomiting, a high prevalence of undernutrition is expected in hydrocephalus patients, which may contribute to their poor surgical outcomes. The aim of this study was to evaluate the influence of preoperative nutritional status on the outcome of Indian patients with hydrocephalus undergoing neurosurgical shunt surgery. One hundred and twenty-four consecutive patients undergoing scheduled hydrocephalus shunt surgery were studied prospectively. All patients underwent nutritional screening according to different parameters prior to surgery. The patients were classified into normally nourished and undernourished groups. The undernourished group was further subdivided into moderately and severely undernourished. The surgical outcome was compared between these groups. A high prevalence (53%) of undernutrition was observed in these patients. Postoperative complications such as shunt infection (P = 0.0023), shunt revision (P = 0.0074) and mortality (P = 0.0003) were significantly more common in undernourished patients compared with normally nourished patients. Serum albumin emerged as the most significant independent predictor of postoperative mortality. The present study demonstrated a high prevalence of undernutrition in hydrocephalus patients in India and its adverse influence on the outcome of shunt surgery. Early preoperative nutritional status screening and its optimisation may decrease the morbidity and mortality of shunt surgery for hydrocephalus.

  7. Gender-dependent reduction of spontaneous motor activity and growth in rats subjected to portacaval shunt.

    PubMed

    Conjeevaram, H S; Mullen, K D; May, E J; McCullough, A J

    1994-02-01

    Alterations in behavior are frequently described in rats subjected to portacaval shunt. Previous work has reported reduced spontaneous motor activity in various settings (nighttime, red light, decreased illumination) in this animal model. We investigated this phenomenon in rats of both genders subjected to portacaval shunt to determine whether our previously observed divergent growth patterns (males reduced, females unchanged) had any impact on the alterations in spontaneous motor activity in this model. Dietary intake, growth, motor activity and serum ammonia and amino acid concentrations were measured, in addition to final liver and spleen weights, in each animal after 3 to 4 wk of observation. Our results reconfirm the differential impact of portacaval shunt on growth in male (35% reduction p < 0.01) but not female rats (5% reduction, NS) compared with their respective-gender sham-operated controls. In addition, spontaneous motor activity was significantly reduced in male (congruent to 50%, p = 0.01) but not female rats subjected to portacaval shunt. The reduction of activity in male rats subjected to portacaval shunt did not correlate with any of the measured biochemical data or calculated nutritional/growth parameters. Thus we observed gender-dependent reduction in spontaneous motor activity after portacaval shunt in the rat. The mechanism for this phenomenon is unknown, but it is easily investigated with this reproducible model.

  8. Bucket and straw technique to facilitate passage of a ventriculoperitoneal shunt through the distal tunneling sheath.

    PubMed

    Downes, Angela E; Vandergrift, William A; Beckman, Joshua M; Truong, Devon; Tuite, Gerald F

    2014-12-01

    Placement of a ventriculoperitoneal shunt (VPS) is a procedure comprising many small steps. Difficulties and delays can arise when passing the distal shunt tubing down the distal tunneling sheath during surgery. The authors of this report describe a simple technique for quickly passing the distal catheter of a VPS through the tunneler sheath, whereby the sheath is used as a fluid tube to allow the distal catheter to be drawn through the fluid tube under suction pressure. The plastic sheath that surrounds the shunt tunneler device is used as a fluid tube, or "straw," with the proximal aperture submerged into a bucket of sterile irrigation liquid containing the distal catheter. Suction pressure is placed against the distal aperture of the tunneler, and the shunt catheter is quickly drawn through the sheath. No special equipment is required. In time trials, the bucket and straw technique took an average of 0.43 seconds, whereas traditional passage methods took 32.3 seconds. The "bucket and straw" method for passing distal shunt tubing through the tunneler sheath is a technique that increases surgical efficiency and reduces manual contact with shunt hardware.

  9. Prevention options for ventriculoperitoneal shunt infections: a retrospective analysis during a five-year period

    PubMed Central

    Wu, Xing; Liu, Qin; Jiang, Xiaofei; Zhang, Tao

    2015-01-01

    Shunt infection is the most common and dreaded complication in patients with hydrocephalus. For the purpose of reducing the high morbidity and mortality, how to prevent is a vital step. A retrospective analysis of 384 CSF cerebrospinal fluid (CSF) shunt procedures was undertaken from 2006 to 2010 in our neurosurgery department. Infection diagnosis was established by subjecting the CSF to biochemical and microbiological parameters. The patients’ demographic and clinical characteristics, various treatment procedures and outcome were evaluated. The infection rate of ventriculoperitoneal (VP) shunt was 12.5% in 2006, which dropped to 2% and stabilized at lower level from 2008. The most common causes of hydrocephalus were traumatic injury and brain tumor. Fever and consciousness disturbance were the major clinical symptoms. Gram-negative rods episodes was the most frequently isolated microorganisms accounting for 58%, followed by S. aureus , S. epidermidis and Staphylococcus haemolyticus. With the removal of shunt and intravenous antibiotics therapy, 82% of the patients survived. Majority of the isolates were sensitive to the carbopenem antibiotics and vancomycin. The mean length of hospital stay was 47 days. Prompt shunt removal and perioperative antibiotic prophylaxis seems to be essential for the survival of patients with VP shunt infection. PMID:26770643

  10. Shunt for bypass graft of the cavernous carotid artery: an anatomical and technical study.

    PubMed

    al-Mefty, O; Khalil, N; Elwany, M N; Smith, R R

    1990-11-01

    During direct surgery of neoplastic and vascular lesions of the cavernous sinus, the intracavernous carotid artery may be injured beyond repair, or its total isolation may be necessary for surgical management of these lesions. The newly developed procedure of a saphenous vein graft bypass of the cavernous carotid artery allows re-establishment of carotid circulation. Patients with poor collateral circulation are at high risk for ischemic complications induced by the prolonged temporary occlusion required to perform the bypass graft. Optimal management of these patients is to perform the venous bypass graft for permanent vascularization while maintaining carotid cerebral circulation through an intraoperative shunt. We studied this procedure in cadavers, and three shunt types were evaluated: the external intrapetrous-supraclinoid shunt (Type A), the internal intrapetrous-supraclinoid shunt (Type B), and the neck internal carotid-supraclinoid shunt (Type C). Anatomical landmarks, techniques, distances, caliber, and materials used are presented. The rationale and candidates for such a procedure are discussed. The specifications of an optimal balloon shunt are presented, and the three procedures are compared.

  11. Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement

    PubMed Central

    Tulipan, Noel; Wellons, John C.; Thom, Elizabeth A.; Gupta, Nalin; Sutton, Leslie N.; Burrows, Pamela K.; Farmer, Diana; Walsh, William; Johnson, Mark P.; Rand, Larry; Tolivaisa, Susan; D’Alton, Mary E.; Adzick, N. Scott

    2016-01-01

    Object The Management of Myelomeningocele Study (MOMS) was a multicenter randomized trial comparing the safety and efficacy of prenatal and postnatal closure of myelomeningocele. The trial was stopped early because of the demonstrated efficacy of prenatal surgery, and outcomes on 158 of 183 pregnancies were reported. Here, the authors update the 1-year outcomes for the complete trial, analyze the primary and related outcomes, and evaluate whether specific prerandomization risk factors are associated with prenatal surgery benefit. Methods The primary outcome was a composite of fetal loss or any of the following: infant death, CSF shunt placement, or meeting the prespecified criteria for shunt placement. Primary outcome, actual shunt placement, and shunt revision rates for prenatal versus postnatal repair were compared. The shunt criteria were reassessed to determine which were most concordant with practice, and a new composite outcome was created from the primary outcome by replacing the original criteria for CSF shunt placement with the revised criteria. The authors used logistic regression to estimate whether there were interactions between the type of surgery and known prenatal risk factors (lesion level, gestational age, degree of hindbrain herniation, and ventricle size) for shunt placement, and to determine which factors were associated with shunting among those infants who underwent prenatal surgery. Results Ninety-one women were randomized to prenatal surgery and 92 to postnatal repair. The primary outcome occurred in 73% of infants in the prenatal surgery group and in 98% in the postnatal group (p < 0.0001). Actual rates of shunt placement were only 44% and 84% in the 2 groups, respectively (p < 0.0001). The authors revised the most commonly met criterion to require overt clinical signs of increased intracranial pressure, defined as split sutures, bulging fontanelle, or sunsetting eyes, in addition to increasing head circumference or hydrocephalus. Using

  12. Histologic progression in non-hodgkin's lymphoma

    SciTech Connect

    Hubbard, S.M.; Chabner, B.A.; DeVita, V.T., Jr.; Simon, R.; Berard, C.W.; Jones, R.B.; Garvin, A.J.; Canellos, G.P.; Osborne, C.K.; Young, R.C.

    1982-02-01

    The clinical course and biopsy specimens from 515 consecutive non-Hodgkin's lymphoma patients was evaluated retrospectively in an attempt to determine the clinical importance of documented changes in histology over time. Two-hundred and five of these patients has an initial diagnosis of nodular lymphoma and were reviewed for this anaysis. Sixty-three underwent a repeat biopsy greater than 6 mo after initial diagnosis. In 23 patients, these repeat biopsies revealed a change in histology to a diffuse pattern and/or a change to a larger ''histiocytic'' cell type, while repeat biopsies for the other 40 (63%) disclosd persistence of a nodular pattern and no clear change in basic cell type. Progression from nodular lymphoma to diffuse histiocytic, mixed, or undifferentiated types of lymphomas of Rappaport was found in repeate biopsies obtained from 19 patients (30%). Prognosis for survival following a biopsy that demonstrated histologic change was related to the histology demonstrated at the most recent biopsy and to the response to subsequent drug treatment. Survival following repeat biopsy for these 19 patients was significantly shorter than for the 40 patients whose histology remained nodular (p < 0.001). However, attainment of a complete remission with intensive combination chemotherapy was associated with prolonged survival in eight patients and prolonged disease-free survival in one patient. Since prior treatment may compromise the ability to achieve a complete response to chemotherapy in patients with nodular lymphoma who develop an aggressive diffuse histology, the likelihood of histologic progression must be considered in the design of future clinical trials in nodular lymphoma. Histologic progression does not preclude attainment of a complete response to intensive chemotherapy.

  13. Graphs and Grammars for Histology: An Introduction

    PubMed Central

    Prewitt, Judith M. S.

    1979-01-01

    The invention of the microscope disclosed a whole new world, that of the hitherto invisibly small. Histologic evidence as revealed by the microscope has become a cornerstone of medical diagnosis, and efforts are now being made to lay foundations so that the medical visual information processing burden can be alleviated significantly by cost-effective automation. This paper lays image processing foundations by presenting a graph-theoretic and syntactic model for the analysis of histologic patterns, and presents results to date.

  14. Diagnostic dry bone histology in human paleopathology.

    PubMed

    de Boer, H H Hans; Van der Merwe, A E Lida

    2016-10-01

    Paleopathology is the study of trauma and disease as may be observed in ancient (human) remains. In contrast to its central role in current medical practice, microscopy plays a rather modest role in paleopathology. This is at least partially due to the differences between fresh and decomposed (i.e., skeletonized or "dry bone") tissue samples. This review discusses these differences and describes how they affect the histological analysis of paleopathological specimens. First, we provide a summary of some general challenges related to the histological analysis of palaeopathological specimens. Second, the reader is introduced in bone tissue histology and bone tissue dynamics. The remainder of the paper is dedicated to the diagnostic value of dry bone histology. Its value and limitations are illustrated by comparing several well-studied paleopathological cases with similar contemporary, clinical cases. This review illustrates that due to post-mortem loss of soft tissue, a limited number of disorders display pathognomonic features during histological analysis of skeletonized human remains. In the remainder of cases, histology may help to narrow down the differential diagnosis or is diagnostically unspecific. A comprehensive, multidisciplinary diagnostic approach therefore remains essential. Clin. Anat. 29:831-843, 2016. © 2016 Wiley Periodicals, Inc.

  15. Effects of isradipine and other calcium antagonists on arteriovenous-shunt flow in anesthetized rabbits and cats

    SciTech Connect

    Hof, R.P.

    1989-04-17

    The effects of vasodilators on arteriovenous (AV)-shunt flow was investigated in anesthetized cats and rabbits, using the tracer microsphere method. In cats, the calcium antagonist isradipine reduced AV-shunt flow; verapamil showed a similar tendency and nicardipine was without effect. Dihydralazine strongly increased, but nitroglycerin and dipyridamole decreased AV-shunt flow. In rabbits, the effects of isradipine and verapamil were similar to those seen in cats. Sodium nitroprusside had no effect, whereas prazosin, minoxidil, and the potassium-channel activator cromakalim increased AV-shunt flow. The contrasting effects of drugs sharing the same mechanism of action suggest that target-tissue selectivity is more important than the mechanism of action. An increase of AV-shunt flow is unlikely to be beneficial but could be associated with a number of undesirable side effects. It might negatively affect migraine sufferers and, if AV-shunt dilatation shows no tolerance development, it represents an unnecessary hemodynamic burden for the heart.

  16. Shunt detection with the short-lived radioactive gases.

    PubMed

    Watson, D D

    1980-01-01

    Conventional radionuclide techniques are limited by their inability to deliver noninvasively a compact bolus of radionuclide indicator into the left heart. This can be accomplished by the inhalation of oxygen-15-labeled carbon dioxide. The inhaled carbon dioxide passes freely across the alveolar membrane and enters the carbonate cycle, which, under the accelerating influence of carbonic anhydrase, transfers the oxygen-15 tracer onto water in the pulmonary venous blood. The result is an abrupt tracer delivery to the pulmonary venous system with subsequent tracer input to the left heart at a rate limited only by the pulmonary blood flow. These properties of oxygen-15-labeled carbon dioxide have been used to develop a specialized indicator-dilution method for quantitation of left-to-right cardiac shunt flow. The results agree well with those obtained by oxymetry at cardiac catheterization. In clinical application, the ease and reliability of this technique are remarkable. Its use is presently limited to clinical facilities with the capability for on-line production of the short-lived gases. The techniques provide a good example of the utilization of biologically active radiopharmaceuticals and are a potentially useful source of information about the hemodynamic properties of the central circulatory system.

  17. Integrated fuel cell stack shunt current prevention arrangement

    DOEpatents

    Roche, Robert P.; Nowak, Michael P.

    1992-01-01

    A fuel cell stack includes a plurality of fuel cells juxtaposed with one another in the stack and each including a pair of plate-shaped anode and cathode electrodes that face one another, and a quantity of liquid electrolyte present at least between the electrodes. A separator plate is interposed between each two successive electrodes of adjacent ones of the fuel cells and is unified therewith into an integral separator plate. Each integral separator plate is provided with a circumferentially complete barrier that prevents flow of shunt currents onto and on an outer peripheral surface of the separator plate. This barrier consists of electrolyte-nonwettable barrier members that are accommodated, prior to the formation of the integral separator plate, in corresponding edge recesses situated at the interfaces between the electrodes and the separator plate proper. Each barrier member extends over the entire length of the associated marginal portion and is flush with the outer periphery of the integral separator plate. This barrier also prevents cell-to-cell migration of any electrolyte that may be present at the outer periphery of the integral separator plate while the latter is incorporated in the fuel cell stack.

  18. Geometric Studies of Shunt and Lead Orientation in EEC Devices

    NASA Astrophysics Data System (ADS)

    Werner, F. M.; Solin, S. A.

    2014-03-01

    Electric field sensors are ubiquitous in modern technology, from field effect transistors (FETs) in circuit boards to point-of-care testing (POCT) devices used in detecting the presence of specific protein markers in blood. The transport properties of these devices are limited by two general categories: intrinsic material properties and extrinsic geometric effects. Devices with a maximum electric field resolution of 3.05V/cm were previously reported. The metal semiconductor hybrid (MSH) devices are constructed by forming a Schottky interface between a mesa of nGaAs and Ti, while four ohmic leads surround the perimeter of the mesa and are used for four point resistance measurements. These devices exhibit extraordinary electroconductance (EEC) and make it possible to correlate measured four point resistance to changes in the local electric field. While maximizing the EEC response by optimizing the intrinsic material properties has been theoretically investigated, we present a phenomenological study of the impact of lead orientation and shunt geometry in the sensing capabilities of these devices. S.A.S. is a co-founder of and has a financial interest in PixelEXX, a start-up company whose mission is to market imaging arrays.

  19. Vision Loss and Recovery after Baerveldt Aqueous Tube Shunt Implantation

    PubMed Central

    Kim, Esther Lee; Tran, Jeffrey; Töteberg-Harms, Marc; Chahal, Jasdeep; Rhee, Douglas

    2017-01-01

    This study aims to determine the course of vision loss after Baerveldt aqueous tube shunt placement and identify risk factors associated with unexplained severe long-term vision loss, or snuff-out. We retrospectively reviewed 247 eyes of 222 patients who underwent Baerveldt implantations at one of two academic institutions. Postoperative vision loss at 6 months following surgery was categorized as mild-to-moderate versus severe and long-term versus transient. Long-term vision loss, defined as 3 or more lines of Snellen visual acuity (VA) loss compared with preoperative VA, occurred in 63 of 247 eyes (25.5%), and 39 had mild-to-moderate and 24 had severe loss. Of these 63 eyes, 18 had no identifiable cause of vision loss. On multivariate analysis, poorer Snellen VA on postoperative day 1 (POD1) was found to be a significant risk factor for long-term vision loss (p = 0.005). In addition, the negative change in preoperative versus POD1 Snellen VA (p = 0.021) and the presence of split fixation involving the inferonasal quadrant on preoperative Humphrey visual field (p = 0.044) were significant risk factors for snuff-out. Transient vision loss occurred in 76 of 242 eyes (30.8%). In conclusion, vision loss is not uncommon after Baerveldt surgery, with snuff-out occurring in 2.4% of cases in this study. PMID:28197338

  20. Hyperglucagonemia and hyperkinetic circulation after portocaval shunt in the rat

    SciTech Connect

    Kravetz, D.; Arderiu, M.; Bosch, J.; Fuster, J.; Visa, J.; Casamitjana, R.; Rodes, J.

    1987-02-01

    The study was aimed at investigating whether increased portal venous inflow (PVI) after portocaval shunt (PCS) in the rat is the result of selective splanchnic vasodilatation or whether it is part of a generalized circulatory disturbance. Rats with PCS and sham-operated controls were studied 2 wk after surgery by measuring cardiac output (CO), PVI, and hepatic artery flow (HAF) with radioactive microspheres (V Cr and UC). Plasma glucagon (GL) was measured by radioimmunoassay. PCS rats had increased CO and reduced arterial pressure and total peripheral resistance. PVI was markedly increased, but this appeared to be part of a generalized circulatory disturbance, since when PVI is expressed as percent of CO no difference is observed between PCS and sham-operated rats, indicating the absence of a preferential splanchnic vasodilatation. GL increased after PCS, and significant correlations were observed between GL and CO and between GL and PVI. HAF increased after PCS but did not compensate the loss of portal flow, evidence by a lower total hepatic flow in PCS rats. These results suggest that PCS induces a hyperkinetic circulatory state in which increased PVI represents its splanchnic manifestation and that increased GL release may be in part responsible for these hemodynamic changes.