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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Determination of cerebrospinal fluid shunt patency with water-soluble contrast medium is a simple, rapid, reliable, and safe technique. Since September, 1974, the authors performed 113 examinations. With the Spitz-Holter valve, only the atrial catheter can be studied, but, with the Pudenz valve and with the shunting devices that have a double-dome reservoir, both the proximal and the distal catheter can be visualized. Through the ventricular catheter a full ventriculographic study can be made, demonstrating ventricular size, malposition of the catheter, and the lesion that caused the hydrocephalus, or its evolution. The problem of collapsed ventricules, in which clinical and "manual" evaluation of the flushing device can give misleading findings, is emphasized. The injection of the atrial or peritoneal catheter in the pathological cases demonstrated its blockage, level of disconnection, malposition, sleeve, or cyst formation. Computerized tomography has only slightly decreased the number of these studies: when the ventricles are large, the examination with water-soluble contrast medium is still needed to demonstrate the exact level of malfunction. This demonstration has decreased the number of the total revisions complete changes of shunting systems, eliminating some unnecessary changes of normally functioning catheters.
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PMID:Determination of cerebrospinal fluid shunt function with water-soluble contrast medium. 30 97

The authors have developed a simplified technique of lumbar subarachnoid peritoneal shunt in which the spinal tube is easily introduced through a puncture needle without doing a laminectomy. Seventeen cases of communicating hydrocephalus of various orgin have been treated by this procedure. In this paper, we reported our shunting system and the technique of precedures, and discussed the clinical results and some advantages of this method. The spinal tube is a custom made Silastic tube with small side holes 2 mm apart from each other at slanting tip located within the first 1.0 cm of the end. French No. 5 tube is available for older children and for adults, and French No. 3.6 tube for infants. Total length of the tube measures 30 cm with 4 black markers at 5 cm intervals from the tip for assisting in positioning. The puncture needle is a modified Touhey needle. Two needles different in size are prepared according to the size of the tube. Outer diameter of these needles is 2.1 mn & 1.8 mn. Our operative procedures are divided into following three steps. 1) Puncture of the lumbar subarachnoid space and insertion of the spinal tube through the needle. 2) Introduction and placement of the peritoneal tube into some point of the peritoneal cavity. Concerning to this point, we have the three candidates, namely into the Douglas pouch, the suprahepatic space, and the bursa omental cavity. 3) Connection of the spinal tube and the peritoneal catheter end. We used a kind of flushing device only in some exceptional cases, and recently, we feel that it is not so necessary for this shunting. We have employed this technique in a total of 17 cases. Eleven cases of them are adults and the other 6 cases are children less than 2 years of age. Postoperative follow up period varied from 13 months to 1 month, and all the cases except two had good result, suggesting the shunt system is working well with no evidence of complications such as low pressure syndrome or radicular irritation. Some troubles occurred in two children. One was a disconnection between the spinal and the peritoneal tube, and the other was an obstruction at the peritoneal tube end. The authors believe that our L-P shunt has several advantages as listed below, 1)Procedure is very simple, in other words, there is no need of laminectomy. 2) The entire system is short. 3) No need to pass the catheter into the brain tissue. 4) Obstruction of the spinal catheter end is very unusual. 5) Alteration of communicating hydrocepalus into non communicating one by secondary obstruction of aqueduct of Sylvius is less likely with this shunting system. 6) Siphon effect might be minimal, if present. 7) As compared to V-A shunt, severe complication like septicemia will not occur in the L-P shunt. With this simple method and good material, we hope that this L-P shunt is employed more widely for the patients with communicating hydrocephalus.
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PMID:[Simplfied technique of lumbar subarachnoid-peritoneal shunt (author's transl)]. 55 43

Experience with a continuous-pressure controlled, external ventricular drainage system (EVD) in 100 patients (n = 49 female, n = 51 male; mean age, 56.3 yr) with acute hydrocephalus is reported. Cerebrospinal fluid circulation disturbances resulted from hemorrhages caused by subarachnoid hemorrhage (n = 45), parenchymal hemorrhages from angioma (n = 4), anticoagulants (n = 7), or hypertension or other reasons (n = 30); in addition, hydrocephalus developed from infections (n = 3), tumors (n = 2), infratentorial infarction (n = 5), or unknown reasons (n = 4); 52 patients had ventricular hemorrhages. No patient died of system-associated morbidity. Mean time of EVD treatment was 9.5 days, with 40 patients being treated for 10 to 29 days; routine refobacin (5 mg) flushing of the system was performed three times a day. Patients without cerebrospinal fluid leakage had a 2% rate of secondary infection compared with 13% in patients with cerebrospinal fluid leakage due to ventricular catheter placement (P < 0.05; overall infection rate, 5%). A clinical mortality rate of 29% during EVD treatment was observed in subarachnoid hemorrhage patients (Hunt and Hess Grades II, III, IV, and V; n = 9, 9, 18, and 9, respectively); recurrent hemorrhages during EVD treatment occurred in 19 patients (26 hemorrhages), and of these, 10 patients died. System occlusion was seen in 19 cases (12 of 45 patients with subarachnoid hemorrhage), requiring catheter and system renewal in 1 case; system extraction was seen in 3 cases, misplacement was seen in 11 cases, and disconnection was seen in 5 cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus--evaluation of risk factors. 143 14

The changes in daytime levels of melatonin (MLT) in the cerebrospinal fluid (CSF) of twenty seven hydrocephalic patients were studied by the high-performance liquid chromatography (HPLC) method. Patients comprised three with congenital hydrocephalus (spina bifida 1, Chiari type II malformation 2), four post-meningitic hydrocephalus, fifteen brain tumors (chiasmal germinoma 3; malignant glioma of frontal 3, and temporal lobes 1; germinoma 1, teratoma 2, yolk sac tumor 1, epidermoid 1 in pineal region) and five cases of normal pressure hydrocephalus. CSF was collected between 0930 and 1030 h through puncture of the flushing device of shunt system or the lateral ventricle. The lowest value of MLT detected by HPLC was 15 pg/ml. Melatonin values were higher in patients aged under 10 years than over 20 years in the absence of meningitis or tumor in the pineal region. Even at ages over 15 years, higher CSF MLT values were obtained in the patients with meningitis or tumors in the pineal region. These results suggest that the inflammation or invasion of tumor into the pineal gland may stimulate the secretion of MLT by the pineal gland. However, lower MLT values were obtained in all patients over 40 years old. For these reasons, if one may use the changes of MLT values in CSF as a tumor marker or for determination of the treatment modality, time of CSF collection, age of patient, location or character of the tumor and presence of meningitis should be given due consideration. Also, the presence or absence of the rhythmical changes of melatonin values in a day following circadian rhythm are very important in determination of the treatment modality.
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PMID:[The studies of melatonin values in the cerebrospinal fluid of hydrocephalic patients]. 191 Sep 47

A case of hydromyelia (syringomyelia) combined with hydrocephalus is presented. The patient was a 17-year-old-boy. He was a admitted to our hospital because of disturbance of fine movement of the right hand. Neurological examinations showed right hemiparesis, right upper muscle atrophy and sensory dissociation of C1-T2 dermatomes. This dissociated sensory impairment gradually deteriorated. CT scan performed 3 and 6 hours after the intrathecal injection of metrizamide revealed an intramedullary syrinx extending between C1 and T4 vertebral levels and communicating with the 4th ventricle. Ventriculo-peritoneal shunt with a multipurpose flushing device was done and at the same time continuous intracranial pressure (ICP) monitoring was done on- and off-state of shunt system. When the shunt was closed, B wave (systoric pressure: 40 mmHg) appeared frequently. When the shunt was opened, B wave disappeared and resting pressure and pulse pressure decreased. The signs and symptoms of this patient improved after placement of the V-P shunt. These results supported Gardner's hydrodynamic theory of hydromyelia (syringomyelia).
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PMID:[Hydromyelia combined with hydrocephalus]. 395 65

Fifteen patients with recalcitrant cerebrospinal fluid (CSF) fistula underwent the insertion of a lumboperitoneal shunt. The shunt consists of a two-piece Silastic tube and has been used in a population of 150 patients with communicating hydrocephalus, persistent postoperative meningocele, and benign intracranial hypertension. The spinal catheter is introduced subcutaneously and no flushing device is used. We studied three groups: 9 patients had a history of head trauma, and 7 of these had undergone one or several ineffective direct approaches to the dural leak. Four patients presented with a presumably congenital fistula. Two patients had persistent rhinorrhea due to previous intracranial procedures. Indium-111 cisternography was performed in 10 patients before lumboperitonel (LP) shunting and failed in 2 of those to document the site of leakage. Twelve patients showed cessation of rhinorrhea after LP shunting. In 4 of these, shunt-related complications responded to shunt removal with no further recurrence of rhinorrhea. Two patients underwent revision of the shunt. In 3 patients, the LP shunt failed to control the CSF leak and further intracranial procedures were indicated. The LP shunt provides an attractive and technically simple solution when direct methods of treatment have failed. Additionally, LP shunting should be considered as a primary mode of treatment in elderly patients or when impairment of CSF dynamics is documented by radionuclide cisternography and computed tomographic scanning. When an LP shunt is ineffective, shunt function should be checked by isotopic studies before additional surgery is performed.
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PMID:Treatment of cerebrospinal fluid rhinorrhea by percutaneous lumboperitoneal shunting: review of 15 cases. 397 11

Different procedures have been since 1965 by the authors to test with isotopes the patency of shunts for hydrocephalus. The authors now measure the time 99m Technetium takes to appear in the thyroid gland after injection in the flushing device. This method shows easily and very quickly, with no computing, the dynamics of C.S.F. shunts. No hospitalisation is necessary and it is often possible to determine the cause of the disturbance in the shunt.
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PMID:[Sequential scintiscans. An easy method for testing C.S.F. shunts]. 713 75

In view of complications arising from physical properties of cerebrospinal fluid shunts, a biomechanical model of hydrocephalus was set up to study in vivo parameters that may influence their function. These include: intracranial pressure, compliance and pulses, intrathoracic, intra-abdominal, and subcutaneous pressures, and the effects of siphonage and repeated valve flushing. Each of these factors was studied separately upon shunt implantation in the model. Results of testing of a sample low-pressure valve with antisiphon device conformed with consumer information in regard to valve opening pressure and pressure flow measurements. No customer information, however, was supplied concerning the deleterious effects of direct subcutaneous pressure, variable degrees of siphonage, and repeated valve flushing that were demonstrated by the model. Such results indicate that shunts should be similarly tested prior to marketing and implantation in patients.
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PMID:A nonlinear biomechanical model for evaluation of cerebrospinal fluid shunt systems. 795 99

Hydrodynamic properties of hydrocephalus shunts are not always properly characterized by the manufacturer. Therefore, the choice of the shunt should be made, by matching performance of the shunt to the disturbed profile of CSF circulation of a given patient. The aim of the present shunt evaluation study is to evaluates all types of shunts presently in use in the U.K. and make this information available to neurosurgeons. Ten most common models of valves have been tested to date: Medtronik PS Medical: Delta Valve, Flow Control Valves and Lumbo-Peritoneal Shunt, Heyer-Schulte: In-line, Low Profile and Pudenz Flushing Valve, Codman: Medos-Programmable, Hakim-Precision, Sophy Programmable Valve, Cordis Orbis-Sigma. Our results show the majority of valves have low hydrodynamic resistance (exception: PS Lumboperitoneal, Orbis-Sigma), which increase by 100-200% after connection of a long distal catheter. A few shunts with siphon-preventing mechanism (Delta, Hayer-Schulte Low Profile, Pudenz-Flushing) offer reasonable resistance to negative outlet pressures, however, these valves may be blocked by raised subcutaneous pressure. All programmable valves are susceptible to siphoning. Programmed settings may be changed by external magnetic field.
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PMID:Hydrodynamic properties of hydrocephalus shunts. 977 23

This report documents clinical features in five children who developed transient reddening of the skin (epidermal flushing) in association with acute elevations in intracranial pressure (ICP). Four boys and one girl (ages 9-15 years) deteriorated acutely secondary to intracranial hypertension ranging from 30 to 80 mm Hg in the four documented cases. Two patients suffered from ventriculoperitoneal shunt malfunctions, one had diffuse cerebral edema secondary to traumatic brain injury, one was found to have pneumococcal meningitis and hydrocephalus, and one suffered an intraventricular hemorrhage and hydrocephalus intraoperatively. All patients were noted to have developed epidermal flushing involving either the upper chest, face, or arms during their period of neurological deterioration. The response was transient, typically lasting 5 to 15 minutes, and dissipated quickly. The flushing reaction is postulated to be a centrally mediated response to sudden elevations in ICP. Several potential mechanisms are discussed. Flushing has clinical importance because it may indicate significant elevations in ICP when it is associated with neurological deterioration. Because of its transient nature, the importance of epidermal flushing is often unrecognized; its presence confirms the need for urgent treatment.
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PMID:Flushing in relation to a possible rise in intracranial pressure: documentation of an unusual clinical sign. Report of five cases. 1083 68


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