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Premature very-low-birth-weight infants with posthemorrhagic hydrocephalus are often managed with intermittent cerebrospinal fluid drainage from a ventricular reservoir. There are little data regarding intracranial pressure changes during intermittent drainage to determine the amount and frequency of cerebrospinal fluid removal or to determine the correct resistance of future programmable shunts. The objective of this study was to determine the feasibility of using a commercially available intracranial pressure transducer to measure changes in pressure associated with this procedure. Continuous intracranial pressure was measured in three infants with a transducer placed at the time of ventricular reservoir insertion. Daily reservoir taps began 48 hours after placement and intracranial pressure was monitored for 7 days. Intracranial pressure before the initial tap was comparable to levels previously reported as normal. The daily removal of 10 cc/kg of cerebrospinal fluid was sufficient to lower intracranial pressure below baseline, however it was associated with wide swings in pressure and, in one patient, sustained negative pressure. The use of direct intracranial pressure monitoring may be useful in determining the optimal amount and frequency of cerebrospinal drainage from infants with posthemorrhagic hydrocephalus managed with a ventricular reservoir, as well as determining resistance settings of subsequent programmable shunts.

The efficiency of the M. E. Müller acetabular roof reinforcement ring is documented on 141 patients with 150 operated hips since 1976 with a minimal clinically and radiologically follow-up of 6 years. The metal backing of the cup prevented cranial migration and protrusion almost completely. After 1982, when a bone bank with frozen femoral heads was established, the loss of bone stock was replaced with allograft, which can be fixed sufficiently with the reinforcement ring. In revision arthroplasty with bone stock of poor quality and quantity the acetabular roof reinforcement ring is a good method to reconstruct the acetabulum.

In order to assess the complication rates of cerebrospinal fluid diversion techniques used at our institution, a retrospective study of the surgical management of posthemorrhagic hydrocephalus was conducted from a population of 547 premature infants admitted to the neonatal intensive care unit from 1987 to 1989. The incidences of periventricular-intraventricular hemorrhage in the 3 years studied were 44%, 37%, and 27%, respectively. Thirty-nine of the infants developed posthemorrhagic hydrocephalus as determined by serial cranial ultrasonography; 22 required cerebrospinal fluid diversion. During the study period, we began using subcutaneous ventricular reservoirs and a low-pressure Neonatal Shunt (customized device) in infants weighing less than 1500 g at the time of instrumentation. This change in management was associated with a significant reduction (P < 0.005) in the morbidity and mortality compared to the use of external ventricular drainage devices. On the basis of these findings, the use of external ventricular drainage devices was discontinued.

This paper is concerned with the causes of spontaneous abortion in a sample of 200 pregnancies induced by artificial insemination. In particular it examines the importance of the following factors: existing disorders in the woman's menstrual cycle, the influence of hormone treatment during the conception cycle, the age of the woman treated, and the type of semen used. Of the 200 pregnancies in our treatment sample 27 terminated in abortions (13.5%). Clinical examination before treatment established the presence of menstrual disorders in 69 of 180 women to be treated: 23.9% exhibited corpus luteum deficiency, 12% anovular cycles, and 2% oligomenorrhea. On the basis of this preliminary examination the principal cause of abortion proved to be an existing corpus luteum deficiency, since 15 of the 27 abortions occurred in women with this type of menstrual disorder. Our observations show that it is important when performing artificial insemination to correct the patient's existing menstrual disorders by means of hormone treatment. This emerges from the following figures: In 26 cases without hormone treatment the incidence of abortion was 35%. In 174 cases that received hormone treatment during the successful cycle only 18 abortions occurred (an incidence of 10.3%). Breaking down hormone treatment into 6 basic types, we get incidences of abortion ranging from 0 to 25% in the different groups. Dividing the treatment sample into age groups reveals an 11 to 14% incidence of abortion in the 30 to 34 age group; in the 35 to 40 group age group the incidence doubles to 26%. Whereas existing menstrual disorders and adequate hormone treatment significantly influence the incidence of abortion, there is no close relationship between incidence of abortion and the type of semen used. The innocuousness of using deep-frozen semen with an admixture of glycerine has been shown by various authors reporting on laboratory and clinical investigations. For 117 pregnancies induced purely with deep-frozen semen we had an incidence of abortion of 13.7%. This figure is of the same order as the incidence of abortion in pregnancies induced by insemination with fresh semen. The results obtained permit one to conclude that incidence of abortion is not significantly dependent on the type of semen used. Our work demonstrates the importance of assessing the patient's genital constitution from both the functional and the organic points of view, not merely in order to achieve conception but also for the purposes of preventing abortion by means of the appropriate hormone treatment. If satisfactory therapeutic results are to be achieved candidates for artificial insemination must therefore be given a thorough diagnostic examination beforehand and, if necessary, adequate hormone treatment during the insemination cycle.