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Objectives Due to increased number of patients suffering from hydrocephalus (HCP) and lack of data concerning volumetric changes after shunting operations, this study aims to assess the volumetric changes in brain ventricles after successful ventriculoperitoneal (VP) shunt surgery in correlation with clinical improvement. Patient and methods This study included 20 patients; all of them are below the age of 2 years. All the patients had hydrocephalus, were treated surgically with VP shunts, and have clinically improved over the period of study. We measured the volumetric changes radiologically using the fronto-occipital horn ratio (FOHR) over a period of 6 months postoperatively. Results The frontal and occipital horn ratio was calculated in all these patients both pre and postoperatively. There was a significant radiological improvement in the majority of children after the shunt operation. One month postoperatively, the FOHR decreased to about 85% of its preoperative value in average. The FOHR was found to be significantly improving with time over a period of 6 months reaching 63% of its preoperative value. Conclusion Successful treatment of HCP in infants via VPS seems to be of benefit in decreasing the ventricular size gradually to a near normal FOHR with clinical improvement.

We investigate the dynamics of a bypass in terms of determining the optimal parameters of shunt operation. The equations that describe the propagation of pressure pulse waves in blood vessels are presented in differential form and in approximate form for the averaged values based on the conservation laws. The correspondence of these forms is shown from the solution of the initial---boundary-value problem for vascular junction. The influence of the parameters such as various diameters, wall thicknesses, and elastic properties of blood vessels on the shunt effectiveness is investigated. In particular, we investigate the influence of the shunt form and junction area, as well as the angle of the shunt connection with the vessel, on the passage of the coronary vessels and blood coagulation. On the basis of the calculations, conclusions about the influence of various parameters on the dynamics of bypass are made.

A newborn with right isomerism, infracardiac total anomalous pulmonary venous return (TAPVR), and obstruction of the ductus venosus underwent stent implantation in the ductus venosus at 4 h after birth. This procedure averted early pulmonary venous obstruction. Since gradual neointimal proliferation subsequently occurred within the stent, the patient underwent stent balloon dilatation at 35 days of age and underwent surgical repair of the TAPVR with a Blalock-Taussig shunt operation at 53 days of age. Finally, the patient was discharged without any complications. Transthoracic echocardiography is very useful to confirm subsequent minimal change within the stent.

Sind bei Patienten mit Normaldruckhydrozephalus hydrostatische Ventile konventionellen Differenzialdruckventilen bezuglich der postoperativen Behandlungsergebnisse und moglicher Komplikationen uberlegen? Von 1997 bis 2002 wurden im Unfallkrankenhaus Berlin-Marzahn 60 Patienten mit einem idiopathischen Normaldruckhydrozephalus durch Implantation eines hydrostatischen Ventils (Miethke-Dual-Switch-Ventil) operativ behandelt. Von den Patienten weisen 33% einen sehr guten, 33% einen guten und je 17% einen befriedigenden bzw. schlechten Krankheitsverlauf ein Jahr nach der Shunt-Operation auf. Die ventilabhangigen und -unabhangigen Komplikationen (Katheterdislokalisationen, Ventilinfektionen, Unter- bzw. Uberdrainagen) sind mit 20% noch relativ hoch. Die Druckstufe des Miethke-Dual-Switch-Ventils korreliert nicht mit den postoperativen Behandlungsergebnissen! Nach unseren Erfahrungen sind bei Patienten mit einem idiopathischen Normaldruckhydrozephalus hydrostatische Ventile (Miethke-Dual-Switch-Ventil) konventionellen Differenzialdruckventilen und verstellbaren Ventilen ohne zusatzliche Schwerkrafteinheit hinsichtlich der postoperativen Behandlungsergebnisse und moglicher Komplikationen uberlegen.

An 1076 chirurgischen und internistischen Abteilung in der BRD (West) wurde eine Umfrage zur Behandlung der Osophagusvarizenblutung durchgefuhrt. Es uberwiegt die Akutsklerosierung bzw. die Ballonsondenbehandlung mit nachfolgender Sklerosierung bei der aktiven Blutung. Die abdominelle Sperroperation wird bei der konservativ nicht stillbaren Blutung noch vor dem portokavalen Notshunt bevorzugt. Betablocker werden vor allem in internistischen Abteilungen zur Rezidivprophylaxe eingesetzt. Erst nach mehrfacher Rezidivblutung trotz Sklerosierung sehen etwa die Halfte der Abteilungen eine Indikation zum elektiven Shunt. Der distale splenorenale Shunt nach Warren and die portokavale Anastomose dominieren deutlich gegenuber den anderen Shuntformen.

In patients with tetralogy of Fallot, those with intrapulmonary pulmonary arterial stenosis (IPPS) diagnosed by angiocardiographic measurement and pulmonary scintiscanning seem to be poor candidates for one stage total correction. The results obtained in the present study indicate the significance of developmental state of pulmonary vascular bed in establishing indication for total correction of tetralogy of Fallot. In view of the improvement of IPPS following the shunt operation, second-stage total correction after the Blalock shunt is recommended in those with IPPS.

Von 1970–1978 wurden 135 Sauglinge mit angeborenen Herzgefasmisbildungen wegen Herzinsuffizienz, progredienter pulmonaler Hypertonie und schwerer Cyanose operiert. In 63% bestanden acyanotische Vitien, 68% aller Eingriffe erfolgten im ersten Lebenshalbjahr. Die Spatletalitat betrug 5%, die Operationssterblichkeit 17% und war im ersten Trimenon deutlich hoher als im zweiten Lebenshalbjahr. Beim haufigsten Herzfehler dem isolierten Ductus war das Operationsrisiko mit 2,5% nur geringfugig hoher als bei Eingriffen im spateren Leben. Die Gesamtletalitat der „Banding” Operation beim isolierten Ventrikelseptumdefekt betrug einschlieslich zweizeitiger Korrektureingriffe 12,5%, bei acyanotischen Vitien insgesamt 17%. Bei einer Gesamtletalitat von 26% fand sich bei Aortenisthmusstenosen eine Rezidivrate von 20%, weshalb eine Ausweitung der Indikation auf asymptomatische Stenosen abgelehnt wird. Ein hoheres Operationsrisiko kennzeichnete komplexe cyanotische Anomalien sowohl hinsichtlich der „Banding” Operation (38%) als auch bei den Shuntoperationen (44%). Die moglichst fruhzeitige chirurgische Intervention wird bei entsprechender Indikation empfohlen.

20 cases of operated developmental CSF cysts are surveyed: 8 Dandy-Walker syndromes and 12 extraaxial “arachnoid” cysts. A CSF shunt is the only possible operation for Dandy-Walker syndrome and a single shunt from the cyst is preferable to a double shunt; the success rate is 50%. Congenital extraaxial “arachnoid” cysts, which arise from a developmental anomaly of the roof of the hindbrain or primitive leptomeningeal spaces, must be differentiated from acquired arachnoid cysts. Those of this series fall into two groups: midline and lateral. Supravermian midline cysts resemble the Dandy-Walker syndrome in several respects, including the frequent recourse to a shunt operation and the uncertain distant prognosis, whilst the other extra-axial cysts usually simulate a cerebellar tumor. Lateral cysts may, however, present peculiar symptoms such as a homolateral motor deficit that does not always respond to surgery, and an oscillating symptomcomplex. Surgical removal is the treatment of choice both for subvermian midline and lateral cysts but subsequent shunting may be necessary to control persisting hydrocephalus. The long term prognosis is generally excellent for subvermian midline cysts but may be only fair for lateral cysts.

In seven myelomeningocele patients, six were operated upon while in one severe case no surgery was performed. The posterior fossa areas were measured and expressed by the posterior fossa ratio method. In two shunted patients both ratios were primarily below the lowest normal limit, but following shunt operation the ratios become normal. In five patients who were not shunted one only showed a normal ratio, two showed borderline values and in a fourth instance the ratio normalized but before two years had passed. The fifth case remained unoperated and therefore the natural course could be followed. In this case the decrease in the posterior fossa ratio explained the progress of hydrocephalus.

In the families of 40 children with surgically corrected tetralogy of Fallot there were 6 instances of marriage dissolution since the birth of the affected child. Couples remaining together had high indexes of family stability. In control families of 40 children with appendectomy, matched for age, sex, and time since surgery, the findings were similar. No differences were observed in marriage breakup or family stability between families of children with moderate disability who had a shunt operation prior to total correction and families of children with presumably milder disability who had not had a shunt operation prior to total correction. Thus, stress due to reparable tetralogy of Fallot appears to be well tolerated in the family and is associated with no more family instability or marriage dissolution than a childhood appendectomy.

A review on a current status of surgical treatment of portal hypertension in Japan based on 1,500 cases collected by the research committee for surgery of portal hypertension is presented. Since, unlike in Europe and in United States, the type of the cirrhotic patients encountered in Japan are mostly of postnecrotic type and portacaval shunt is contriandicated, alternative operative approaches have been made. Concerted efforts along this line made by the members of the committee culminated in the improvement of surgical intervention for portal hypertension in this country, where conventional shunt operation fails. It is obvious that continued clinical evaluation is necessary to determine indication and limitation for each procedure.

An ultrasonic instrument was devised to aide accurate placement of the cardiac tube during the vertriculo-atrial shunt operation. The ultrasonic method was applied in 22 clinical cases in surgery and compared with the roentogenographic method and the endocardiac electrocardiographic method. The tricuspid valve echo was easily detected, because it has characteristic pulsating, polyspiky and shifting nature within an extent of 1 cm according to the cardiac beat. It was concluded from the comparative study that the roentogenographic method only gives silhouette, and the relationship between the probe tip and the vertebral body segment was almost inconsistent. Furthermore, the endocardiac electrocardiogram did not always show biphasic P wave and biphasic P wave was recorded at various distances ranging from 0 cm to 3.5 cm from the tricuspid valve. On the other hand, the ultrasonic method has the important advantages that the distance between the probe tip and the tricuspid valve can be measured directly and correctly, thus enabling operator to place the probe at any desired position in relation to the tricuspid valve.

25 chronisch niereninsuffiziente Patienten, bei denen zur Durchfuhrung einer chronisch intermittierenden Hamodialysebehandlung Shuntoperationen zwischen Arteria radialis und Vena cephalica antebrachii bzw. Arteria ulnaris und Vena basilica oder Vorlagerungen der Arteria femoralis bzw. Vorlagerungen der Arteria femoralis und Anastomosierung mit der Vena saphena magna durchgefuhrt worden waren, wurden in einem Zeitraum von 3 Wochen bis zu 4 1/2 Jahren nach den Operationen gezielt mit der Frage nach operationsbedingten Ausfallen peripherer Nerven nachuntersucht. Nach 28 Unterarmshuntoperationen fanden sich noch 8mal Oberflachensensibilitatsstorungen im Versorgungsgebiet des Ramus superficialis des N. radialis sowie nach 8 Femoralisvorlagerungen 6mal Ausfalle des N. saphenus. Unter Berucksichtigung der Operationstechniken und der anatomischen Gegebenheiten, die individuell variieren konnen, werden die Ursachen fur Ausmas und Schweregrad der neurologischen Ausfalle diskutiert.

A case of bifrontal epidural haematoma secondary to ventriculocardiac (Spitz-Holter) shunt operation and posterior fossa exploration is reported. The relevant literature has been reviewed. The diagnosis of this complication was made by CT scan.

From 1940 to 1975, congenital hepatic fibrosis was diagnosed in 18 patients who were less than 18 years old. Only patients with histologic confirmation of congenital hepatic fibrosis were included. Although the symptoms and clinical courses differed among the age groups, the histologic liver changes showed little variation. All four patients who presented before the age of 3 months had enlarged kidneys, and all four died in respiratory failure. Fourteen patients were seen after the age of 3 months because of symptoms associated with portal hypertension. Of the 14 patients, 6 died after massive upper gastrointestinal hemorrhage and 1 died after a shunt operation. All 7 patients in this age group who died had renal insufficiency. Of the seven patients still alive at the time of this study, only two had mild renal insufficiency, but all seven had evidence of portal hypertension. Polycystic renal disease was diagnosed in all patients. Fourteen had renal tissue diagnosis, and four had urographic evidence of the disease. Review of the histologic specimens of eight patients revealed that, in the four patients less than 3 months old, the findings were typical of infantile polycystic disease, and in the four older patients, cortical and medullary cysts were present--findings consistent with infantile polycystic kidney disease.