Abnormal Accumulation Of Fluid Research Articles

Efficacy and Safety of Endoscopic Third Ventriculostomy Versus Ventriculoperitoneal Shunting for the Treatment of Hydrocephalus: A Meta-Analysis

<i>Introduction</i>: Hydrocephalus, characterized by abnormal cerebrospinal fluid (CSF) accumulation, presents significant challenges requiring timely intervention to prevent neurological complications. Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting (VPS) are primary surgical options, yet their relative efficacy and safety remain debated. This meta-analysis aims to compare ETV and VPS for hydrocephalus treatment, providing evidence-based insights to guide clinical decision-making. <i>Objectives</i>: To compare the efficacy of ETV and VPS in achieving symptom relief and radiological resolution of hydrocephalus. To evaluate the safety profiles of ETV and VPS by assessing perioperative and postoperative complication rates. To examine long-term outcomes following ETV or VPS placement. To conduct subgroup analyses based on patient characteristics influencing treatment effectiveness and safety. <i>Methods</i>: A comprehensive literature search was conducted in PubMed and Scopus databases to identify relevant studies comparing ETV and VPS for hydrocephalus treatment. Inclusion criteria encompassed comparative studies reporting efficacy and safety outcomes in pediatric and adult populations. Data extraction and quality assessment were performed using standardized protocols. Meta-analysis was conducted using appropriate statistical methods, with sensitivity and subgroup analyses conducted to assess robustness and variability. <i>Results</i>: Symptom improvement was comparable between ETV and VPS, with lower major complications associated with ETV. Mortality and postoperative complications favored ETV, although VPS exhibited lower CSF leakage risk. Overall success rates were similar, but ETV demonstrated superior safety profiles. Subgroup analyses revealed variations based on patient characteristics. <i>Conclusion</i>: ETV and VPS are effective in achieving symptomatic relief and radiological resolution of hydrocephalus, with ETV demonstrating superior safety profiles. Shared decision-making considering patient factors is crucial in selecting the most appropriate treatment approach. Further research is warranted to refine treatment algorithms and optimize outcomes for hydrocephalus patients.

Characterization of central-involved diabetic macular edema using OCT and OCTA.

To characterize the occurrence of diabetic macular edema and the presence of abnormal retinal fluid accumulation in nonproliferative diabetic retinopathy (NPDR). In this two-year prospective study, a total of 122 eyes with diabetes type 2 underwent optical coherence tomography (OCT) and OCT-Angiography in association with OCT-Fluid imaging, a novel algorithm of OCT analysis allowing quantification of abnormal accumulation of fluid in the retina through low optical reflectivity ratios (LOR). Early Treatment Diabetic Retinopathy Study (ETDRS) grading for diabetic retinopathy (DR) severity assessment was performed using 7-field color fundus photography. Best corrected visual acuity was also recorded. During the 2-year follow-up, 23 eyes (19%) developed central-involved diabetic macular edema (CI-DME) and 2 eyes (2%) developed clinically significant macular edema (CSME). In the two-year period of the study, eyes that developed CI-DME showed a progressive increase in central retinal thickness (CRT) (β = 7.7 ± 2.1 µm/year, p < 0.001) and in LOR values (β = 0.009 ± 0.004 ratio/year, p = 0.027). The increase in CRT and abnormal retinal fluid, represented by increased LOR ratios, are associated with increased retinal perfusion in the deep capillary plexus (DCP) (skeletonized vessel density, p = 0.039). In contrast, the eyes with CSME showed decreased retinal perfusion and abnormal fluid located in the outer layers of the retina. CI-DME and CSME appear to represent different entities. Eyes with CI-DME show increases in abnormal retinal fluid associated with increased retinal vascular perfusion in the DCP. Eyes with CSME are apparently associated with decreased retinal vascular perfusion in the DCP and abnormal fluid in the outer retina.

Falciform technique in laparoscopic revision of distal catheter obstruction: an evaluation

Background: Ventriculoperitoneal (VP) shunting is a cornerstone treatment for hydrocephalus, a condition characterized by the abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain. Despite its efficacy, this procedure is associated with various complications, among which distal catheter obstruction poses significant challenges. This study aimed to evaluate the effectiveness of the “falciform technique” in laparoscopic revision of distal catheter obstructions, offering a novel approach to mitigate this prevalent issue. Materials and Methods: This study retrospectively analyzed 28 patients with ventriculoperitoneal shunt distal catheter obstructions who underwent laparoscopy-assisted shunt revision between January 2016 and June 2022. All of these were done using the “falciform technique” with the fixation of the distal catheter to the falciform ligament in supra-hepatic space. Results: The most common etiology of primary shunt surgery was hydrocephalus, followed by intracranial hemorrhage (ICH) (42.9%) and traumatic brain injury (TBI) (32.1%). Normal pressure hydrocephalus (NPH) occurs in 14.3% of cases. Fifteen patients (53.6%) required revision surgery within 1 year of index surgery. Thirteen patients (46.4%) underwent revision surgery more than one year after the index surgery, either as a first revision or subsequent revision. The average surgery time was 32.1±14.7 minutes and hospital stay was 4.2±1.8 days. After a mean follow-up period of at 20.3±8.7 months, except for 3 patients who died from other causes (2 patients due to pneumonia and 1 due to exhaustion), there were no shunt-related complications in the remaining 25 patients. Conclusion: Laparoscopy with the application of “falciform technique” is a safe and highly effective method in distal catheter obstruction revision following ventriculoperitoneal shunt.

Natural antibodies targeting LPS in pleural effusions of various etiologies.

Respiratory infection, cancer and heart failure can cause abnormal accumulation of fluid in the pleural cavity. The immune responses within the cavity are orchestrated by leucocytes that reside in the serosal associated lymphoid tissue. Natural antibodies (NAbs) are abundant in the serum having a major role in systemic and mucosal immunity, however their occurrence in pleural fluid remains an open question. Our aim herein was to detect and measure the levels of NAbs targeting LPS of M, G, and A class in both, the pleural fluid and the serum of 78 patients with pleural effusions (PEs) of various etiologies. The values of anti-LPS NAb activity were extracted through a normalization step regarding the total IgM, IgG and IgA levels and in addition the ratio of PF/S values were analyzed further with other critical biochemical parameters from biopsies. Anti-LPS NAbs of all Ig classes were detected in most of the samples, while a significant increase of anti-LPS activity was observed in infectious and non-infectious compared to malignant PEs. Multivariate linear regression confirmed a negative correlation of IgM and IgA anti-LPS PF/S ratio with malignancy. Moreover, anti-LPS NAbs PF/S measurements led to increased positive and negative predictive power in ROC curves generated for the discrimination between benign and malignant PEs. Our results highlight a potential role of anti-LPS NAbs in the pleural cavity that should be further explored.

Nonimmune hydrops fetalis in a primigravida in the third trimester: A case report

Background: Hydrops fetalis is abnormal fluid accumulation within at least two fetal compartments, which may include pericardial effusion, pleural effusions, ascites, and skin edema. In the absence of red cell alloimmunization, hydrops fetalis is nonimmune (NHIF) and affects approximately 1 in 2000 pregnancies. Case presentation: A 33-year-old primigravida presented to the high-risk clinic for further management following an abnormal obstetric scan. Her antenatal follow-up was uneventful. She was blood group O, and rhesus positive. Physical examination was unremarkable. Abdominal examination revealed a fundal height of 32 weeks, which corresponded to  her date. The first obstetric scan performed in the third trimester revealed a live baby with features of hydrops fetalis. Management included couple counseling, multidisciplinary discussion with a fetomaternal specialist, dexamethasone injection for  fetal lung maturation, and expectant management. Discussion: The parents agreed to keep the pregnancy to term and plan for vaginal and cesarian deliveries reserved for obstetric indications. Nonimmune hydrops fetalis is associated with severe perinatal morbidity and significant maternal risk. The main causes of NIHF are chromosomal, fetal infection, and fetal cardiovascular problems. Conclusion: NIHF is rare, and a high index of suspicion is required for antenatal diagnosis. This affords parents tailored information and choices and supports multidisciplinary care with the additional aim of recognizing cases where fetal therapy may be appropriate, including timing for delivery.   

Continuous Laser Versus Micropulse Laser in the Treatment of Central Serous Chorioretinopathy: A Retrospective Study.

Central serous chorioretinopathy (CSCR) is a retinal disorder characterized by complex mechanisms leading to abnormal fluid accumulation under the retina. While management remains controversial, laser therapy has been successfully used. This study compares the efficacy of continuous laser (CL) and micropulse laser (ML) therapy in treating CSCR, focusing on reduction in macular thickness and improvement in visual acuity. A retrospective cohort study was conducted, including patients with CSCR treated with either CL or ML. The primary outcome measured was the reduction in average macular thickness (AMT), alongside secondary outcomes like changes in best corrected visual acuity (BCVA), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). The study evaluated 121 patients with CSCR, treated either with CL or ML. The primary outcome showed that the mean reduction in AMT was 51.14 µm (±20) in the CL group and 29.88 µm (±22) in the ML group, without a statistically significant difference (p=0.10). For the secondary outcomes, the improvement in BCVA was comparable in both groups, with CL at 0.15 (±0.1) and ML at 0.12 (±0.1) and no significant difference (p=0.41). However, in SFCT reduction, CL showed greater efficacy with a mean reduction of 32.19 µm (±15) compared to ML's 4.85 µm (±18), which was statistically significant (p=0.0004). The degree of SRF resolutionshowed no significant difference between the treatments (p=0.065). Both CL and ML are effective in the management of CSCR, with CL being more effective in reducing SFCT. These findings suggest the need for personalized treatment strategies based on individual patient characteristics and underline the complexity of CSCR management.

Unveiling Insights: A Comprehensive Review of the Role of Medical Thoracoscopy in Pleural Effusion Assessment.

Pleural effusion, characterized by abnormal fluid accumulation in the pleural cavity, poses diagnostic and therapeutic challenges across various medical conditions. This comprehensive review explores the role of medical thoracoscopy in assessing pleural effusions, providing insights into its historical context, procedural intricacies, diagnostic performance, safety considerations, and clinical applications. Medical thoracoscopy, a minimally invasive endoscopic procedure, offers advantages such as high diagnostic yield, therapeutic interventions, real-time assessment, and a minimally invasive nature. The review critically analyzes the procedure's advantages and disadvantages, including technical expertise, risk of complications, resource intensity, and patient selection criteria. Comparative analyses with alternative diagnostic modalities highlight the unique benefits of medical thoracoscopy in specific clinical scenarios. The diagnostic yield of medical thoracoscopy is examined, considering sensitivity and specificity in various contexts. Patient selection criteria, complications, and safety measures are discussed, emphasizing the importance of careful consideration in integrating thoracoscopy into clinical practice. The review further explores its clinical applications, including differentiating exudative and transudative effusions, identifying specific etiologies, and its role in treatment planning. In conclusion, medical thoracoscopy emerges as a valuable tool in the comprehensive management of pleural effusions, offering a nuanced approach to diagnosis and treatment. The evolving landscape of diagnostic modalities underscores the continued significance of medical thoracoscopy and potential advancements in the field.

Anesthetic Strategies in Cerebral Edema: Navigating Neurological Challenges Amid Trauma, Tumors and Therapeutic Advances

Cerebral edema, characterized by abnormal fluid accumulation in brain tissue leading to increased intracranial pressure, poses significant challenges for anesthesiologists. This review delves into the pathophysiology, clinical manifestations, diagnostic approaches, pharmacological strategies, and anesthesiological considerations associated with cerebral edema. Disruptions in the blood-brain barrier, alterations in cerebral blood flow, cellular swelling, and aquaporin dysregulation contribute to the complexity of cerebral edema. Clinical presentations vary, encompassing cognitive changes, seizures, and neurological deficits. Accurate diagnosis relies on clinical assessments and neuroimaging, with MRI and CT scans playing pivotal roles. Pharmacological interventions, including osmotic agents, corticosteroids, diuretics, and barbiturates, target specific causes and symptoms. Anesthesiological challenges encompass ICP monitoring, choice of anesthetic agents, maintenance of cerebral perfusion, fluid management, temperature control, and collaboration with neurosurgical teams. This multidisciplinary approach ensures optimal patient care and emphasizes ongoing research collaboration for refining therapeutic strategies. This comprehensive review provides valuable insights for clinicians managing cerebral edema, offering a roadmap for tailored interventions and highlighting the need for continued advancements in understanding and treating this critical condition.&#x0D; Material and method: ​​&#x0D; The literature review applied standard criteria and focused on PubMed articles using keywords: cerebral edema, pathophysiology, aquaporin, blood-brain barrier, anesthesiology, cerebral edema treatment, corticosteroids

Pattern and outcome of paediatric pleural effusion seen at Usmanu Dafodiyo University Teaching Hospital, Sokoto: A 5-year retrospective study

Background: Pleural effusion is an abnormal accumulation of fluid in the pleural cavity which present with spectrum of clinico-aetiological manifestations often requiring multidisciplinary approach.&#x0D; Objectives: This study set out to determine the prevalence, aetiology, clinical presentation, treatment modalities and outcome of pleural effusion in children.&#x0D; Materials and Methods: This was a retrospective study where records of children with diagnosis of pleural effusion admitted at UDUTH, Sokoto were obtained between January 2017 and December 2022 and reviewed. Diagnosis was based on clinical presentation and radiological confirmation of pleural effusion. Data was analyzed with SPSS version 20.0.&#x0D; Results: A total of 49 cases were retrieved. The prevalence of pleural effusion was 0.54% (9,056). It was more prevalent in males with ratio of 2.5:1 (χ² = 9.833, P = 0.007). The median age was 9 years (IQR 7). The most common cause of pleural effusion was pneumonia 26 (53.1%) followed by tuberculosis 16 (32.6%), malignancy 3 (6.1%), cardiac and renal causes accounted for 2 (4.1%) each. Cough (100.0%), difficulty in breathing (100.0%), tachypnea (100.0%), respiratory distress (100.0%), and desaturation (98.0%) were the common presentations. Most (77.5%) of them presented with right sided pleural effusion. The majority (93.9%) had closed thoracostomy tube drainage. The outcome showed majority (83.7%) of the cases been discharged, with a median duration of hospital stay of 22days (IQR 17). However, mortality rate for the malignant causes was 100.0%.&#x0D; Conclusion: Infections were the major cause of paediatric pleural effusion with relatively good outcome. Surgical intervention and multidisciplinary team approach are needed to reduce the morbidity and mortality in patients with pleural effusion especially for the malignant causes.

Racial and ethnic differences in infant survival for hydrocephaly-Texas, 1999-2017.

Congenital hydrocephaly, an abnormal accumulation of fluid within the ventricular spaces at birth, can cause disability or death if untreated. Limited information is available about survival of infants born with hydrocephaly in Texas. Therefore, the purpose of the study was to calculate survival estimates among infants born with hydrocephaly without spina bifida in Texas. A cohort of live-born infants delivered during 1999-2017 with congenital hydrocephaly without spina bifida was identified from the Texas Birth Defects Registry. Deaths within 1 year of delivery were identified using vital and medical records. One-year infant survival estimates were generated for multiple descriptive characteristics using the Kaplan-Meier method. Crude hazard ratios (HRs) for one-year survival among infants with congenital hydrocephaly by maternal and infant characteristics and adjusted HRs for maternal race and ethnicity were estimated using Cox proportional hazard models. Among 5709 infants born with congenital hydrocephaly without spina bifida, 4681 (82%) survived the first year. The following characteristics were associated with infant survival: maternal race and ethnicity, clinical classification (e.g., chromosomal or syndromic), preterm birth, birth weight, birth year, and maternal education. In the multivariable Cox proportional hazards model, differences in survival were observed by maternal race and ethnicity after adjustment for other maternal and infant characteristics. Infants of non-Hispanic Black (HR: 1.28, 95% CI: 1.04-1.58) and Hispanic (HR: 1.31, 95% CI: 1.12-1.54) women had increased risk for mortality, compared with infants of non-Hispanic White women. This study showed infant survival among a Texas cohort differed by maternal race and ethnicity, clinical classification, gestational age, birth weight, birth year, and maternal education in infants with congenital hydrocephaly without spina bifida. Findings confirm that mortality continues to be common among infants with hydrocephaly without spina bifida. Additional research is needed to identify other risk factors of mortality risk.

Gansui Banxia decoction modulates immune-inflammatory homeostasis to ameliorate malignant ascites in rats

Background“Gansui Banxia decoction” (GBD) is a classical traditional Chinese medicine formula for treating abnormal accumulation of fluid, such as malignant ascites (MA). Although GBD has shown definite water-expelling effects, its exact underlying mechanism has not been elucidated. PurposeThis study aimed to investigate the drug effects of GBD on MA rats and its underlying mechanisms. MethodsThe main chemical composition was determined by ultra-high performance liquid chromatography. The drug effects of GBD was evaluated in the established cancer cell-induced MA rat model. The symptoms were analyzed, and biological samples were collected for detecting immune and inflammation-related indicators by enzyme-linked immunosorbent assays, western blot, and flow cytometry. ResultsGBD increased urine discharge, decreased ascites production, and alleviated cachexia. After GBD treatment, the expression of TLR4, MyD88, and NF-кB and the release of pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α were reduced. In addition, GBD increased G1 phase arrest and inhibit excessive proliferation of cells in bone marrow while alleviating G1 phase arrest and increasing proliferation of cells in the thymus. Correspondingly, the development and maturation of T cells also changed. GBD increased the proportion of mature T-cells (CD4+CD8− and CD4−CD8+ single-positive (SP) T-cells), and decrease the proportion of immature cells (CD4+CD8+ double-positive (DP) T-cells and CD4−CD8− double-negative (DN) T-cells) in the blood or tumor microenvironment (TME, the ascites microenvironment). Finally, we further analysis of immune cell subsets, GBD decreased the proportion of immunosuppressive T-cells in the blood (CD4+CD25+Foxp3+T-cells) and TME (CD8+CD25+Foxp3+T-cells), and increased the proportion of anti-tumor immune cells (CD8+CD28+T-cells and NK cells) in the TME. ConclusionThese findings indicated that the drug effects of GBD were attributed to regulating the immune-inflammatory homeostasis, thereby mitigating the destruction of cancer cells and reducing the generation of ascites, which provided theoretical support for the clinical rational application and extended the scientific connotation of “water-expelling” of GBD.

Formulation and evaluation of controlled porosity oral osmotic pump tablets of furosemide

Oedema is an abnormal accumulation of fluid in the interstitium located beneath the skin and in the cavities of the body which can cause severe pain. Furosemide has been shown to be effective and safe in patients with hypertension and/ or coronary heart disease. Osmotic pump tablets deliver the drug in an optimized manner to maintain drug concentration within the therapeutic window and minimize toxic effects. The major objective of the study was to prepare and evaluate oral controlled porosity osmotic pump tablets of furosemide, to reduce the dosing frequency and thereby side effects, and to release the drug for a prolonged period in a controlled manner that is independent of pH and hydrodynamic activity. Pre-formulation studies and pre-compression parameters of tablet blends of osmotic pump tablets of furosemide were carried out. Oral-controlled porosity osmotic pump tablets of furosemide were prepared and subjected to different evaluation tests. Precompression parameters indicated that granules have a good flow property. All the formulations showed good mechanical strength. All the nine formulations showed a drug release of more than 60% in the 12th hour. Optimised formulation showed a drug release of 99.21% in 12th hr. Stability studies conducted indicate that the product is stable.

An Observational Study for the Clinical Correlation of Sama-Snayugata Vata (Non-Specific Chronic Synovitis) with the Analysis of the Synovial Fluid

This study delves into the intricate interplay between the Ayurvedic concept of Sama-Snayugata Vata, characterized by the vitiation of Vata dosha affecting the musculoskeletal system, and the analysis of synovial fluid in the context of knee effusion. Synovial fluid, a crucial component within diarthrodial joints, serves to nourish, lubricate, and protect the joint structures. Under normal circumstances, its biochemical composition closely mirrors that of plasma. However, pathological conditions, such as arthritis, can lead to alterations in its constituents, offering insights into underlying joint pathology. Central to this study is the Ayurvedic concept of Shleshmadhara Kala, representing a phase characterized by optimal nourishment and lubrication of bodily tissues, essential for joint health and functionality. The Janu Sandhi, or knee joint, exemplifies this interplay, where the integrity of tendons and ligaments (Snayu) is crucial. Conditions like knee effusion, marked by abnormal synovial fluid accumulation, disrupt this equilibrium, leading to clinical manifestations and impairments. This observational study aims to comprehensively explore the correlation between Shleshmadhara Kala and the Snayu of the Janu Sandhi in the pathogenesis of Sama-Snayugata Vata, particularly in the context of knee effusion. Insights gained from this research will provide a foundation for devising effective therapeutic strategies, with the goal of restoring Vata dosha balance, rejuvenating affected tissues, and ultimately alleviating the manifestations of this condition. This investigation holds promise for enhancing our understanding of non-specific chronic synovitis and refining treatment modalities for improved patient outcomes.

Cerebral microvascular markers of intracranial pressure in acute and subacute porcine hydrocephalus model

Hydrocephalus affects 1.1% of infants, resulting in abnormal accumulation of cerebrospinal fluid and elevated intracranial pressure (ICP). Elevated ICP can occur prior to detectable morphological changes using computed tomography, resulting in delayed diagnosis and treatment. To improve early diagnosis, we propose vascular imaging using ultrasound localization microscopy (ULM) and ultrafast Doppler to measure cerebral blood flow changes due to acute to subacute elevations in ICP. We performed a pre-clinical study on a neonatal porcine model with 30 min, 8 h, 12 h, and 24 h ICP elevations while performing brain ultrasound measurements in hourly intervals. Ultrafast plane-wave ultrasound imaging was implemented using the Verasonics Vantage-256 and GE IC59D curved array probe at 400Hz frame rate. Lumason contrast agent was infused into each animal, providing tracers for ULM and enhancing the ultrafast Doppler imaging. Based on preliminary analysis, ultrafast Doppler showed reduced total cerebral blood volume after acute ICP elevation. ULM showed highly correlated parabolic reductions in cortical microcirculation with increasing ICP. Drastic reductions in cerebral microcirculation but less so in microcirculation accompanied microdialysis evidence of brain ischemia. Additionally, there were spatiotemporal changes in cerebral microvascular flow with varying ICP durations that warrant additional investigations using ultrafast ultrasound imaging.

Strategies in activating lymphatic system on symptom distress and health-related quality of life in patients with heart failure: secondary analysis of a pilot randomized controlled trial.

Abnormal interstitial fluid accumulation remains the major cause for patients with heart failure (HF) to endure a myriad of distressing symptoms and a decline in their health-related quality of life (HRQoL). The lymphatic system is essential in regulating fluid balance within the interstitial compartment and has recently been recognized as an important target for the prevention and mitigation of congestion. This study aimed to investigate the effects of exercises in activating lymphatic system on symptom distress and HRQoL among patients with HF. This was a pre-determined, secondary analysis of the TOLF-HF [The-Optimal-Lymph-Flow for Heart Failure (TOLF-HF)] study, a two-arm pilot randomized controlled trial evaluating the preliminary effects of the lymphatic exercise intervention in enhancing interstitial decongestion among patients with HF. Participants were randomized to receive either a four-week TOLF-HF program in addition to standard care or standard care alone. The Chinese version of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was employed to measure symptom distress and HRQoL before and after the intervention. Data analyses included descriptive statistics, the independent sample t-test, Pearson's chi-square test, the Mann-Whitney U test, and covariance analysis. Of the 66 patients enrolled, 60 completed the study. The study results exhibited that the TOLF-HF intervention were effective in alleviating both physical and psychological symptom distress. The intervention group yielded significantly lower MLHFQ total scores in comparison to the control group. The odd ratio of achieving meaningful improvement in HRQoL in TOLF-HF group was 2.157 times higher than those in the control group. The TOLF-HF program focusing on activating lymphatic system was effective in alleviating physical and psychological symptom distress as well as improving HRQoL for patients with HF. The tolerability, feasibility, and effectiveness of the TOLF-HF intervention make it a promising intervention for patients to manage HF. http://www.chictr.org.cn/index.aspx, identifier (ChiCTR2000039121).

An Overview of Hydrocephalus and Shunts Used in The Clinical Management of Hydrocephalus

Hydrocephalus is a complex neurological condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, leading to increased intracranial pressure. The clinical management of hydrocephalus often involves the surgical placement of a shunt system to divert CSF and restore normal fluid dynamics. This article provides a comprehensive overview of hydrocephalus, its etiology, clinical presentation, and various types of shunts used in its management. The outline of this report encompasses the principles of shunt surgery, indications for shunt placement and primary types of shunts used in the clinical management of hydrocephalus, including ventriculoperitoneal (VP), ventriculoatrial (VA), ventriculopleural (VPL), lumboperitoneal (LP) and ventriculo-subgaleal (VS) shunts. Additionally, some non-conventional shunts such as ventriculo-osseous, ventriculo renal, ventriculo gall bladder, intraventricular (Aqueductal stents) and long-tunnelled external ventricular drains are also discussed. The distinct features of each shunt type, its associated advantages, limitations and complications are also outlined together with a comparison between pressure vs flow regulated valves. An understanding of the different shunt types and their specific characteristics is essential for clinicians to make informed decisions in tailoring treatment to individual patients. This review offers a comprehensive understanding of shunt characteristics which we believe will empower clinicians to make informed decisions tailored to individual patients, ensuring effective CSF diversion and long-term management of hydrocephalus.

Ascites Volume Quantification via Abdominal CT: A Novel Approach to Predict Severity in Acute Pancreatitis.

BACKGROUND Acute pancreatitis, a sudden inflammation of the pancreas, can result in severe complications. The presence and volume of ascites, an abnormal accumulation of fluid in the abdomen, has been linked to disease severity. Our study investigates ascites volume, quantified via abdominal CT scans, as a potential predictive tool for disease severity. MATERIAL AND METHODS In this retrospective analysis, patients diagnosed with acute pancreatitis were evaluated. Patients were categorized into groups with and without ascites, with comparisons made regarding clinical characteristics. We further compared the mean ascitic volume against various outcome parameters in patients with ascites. Ascites volume and other predictive systems were assessed through receiver operating characteristic (ROC) curves, with the area under the ROC curve (AUC) for different predictive systems being analyzed. RESULTS The ascites group had higher severity scores and related serological indexes (P<0.05 for all). Among patients with ascites, a significant correlation was observed between ascites volume and outcome parameters (P<0.05 for all). The area under the ROC curve for predicting severe acute pancreatitis was 0.896, with 93% sensitivity and 79% specificity. Ascites volume yielded the highest diagnostic odds ratio (53.1; 95% confidence interval: 13.2,199.6). CONCLUSIONS Early-stage acute pancreatitis patients with ascites are indicative of severe illness and poor prognosis. An increase in ascites volume correlates with adverse clinical outcomes, thus highlighting the significance of ascites volume as a prognostic marker. This underscores the importance of abdominal CT in measuring ascites volume to predict disease severity.

Evaluation of Overshunting between Low and Medium Pressure Ventriculoperitoneal Shunts in Dogs with Severe Hydrocephalus Using Frameless Stereotactic Ventricular Shunt Placement

Hydrocephalus is a neurological disorder characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricular system of the brain, leading to cerebral ventricular dilation, brain parenchyma compression, and neuronal cell loss. Surgery is an effective method of draining excessive amounts of CSF. Ventriculoperitoneal shunt (VPS) allows excess CSF to divert into the abdomen; this device is the most commonly used in the treatment of hydrocephalus both in veterinary and human patients. This study aims to describe the application of two types of VPS, low-pressure valve and medium-pressure valve, using a frameless stereotactic neuronavigational system in eight severe hydrocephalus in dogs and, in particular, analyze the prevalence of postoperative overshunting. Non-communicating hydrocephalus was found in seven dogs, whereas the rest of them had communicating hydrocephalus caused by traumatic brain injury with a skull fracture. The criteria for pressure valve selection depended on the intraoperative intraventricular pressure (IVP) that was determined by the adaptive manometer, according to the human protocol. Low-pressure valve placement was performed in five dogs, and the others received medium-pressure valve placement. The follow-up period was 2 weeks, 4–12 weeks, and 12 weeks to 12 months. Pre- and postoperative information including neurological signs, CT-Scan or MRI, medical treatment, complications, and ventricular volume were compared in all dogs. Seven dogs showed neurological improvement within 2 weeks after surgery. Overshunting was seen in four dogs who received low-pressure valve placement. Three of them had shunt infections within 4 to 6 weeks after surgery. One dog underwent shunt revision from a low-pressure valve to a medium-pressure valve caused by severe overshunting and progressive neurological signs. In addition, cognitive and learning improvements were evaluated based on the owners’ feedback, and neurological signs were examined during the follow-up period in two dogs that received low-pressure valve placement. We conclude that a medium-pressure valve is recommended for overshunting prevention. However, low-pressure valve placement seems to improve cognitive function and learning ability, which is related to an increase in the brain parenchyma observed during long-term monitoring. Moreover, we also report our experience and surgical procedure for frameless stereotactic ventricular shunt placement (FSVSP) in VPS surgery in dogs affected by hydrocephalus.

Biomechanical effects of hyper-dynamic cerebrospinal fluid flow through the cerebral aqueduct in idiopathic normal pressure hydrocephalus patients

Normal pressure hydrocephalus (NPH) is an intracranial disease characterized by an abnormal accumulation of cerebrospinal fluid (CSF) in brain ventricles within the normal range of intracranial pressure. Most NPH in aged patients is idiopathic (iNPH) and without any prior history of intracranial diseases. Although an abnormal increase of CSF stroke volume (hyper-dynamic CSF flow) in the aqueduct between the third and fourth ventricles has received much attention as a clinical evaluation index in iNPH patients, the biomechanical effects of this flow on iNPH pathophysiology are poorly understood. This study aimed to clarify the potential biomechanical effects of hyper-dynamic CSF flow through the aqueduct of iNPH patients using magnetic resonance imaging-based computational simulations. Ventricular geometries and CSF flow rates through aqueducts of 10 iNPH patients and 10 healthy control subjects were obtained from multimodal magnetic resonance images, and these CSF flow fields were simulated using computational fluid dynamics. As biomechanical factors, we evaluated wall shear stress on the ventricular wall and the extent of flow mixing, which potentially disturbs the CSF composition in each ventricle. The results showed that the relatively high CSF flow rate and large and irregular shapes of the aqueduct in iNPH resulted in large wall shear stresses localized in relatively narrow regions. Furthermore, the resulting CSF flow showed a stable cyclic motion in control subjects, whereas strong mixing during transport through the aqueduct was found in patients with iNPH. These findings provide further insights into the clinical and biomechanical correlates of NPH pathophysiology.

Evaluation of Pleural Effusion Type Determination Based on Light's and Heffner's Criteria

Pleural effusion is an abnormal accumulation of pleural fluid in the pleural cavity due to excessive transudation or exudation. Light's criteria is used as the standard method to distinguish between exudates and transudates. Some recent studies reported misclassifications which led to development of several alternative criteria, such as Heffner's criteria. The purpose of this study was to determine the sensitivity and specificity of Heffner's criteria to determine the type of pleural effusion. This research was an observational study with a cross-sectional method using a pleural effusion of patients at the Clinical Pathology Laboratory Installation at the Wahidin Sudirohusodo Hospital in July 2018. Total protein, LDH, and cholesterol levels were measured in all samples that met the inclusion and exclusion criteria. There were 45 pleural effusion samples that consisted of 30 transudate and 15 exudate samples. Based on clinical diagnosis, the Light's criteria showed 3 misclassifications and Heffner's criteria obtained showed 2 misclassifications. Based on the data above, the statistical data showed that Light's criteria had a sensitivity of 96.7% and specificity of 86.7%. Heffner's criteria had a sensitivity of 100% and specificity of 86.7%. Heffner's criteria can be used an alternative method to determine the type of pleural effusion because it showed a better sensitivity and specificity than Light's criteria.