Neurogenic Bladder Dysfunction as Signal of Late Failure of Endoscopic Third Ventriculostomy in Child with Spina Bifida

BACKGROUND

Endoscopic third ventriculostomy (ETV) is an option for hydrocephalus treatment in patients with myelomeningocele, mostly after a previous shunt dysfunction. Late failure of ETV is a rare event, traditionally associated with dramatic symptoms of intracranial hypertension. In patients with myelodysplasia and neurogenic bladder dysfunction, urodynamic deterioration can be a signal of neurologic worsening as a consequence of tethered cord or shunt problems.

CASE DESCRIPTION

We describe here a rare case of a 12-year-old female patient with myelomeningocele and evidence of a failure 10 years after a previously successful ETV whose initial symptoms were worsening of urinary complaints. After 2 months, she was admitted to the emergency department with seizures and acute hydrocephalus and was shunted.

CONCLUSIONS

Pediatric neurosurgeons must follow myelomeningocele patients with successful ETV for a long time and take care of subtle alterations of organic functions that have a close relationship with central nervous system integrity. A multidisciplinary approach can facilitate this strategy and avoid a tragic outcome.

Incidence of bovine leukocyte adhesion deficiency, complex vertebral malformation, and deficiency of uridine-5-monophosphate synthase carriers in Brazilian Girolando cattle

Among the various hereditary diseases that have been widely studied in dairy cattle, bovine leukocyte adhesion deficiency (BLAD), deficiency of uridine-5-monophosphate synthase (DUMPS), and complex vertebral malformation (CVM) are noteworthy because of their high impact on overall herd productivity as a consequence of increased calf mortality. The aim of this study was to verify the frequency of carriers of BLAD, CVM, and DUMPS mutant alleles in cows and bulls from the National Girolando Progeny Test carried out in Brazil by using polymerase chain reaction (PCR)-restriction fragment length polymorphism and allele-specific PCR assays. A total of 777 animals were genotyped for BLAD, 783 for CVM, and 122 for DUMPS. The frequencies of carriers for BLAD and CVM were 0.77 and 1.53%, respectively, whereas no carriers of DUMPS were observed.

Respiratory mechanics after prosthetic reconstruction of the chest wall in normal rats

OBJECTIVE

Prosthetic reconstruction of the chest wall may yield several respiratory changes. Nevertheless, to our knowledge, no comprehensive analysis of respiratory mechanics under this condition has been hitherto performed.

METHODS

Respiratory mechanics were evaluated in two groups of rats. In one group (n=8), a polytetrafluoroethylene (PTFE) patch was used; in another group (n=8), a polypropylene mesh (Marlex) associated with methylmethacrylate (PPMM) was employed. All animals were sedated, anesthetized, paralyzed, and mechanically ventilated before and after the prosthetic reconstruction of the chest wall. After airway occlusion at end inspiration, respiratory system, pulmonary, and chest wall resistive pressures (deltaP1rs, deltaP1L, and deltaP1cw, respectively) and viscoelastic/inhomogeneous pressures (deltaP2rs, deltaP2L, and deltaP2cw, respectively) were determined. Respiratory system, lung, and chest wall static (Est(rs), EstL, and Est(cw), respectively), and dynamic elastances (Edyn(rs), EdynL, and Edyn(cw), respectively), and the corresponding delta elastances (deltaE, calculated as Edyn-Est) were also obtained.

RESULTS

In both groups, significant increases in deltaP2rs, deltaP2cw, deltaErs, deltaEcw, Est(rs), EstL, and Est(cw) were observed after chest wall reconstruction. However, deltaP2rs, deltaP2cw, deltaErs, deltaEcw, Est(rs), and EstL were significantly higher in the PPMM group than in the PTFE group.

CONCLUSIONS

Prosthetic reconstruction of the chest wall yields not only elastic changes, but also there is also an important increase of pressure dissipated against viscoelastic/inhomogeneous segments of the chest wall. Furthermore, taking into account respiratory mechanics, the PTFE patch might be preferred to the PPMM patch.

Respiratory mechanics after chronic diethylcarbamazine

This study was performed to evaluate the role of diethylcarbamazine (DEC), the drug of choice for treating Lymphatic Filariasis and Tropical Pulmonary Eosinophilia, on respiratory mechanics of higid rats. Thus, during 30 days two groups of six rats each received intraperitoneally either isotonic saline solution, or 12 mg/kg per day of DEC. Thereafter, they were sedated, anesthetized, paralysed and mechanical ventilation followed. After airway occlusion at end inspiration, respiratory system, pulmonary and chest wall resistive pressures (delta P1,rs, delta P1,L, and delta P1,w, respectively) and viscoelastic/inhomogeneous pressures (delta P2,rs, delta P2,L and delta P2,w, respectively) were determined in each group. Total delta pressures (delta Ptot) were calculated as the sum of delta P1 and delta P2, yielding the values of delta Ptot,rs, delta Ptot,L, and delta Ptot,w, respectively. Respiratory system, lung and chest wall static (Est,rs, Est,L, and Est,w, respectively) and dynamic elastances (Edyn,rs, Edyn,L, and Edyn,w, respectively), and the corresponding delta elastances (calculated as Edyn-Est) were also obtained. DEC therapy significantly decreased delta Ptot,rs, delta P tot,L, delta P2,rs, delta P2,L, Est,ts, Est,L, delta Ers and delta EL, in relation to the respective control values. It can be concluded that DEC decreases respiratory system impedance, being potentially useful for allowing airway dilation at the lung periphery.