Pneumocephalus following ventriculoperitoneal shunt. Case report.

The authors describe a case of massive pneumocephalus following ventriculoperitoneal shunting for hydrocephalus. After multiple diagnostic and surgical procedures, congenital defects in the tegmen tympani of both temporal bones were identified as the sources for entry of air. A functioning shunt intermittently established negative intracranial pressure and allowed ingress of air through these abnormalities; when the shunt was occluded, air did not enter the skull, and there was no cerebrospinal fluid leakage. Repair of these middle ear defects prevented further recurrence of pneumocephalus.     

Calcification of a ventriculoperitoneal shunt tube. Case report

A 16-year-old boy who had undergone a ventriculoperitoneal (VP) shunt because of hydrocephalus at 8 years of age complained of pain around the right neck and chest. He concomitantly had a slight fever of unknown etiology, which had been lasting for several years. Skull and chest roentgenograms revealed an unusual calcified shadow around the shunt tube. After removal of the shunt apparatus, his pain and fever disappeared. Silicone tubes used in a VP shunt apparatus may induce fibrous connective tissue proliferation around the tubes in both children and adults, but no reports of radiologically verified calcification of a VP shunt tube are found in the literature, to the best of our knowledge. The possible mechanism of calcification of the VP shunt tube is discussed.     

Bacterial peritonitis in patients with ventriculoperitoneal shunt.

Bacterial peritonitis is an unusual complication of ventriculoperitoneal (VP) shunt for hydrocephalus. This complication, usually associated with peritoneal cysts of perforated viscus, may occur as the first manifestation of shunt infection. Early recognition of this form of bacterial peritonitis and appropriate antibiotic therapy may avert major abdominal surgery in selected cases.     

Migration of ventriculoperitoneal shunt into the chest. Case report

A case is presented of a baby in whom the abdominal catheter of a ventriculoperitoneal shunt entered the thoracic cavity. It is believed that the catheter migrated along the xiphocostal margin beneath the rectus abdominis muscle.     

Distal ventriculoperitoneal shunt failure caused by silicone allergy. Case report

The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus. Although allergic reactions to the silicone in shunt hardware are very rare, the authors describe a case of silicone allergy causing multiple ventricular shunt revisions. A 24-year-old man, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissues surrounding the shunt tubing. The patient's existing silicone-based shunt was replaced with a new polyurethane system, including the proximal and distal catheters as well as the valve mechanism. Contrary to recommendations in previous studies of silicone shunt allergies, long-term immunosuppression was not initiated. The patient was followed up for more than 8 years without recurrence of an allergic reaction to the shunt. This outcome indicates that replacing the original silicone-based shunt system with a polyurethane-based system alone is sufficient in the treatment of a silicone shunt allergy.     

Case report of a successfully treated gentamicin and ciprofloxacin resistant Serratia marcescens prosthetic joint infection

We report the case of an eradicated multiresistant Serratia marcescens prosthetic hip joint infection. It is estimated that enteric Gram-negative organisms account for approximately 8% of prosthetic joint infections. However, the evolving multiresistant strains of organisms being encountered in hospital acquired infections is making eradication increasingly difficult. We describe n our surgical and microbiological approach to this in a complex case.     

Ulcer infection by ESbetaL-producing Proteus mirabilis: a case report

In this article, a case of decubitus ulcer infection caused by an extended-spectrum beta-lactamase-producing Proteus mirabilis strain, successfully treated with oral amoxicillin-clavulanate (1-month therapy) is described. This article focuses on diffusion and clinical effect of extended-spectrum beta-lactamases-producing Proteus mirabilis on treatment of gram negative lower extremity infections.     

Spontaneous bacterial peritonitis due to streptococcus pneumoniae--case report

Spontaneous bacterial peritonitis is caused by infection of ascitic fluid without any apparent intraabdominal source of infection. The disease most commonly occurs in patients with cirrhosis and 70% of cases of infections are caused by pathogenes from gastrointestinal tract. The article presents the case of 38-year-old patient with spontaneous peritonitis who was treated surgically. The primary nature of the disease was confirmed by laparotomy and bacteriological examination results (Streptoccocus pneumonia) of ascitic fluid. After 54 days of hospitalisation and undergoing re-laparotomy, he was discharged in good condition.     

Antibiotic-resistant Serratia marcescens infection in a hospital.

Over a 12-month period, 74 isolates of Serratia marcescens were obtained from various sources at Tygerberg Hospital. The majority of these isolates were from catheterized patients with urinary tract infections, and were non-pigmented and resistant to all antibiotics tested, excepting amikacin and neomycin. All isolates transferred resistance to tobramycin, gentamicin and tetracycline by conjugation to Escherichia coli recipients as separate markers at low frequency. A non-self-transmissible plasmid conferring resistance to kanamycin, ampicillin and gentamicin was mobilized from Serratia species to E. coli, and became fully self-transmissible in subsequent matings.     

Intractable seizures associated with proximal migration of a ventriculoperitoneal shunt. Case report

A 6-year-old girl, who had received a ventriculoperitoneal (VP) shunt using the Codman-Hakim programmable valve system at age 3 months, presented with intractable seizures. Neuroimaging studies showed migration of the proximal part of the system, including the prechamber, into the cranium through the right frontal burr hole. Electroencephalography showed spike-and-wave complexes in the right hemisphere including the site of the migration. The ictus was resolved following revision surgery. The clinical findings suggested the seizures were due to irritation of the brain parenchyma by the migrated system. Proximal migration of a VP shunt may cause both shunt failure and additional focal symptoms.     

Primitive neuroectodermal tumor with peritoneal metastasis through a ventriculoperitoneal shunt. Case report

A 13-month-old boy admitted with lethargy and hydrocephalus was found to have a right thalamic mass. Ventricular drainage was instituted, and the tumor mass was reduced by partial resection and local irradiation. A ventriculoperitoneal shunt was then placed. However, the tumor recurred 16 months later, with extensive ventricular seeding and peritoneal metastasis through the shunt tube. The child died 22 months after onset. Histological study of surgical specimens of the primary tumor and autopsy specimens of the brain and peritoneal metastatic tumors revealed poorly differentiated, small, round cells with numerous mitotic figures. In addition, autopsy specimens of the brain tumor contained areas of ependymal, oligodendroblastic, and spongioblastic differentiation. On immunohistochemical study, the tumor cells of each specimen were positive for anti-neuron specific enolase and anti-neurofilament antibodies, but negative for anti-glial fibrillary acidic protein antibodies. Electron microscopy revealed some zonulae adherens. These findings strongly suggest that the tumor originated from primitive multipotential cells capable of differentiating into ependymal, glial, and neuronal lines.     

Leech-borne Serratia marcescens infection following complex hand injury.

Leeches are commonly used in the postoperative course of plastic surgical operations where there is venous congestion in a pedicled or free flap. They provide a temporary relief to venous engorgement whilst venous drainage is re-established. It is known that leeches can carry Aeromonas hydrophila infection, and a second or third generation cephalosporin antibiotic has traditionally been given as prophylaxis against infection. We report a new observation that leeches can carry Serratia marcescens and give rise to clinically significant infection. The implication for prophylaxis and treatment of leech-associated cellulitis is discussed.     

Abdominal metastasis of a pineal region tumor through ventriculoperitoneal shunt. Case report]

An 18-year-old male was admitted with headache, nausea, and vomiting. Computed tomography (CT) revealed an enhanced tumor of the pineal region and hydrocephalus. The tumor was partially resected via a parieto-occipital craniectomy. The histological diagnosis was germinoma. No serum tumor markers such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) were detectable. A ventriculo-peritoneal (V-P) shunt was emplaced and radiation therapy (whole brain 59 Gy) given. The tumor and the hydrocephalus regressed completely and he returned to work. Six years later, he experienced constipation and general fatigue. CT and echotomography of the abdomen showed a large peritoneal tumor and ascites. Laboratory investigation demonstrated serum levels of AFP 7640 ng/ml and HCG 150 IU/l, and high ascitic levels of AFP 12,890 ng/ml and HCG 1030 IU/l. AFP and HCG levels regressed after combined chemotherapy. However, he died due to leukopenia and pneumonia. Autopsy found no metastasis of tumor cells to the central nervous system. The peritoneal cavity contained hemorrhagic fluid and a large tumor 4100 g in weight. The tip of the V-P shunt tube was in front of the tumor. No neoplasm was found in the testis, retroperitoneal cavity, thymus, and other organs. The microscopic appearance of the peritoneal tumor was different to the first pineal tumor. The neoplasm was confirmed as a mixed germ cell tumor with teratoma components and suspected to be a metastasis of the pineal tumor through the V-P shunt system.     

Serratia marcescens endocarditis treated with ceftazidime. A case report

A 14-year-old Black girl developed Serratia marcescens endocarditis following a mitral valve repair. This was refractory to treatment with several courses of antibiotics and valve replacement, and was eventually cured after a second valve replacement and treatment with ceftazidime (GR 20263 Glaxo), a new cephalosporin derivative.