Stereotactically-guided fourth ventriculo-peritoneal shunting for the isolated fourth ventricle.

The isolated fourth ventricle (IFV) develops in which obstruction to the out flow of cerebrospinal fluid from the choroid plexus of the fourth ventricle occurs rostrally and caudally. IFV has been a rare occurrence and is difficult to treat. We had an occasion to admit a 28-year-old female to our hospital due to hydrocephalus: she also had a history of meningitis a year ago. The patient was initially managed by a lateral ventriculo-peritoneal shunting procedure. Six months after the procedure the patient began to suffer from vomiting, nausea, and diplopia. CT and MRI scans demonstrated an isolated fourth ventricle enlargement; and thus, a fourth ventriculo-peritoneal shunting procedure was performed under stereotactic conditions. The authors present a case of an isolated fourth ventricle after lateral ventriculo-peritoneal shunting for hydrocephalus, which was treated with a stereotactically guided fourth ventriculo-peritoneal shunting procedure. The technique of this procedure is described below.     

Initial experience with laser retinal surgery

The authors describe 21 cases with resection of the retinal rupture valve with Nd:YAG laser impulse, performed to reduce the vitreoretinal tractions. Resection of the 'dump' rupture valve has been carried out in 10 cases, in the rest 11 the operation has been performed in the presence of a detachment of the retina. Anatomic success (detachment of the valve from the retina) has been achieved in 16 cases. The technique of the surgery is described, as are indications and contraindications to the operation.     

Umbilical artery reactivity and ultrastructural changes in pregnancy-induced hypertension and other complicated pregnancies

Abnormal pressor responses are known to occur in the maternal circulation in pregnancy-induced hypertension (PIH), but little is know of the response of the foetal circulation. The responsiveness of umbilical arteries in PIH can be studied after delivery, and this is a useful model to explore the pathophysiological mechanisms involved. In the present experiments, the in vitro response of umbilical artery rings to bradykinin and 5-hydroxytryptamine (5-HT) was tested and ultrastructural changes investigated. Umbilical arteries from 48 cords were studied. Fifteen of the mothers had PIH, five had essential hypertension pre-dating the pregnancy and five had diabetes. Twenty-three women had pregnancies uncomplicated by hypertension or serious medical or obstetric problems and these served as controls. Umbilical arteries from the severe proteinuric PIH group were significantly more responsive to 5-HT as assessed by affinity constants (P less than 0.05). The responsiveness of arteries from all other groups did not differ from the normal cases. A probable mechanism for the findings is endothelial damage as a result of pre-eclamptic disease. This was substantiated by ultrastructural evidence.     

Prediction of full scale plant performance from pilot columns

The first attempt to provide a data base for comparing a pilot and full scale system for various organics produced results that require further investigation. Although both of the pilot systems had longer average contact times than their respective full scale systems, a uniform pattern of longer service time for the different substances evaluated did not occur. These results may not be consistent with the data collected using pilot contactors in series to observe the effect of contact time. The series pilot contactor system provided data that show the effect of varying empty bed contact time on the removal of the organic substances studied. Improved effluent quality was generally achieved with increased contact time. A pilot series system similar to the one used is considered essential in collecting and interpreting design data. A method of statistical interpretation of the results was developed that shows promise for use in evaluating pilot column results. Further evaluation is required to assess that all pertinent factors were properly controlled during the investigation. Also, repeat testing will be conducted, attempting to control more closely the contact times between the pilot and full scale systems. The comparative granular activated carbon particle sizes also will be more closely examined. Although pilot to full-scale comparisons have been successfully performed for single parameters, the results for multiple organics have not been previously reported. Such a data base, if properly collected, will provide invaluable background in assessing what types of design safety factors are required when using pilot column data to predict full scale results for a naturally occurring mixture of organic substances.     

Zinc deficiency and hyperprolactinaemia are not reversible causes of sexual dysfunction in uraemia

We selected a group of male dialysis patients complaining of sexual dysfunction in whom penile vascular insufficiency and drug-induced impotence had been excluded. Monitoring of nocturnal penile tumescence was used to confirm organic disturbance. Patients with normal serum prolactin concentrations (n = 18) had significantly lower serum zinc values than normal controls (P less than 0.001) and were entered in a 6-month double-blind study comparing oral zinc acetate with placebo. Patients with elevated prolactin concentrations (n = 8) were entered in a 3-month double-blind crossover study comparing oral pergolide mesylate with placebo. In the zinc study, serum zinc concentrations increased (P less than 0.05) in the zinc-treated but not the placebo-treated group. One of nine patients receiving zinc reported improved sexual function, as did two of nine patients receiving placebo. There were no significant changes in sperm counts, nocturnal penile tumescence, testosterone, sex hormone binding globulin or gonadotrophin concentrations in either treatment group. In the pergolide study, serum prolactin values decreased (P less than 0.01) in the pergolide but not in the placebo treatment period. One patient reported improved sexual function during the pergolide treatment period and two during the placebo period. There were no significant changes in sperm counts, nocturnal penile tumescence, testosterone, sex hormone binding globulin or gonadotrophin concentrations after pergolide. These studies show no benefit of zinc or pergolide compared with placebo in the treatment of uraemic impotence.