Transcranial doppler ultrasonography for the evaluation of shunt malfunction in pediatric patients

Previous studies have demonstrated a high correlation between hydrocephalus and the resistive index (RI), as determined by transcranial Doppler ultrasonography. Measurements of RI, calculated by dividing the difference between the peak systolic velocity and the enddiastolic velocity by the peak systolic velocity, were attempted in 55 pediatric patients during evaluations for ventriculoperitoneal shunt malfunctions; values were obtained in 52. Indications of shunt malfunction included both clinical and radiographic evidence of increased intracranial pressure. Eleven patients, determined to have functional shunts both by clincal criteria and subsequent outcome, had RIs of 47±5 (average±1 standard deviation). Shunt malfunctions were confirmed in 41 patients. Prior to shunt revisions, these 41 patients has RIs of 71±10%; following revision, the RIs fell to 53±12%. Nine patients had had pre-malfunction RIs of 48±11% obtained during routine follow-ups; when they subsequently had shunt malfunctions, their RIs had significantly increased. Four of the 41 patients with shunt malfunctions had essentially normal RIs (52±7%), but had fluid tracking along the shunt; in these, RIs were essentially unaffected by shunt revision. For comparison, 119 pediatric patients with clinically functional ventriculoperitoneal shunts had RIs of 50±9%. The data, statistically significant with a P value of <0.001, showed a correlation between elevated RIs and shunt malfunction; thus, transcranial Doppler ultrasonography is a practical, non-invasive technique useful in the diagnosis of ventriculoperitoneal shunt malfunction.Presented at the Annual Meeting of the Pediatric Section of the American Association of Neurological Surgeons, Washington D.C., November 1989     

Electrotonic coupling among neuroendocrine cells in Aplysia.

1. We have discovered and characterized direct electrotonic synaptic coupling among a population of neuroendocrine (bag) cells in the parietovisceral ganglion of the marine gastropod Aplysia dactylomela. Pairs of ipsilateral and contralateral bag cells were impaled in vitro with microelectrodes. Current pulses applied through the electrometer amplifier to either cell influenced the other cell via electrotonic connections. 2. The coupling between bag cells was relatively weak when measured at the somata; the mean ratio of postsynaptic/presynaptic response amplitudes is 0.0075. Junctional rectification was not detected. The latency between pre- and postjunctional responses was long, up to 50 ms, a delay comparable to that for chemical synaptic transmission among neurons in this ganglion. Low-Ca2+/high-Mg2+ bathing solutions did not block transmission between bag cells, but did block chemical synaptic potentials in other identified neurons. 3. Postjunctional electrotonic responses had markedly slow time courses compared to the prejunctional responses, a characteristic that permitted summation of otherwise undetectable electrotonic PSPs and the demonstration of coupling between the two (bilateral) clusters of bag cells. 4. Based on extracellular recordings of their compound action potentials, the neurites of A. dactylomela bag cells extended a shorter distance (approximately 3 mm) along the connective than the neurites of A. californica or A. brasiliana. 5. Electrolytic lesions made along the neurites during intrasomatic coupling measurements significantly shortened the duration of postjuctional electrotonic responses, indicating that the neurites are widely electrically interconnected and, as a population, have a large effective membrane capacitance. The lesions furthermore revealed that an important site of electrotonic coupling is at the base of the pleurovisceral connective just rostral to the bag cell cluster. 6. The small-amplitude, long-latency and prolonged time course of postjunctional responses are interpreted to indicate remote and widespread coupling sites among the bag cells. This electrotonic coupling underlies the synchronized firing of the bag cells.