RESUMO
Shunting procedures specifically ventriculoperitoneal shunts are the main line of treatment for management of hydrocephalus despite available new techniques and systems of shunting. Associated complications should be recognized and managed properly, but the most recognized complications are shunt obstruction which its prevalence through surgical approach is discussed here. Two approaches [frontal and parietal] are used to insert ventriculoperitoneal shunt. In this study we retrospectively examined patterns of shunt failure in patients with symptoms of shunt malfunction. Factors analyzed included site of failure, time from shunt placement or last revision of failure, age of patient at time of failure, infection and primary etiology of hydrocephalus. Two approaches were compared to determine which one is more associated with shunt failure. 250 patients with symptoms of shunt malfunction over 4 years period were retrospectively examined, in 126 cases who were shunted through frontal approach, 48 cases and in 124 patients whose shunts were inserted through parietal approach 64 cases of malfunction observed. All data was analyzed with SPSS software and with T-test, and then the failure rate for frontal versus parietal approach was compared. Significant difference in malfunction rate between these two approaches regardless of underlying cause of ventriculoperitoneal shunt failure was observed, with the less failure rates through frontal approach. Although proximal obstruction is the most common cause of ventriculoperitoneal shunt failure and frontal approach demonstrated less failure rate, but as it is known placing the catheter tip away from the choroids plexus is the most important factor avoiding obstruction
RESUMO
As a well-recognized clinical phenomenon, persistent detectable viral genome in liver or sera in the absence of other serological markers for active hepatitis B virus [HBV] replication is called occult HBV infection. The main mechanism through which occult infection occurs is not completely understood and several possible explanations, such as integration into human genome and maintenance in peripheral mononuclear cells, exist. Occult HBV infection has been reported in different populations, especially among patients with Hepatitis C [HCV] related liver disease. The probable impact of occult HBV in patients with chronic HCV infection has been previously investigated and the evidence suggests a possible correlation with lower response to anti-viral treatment, higher grades of liver histological changes, and also developing hepatocellular carcinoma. However, in the absence of conclusive results, further studies should be conducted to absolutely assess the impact of occult HBV contamination on the HCV related liver disease