Laparoscopically assisted ventriculoperitoneal shunt placement in infants with previous multiple abdominal operations.

BACKGROUND: The insertion of a ventriculoperitoneal shunt (VPS) is the treatment of choice in patients with hydrocephalus. However, VPS placement may be difficult in patients with extensive adhesions following prior abdominal interventions. Laparoscopic placement of the abdominal part of the VPS allows controlled adhesiolysis in combination with an optimal shunt placement in patients with a body weight above 5 kg. We investigated the feasibility and safety of laparoscopic VPS placement in young infants who had undergone abdominal operations. PATIENTS AND METHODS: In our institution, 6 children with prior laparotomies (range: 2-9; median 3) received a VPS catheter between 2004 and 2008. The median age was 9 months (range: 2 months-4 years) and the median body weight was 4.5 kg (3.5-8.2 kg). All procedures were laparoscopically assisted and performed simultaneously by an interdisciplinary neurosurgical and a pediatric surgical team. RESULTS: Median operating time was 63 min (35-100 min). In all cases, correct placement of the shunt with sufficient drainage was achieved. Enteral feeding was started on the day of operation in all patients. Median follow-up was 10 months (range: 2 months-3 years). There were no complications except in one patient, who developed shunt dysfunction 4 weeks postoperatively and underwent a laparoscopic shunt revision. CONCLUSION: In our series laparoscopically assisted VPS insertion in low-weight children who had undergone repeated prior abdominal surgery was feasible and had a low complication rate. We recommend laparoscopically assisted VPS insertion in small infants to avoid the complications of alternative techniques, such as open techniques or ventriculoatrial shunt.

First experimental results with a new waterjet dissector: Erbejet 2.

BACKGROUND: Waterjet dissection represents a useful technique for many surgical procedures. In this experimental study, the technical features and dissection qualities of the new Erbejet 2 with its new pump and nozzle applicator system are evaluated for its neurosurgical use compared to the established Helix Hydro-Jet. METHODS: One hundred twenty-six fresh cadaveric pig brains were simultaneously cut with the Helix Hydro-Jet and Erbejet 2. Different pressure levels were applied to cerebral tissue with and without meninges, cerebellum and brainstem. Additionally, dissection characteristics of various cutting media were investigated. FINDINGS: There was a nearly equal dissection quality at up to 10 bar of both instruments. In contrast to the Helix Hydro-Jet, Erbejet 2 application at higher pressures resulted in an almost linear increase of dissection depth with a small standard deviation. Smoother cutting margins and less foaming were found. Preserved vessels were observed with both devices. Hydroxyaethyl starch led, in contrast to Ringer's solution and isotonic saline solution, to increased dissection width and more foaming. CONCLUSIONS: The new Erbejet 2 is more precise, with almost linear correlation of pressure and dissection depth compared to the Helix Hydro-Jet. Less foaming and the possible application of various separating media are a considerable advantage. All things considered, the new Erbejet 2 offers more options to enlarge the field of neurosurgical indications for waterjet dissection.

Time course of increasing numbers of mutations in the granulocyte colony-stimulating factor receptor gene in a patient with congenital neutropenia who developed leukemia.

Point mutations in the granulocyte colony-stimulating factor receptor (G-CSFR) gene have been linked to the development of secondary leukemia in patients with congenital neutropenia (CN). This report presents data on a now 18-year-old patient with CN who has received G-CSF treatment since 1989 and who developed acute myeloid leukemia (AML) in 1998. To evaluate whether there is an association between the occurrence of point mutations of the G-CSFR gene and development of secondary AML, DNA/messenger RNA of neutrophils and mononuclear cells from this patient were analyzed at different time points by polymerase chain reaction and subsequent cloning by DNA sequencing of representative numbers of individual clones. Findings suggest an increasing instability of the G-CSFR gene in time as judged by increasing numbers of mutations proposed to be one important step in the development of AML in this patient.