On the neurological complications of internal and external shunt in patients with non-neoplastic stenosis of the aqueduct.

In our Department 35 patients have been operated for non-neoplastic stenosis of the aqueduct. In the first years, ventriculocisternal shunt according to Torkildsen was performed, obtaining 6 recoveries and 1 death. Later, ventriculosternostomy acc. to Stookey and Scarf, was carried out in 3 cases, obtaining 2 recoveries and 1 death; by using right ventriculo-atrial shunt we had 4 successes and 1 failure. More recently, since 1973, ventriculoperitoneal shunt has been carried out without deaths out of 21 operated patients. With this technique we have had many complications requiring repeated drainage system revisions in 9 cases, and evacuation of a chronic subdural haematoma in 3 cases. 2 patients, operated by drainage system revision and 1 for evacuation of subdural haematoma, had a dramatic postoperative course, characterised by apallic syndrome. Considering the results of the various techniques, we could conclude that the elective operation must be internal shunt (posterior or anterior ventriculocisternostomy) if, of course, the patency and the functionality of the cisterns have been ascertained.

Cyclic AMP excretion in urines of patients with subarachnoid hemorrhages.

Urinary excretion of cAMP was closely monitored for several days in 74 patients with subarachnoid hemorrhages. A rise in urinary cAMP up to 45 microM/24h was observed (normal values being 1 to 5 microM/24h). Patients with associated metabolic disorders were excluded from this study. We have found a correlation between the severity of the clinical conditions, recovery from acute disorder and cAMP excretion, thus suggesting that an increase of urinary cAMP level is related to the extent and the evolution of the acute cerebral damage.