The fate of ventriculo-peritoneal shunts and outcome of revision surgery

Insertion of a ventriculo-peritoneal shunt (VPS) is the only effective treatment for hydrocephalus. Revision of a VPS can be indicated for infective or mechanical complications. This study aimed to investigate the middle to long-term outcome after insertion of a VPS in Zambia and the outcome after revisions.Between August 1935 and August 1998, at St Francis' Hospital, Katete, 60 Harare type VPS were inserted in 54 children. The age range at the time of insertion was 14 days to 12 months. Twenty children (37%) underwent a revision during the study period, mainly for mechanical problems (blockage). Follow-up data were available for 22 children (40% of the total) of which six had undergone revision.Twenty-one children still had a functioning VPS in situ. Thirteen of the 21 had moderate to severe psychomotor retardation and eight(38%) were normal or mildly impaired. None of the six children who needed revision, were in the latter category.Of the 54 children with a VPS, 20 (37%) needed revision within three years of insertion. The psychomotor development of these children was found to be moderately to severely delayed during follow-up. The need for revision of a VPS appears to be associated with a poor outcome.Keywords: ventriculo-peritoneal shunt, outcome, revision, Afric

Imaging of acute appendicitis in children: EU versus US ... or US versus CT? A European perspective

There is substantial evidence that imaging may reduce the negative appendectomy rate, also in children. However, controversy exists about the preferred method: US or CT, and the choice appears to be determined by the side of the Atlantic Ocean. This review brings forth several arguments in favour of U

At the bottom of the differential diagnosis list: unusual causes of pediatric hypertension

Hypertension affects 1–5% of children and adolescents, and the incidence has been increasing in association with obesity. However, secondary causes of hypertension such as renal parenchymal diseases, congenital abnormalities and renovascular disorders still remain the leading cause of pediatric hypertension, particularly in children under 12 years old. Other less common causes of hypertension in children and adolescents, including immobilization, burns, illicit and prescription drugs, dietary supplements, genetic disorders, and tumors will be addressed in this review

A comprehensive overview of radioguided surgery using gamma detection probe technology

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology