Neurosurgery
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Sixteen patients each received infusions of 1 g of mannitol per kg over 5 to 10 minutes, and serial determinations of intracranial pressure (ICP), systemic arterial blood pressure (SABP), central venous pressure, cerebral perfusion pressure (CPP), hematocrit, hemoglobin, serum Na+, K+, osmolarity, and fluid balance were carried out for 4 hours. Urine output was replaced volume for volume with 5% dextrose in 0.45% NaCl solution. We tested the hypothesis that patients with high (greater than or equal to 70 torr) CPP would respond less well to mannitol by either ICP or CPP criteria than patients with low (less than 70 torr) CPP. ⋯ These data suggest that mannitol infusion is at least partly dependent upon hemodynamic mechanisms that allow vasoconstriction to occur with reduction in cerebral blood volume and that little may be gained by using mannitol when CPP greater than or equal to 70 either by SABP, ICP, or CPP criteria because vasoconstriction is already nearly maximal. This mechanism is not exclusive of other potential mechanisms of action. Mannitol "rebound" may be a function of net dehydration, hemoconcentration, and SABP decline.
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The intrahepatic migration of a peritoneal shunt tube of a ventriculoperitoneal shunt system (low pressure Pudenz valve and low pressure Pudenz peritoneal catheter) is reported. This is a rare complication of ventriculoperitoneal shunting and was diagnosed by metrizamide shuntography and abdominal computed tomography. To our knowledge, this is the second case complicated with migration of a peritoneal shunt tube into the liver.
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Biography Historical Article
Harvey Cushing's Guillain-Barré syndrome: an historical diagnosis.
Harvey Cushing developed an illness in the last months of World War I that made it impossible for him to operate and forced him to bed for over a month. The features of Cushing's malady included symmetrical weakness, numbness, and paresthesias of the hands and feet, areflexia, bilateral facial paresis, diplopia, and fever. ⋯ John Fulton, Cushing's biographer, misdiagnosed the condition as a "vascular polyneuritis," and Harry Zimmerman, who performed Cushing's autopsy, incorrectly attributed his symptoms to occlusion of the abdominal aorta. Based on extensive notes in Cushing's war diary describing the illness, it is readily recognized today as Guillain-Barré syndrome.
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Ten cases of craniosynostosis associated with hydrocephalus were found in a retrospective review of 250 cases of children with craniosynostosis. Four children had Pfeiffer's syndrome, 3 had Crouzon's syndrome, 2 had kleeblattschädel with multiple anomalies and therefore could not be classified into a definite syndrome, and 1 had isolated sagittal synostosis. ⋯ In all patients, hydrocephalus was controlled by a shunting procedure. Possible causes of hydrocephalus in association with craniosynostosis are discussed.