Shunt procedures

Cerebrospinal fluid shunt procedures 5. aureus, S. epidermidis Cefazolin 1 g every 8 hours x 3 doses or ceftriaxone 2 gx 1 No agents have been shown to be better than cefazolin in randomized comparative trials. IA... 

Three patients developed priapism after taking cocaine or non-prescription weight loss formulations containing ephedrine (216). Intracavemous injection of phenylephrine and irrigation with heparinized saline, followed by an Al-Ghorab shunt procedure, was effective. 

Management involves measures directed at the varices and also to reduce portal pressure by pharmacological methods and blood shunting procedures. 

Of the many surgical methods used in the treatment of bleeding oesophageal varices, only two groups are of relevance (7.) block surgery and (2.) pressure-reducing shunt procedures, (s. tab. 19.7)... 

The classical form is the portacaval end-to-side anastomosis (lat-erolateral), applied for the first time in a dog by N.W von Eck in 1877. Nevertheless, this was still a long way from clinical applicability. Not until 1901 was a clinical attempt made by R. Lenoir, yet without success. A renewed attempt to use this (end-to-side) shunt procedure undertaken by M. Vidal (1903) proved to be satisfactory. The first successful portacaval (side-to-side) anastomosis was reported by R Rosenstein in 1912. Extensive clinical use of the portacaval shunt was encouraged by the studies of A.O. Whipple and A.H. Blakemore (1945). The following years saw the development of a large munber of varying shunt techniques and their modifications, (s. tab. 19.7)... 

In this case it was felt that the 20% fat emulsion had increased platelet activity, which was already increased before the start of therapy, and that this had predisposed to the development of priapism. The authors pointed out that a shunt procedure should be performed as soon as possible if erectile capacity is to be preserved. 

A 47-year-old man presented with a 4-day history of priapism and moderate pain. Several brief but otherwise similar episodes had occurred during the previous month. He had a history of depression and had been taking sertrahne 200 mg/day and dexamfetamine 10 mg/ day. He received intracorporeal methoxamine, but when this proved ineffective he was treated with intracorporeal adrenaline and a shunt procedure. However, detumescence was incomplete. At fohow-up after several weeks the priapism had resolved and he had not become impotent (a significant risk in cases of... 

Neurosurgery S. aureus, S. epidermidis CSF shunt procedures Cefazolin 1 g x 1 or ceftriaxone 2 g x 1 Craniotomy Cefazolin 1 g x 1 or cefotaxime 1 g x 1 or trimethoprim-sulfamethoxazole (160/800) IV X 1 No agents have been shown better than cefazolin in randomized control comparative trials. 

Cavernosal blood aspiration followed by intra-cavernous microbubble injection allows identification of non-enhancing cavernosal blood clots. In patients who had undergone shunting procedure, shunt patency can be evaluated when microbubbles injected in the corporal bodies are observed flowing outside the corpora cavernosa (Fig. 21.9). 

Continuous versus intermittent administration A study randomised 20 patients who underwent a transjugular intrahepatic portosystemic shunt procedure to be treated with either TV bolus infusion of terlipressin (1 mg) followed by continuous infusion (4 mg/24 h) or intravenous bolus injection of ferlipressin (2 mg) followed by intermittent injections (1 mg/6 h) [92 ]. The continuous administration route more stably reduced portal venous pressure and did so with a lower initial IV dose, which could minimise tiie risk of adverse drug reactions. Larger studies are required to assess that possibility. 

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