Therapeutic criteria in hydrocephalic children

Abstract

The xanthine, hypoxanthine, and total oxypurine levels were determined in the CSF of 28 hydrocephalic patients (age from newborn to 2 years) and 8 healthy controls using HPLC. The Evans' index, the mean weekly increase in cranial circumference, and the intracranial pressure were also measured. Of the hydrocephalic patients 13 were self-compensated and the other 15 had a shunt implanted during the course of the study. The mean xanthine, hypoxanthine, and total oxypurine levels in the normal children were 5.20, 5.94, and 11.29 mumol/l, respectively. In the self-compensated hydrocephalics these levels were 5.17, 5.71, and 10.79 mumol/l, respectively. In the noncompensated hydrocephalics, they were 9.90, 9.91, and 19.82 mumol/l. The differences between the latter group and the first two are statistically significant (P less than 0.001). The mean Evans' index and the mean weakly increase in cranial circumference in the self-compensated hydrocephalics were 0.35 and 0.25 cm, respectively. In the noncompensated hydrocephalics, they were 0.55 and 0.95 cm. The differences between the two groups are statistically significant (P less than 0.001). Two weeks after implantation of shunts in the noncompensated cases, the mean xanthine, hypoxanthine, and total oxypurine levels fell to 4.22, 4.57, and 8.80 mumol/l, respectively. These changes are statistically significant (P less than 0.001). We think that the two criteria (clinical and biochemical) are equally useful for the prediction of self-compensation in hydrocephalic children and that the oxypurine values after shunt implantation can be used to monitor progress in noncompensated cases.

Concentration of purine compounds in the cerebrospinal fluid of infants suffering from sepsis, convulsions and hydrocephalus

“…In our study, hypoxanthine values in the control group are higher than described by other authors [5,12]. Probably this was due to mild fever in these newborns.…”

“…A good correlation was described in the concentrations of hypoxanthine and xanthine and the intracranial pressure, e.g. noncompensated hydrocephalus [3][4][5][6]17]. …”

Ultrastructural study of the lateral ventricle choroid plexus in experimental hydrocephalus in Wistar rats

“…The fragments observed on the choroid plexus surface of hydrocephalic animals are consequence of an impaired ciliar movement due to the ciliar degeneration described previously 12,22 . In this way, an altered CSF dynamics and the CSF accumulation on an enlarged ventricular system impairs the correct elimination of the metabolic products 23 .…”

Biochemical parameters predictive of neuronal damage in children with neonatal hypoxic ischemia

“…We have determined CSF levels of purine nucleotide degradation products and in some cases NSE in various pediatric clinical conditions [2,3,[131][132][133][134][135][136][137][138][139][140][141][142][143][144][145][146]. In children with severe HIE, we have observed very high levels of AMP, IMP, inosine, guanosine, adenine, hypoxanthine, xanthine and uric acid.…”