Akademik Veri Yönetim Sistemi
Tezin Türü: Tıpta Uzmanlık
Tezin Yürütüldüğü Kurum: Akdeniz Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Türkiye
Tezin Onay Tarihi: 2020
Tezin Dili: Türkçe
Öğrenci: Onur Tekeli
Danışman: Nilgün Erkek
Özet:
ABSTRACT
Retrospective Evaluation of Clinical and Radiological Characteristics of
Children with Ventriculoperitoneal Shunts
Clinical and radiological features of children with Ventriculoperitoneal
(VP) shunts were retrospectively analyzed from the pediatric emergency
department admissions records. The aim of this study was to investigate the
effectiveness of the history and examination characteristics of the patients and
laboratory tests and radiological imaging in the diagnosis of shunt malfunction, and
to determine the imaging-related radiation burden of patients were exposed to
during the follow-up.
Socio-demographic, clinical and radiological data of 84 patients aged
between 0-18 years who underwent VP shunt operation and have been followedup in hospital of Akdeniz University Faculty of Medicine between 01.08.2014 and
31.07.2018 were reviewed. Clinical characteristics, laboratory tests and
radiological imaging results and prognosis of 123 admissions to pediatric
emergency department of patients with VP shunts were also retrospectively.
Sixty two percent of the 84 patients of the study were male. The reason for
the first shunt installation were congenital malformations of the central nervous
system in 53.6% of the patients. The first shunt insertion age was 4 months in
median. Shunt replacement was performed at least once in 47.6% of the patients. A
significant moderate negative correlation was found between the total number of
shunt replacements and ages of patients, both at the first shunt insertion (r:-0.394)
and at the first shunt replacement (r:-0.389). The total number of shunt
replacements were found to be statistically higher in patients younger than 6 months
at their first shunt replacements (p:0.016). On 123 admissions to pediatric
emergency department of 84 patients with VP shunts, having a complaint of shunt
entry or track (p:0.02) and the presence of increased CSF pressure findings on
physical examination (p:0.001) were found statistically significant different.
Admission with fever to pediatric emergency department showed a significant
difference in diagnosis of shunt infection (p:0.003). In diagnosis of shunt
malfunction, sensitivity and specificity of CBT were found as 73% and 35%. The
120
mean cumulative radiation dose per patient was calculated as 16.1 mSv / follow-up
year. This was equivalent to about 8 BBT shots.
In conclusion, it seems necessary to detect and apply the discriminant
clinical criteria when deciding to shoot a BBT in patients with suspected shunt
malfunctions. The basic data for planning large prospective controlled studies about
extracting the risk scoring parameters based on clinical findings in the future were
provided by this study.
Key words: Hydrocephalus, Ventriculoperitoneal (VP) shunt, Shunt
malfunction, Computed brain tomography (CBT), İmaging-related radiation burden