Pleural Effusion

[fabriccrafter]

hi
I have a vp shunt which is implanted in my right plura. My shunt was placed after I suffered a cerebral hemmorhage 6 years ago, which caused me to have hydrocephalus. The shunt was initially placed in my abdomen but it caused so much pain, that after 5 months , the surgeon moved it to my stomach. That lasted for 4 days, when I fainted from a knife-like pain while eating dinner. Next it was placed in my pleura. After the surgery I was in acute pain from every breath. It took a month to adjust to breathing but then I began having lung spasms upon waking every few days, with extreme pain. I have been living with this for the past few years because the neurosurgeons tell me that shunts almost never cause pain. I only had Medicade for insurance and I live in N.Y. state where doctors can and do refuse to see you when you have Medicade. So choosing a better neurosurgeon was not an option. Now, I have 3 liters of cerebral spinal fluid in my right pleura which has crushed my lung. Every month or 2 lately I have to go to my pulmanary doctor and have it drained. I've been researching on the web and I have a strong suspicion that I have an allergy to silicone, which is what the shunt is made of. My pulmanary doctor has been great and is trying to help. He tested the fluid from my pleura and found white cells that indicate an allergy. I tried seeing a different neurosurgeon, but he doesn't believe in silicone allergy and thinks that he could remove the shunt from the pluera and place it in my heart!!!!!!
Well, I just turned 65, thank God and now I have Medicare. I am trying to find a doctor that will accept that insurance before I drown! Has anyone out there had a similar problem with pleural effusion from a shunt???? Please write if you know anything. Getting desperate!!!!

[UroDoc]

Wow sounds like a very unusual case, I am used to shunts being only placed in the abdomen, good luck

[songofdeb1]

yes. you may have silicon allergy and my daughter has had the same thing you are describing. sorry for your difficulties.

a friend

[fabriccrafter]

Thank you for responding! Can you send me any more information about your daughters case?? Like symptoms, tests, where she had the allergy? Thanks , Michele

[songofdeb1]

Michele,

My daughter has undergone almost 40 surgeries related to vp shunts and the failure and complicaitons that have ensued. She has been diagnosed with pseudotumer cerebri and for the last 7 years has had replacement after replacement without success. She has recently had two chest tubes placed at separate times due to CSF building up around her lungs and almost collapsing the lung. There is not enough space available to include the numerous episodes involved in this attempt to live with vp shunts made of silicon. I am attaching articles that indicate the direct link of silicone allergy and failure of vp shunts. Hope this helps.....I am a nurse and found this information through trying to find a cause for my daughter's difficulty. Each paragraph is about a different case study and if you read there is a test for "silicone allergy" that came about as a result of the problems women were having from breast implants. As you will see 5 out of 6 people that have difficulty with vp shunts have silicone allergy.
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In August 1992, a study published in The Lancet reported that silicone shunts had been found to cause "severe, apparently immune-mediated reactions". The authors, who included Dr. John Heggers from the University of Texas, concluded that, "These findings show that specific immune reactivity [to silicone] can develop in human beings." The patients developed severe inflammatory reactions, despite the absence of infection. The reactions were found to be immunological using an enzyme-linked immunosorbent assay.

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Garry has also applied the anti-polymer antibody test to the blood of hydrocephalus patients who have repeatedly rejected silicone shunts—tubing that draws excess fluid from the brain. He found that about five out of six of the patients who had recurrent problems of shunt rejection tested positive on the assays.

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Reported are the cases of three hydrocephalic patients who developed a clinically heterogenous entity with an allergic rejection of their silicone ventriculoperitoneal shunts. All of the patients had an original presentation indicative of a shunt infection, but laboratory analysis revealed sterile cerebrospinal fluid in all three cases. The typical course included recurrent skin breakdowns over the shunt tract, subsequent infections and development of fungating granulomas. Treatment, with successful resolution of the symptoms, included changing the shunt material from silicone to polyurethane, with immunosuppression in one patient and removal of the shunt altogether in the other two patients. The roles of the immune system and silicone in the pathophysiology of this condition are discussed.
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Case report The authors present a case of a patient with an abdominal CSF pseudocyst that resulted from an allergic reaction to silicone. The patient underwent repair surgery of the meningomyelocele associated with the Chiari II malformation, and the V-P shunt was instituted at 6 months of age. A formation of the abdominal CSF pseudocyst and the consequent shunt malfunction were observed 40 days after the V-P shunt. An increase in the number of the peripheral eosinophils and serum immunoglobulin E (IgE), and an infiltration of eosinophils in the specimen harvested from the pseudocyst wall suggested an allergic reaction as the cause of the pseudocyst. A sixth operation to revise the V-P shunt was performed using the shunt system made of extracted silicone , which was produced extracting the allergic substances.
Outcome The serum IgE was normalized after surgery and the abdominal CSF pseudocyst has not recurred for 22 months.
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The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus. Although allergic reactions to the silicone in shunt hardware are very rare, the authors describe a case of silicone allergy causing multiple ventricular shunt revisions. A 24-year-old man, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissues surrounding the shunt tubing. The patient's existing silicone-based shunt was replaced with a new polyurethane system, including the proximal and distal catheters as well as the valve mechanism. Contrary to recommendations in previous studies of silicone shunt allergies, long-term immunosuppression was not initiated. The patient was followed up for more than 8 years without recurrence of an allergic reaction to the shunt. This outcome indicates that replacing the original silicone-based shunt system with a polyurethane-based system alone is sufficient in the treatment of a silicone shunt allergy.
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Abstract
The implantation of ventriculo-peritoneal (VP) shunting systems is the most commonly performed neurological procedure in children with hydrocephalus. Although the overall complication risk is low, the cumulative risk of shunt failure is high and unfortunately results in a high prevalence of revision surgeries. In this study, we explored the concept that some pediatric patients may develop an immune response to either the proteins attached to the silicone implant surface or to the biomaterial itself, and that this reaction may contribute to VP shunt failure in some individuals. The data displays that the sterile shunt malfunction group had a higher rate of protein deposition and increased levels of autoantibodies to the extracted surface proteins as compared to individuals with functioning shunting systems. The precise nature of the shunt-bound proteins that serve as antigens in this experiment have not yet been determined. The data also indicated that some individuals develop antibodies to polymeric substances that cross-react with partially polymerized acrylamide. The detection of significant amounts of shunt-bound protein, antibody responses to these proteins and to polymeric substances suggest that an immunological response to these proteins may play a role in the mechanism behind sterile shunt malfunctions.
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Title: Colonic perforation by ventriculoperitoneal shunt tubing:
a case of suspected silicone allergy.
Author: Brownlee JD; Brodkey JS; Schaefer IK
Address: Department of Surgery, Columbia Saint Luke's Medical Center, Cleveland, OH 44104, USA.
Source: Surg Neurol, 49(1):21-4 1998 Jan
Abstract BACKGROUND: A case of colonic perforation by a ventriculoperitoneal shunt is presented in a patient with several previous complications associated with shunt tubing.
CASE DESCRIPTION: Initially managed by intravenous antibiotics, shunt externalization, and colonoscopy, the entire ventriculoperitoneal shunt system was subsequently replaced after cerebrospinal fluid cultures had grown Propionibacterium acnes and Streptococcus sanguis organisms. The patient has had three episodes of skin breakdown over his shunt tubing (two prior and one subsequent to colonic perforation) without evidence of shunt infection or malfunction.
CONCLUSIONS: The etiology of these complications is consistent with silicone tubing allergy. Replacement with a polyurethane system produced no similar complications thus far, which further supports a possible silicone allergy to the ventriculoperitoneal shunt and possible etiology of this patient's colonic perforation.


YOUR FRIEND

[fabriccrafter]

Hello "my friend" and so many thanks for your long email. I recognise some of the articles from my own research on line but some were new to me. I tried to find the abstract for the article from the Lancet, but no luck!
When you have a minute, can you let me know how your daughter is doing now? Djd you ever find a neuro surgeon that would consider the possibility of the silicone allergy? Isn't it amazing how rigid they are in thier thinking??
I'm going into the hospital tomorrow morning to have my pluera drained. (I had it done last week but I am drowning again. I'm averaging about 1 liter per week) They are also going to do a biopsy of the pleura tissue near the distal end of the shunt and they will examine the surrounding tissue to see if there is a pseudo-cyst or irritation from the shunt. THe surgeon is a thorax specialist not aneuro surgeon. I have a wonderful pulmonologist who believes that I have a silicone allergy and he has been finding articles to support this and doing lab tests of the csf fluid and he asked the thorax guy to help out and do the biopsy to add more data to my case.
The neuro surgeons that I have seen really avoid dealing with changing the shunt material so I'm going the long way around to get my own proof through these other doctors, sneaky, huh??
Well, please keep your fingers crossed for me....I'll let you know how this turns out. Would love to stay in touch and PLEASE let me know how you are doing! And thanks again for your email!! You're the only person that I have spoken with that has been here..............great to hear from you.
Bye for now, Michele