Interaction of Antioxidant Trace Minerals Affecting Blood Picture Including Antioxidant Profile of Healthy Buffalo (Bubalus bubalis) Calves.

Copper (Cu) and selenium (Se) are antioxidants and essential trace elements that have mutual interaction and are reported to have beneficial effects at supranutritional levels. The experiment was executed to evaluate the individual impact of supranutritional levels of targeted elements with the effect of their interactions in buffalo calves. Twenty male Murrah buffalo calves of about 8-9 months (bodyweight 112.1 ± 7.69 kg) were distributed into four groups of five calves in each group and fed either a control (C) diet or supplemented with supranutritional levels of Cu (T1), Se (T2), or combination of both (T3) for 120 days. Higher (P = 0.015) values of packed cell volume were observed in group T2 at day 120; otherwise, all other hematological parameters remained comparable among groups. Over the period (day 120 vs. day 0), an enhancement in the percentage of lymphocytes (P = 0.006) with a reduction in neutrophils (P = 0.028) and hemoglobin (P = 0.024) values was observed in the control group. An enhancement in the percentage of monocytes (P = 0.031), with a reduced percentage of neutrophils (P = 0.022), was reported in groups T2 and T3, respectively. Interaction of Cu and Se at supranutritional level (T3) dramatically reduced plasma Cu (P = 0.008) level against the control values, with an improvement in Se markers (i.e., plasma Se, P = 0.041 and enzyme glutathione peroxidase, P = 0.057) over the values in calves fed supplemental Se alone (T2). Additionally, Cu (T1 and T3) was forced to decline (P < 0.05) Zn level in the plasma of buffalo calves. Cu (T1, P < 0.05) and Se (T2 and T3, P ≤ 0.01) supplementation was able to improve their respective plasma levels. The interaction of two trace elements at the supranutritional level further helped in reducing the lipid peroxidation (P = 0.01) values as well. Though antioxidant vitamins and cell-mediated immunity remained unaffected, humoral immunity against antigen P. multocida was high (P = 0.005) in the group T2. The conclusion may be drawn that supranutritional Cu and Se were capable to influence certain blood parameters with an additional interaction effect due to simultaneous supplementation in buffalo calves.

Rifampicin-Associated Secondary Minimal Change Disease Presenting with Nephrotic Syndrome in a Pulmonary Tuberculosis Patient.

Various extraglomerular disease processes have been associated with drug-induced secondary minimal change disease (MCD). In a majority of cases, preferably, a hypersensitivity reaction appears to be involved, and in some cases, there is direct toxic effect over glomerular capillaries. There are several reports to demonstrate that rifampicin has been associated with various nephrotoxic adverse effects, but rifampicin-induced secondary minimal change disease (MCD) is very rare. Here, we report the case of a young adult male who presented with nephrotic proteinuria with bland urine sediment after one month of initiation of rifampicin treatment for pulmonary tuberculosis. The patient had no proteinuria before the start of antituberculosis treatment. Renal biopsy showed nonproliferative glomerulopathy and immunofluorescence did not show significant glomerular immune deposits. Electron microscopy showed diffuse effacement of visceral epithelial cell foot processes and did not show any presence of glomerular immune complexes and thickening of glomerular basement membrane, promoting the diagnosis of minimal change nephrotic syndrome. The patient got complete remission after discontinuation of rifampicin.

Response of anestrous heifers fed local grass or oak foliage-based diet with two different mineral mixtures.

The effect of incorporation of two different mineral mixtures and/or oak leaves was studied on nutrient utilization and reproductive performance in anestrous heifers. Twenty-one anestrous heifers (18.2 ± 1.45 months; 229 ± 14.2 kg body weight) were randomly distributed into three similar groups. Heifers in control (T1) and first treatment group (T2) were fed concentrate mixture incorporated with Bureau of Indian Standards (BIS) specific mineral mixture and a customized mineral mixture developed specially for Kumaon hills (MMKH), respectively, along with local green grass (Pennisetum orientale). In the second treatment group (T3), concentrate mixture was the same as that of T2, while the source of roughage was local oak (Quercus leucotricophora) leaves containing 3.35% condensed tannin. A digestibility trial was conducted after 120 days of study. The feed intake was similar among the groups. Digestibility coefficient of crude protein (CP) was lower in T3 than T2 and comparable to T1. Feeding oak leaves improved absorption of calcium as compared to grass-fed animals. Bioavailability of copper and zinc was higher (P < 0.05) in oak leaves and MMKH fed group (T3) as compared to T1, but similar to T2. Conversely, absorption of iron had the reverse trend and was reflected in serum Fe concentration. Hematological, biochemical, enzyme and hormonal profiles were not influenced by any of the treatments. The relative occurrence of estrus cyclicity and conception rate was more in groups T2 and T3, respectively, than other groups. It was concluded that feeding oak foliage-based diet containing 1.87% tannin along with customized mineral mixture developed for Kumaon hills improved certain nutrient utilization and reproductive performance as compared to local green grass supplemented with BIS-specific mineral mixture or MMKH.

Complications of Hair Transplant Procedures-Causes and Management.

Hair transplant surgery per se has low risk, is relatively safe, and has minimum incidence of complications. However, it is a well-accepted fact that no medical science procedure exists without any potential risk of complications. The complication may be a single complaint in the form of pain, itching, dissatisfaction related to the procedure's outcome, or surgical complication in the form of infection, wound dehiscence or skin necrosis. Inadequate counselling increases unsatisfaction. Improper examination increases the complications, and incomplete medical history and history of allergy increases the risk during surgery. The author collected data of his 2896 patients, operated over a period of 10 years, and recorded the complains and complications. The most common complications were sterile folliculitis, noted in 203 patients, vasovagal shock in seven patients of, hypertensive crisis in one patient, hiccups in six patients, facial edema after hair transplant in 18 patients, graft dislodgement in 8 patients, infection in two diabetic patients, minor necrotic patches in recipient area in three patients, keloid development in one patient, numbness in 18 cases, and hypersensitivity in recipient and/or donor area. Donor area effluvium was seen in one case and three patients showed recipient area effluvium. Twenty-six patients were not happy with the results, and five cases showed partial loss of implanted hair. The overall significant life-threatening or major complications were zero, but the total minor complications' percentage was 0.10%. The key to minimize complaints and complications are detailed counselling, taking careful medical history and history of allergy, and proper examination of patients.

An Interesting Case of Nonlupus Full-House Nephropathy.

Full-house immunofluorescence and endothelial tubuloreticular inclusions are known as characteristic features of lupus nephritis. However, both features are not pathognomonic for lupus nephritis. A kidney biopsy specimen showing full-house immunofluorescence pattern in the absence of autoantibodies and classical clinical features of Systemic Lupus Erythematosus (SLE) is now considered as nonlupus full-house nephropathy (FHN). Nonlupus FHN may be idiopathic or due to other disease processes known as secondary nonlupus FHN. Here, we report the case of a 36-year-old female who presented with nephrotic proteinuria with bland urine sediment. Additional analyses revealed normal serum antinuclear antibody (ANA), normal anti-double-stranded DNA (anti-dsDNA) antibodies, and normal serum C3 and C4 levels. A renal biopsy showed a normal-appearing glomerulus without any proliferation or capillary wall thickening and widespread glomerular immune deposits (full-house effect; IgA, IgG, IgM, C3, and C1Q) on direct immunofluorescence. Renal electron microscopy showed diffuse effacement of visceral epithelial cell foot processes and mesangial electron dense deposits. The patient was diagnosed as nonlupus FHN. There is a controversial role of steroids and other immunosuppressive drugs in the treatment of nonlupus FHN patients, but our case patient responded favourably to steroid therapy. The term nonlupus FHN can be used as an umbrella term for patients who do not satisfy the clinical and serological criteria of SLE.

A Histological and Clinical Evaluation of Plasma as a Graft Holding Solution and Its Efficacy in Terms of Hair Growth and Graft Survival.

Background There is a time lag between hair follicle harvesting and implantation, during this time hair follicles suffer ischemic injury. We need a holding medium or a solution to minimize or neutralize ischemic injury. Aims and Objective To evaluate plasma as a graft holding solution in terms of its efficacy in hair growth and hair graft survival. Method and Material A split scalp study was performed. The left side was designated as the control area (Group A) where grafts implanted were kept in Ringer's lactate, and the right side behaved as the test area (Group B) and received grafts preserved in autologous plasma. The p -value was calculated. Observations MTT staining for grafts stored in Ringer's lactate at 12 and 72 hours showed poor hair follicle cells' survival while grafts kept in plasma showed viable cells even after 72 hours. The hair count and density in plasma group were significantly higher than those in the Ringer's lactate group. There was an improvement in hair thickness in both groups from 6 months to 12 months. Conclusion Autologous plasma is an easily available graft holding solution. Platelets along with the plasma provide multiple growth factors promoting epithelialization, neovascularization, and action on hair follicle stem cells to improve growth. The fibrin coating around the graft makes it sticky and prevents dehydration. The split scalp controlled study certainly shows the advantages of using plasma over other extra cellular graft holding solutions.

Differential expression of endometrial toll-like receptors (TLRs) and antimicrobial peptides (AMPs) in the buffalo (Bubalus bubalis) with endometritis.

Toll like receptors (TLRs) and ß-defensins expressed in the endometrium are part of the innate uterine defense mechanism (UDM). In the present study, transcriptional profile of TLRs (1-3, 6-8, 10, and) and ß-defensins such as lingual antimicrobial peptide (LAP), tracheal antimicrobial peptide (TAP) and bovine neutrophil beta-defensin 4 (BNBD4) were studied. Bubaline genitalia were collected from abattoir and the endometrium was categorized into one of the following seven groups (n = 7/group) based on cyclicity and endometritis: follicular non-endometritis (FNE), luteal non-endometritis (LNE), follicular cytological endometritis (FCE), luteal cytological endometritis (LCE), follicular purulent endometritis (FPE), luteal purulent endometritis (LPE) and acyclic non-endometritis (ANE). Cytological endometritis (CE) was diagnosed by uterine cytology while purulent endometritis (PE) was diagnosed by the presence of purulent or mucopurulent exudate in the uterine lumen. Real time PCR was performed and the relative fold change was analysed. TLR1 and BNBD4 transcripts were not found in the buffalo endometrium. Of all the innate immune genes studied, upregulation of TLR and ß-defensins was mostly contributed by the inflammatory status of endometrium. Further, there was a prominent upregulation of TAP in buffaloes with endometritis. However, no association could be found between the inflammatory status of the endometrium and phase of estrous cycle with respect to the expression of TLRs and ß-defensins.

Postinfectious Glomerulonephritis with Crescents in an Elderly Diabetic Patient after Acute Gastroenteritis: Case Report.

Postinfectious glomerulonephritis (PIGN) is primarily a disease of childhood. It occurs after upper respiratory tract infection or skin infections. Streptococcus is the most common causative agent, but in the elderly, staphylococcus is the main culprit. In adults, PIGN is more common in immunocompromised patients, particularly diabetics and alcoholics. Here, we report the case of an elderly diabetic male who presented with severe acute kidney injury with active urinary sediment after acute gastroenteritis. Additional analyses revealed a very low serum C3 level and a normal serum C4 level. Renal biopsy showed diffuse proliferative glomerulonephritis with crescents. Direct immunofluorescence showed mesangial and capillary wall staining for C3 and IgG (2+, mesangial and segmental capillary wall, granular). Renal electron microscopy showed subepithelial hump-like electron-dense deposits. The role of steroid in the treatment of PIGN is controversial and there is no standard protocol, but our patient responded very well to steroid as he did not require hemodialysis after 2 weeks of initiation of steroid therapy. We should be aware of an atypical presentation of PIGN in elderly to ensure correct diagnosis.

Selenium and copper interaction at supra-nutritional level affecting blood parameters including immune response against P. multocida antigen in Murrah buffalo (Bubalus bubalis) calves.

Minerals play important role in the diet of an animal. Bio-availability of minerals largely gets affected by absolute as well as the relative amount of each mineral present in the diet of an animal. Copper and selenium are two such an essential elements affect utilization of each other in the gastrointestinal tract. The present study elucidates the utilization of copper and selenium at supra-nutritional levels (higher than nutritional requirements). Male Murrah buffalo (Bubalus bubalis) calves (n = 10, 8-9 months, 111.7 ± 12.55 kg body weight) were divided equally into two groups and fed either a standard (Control) diet or the same diet supplemented with 0.3 ppm selenium (Se) and 10 ppm copper (Cu) (Treatment). Supplementation was made using liquid solutions of two inorganic mineral sources after mixing in the concentrate mixture and study lasts for a period of 80 days. Blood samples were collected just before starting supplementation (designated as 0 day of study) and at day 40 and 80 after starting supplementation. Blood samples were subjected to haematological parameters, plasma minerals and various oxidative stress-related parameters were determined with the cell-mediated and humoral immune response against antigen P. multocida (P52 strain). Supra-nutritional Se with Cu had higher blood monocytes (P < 0.05) and plasma selenium (P < 0.01) levels, while other hematological parameters and plasma minerals (except zinc, which was lower (P = 0.025) at day 80 in the treatment group) remained unaffected. Among markers for oxidative stress in blood, levels of lipid peroxidation were lesser (P < 0.01), at day 80 and overall mean values of the enzyme glutathione peroxidase and catalase were higher (P < 0.05) in the supra-nutritional group against control values. The overall mean activity of other oxidative stress markers including reduced glutathione, ceruloplasmin as well as the concentration of α tocopherol, retinol, and ß carotene remained unaffected due to supra-nutritional Se and Cu. Although cell-mediated immune response remained comparable (P > 0.05) between groups, higher (P < 0.05) overall mean antibody titer values, as well as the values at day 80, was reported in supra-nutritional Se + Cu group. The study concluded that supra-nutritional Se with Cu in the ration of growing Murrah buffalo calves was helpful to reduce the oxidative stress and to enhance the humoral immune response. Simultaneously, higher plasma Se level and number of monocytes in blood highlighted the additional role of selenium and copper in a ration of growing buffalo calves as compared to its normal recommended dose.

A learning module in hair restoration surgery: A simple and economic method to learn all steps of strip method of hair follicles harvesting and implantation.

BACKGROUND: There is a global increase in demand for hair transplant as well as increasing demand for trained assistants and surgeons. It is a fact that permanent donor hair follicles are limited and any loss during learning is permanent and irreversible, so there is no place to learn and/or practice on a patient. OBJECTIVE: To develop a learning module in hair restoration surgery to learn all steps of strip method of hair follicles harvesting and methods of implantation. MATERIALS AND METHODS: In this learning module, the materials used are paper, pencil, plant leaf, foam and thread. The last step is on goat skin. Module has been divided into multiple steps. The first step is training of microsurgery position, the second step is training of movement at wrist using paper and pencil, the third step is strip harvesting and slivering on foam model, the fourth step is learning of follicle dissection on leaf model, the fifth step is thread follicle implantation on leaf bed. After practising on non-living model finally, all steps are practised on goatskin, starting from slivering, follicle dissection and implantation of goat follicles on leaf. CONCLUSION: This is very economical and user-friendly system to learn all steps of strip method of hair follicle harvesting and methods of implantation as well. The materials used are available around us and anyone can learn as well as train his or her technicians in very short time.

Increasing the dietary supply of carotenoids through forage supplementation: Effect on nitrogen and mineral retention in captive Golden pheasants (Chrysolophus pictus).

This experiment was conducted to evaluate the effects of feeding different levels of green forages on feed consumption, nutrient and mineral utilization in Golden pheasants (GP). Twenty-seven female GP (BW 617-635 g) were randomly distributed into three groups of nine birds each in an experiment based on completely randomized design (CRD). Birds in group T1 were fed a conventional zoo diet containing 1.4% green forages; however, the diets of the birds in groups T2 and T3 contained 2.7% and 5.0% of green forages, respectively. Intake of total carotenoids increased with increased level of green forages in the diet. Apparent retention of N, Ca, and Zn was higher in GP laying hens fed diet containing 5.0% green forages as compared to those fed conventional diet containing 1.4% green forages. Results of the present study indicate that inclusion of 5% green forage in the diet of GP would improve the utilization of N, Ca, and Zn without any adverse effect on intake and utilization of other nutrients. Data related to nutrient intake, basal endogenous losses (BEL) and coefficient of retention (COR) of N, Ca, P, Mg, Fe, Cu, Mn, and Zn are novel and may be of use for future research. Zoo Biol. 35:522-532, 2016. © 2016 Wiley Periodicals, Inc.

Effect of vitamin E supplementation on arsenic induced alteration in blood biochemical profile, oxidant/antioxidant status, serum cortisol level and retention of arsenic and selenium in goats.

Arsenic (As) exerts oxidative stress with depletion of body selenium in monogastric animals. But in ruminants this fact is not yet verified. Vitamin E is an effective dietary antioxidant. Thus, in this experiment, the protective effect of vitamin E against arsenic toxicity induced by sodium arsenite (60mg As/kg diet) was investigated in goat kids. For this, 21 male kids were divided into three equal groups and fed either basal diet as such (control), or supplemented with 60mg As/kg diet and 60mg As/kg diet+250IU vitamin E/kg diet for 180 days. Vitamin E supplementation alleviated the toxic effects caused by arsenic on serum alanine aminotransferase and aspartate aminotransferase and lipid peroxidation. It also prevented the depletion of reduced glutathione content and reduction in activity of catalase, superoxide dismutase and glutathione-s-transferase in erythrocytes resulted from arsenic intoxication. The elevated levels of arsenic and reduced levels of selenium in the serum and tissues in arsenic treated animals were attenuated by vitamin E supplementation, though not completely. However, serum cortisol level was not affected by arsenic. It was concluded that arsenic exerts cortisol independent stressor mechanism and supplementation of vitamin E at a level of 250IU/kg diet was partially effective in reducing tissue accumulation of arsenic in the body and protect the kids from oxidative stress induced by arsenic.

Blood biochemistry, thyroid hormones, and oxidant/antioxidant status of guinea pigs challenged with sodium arsenite or arsenic trioxide.

The present experiment aimed to compare the two most commonly used compounds of arsenic (sodium arsenite and arsenic trioxide) for their effect on blood metabolites, thyroid hormones, and oxidant/antioxidant status in guinea pigs. Twenty-one adult guinea pigs were randomly divided into three equal groups. Animals in group T1 (control) were fed a basal diet, whereas 50 ppm arsenic was added in the basal diet either as sodium arsenite (T2) or arsenic trioxide (T3) and fed for 11 weeks. Serum aspartate aminotransferase and alanine aminotransferase activities were significantly increased along with a decrease in blood hemoglobin level in both the arsenic-administered groups. The level of erythrocytic antioxidants (catalase, superoxide dismutase, reduced glutathione, glutathione-S-transferase, and glutathione reductase) was decreased and lipid peroxidation was elevated upon arsenic exposure. Serum thyroid hormone levels were reduced and arsenic levels in tissues increased in both the arsenic-exposed groups, irrespective of the arsenic compound. Thus, sodium arsenite and arsenic trioxide exerted similar adverse effects on blood metabolic profile, antioxidant status, and thyroid hormones in guinea pigs.

Effect of selenium, zinc, and copper supplementation on blood metabolic profile in male buffalo (Bubalus bubalis) calves.

Twenty male buffalo calves (15 months, 200.2 ± 9.75) were divided into four groups of five animals in each and fed diets without (T1) or supplemented with 0.3 ppm selenium (Se) + 40 ppm zinc (Zn) (T2), 0.3 ppm Se + 40 ppm Zn + 10 ppm copper (Cu) (T3), and 40 ppm Zn + 10 ppm Cu (T4) for 120 days, during which blood samples were collected on days 0, 40, 80, and 120. Concentrations of glucose, total protein, albumin, globulin, urea, uric acid, and creatinine were similar in all the four groups. The level of different serum enzymes viz. lactate dehydrogenase, alkaline phosphatase, glutamate pyruvate transaminase, and glutamate oxaloacetate transaminase, and hormones viz. T(3), T(4), testosterone and insulin were similar (P > 0.05) among the four groups but the ratio of T(4)/T(3) was reduced (P < 0.05) in the groups (T2 and T3) where selenium was supplemented at 120th day of supplementation. It was deduced that supplementation of 0.3 ppm Se and/or 10.0 ppm of Cu with 40 ppm Zn had no effect on blood metabolic profile in buffalo calves, except the ratio of T(4) and T(3) hormone which indicates that selenium plays an important role in converting T(4) hormone to T(3) which is more active form of thyroid hormone.

Ten-year experience of 44 patients with moyamoya disease from a single institution.

We analyzed the records of 44 patients with moyamoya disease evaluated and treated at our Institute from 1998 until 2007. Out of 44 patients, 18 (41%) were in the paediatric age group and 26 (59%) were adults. Presentation was ischemic in 14 (32%) and hemorrhagic in 30 patients (68%). Revascularization was performed in 11 patients (five patients with ischemic presentation and six with hemorrhagic presentation): nine patients underwent indirect revascularization procedures only and two patients underwent indirect revascularization procedures and a combined superficial temporal artery-middle cerebral artery bypass. Thirty-six patients (81.8%) were available for follow-up. Out of 11 patients who underwent revascularization procedures, none had further hemorrhagic or ischemic episodes. Out of the 19 conservatively managed patients who were followed-up, seven (36.8%) developed new episodes of ischemia (n=2) or hemorrhage (n=5). In-hospital mortality was 6.8% (three patients), all of whom were in the hemorrhagic presentation group.

Effect of organic selenium supplementation on growth, Se uptake, and nutrient utilization in guinea pigs.

Forty weaned male guinea pigs (Cavia porcellus) of 152.6 +/- 7.96 g mean body weight were divided into four equal groups and fed a common basal diet comprised of 25% ground cowpea (Vigna unguiculata) hay, 30% ground maize (Zea mays) grain, 22% ground gram (Cicer arietinum) grain, 9.5% deoiled rice (Oryza sativa) bran, 6% soybean (Glycine max) meal, 6% fish meal, 1.5% mineral mixture (without Se), and ascorbic acid at 200 mg/kg to meet their nutrient requirements along with 0, 0.1, 0.2, and 0.3 ppm of organic selenium (Se) in groups I, II, III, and IV, respectively. Experimental feeding lasted for a period of 10 weeks, during which, daily feed intake and weekly body weights were recorded. Intake and digestibility of dry matter, organic matter, ether extract, crude fiber, and nitrogen-free extract as well as uptake of calcium and phosphorus were similar (P > 0.05) among the four groups. Feed:gain ratio was also similar (P > 0.05) in the four groups. However, digestibility of crude protein was significantly (P < 0.001) higher in group II supplemented with 0.1 ppm organic Se as compared to other three group. Intake and absorption of Se was significantly (P < 0.001) higher in all the Se supplemented groups as compared to control group. Average daily gain (ADG) was significantly (P < 0.05) higher in group II (3.16 g/day) and III (3.38 g/day) as compared to group I (2.88 g/day). However, ADG in group IV (supplemented 0.3 ppm organic Se) was significantly (P < 0.05) lower (2.83 g/day) than group II and III, but comparable (P > 0.05) to group I. Findings of the present experiment suggests that Se requirements of guinea pigs are > or =0.2 ppm, as supplementation of 0.1 ppm organic Se in the diet (having 0.1 ppm Se) not only enhanced their growth rate but also improved the protein utilization.

Changes in cerebral perfusion hormone profile and cerebrospinal fluid flow across the third ventriculostomy after endoscopic third ventriculostomy in patients with aqueductal stenosis: a prospective study. Clinical article.

OBJECT: The object of the present study was 3-fold: 1) to study regional cerebral perfusion before and after endoscopic third ventriculostomy (ETV) in patients with obstructive hydrocephalus by using (99m)Tc ethyl cysteinate dimer SPECT: 2) to study any correlation between clinically successful third ventriculostomy and CSF flow across the third ventriculostomy; and 3) to determine any changes in hormone profile following ETV. METHODS: The authors prospectively studied 15 patients with aqueductal stenosis who underwent ETV during the last 2 years. All the patients underwent pre- and postoperative MR imaging, brain (99m)Tc ethyl cysteinate dimer SPECT, and hormone profile studies. RESULTS: Eight patients were infants. The mean follow-up duration was 17.6 months. Thirteen patients (86.7%) exhibited clinical improvement after surgery. In all patients with clinical improvement the studies documented CSF flow through the ventriculostomy site. Clinical progress could be correlated with SPECT changes in 14 cases (93.3%). In the 13 clinically successful cases, 12 were substantiated by improvement on SPECT scans, whereas in the 2 failed cases, SPECT images revealed no improvement of perfusion defects. Hormone analysis conducted in 14 patients revealed hyperprolactinemia in 8, low triiodothyronine values in 2 patients, and hypocortisolemia in 1, which was reversed after ETV. CONCLUSIONS: Clinical improvement is not well correlated with a decrease in ventricular size following ETV. Brain SPECT is a valuable tool for the follow-up of patients with hydrocephalus after ETV, particularly in cases in which MR imaging findings are not clear. There are subtle hormonal changes in patients with hydrocephalus that may improve following ETV.