Incidence of Pinhole Type Durotomy and Subsequent Cerebrospinal Fluid Leakage Following Simple Laminectomy

STUDY DESIGN: Cross sectional study. PURPOSE: The purpose of this study was to determine the incidence and the associated risk factors of pinhole type of durotomy and cerebrospinal fluid (CSF) leakage following a simple laminectomy for spinal stenosis. OVERVIEW OF LITERATURE: The incidence of spinal stenosis is expected to rise with increasing life expectancy. Moreover, lumbar spinal stenosis is the most common indication for spinal injury in the geriatric population. It is therefore important to identify and prevent the risks associated with laminectomy, the most widely used surgical procedure for spinal stenosis. The serious complication of incidental dural tear or durotomy and subsequent CSF leakage has not been studied in the region of Southeast Asia. METHODS: In this cross sectional study, we included 138 adult patients (age>18 years), who underwent a simple laminectomy for lumbar stenosis between 2011 and 2012. CSF leakage was the main outcome variable. Patients' wounds were examined for CSF leakage up to 1 week postoperatively. RESULTS: The incidence of pinhole type durotomy and subsequent CSF leakage in our region was 8.7%. Univariate analysis showed that hypertension, diabetes and smoking were significantly associated with durotomy and increased CSF leakage by 16.72, 44.25, and 33.71 times, respectively. Multivariate analysis showed that only smoking and diabetes significantly increased the chances of leakage. CONCLUSIONS: Glycemic control and cessation of smoking prior to a simple laminectomy procedure reduced the incidence of a dural tear. Larger clinical studies on this lethal complication are required.

Variation in admission rates of acute coronary syndrome patients in coronary care unit according to different seasons

Environmental stresses, especially extreme cold and hot weathers, have tendency to have more admissions for acute coronary syndromes. Due to scarcity of local data, we studied the variation in patient admission rates with acute coronary syndrome according to different seasons. Descriptive study. Coronary Care Unit, Civil Hospital and Pakistan Steel Hospital, Karachi, from January 2011 to December 2011. The study group comprised consecutive patients with acute coronary syndrome [unstable angina, Non STElevation Myocardial Infarction [NSTEMI], ST-Elevation Myocardial Infarction [STEMI] admitted to the coronary care unit. Patients with stable angina and valvular heart disease were excluded. Data was analyzed for admission according to different seasons, [winter, spring, summer and autumn]. The mean age of the 428 cases was 48.5 +/- 10.4 years [range 27 to 73 years]. Among the study group, 261 [61%] and 167 [39%] cases were male and female respectively. ST-elevation myocardial infarction, non ST-elevation myocardial infarction and unstable angina were present in 206 [48%], 128 [30%] and 94 [22%] respectively. Among the 428 patients, 184 [43%] cases had hypertension, 133 [31%] cases were smokers, 103 [24%] cases had dyslipidemia and diabetes mellitus and 08 [2%] cases had history of premature coronary artery disease. The number of patients admissions with acute coronary syndrome tended to change with sudden change in season. It increased in Winter 158 [36.9%] and Summer 130 [30.3%] in comparison to Spring 80 [18.69%] and Autumn 60 [14.02%] season. It was found variation in admission rates of acute coronary syndrome patients according to different seasons. The number of admissions not only increased in the cold season [winter] but also in hot season [summer] with sudden changes in temperature