Body mass index and the risk of postoperative cerebrospinal fluid leak following transsphenoidal surgery in an Asian population

<p><b>INTRODUCTION</b>Postoperative cerebrospinal fluid (CSF) leak is a serious complication following transsphenoidal surgery for which elevated body mass index (BMI) has been implicated as a risk factor, albeit only in two recent North American studies. Given the paucity of evidence, we sought to determine if this association holds true in an Asian population, where the BMI criteria for obesity differ from the international standard.</p><p><b>METHODS</b>A retrospective study of 119 patients who underwent 123 transsphenoidal procedures for sellar lesions between May 2000 and May 2012 was conducted. Univariate and multivariate logistic regression analyses were performed to investigate the impact of elevated BMI and other risk factors on postoperative CSF leak.</p><p><b>RESULTS</b>10 (8.1%) procedures in ten patients were complicated by postoperative CSF leak. The median BMI of patients with postoperative leak following transsphenoidal procedures was significantly higher than that of patients without postoperative CSF leak (27.0 kg/m vs. 24.6 kg/m; p = 0.018). Patients categorised as either moderate or high risk under the Asian BMI classification were more likely to suffer from a postoperative leak (p = 0.030). Repeat procedures were also found to be significantly associated with postoperative CSF leak (p = 0.041).</p><p><b>CONCLUSION</b>Elevated BMI is predictive of postoperative CSF leak following transsphenoidal procedures, even in an Asian population, where the definition of obesity differs from international standards. Thus, BMI should be considered in the clinical decision-making process prior to such procedures.</p>

Percutaneous pedicle screw fixation for thoracolumbar burst fracture: a Singapore experience

<p><b>INTRODUCTION</b>This study aimed to evaluate the clinical and radiological outcomes, and safety and efficacy of percutaneous pedicle screw fixation (PPSF) in the treatment of thoracolumbar burst fractures.</p><p><b>METHODS</b>This was a retrospective review of patients with thoracolumbar burst fractures treated with PPSF in a single hospital from 2010 to 2011. Baseline data included patient demographics, mechanism of injuries, fracture level, neurologic status and the number of percutaneous screws inserted. Kyphotic angle correction, vertebral body height restoration and mid-sagittal canal diameter improvement were used to assess radiological outcome. Screw misplacement, operative complications, functional improvement (ASIA score) and pain score on visual analogue scale were used to assess safety and clinical outcomes.</p><p><b>RESULTS</b>21 patients with 25 thoracolumbar burst fractures were treated with 134 percutaneous screws. There was significant improvement in kyphotic angle correction (mean difference 6.1 degrees, p = 0.006), restoration of anterior and posterior vertebral height (mean difference 19.7%, p < 0.01 and mean difference 6.6%, p = 0.007, respectively) and mid-sagittal canal diameter (mean difference 15.6%, p = 0.007) on discharge. These improvements remained statistically significant at six months post operation for restoration of anterior vertebral body height (mean difference 9.8%, p = 0.05) and mid-sagittal diameter (mean difference 30.0%, p < 0.01).</p><p><b>CONCLUSION</b>In this first local review, we have shown that PPSF is a relatively safe and effective technique for treating selected thoracolumbar burst fractures, and that it yields satisfactory results. However, its long-term outcome and efficacy need to be further evaluated.</p>

External ventricular drain infections: successful implementation of strategies to reduce infection rate

<p><b>INTRODUCTION</b>External ventricular drain (EVD) infections can cause serious complications. We performed an audit of EVD infections within our neurosurgical unit. Through this study, we aimed to reduce the incidence of external ventricular drain-related infection, including ventriculities in neurosurgical patients.</p><p><b>METHODS</b>We conducted an audit of the EVD infections in our institution observed over a one-and-a-half year period. This was conducted in three phases. A baseline EVD infection rate was determined for Phase I, from January to June 2007. We introduced the following measures to reduce EVD infection rate in Phase II, from July to December 2007: (1) For Neurosurgery doctors: performing proper surgical techniques to minimise intra-operative infections; educating junior doctors on proper CSF sampling from the EVD; and minimising the number of days the EVD is maintained in situ; (2) For Neurosurgery nurse clinicians: developing Standard Operating Procedures on nursing management of EVDs; conducting EVD care workshops for nurses working in neurosurgical wards; and competency skill checks on the management of EVDs for nurses working in the neurosurgical wards. Silver-coated EVDs were introduced in Phase III of the study from January to June 2008.</p><p><b>RESULTS</b>The EVD infection rate decreased from a baseline of 6.1% to 3.8% in Phase II; a further reduction from 3.8% to 0% was achieved during Phase III.</p><p><b>CONCLUSION</b>Good teamwork among doctors and nurses is essential for reducing EVD infection rate. We managed to reduce EVD infections substantially and would continue to strive to remain infection-free in the future.</p>

Mentally abnormal offenders in Yangon psychiatric Hospital

Mentally abnormal offenders admitted to the Forensic Unit of Yangon Psychiatric Hospital from 1953 to 1992 were studied (n=332). They are described with respect to their demographic, clinical and forensic profile. A predominance of schizophrenia and a strong association of this diagnosis with homicide, asault and arson were noted. The low prevalence of the female and personality-disordered offenders are attributed to cultural and diagnotic factors. The majority of victims were family members and relatives. Family education and early intervention concerning violent bahaviour in psychiatric patients are discussed.