Reduction of drain-associated cerebrospinal fluid infections in neurosurgical inpatients: a prospective study.

BACKGROUND: External cerebrospinal fluid (CSF) diversion via a drain is associated with a variable risk of associated infections which cause significant morbidity. AIM: To establish whether simple interventions can reduce the incidence of such infections at a single centre. METHODS: A retrospective review of all patients undergoing an external CSF diversion procedure was carried out to determine the historical rate of infection. Following an institutional protocol which included standards on drain insertion, care, sampling and antibiotic prescribing a prospective study was carried out to observe whether infection rates had changed and which factors continued to predict drain-related infections. FINDINGS: Retrospective analysis identified 234 procedures in 159 patients over a two-year period. There were 54 drain-related infections, a rate of 21.5 per 1000 drainage days. Duration of CSF drainage [odds ratio (OR) = 1.15, P < 0.05] and the number of CSF samples taken per drain (OR = 5.98, P < 0.05) were independently associated with infection. In the prospectively gathered phase, 132 procedures were recorded in 107 patients over a one-year period. There were 18 infections, a rate of 13.7 per 1000 drainage days. The only independent prognostic factor was duration of CSF drainage (OR = 1.20, P < 0.05). Coagulase-negative staphylococci were the most commonly isolated type of organism in both series. CONCLUSION: Ensuring drains are removed promptly as soon as CSF diversion is no longer required may reduce the rate of nosocomial infections in this population despite multiple confounding factors. Institutional guidelines may promote best practice in this regard.

Epithelioid hemangioendothelioma of the spine: report of two cases and review of the literature.

We report two patients with spinal epithelioid hemangioendothelioma (EH), an uncommon vascular, potentially malignant tumour. Neurological signs, diagnostic images, surgical techniques and complications, histology and the role of adjuvant therapy are discussed. Primary manifestation of EH of the vertebral column is rare. Thorough preoperative clinical and radiological workup, radical surgical excision, and close postoperative follow-up are recommended.

The two-week waiting time standard for cancer: a neurosurgical perspective.

The implementation of the two-week wait initiative for cancer referrals in the NHS has had a major impact on outpatient services. A low clinical detection rate among GPs for neurological cancer has resulted in a large number of urgent referrals with a low yield of positive diagnoses. We have devised a strategy for minimizing the impact on outpatient clinics: patients are scanned prior to clinical review and those with normal scans are referred back to the GP without a clinic appointment. Out of 69 referrals of suspected CNS cancer made in 2003, 61 were scanned and six resulted in a positive diagnosis. The equivalent of 10 clinics was saved, and an increased speed of diagnosis and treatment was achieved with no compromise in patient care. Our study illustrates the consequences of the 2-week wait initiative on the neurosurgical service, and proposes an effective and safe solution.

Volumetric measurement of human calf muscle from magnetic resonance imaging.

Muscle mass is a determining factor in skeletal muscle function and is affected by inactivity, immobilization, disease, and aging. The aim of this study was to develop an objective and time-efficient method to quantify the volume and cross-sectional area of human calf muscles using three-dimensional magnetic resonance images. We have estimated the errors incurred in muscle volume measurements arising from artifacts known to occur in magnetic resonance imaging (MRI). The largest source of error was due to partial volume effects, which resulted in overestimation of phantom volumes ranging from 145 to 900 cc by 6% to 13%. The magnitude of this effect has been shown to increase with decreasing object size and decreasing spatial resolution. We have presented a straightforward correction for this effect, which has reduced the volume measurement error to less than 4% for all cases. Through the use of computer simulations, the correction algorithm has been shown to be independent of object shape and orientation. To reduce user subjectivity, a semiautomated computer program has been developed to segment MRI data for particular muscle groups. Images from seven human subjects were analyzed by the program, yielding muscle volumes of 154.2 +/- 23.2, 281.2 +/- 35.8, and 432.2 +/- 83.7 for the lateral gastrocnemius, medial gastrocnemius, and soleus, respectively.

Nevus counting as a risk factor for melanoma: comparison of self-count with count by physician.

BACKGROUND: The number of total body nevi is a major risk marker for malignant melanoma. No previous study has evaluated the accuracy of whole body large nevus (> or = 5 mm) self-counts. OBJECTIVE: Our purpose was to evaluate the accuracy of large nevus self-counts by sex, age, educational level, body site, family history of skin cancer, and nevus characteristics. METHODS: Self-counting of large nevi by 125 patients was compared with physician counting, with attention to nevus characteristics. RESULTS: Overall, 79% of the self-counts agreed to within +/- 3 nevi of the physician's count. Analysis of variance revealed that the presence of nonpigmented or flat nevi significantly increased the chance of subject undercount, as did male sex. CONCLUSION: Self-counts of large nevi are comparable to physician's counts and may be useful for melanoma screening.