Gender Differences in Spinal Injuries: Causes and Location of Injury.

BACKGROUND: Spinal injury is common in trauma suffered by both men and women. A lesser degree of involvement of females with spinal trauma, or at least, the different nature of such injuries, has been suggested. It has been proposed that behavioral and structural characteristics may explain the differential type and severity of spinal injuries in women. We carried out this study to find women-specific divergences in spinal traumatic lesions, including suspected mechanisms for their generation. METHODS: All patients with spinal injury, documented by the Trauma Registry at our Medical Center and using the AIS code 65XXXX.X for spinal fractures and dislocations, were evaluated. The women-associated analysis included data related to: type of spinal lesion, area affected, possible mechanisms, associated damage, surgical procedures, and complications. Male-related data were collected for comparison. RESULTS: Between 2006 and 2010, 546 patients with traumatic spine injuries were documented. Of those, 30.6% were women (F:M-168:378). Average age was 43.5 years (women: 49.6 years and men: 40.1 years). Regarding the mechanisms of injury, women with spinal injuries were susceptible to falls from a standing position or had attempted suicide. However, men with similar lesions had a tendency to be more involved in motorcycle accidents or falls from height. Women involved in motor vehicle crashes showed statistically more significant lumbar spine lesions, whereas men in the same situation developed mainly cervical spine damage to a significant level. CONCLUSIONS: The characteristics of spinal injury in women, as opposed to men, stand out as divergent. The mechanisms of trauma and the site of injury differ significantly. We suggest this variance may be due, in part, to skeletal and muscular structure dissimilarity in women and in part to the spinal kinematics attending each group.

Epidemiology of trauma in an acute care hospital in Singapore.

BACKGROUND: Trauma injury is the leading cause of mortality and hospitalization worldwide and the leading cause of potential years of productive life lost. Patients with multiple injuries are prevalent, increasing the complexity of trauma care and treatment. Better understanding of the nature of trauma risk and outcome could lead to more effective prevention and treatment strategies. MATERIALS AND METHODS: A retrospective review of 1178 trauma patients with Injury Severity Score (ISS) ≥ 9, who were admitted to the Acute and Emergency Care of an acute care hospital between January 2011 and December 2012. The statistical analysis included calculation of percentages and proportions and application of test of significance using Pearson's chi-square test or Fisher's exact test where appropriate. RESULTS: Over the study period, 1178 patients were evaluated, 815 (69.2%) males and 363 (30.8%) females. The mean age of patients was 52.08 ± 21.83 (range 5-100) years. Falls (604; 51.3%) and road traffic accidents (465; 39.5%) were the two most common mechanisms of injury. Based on the three most common mechanisms of injury, i.e. fall on the same level, fall from height, and road traffic accident, the head region (484; 45.40%) was the most commonly injured in the body, followed by lower limbs (377; 35.37%) and thorax (299; 28.05%). CONCLUSION: Fall was the leading cause of injury among the elderly population with road traffic injuries being the leading cause among the younger group. There is a need to address the issues of injury control and prevention in these areas.

Our 1-year experience in laparoscopic sleeve gastrectomy.

Sleeve gastrectomy was conceived in 1988 both as a first step to the duodenal switch procedure and as an extension of anti-reflux surgery where patients lost significant weight. It is now a stand-alone laparoscopic bariatric procedure worldwide with two international consensus summits identifying it as a safe and feasible restrictive and appetite-suppressing procedure. In our centre, it is a key component in the surgical armamentarium and used as a first-line and revisional procedure for morbid obesity. The procedure is performed using standard five port technique. One year results are reviewed for its feasibility in our Asian patients. Twenty of 48 laparoscopic sleeve gastrectomies have a 1-year follow-up with four of them a revisional procedure for bands with complications. There were 11 males and 9 females (average age 43.6) and a representation of all four major ethnic groups. Average weight and BMI improved from 116.3 to 90.2 kg and 42.5 to 33.1 kg m(-2) after 1 year, respectively. Average weight loss was 26.1 kg and excess weight loss (in percent) was 49.6%. There was an improvement in diabetes mellitus, hypertension, obstructive sleep apnoea and asthma and three complications including two leaks and a gastro-oesophageal spasm/stricture. Laparoscopic sleeve gastrectomy is safe and feasible as first-line surgery for morbid obesity and revisional procedures for band-related complications in the short term. Further studies are required to elucidate the exact mechanisms of weight loss in the sleeve gastrectomy to answer the appropriateness of the variations in the technique and long-term weight loss and morbidity.

Laparoscopic abdominoperineal resection for anorectal melanoma: a case report and review of the literature.

Anal melanoma is a rare colorectal disease, accounting for 4% of all anal malignancies. Here we report the first case of a patient with anorectal melanoma who was treated laparoscopically. He underwent a totally laparoscopic abdominoperineal resection with excellent postoperative recovery. One year postoperatively, he is now clinically recurrence free with a normal colonoscopy. The literature on anorectal melanoma has been reviewed and controversy still surrounds the optimal treatment modality. We propose that a laparoscopic approach to the management of this disease can be considered when deciding future treatment plans for patients with this condition.

Obstructive sleep apnoea (OSA) patterns in bariatric surgical practice and response of OSA to weight loss after laparoscopic adjustable gastric banding (LAGB).

INTRODUCTION: This study aims to evaluate the incidence of Obstructive Sleep Apnoea (OSA) in severely obese Asians and to study the impact of weight loss on OSA. MATERIALS AND METHODS: We report the results of routine preoperative Polysomnograms in 350 Asian patients undergoing bariatric surgery in our institute. Polysomnograms were repeated in 75 randomly selected patients with moderate to severe OSA after target weight loss with the laparoscopically placed adjustable gastric band (LAGB). RESULTS: The prevalence of OSA in obese Asians is high. Moderate OSA was found in 46% of patients and severe OSA was found in 33%. Severe OSA was significantly more in the Chinese (46%) compared to the Malays (29%) or Indians (21%) (P = 0.035). We identified other risk factors for severe OSA (male sex, higher body mass index and the presence of hypertension) but were unable to select identifying parameters for very low (<5%) likelihood of severe OSA such that routine sleep studies prior to bariatric surgery could be omitted. Apnoea Hypoapnoea Index (AHI) showed improvement of 50% at 20 kg excess weight loss with the cure of OSA in preoperatively severe cases (P <0.005). Mild to moderate cases reported similar improvements although a direct correlation could not be established. Desaturation events, apnoea episodes, work of breathing and subjective assessment of sleepiness scores and quality of life (QOL) showed improving trends, albeit not statistically significant. Similar improvements were seen in sleep architecture with increased rapid eye movement (REM) and stage 3 sleep. CONCLUSIONS: The incidence of OSA in Asians undergoing bariatric surgery is high. Routine sleep studies in Asian patients are justified. Weight loss brought about a significant improvement in AHI and continuous positive airway pressure requirements. LAGB placement should be considered a broadly effective therapy for sleep apnoea in the severely obese patient.

Laparoscopic adjustable gastric banding in a patient with an incidental para-hiatal hernia.

Laparoscopic adjustable gastric banding (LAGB) in patients with a sliding hiatus hernia has become an accepted procedure. However, LAGB in patients with less common types of diaphragmatic hernia is rarely described. We report a super-super-obese woman with a para-hiatal hernia (non-hiatal, diaphragmatic hernia) where LAGB was performed. The para-hiatal hernia was successfully repaired laparoscopically at the same time that the LAGB was performed. A para-hiatal hernia is not a contraindication to LAGB and can be repaired at the same operation.

Exsanguinating hemorrhage following gastric erosion after laparoscopic adjustable gastric banding.

Laparoscopic adjustable gastric banding (LAGB) has become a common bariatric operation, because of its safety, laparoscopic friendliness, acceptable weight loss and absence of long-term adverse nutritional sequelae. Gastric erosion is one of the troublesome complications of gastric banding. The etiology and presentation of erosion remain obscure. We present a patient who complained of persistent pain 6 months after gastric banding. Endoscopy revealed the band to be normally situated, which was also confirmed on upper GI imaging. Despite this, the patient subsequently presented with massive GI hemorrhage and circulatory collapse due to erosion, which necessitated emergency laparotomy with retrieval of the band from within the gastric lumen. This case highlights the possible urgent presentation of erosion after gastric banding, which was hitherto considered to be a more insidious complication. A high index of clinical suspicion remains the mainstay of diagnosis.