Delayed sagittal sinus tear: a complication of spring cranioplasty for sagittal craniosynostosis.

Spring cranioplasty is now a well-established surgical technique in the treatment of sagittal craniosynostosis. It is widely regarded as a less invasive modality compared with operations such as cranial vault remodeling. Indeed, very few complications have been described in the literature in association with spring cranioplasty. We present a case of delayed sagittal sinus tear with hemorrhage following spring cranioplasty in a 4-month-old patient with sagittal craniosynostosis. Likely causes of the injury are discussed highlighting sagittal sinus injury as a potential risk of spring cranioplasty.

A cost-utility analysis of open and endoscopic carpal tunnel release.

BACKGROUND: Open carpal tunnel release (OCTR) is the standard procedure for the surgical treatment of carpal tunnel syndrome. With the advent of minimally invasive surgery, endoscopic carpal tunnel release (ECTR) was introduced. OBJECTIVE: To use a decision analytical model to compare ECTR with OCTR in an economic evaluation. METHODS: Direct medical costs were obtained from a Canadian university hospital. Utility values obtained from experts, presented with carpal tunnel syndrome outcome health states, were transformed into quality-adjusted life years (QALYs). The probabilities of the health states associated with both techniques were obtained from the literature. RESULTS: The incremental cost-utility ratio (ICUR) was $124,311.32/QALY gained, providing strong evidence to reject ECTR when ECTR is performed in the main operating room and OCTR is performed in the day surgery unit. A one-way sensitivity analysis in the present study demonstrated that when both OCTR and ECTR are performed in day surgery unit, the ICUR falls in the 'win-win' quadrant, making ECTR both more effective and less costly than OCTR. If the scar tenderness probability is decreased in the ECTR group in a second one-way sensitivity analysis, the ICUR decreases to $100,621.91/QALY gained, providing evidence to reject ECTR. If the reflex sympathetic dystrophy probability is increased in the ECTR group in a third one-way sensitivity analysis, the ICUR increases to $202,657.88/QALY gained, providing strong evidence to reject ECTR. CONCLUSIONS: There is still uncertainty associated with the costs and effectiveness of ECTR and OCTR. To obtain a definitive answer as to whether the ECTR is more effective than the OCTR, it is necessary to perform a large, randomized, controlled trial in which the utilities and resource use are measured prospectively.

Interleukin-1beta-induced fever does not alter the ability of 5- to 6-day-old rat pups to autoresuscitate from hypoxia-induced apnoea.

Experiments were carried out to determine if endogenous pyrogen-induced fever impairs protective responses of newborn rats to hypoxia. Twenty-seven 5- to 6-day-old conscious rat pups received a subcutaneous injection of 0.20 microg of recombinant rat interleukin-1beta (rrIL-1beta) per kilogram of body weight to induce fever, or an equal volume of vehicle. They were then either exposed to a single period of hypoxia produced by breathing an anoxic gas mixture (97 % N(2)-3 % CO(2)) and their time to last gasp was determined, or they were exposed repeatedly to hypoxia and their ability to autoresuscitate from primary apnoea was determined. Core temperature increased significantly following administration of rrIL-1beta but did not change following administration of vehicle (i.e. vehicle, 0.0 +/- 0.1 degrees C; rrIL-1beta, 0.7 +/- 0.3 degrees C; P < 0.001) before exposure to hypoxia. IL-1beta-induced fever did not alter the time to last gasp when the pups were exposed to a single period of hypoxia or the number of successful autoresuscitations upon repeated exposure to hypoxia. Thus, our data do not support the hypothesis that endogenous pyrogen-induced fever impairs the protective responses in newborns that may prevent death during hypoxia as may occur during single or repeated episodes of prolonged sleep apnoea.