No abstract

Inferior vena caval (IVC) filter thrombosis in patients with contraindications to anticoagulant therapy is a difficult and challenging clinical problem. We report our experience in treating three such patients using a mechanical thrombectomy device, which resulted in rapid symptomatic relief until anticoagulant therapy could be safely introduced.

Objectives:To determine the frequency of primary ventriculoperitoneal shunt infection among patients treated at neurosurgical centres of the Hospital Authority and to identify underlying risk factors.Methods: This multicentre historical cohort study included consecutive patients who underwent primary ventriculoperitoneal shunting at a Hospital Authority neurosurgery centre from 1 January 2009 to 31 December 2011. The primary endpoint was shunt infection, defined as: (1) the presence of cerebrospinal fluid or shunt hardware culture that yielded the pathogenic micro-organism with associated compatible symptoms and signs of central nervous system infection or shunt malfunction; or (2) surgical incision site infection requiring shunt reinsertion (even in the absence of positive culture); or (3) intraperitoneal pseudocyst formation (even in the absence of positive culture). Secondary endpoints were shunt malfunction, defined as unsatisfactory cerebrospinal fluid drainage that required shunt reinsertion, and 30-day mortality.Results: A primary ventriculoperitoneal shunt was inserted in 538 patients during the study period. The mean age of patients was 48 years (range, 13-88 years) with a male-to-female ratio of 1:1. Aneurysmal subarachnoid haemorrhage was the most common aetiology (n=169, 31%) followed by intracranial tumour (n=164, 30%), central nervous system infection (n=42, 8%), and traumatic brain injury (n=27, 5%). The mean operating time was 75 (standard deviation, 29) minutes. Shunt reinsertion and infection rates were 16% (n=87) and 7% (n=36), respectively. The most common cause for shunt reinsertion was malfunction followed by shunt infection. Independent predictors for shunt infection were: traumatic brain injury (adjusted Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factorsNew knowledge added by this study • The local rate of infection in ventriculoperitoneal (VP) shunts meets international standards.• Vancomycin antibiotic prophylaxis is a risk factor for shunt infection and is a novel finding.• VP shunt inserted as an emergency procedure is the strongest risk factor for infection. Implications for clinical practice or policy• There is a need to review prophylactic vancomycin administration in terms of timing, dosage, and the need for its combination with another antibiotic.• Emergency VP shunting is not recommended. Shunts should be implanted whenever possible as an elective procedure.• A comprehensive local shunt surgery protocol to reduce the risk of shunt infection is recommended.

Introduction:Cycling is associated with a greater risk of traumatic brain injury (TBI) than other recreational activities. This study aimed to investigate the epidemiology of sports-related TBI in Hong Kong and to examine predictors for recreational cycling-induced intracranial haemorrhage. Methods: This retrospective multicentre study included patients diagnosed with sports-related TBI in public hospitals in Hong Kong from 2015 to 2019. Computed tomography scans were reviewed by an independent assessor. The primary endpoint was traumatic intracranial haemorrhage. The secondary endpoint was an unfavourable Glasgow Outcome Scale (GOS) score at discharge from hospital. Results: In total, 720 patients were hospitalised with sports-related TBI. The most common sport was cycling (59.2%). The crude incidence of cycling-related TBI was 1.1 per 100 000 population. Cyclists were more likely to exhibit intracranial haemorrhage and an unfavourable GOS score, compared with patients who had TBI because of other sports. Although 47% of cyclists had intracranial haemorrhage, only 15% wore a helmet. In multivariate analysis, significant predictors for intracranial haemorrhage were age ≥60 years, antiplatelet medication, moderate or severe TBI, and skull fracture. Among 426 cyclists, 375 (88%) had mild TBI, and helmet wearing was protective against intracranial haemorrhage, regardless of age, antiplatelet medication intake, and mechanism of injury. Of 426 cyclists, 31 (7.3%) had unfavourable outcomes on discharge from hospital. Conclusions: The incidence of sports-related TBI is low in Hong Kong. Although cycling-related

Objective: To reveal the effectiveness and safety of adding a single slit valve serially to the ventriculoperitoneal shunt system in order to reverse overdrainage. Materials and Methods:The study is a retrospective review of clinical experience in a regional hospital (Tuen Mun Hospital, Hong Kong). A series of 10 cases are reported. All cases showed evidence of cerebrospinal fluid overdrainage after a ventriculoperitoneal shunt procedure. The advantages and disadvantages of other treatment options are also reviewed.