Preliminary study of shunt related death in paediatric patients

Hydrocephalus is a condition commonly encountered in paediatric and adult neurosurgery and cerebrospinal fluid (CSF) shunting remains the treatment of choice for many cases. Despite improvements in shunt technology and technique, morbidity and mortality remain. The incidence of early shunt obstruction is high with later failures seen less frequently. This review aims to examine mortality associated with mechanical failure of CSF shunts within Queensland. Neurosurgical and Intensive Care databases were reviewed for cases of mortality associated with shunt failure. Eight cases were identified between the years of 1992 and 2002 with the average age at death 7.7 years. Deaths occurred on average 2 years after last shunt revision. Seven of the eight patients lived outside the metropolitan area. Shunting remains an imperfect means of treating hydrocephalus. Mortality may be encountered at any time post surgery and delays to surgical intervention influence this. Alternative measures such as third ventriculostomy or the placement of a separate access device should be considered. In the event of emergency, a spinal needle could be used to access the ventricle along the course of the ventricular catheter.

Developing a managed care-pharmaceutical research partnership

Increasingly, MCOs ask pharmaceutical companies for evidence of a new product's cost effectiveness before adding it to the formulary. This article examines a research partnership between a pharmaceutical company and 14 MCOs to assess the cost effectiveness of a new medication for osteoarthritis. The research partnership, a study protocol, and research activities are discussed.

Are we using the right irrigation system?

The relationships between bladder pressure and irrigant fluid flow rate were tested using two commonly used supply systems and a 27 FG Storz resectoscope. Simple and inexpensive modifications would enable transurethral prostatectomy to be carried out with reduced intravesical pressure and less risk of fluid absorption. With a continuous suction resectoscope, the modified system allows accurate balance of the inflow and outflow of the irrigant fluid.