Objective : The aim of the present study is to show the continuous suture technique in which the aortic valve replacement can be safely performed to insert prosthetic valves of an appropriate size in patients with aortic stenosis associated with a small annulus. Patients and Methods : Thirteen patients with severe aortic valve stenosis (aortic valve area <1.0 cm²) underwent aortic valve replacement with the continuous suture technique using three 2/0 non-absorbable monofilament polypropylene sutures. Transthoracic echocardiogram was performed before and after surgery in all patients to determine how large a prosthetic valve could be used compared to the preoperative annular size. Results : The mean size of the prosthetic valve implanted was 23.3 mm, while the preoperative mean value of aortic annulus was 21.7 mm. The 19 mm size prosthetic valves were never used even when the preoperative aortic annular diameter was less than 19 mm (in 2 patients). The duration of procedure time was adequate and the post-operative echocardiography showed excellent results with good prosthetic valve function and no adverse events. Conclusions : Using our continuous suture technique, prosthetic valves of an appropriate size can be safely and effectively inserted at an aortic position in patients with severe aortic stenosis.

Background: External ventricular drainage (EVD) has been widely used for the purpose of cerebrospinal fluid (CSF) diversion at Hospital Kuala Lumpur (HKL). Method: This prospective observational study was conducted in HKL from December 2006 to December 2008 among patients who were subjected for EVD, following strict inclusion and exclusion criteria. Results: The frequency of EVD-related infection was as high as 32.2% (95% CI 23.3% to 42.57%) among 87 patients studied. This study clearly demonstrates that tunnelling the catheter for more than 5 cm under the scalp, from the burr hole to the exit site of the skin, carried a significantly lower risk of infection compared with tunnelling the catheter for 5 cm or less (OR = 0.184, 95% CI 0.083 to 0.406, P < 0.001). The majority of cases (19 out of 28) with EVD-related infection occurred among patients catheterised for more than 10 days (OR = 0.334, 95% CI 0.171 to 0.652, P < 0.001). Conclusion: The technique of subgaleal tunnelling of more than 5cm and the duration of the ventricular catheterisation of 10 days and less should be implemented as standardised protocol at health institutions to reduce the risk of EVD-related infections.

PURPOSE: To determine the impact of an image processing technique on diagnostic accuracy of digital panoramic radiographs for the assessment of anatomical structures in paediatric patients with mixed dentition. MATERIALS AND METHODS: The study consisted of 50 digital panoramic radiographs of children aged from 6 to 12 years, which were later on processed using a dedicated image processing method. A modified clinical image quality evaluation chart was used to evaluate the diagnostic accuracy of anatomical structures in maxillary and mandibular anterior and maxillary premolar region of processed images. RESULTS: A statistically significant difference was observed between pre and post-processed evaluation of anatomical structures (P < 0.05) in the maxillary and mandibular anterior region. The anterior region was found to be more accurate in post-processed images. No significant difference was observed in the maxillary premolar region (P>0.05). The Inter-observer and intra-observer reliability of both pre and post processed images were excellent (>0.82) for anterior region and good (>0.63) for premolar region. CONCLUSION: The application of image processing technique in digital panoramic radiography can be considered a reliable method for improving the quality of anatomical structures in paediatric patients with mixed dentition.
Bicuspid ; Child ; Dentition, Mixed ; Diagnosis ; Humans ; Methods ; Radiography ; Radiography, Panoramic

PURPOSE: The purpose of this study was to obtain the description of the mandibular bone quality of male and female patients between 40-60 years old and their differences based on mandibular cortical bone thickness measured using Mental Index (MI). MATERIALS AND METHODS: Forty digital panoramic radiographs, which consisted of twenty male and twenty female patients, 40-60 years old, were observed. Mandibular cortical bone thickness was measured using MI on both sides of the mandible. The average MI score of two groups were then assessed using t-sample independent test. RESULTS: There were significant differences of mandibular bone quality based on mandibular cortical bone thickness measurement using MI between male and female patients (p<0.05). CONCLUSION: Mandibular bone quality based on cortical bone thickness measurement using MI of male and female patients indicated a significant difference.
Female ; Humans ; Male ; Mandible ; Osteoporosis ; Radiography, Panoramic

INTRODUCTIONCultural influences affect attitudes towards cancer screening, diagnosis, treatment and palliation. The objective of this study is to survey the prevailing attitudes towards cancer in a multicultural tertiary outpatient setting.

MATERIALS AND METHODSThis is a cross-sectional study of 300 respondents visiting the Singapore General Hospital (SGH) Urology Centre over a period of 1 month. A questionnaire was developed assessing responses to various facets of cancer management and administered in English, Chinese or Malay to every 10th person visiting the centre. Institutional review board approval was obtained.

RESULTSOf 300 respondents, 57% were Chinese, 17% Malay, 19% Indian, and 7% others. Mean age was 54.3 years. Most respondents were male (68%) and had up to secondary education (56%). Most Chinese were Taoist/Buddhist (42%) or Christian/ Catholic (36%) while Indians were largely Hindu (47%) or Muslim (27%). Thirty-seven percent of respondents had ever participated in cancer screening. Eighty-nine percent of respondents wanted to be the first to know if they had cancer, and 76% found it unacceptable if the diagnosis of cancer was withheld from them. These were irrespective of race, religion or other factors. Forty percent of respondents believed that being diagnosed with cancer was a matter of fate. Sixty percent of respondents would undergo treatment with 50% chance of cure, even if it involved major surgery and adjuvant therapy. Eighty-one percent believed in efficacy of at least 1 form of alternative treatment. Seventy-one percent of respondents preferred to die at home and this was most marked among Malay respondents (90.4%).

CONCLUSIONThis better understanding of patient attitudes will allow us to help patients balance wishes for autonomy versus family involvement in dealing with cancer. This will help us achieve a more holistic and patient-centred approach to cancer care.

STUDY DESIGN: Cross-sectional. PURPOSE: To develop a strategy to determine a sound method for decision-making based on postoperative clinical outcome satisfaction. OVERVIEW OF LITERATURE: The ideal management of thoracolumbar and lumbar burst fractures (TLBF) without neurological compromise remains controversial. METHODS: This was a prospective study. Patients with thoracolumbar injury severity and classification score (TLICS) <4 were treated nonoperatively, with bed rest and bracing until the pain decreased sufficiently to allow mobilization. Surgery was undertaken in patients with intractable pain despite an appropriate nonoperative treatment (surgery group). The Oswestry disability index (ODI) measure was observed at baseline and at the last follow-up. Clinically success was defined at least a 30% improvement from the baseline ODI scores in both the conservative and surgery groups. All case records were assessed for gender, age, residual canal and angulations at the site of the fracture in order to determine which patients benefited from surgery or conservative treatment and which did not. RESULTS: In all 113 patients with T11-L5, TLBFs were treated. The patients' mean age was 49.2 years. Patients successfully completed either nonoperative (n=99) or surgical (n=14) treatment based on ODI. Clinical examinations revealed that all of the patients had intact neurology. The mean follow-up period was 29.5 months. There was a significant difference between the two groups based on age and residual canal. The mean ODI score significantly improved for both groups (p <0.01). According to the findings, a decision matrix was proposed. CONCLUSIONS: The findings confirm that TLICS <4, age, and residual canal can be used to guide the treatment of TLBF in conservative decision-making.
Bed Rest ; Braces ; Classification* ; Follow-Up Studies ; Humans ; Neurology ; Pain, Intractable ; Prospective Studies

STUDY DESIGN: Case-control study. PURPOSE: To design a new tool for classifying lumbar spinal canal stenosis (CLSCS). OVERVIEW OF LITERATURE: Grading of patients with lumbar spinal canal stenosis (LSCS) is controversial. METHODS: The Oswestry disability index (ODI) and the neurogenic claudication outcome score (NCOS) were recorded. Four parameters, which indicate the severity of LSCS disease, including Hufschmidt-grade, grading of magnetic resonance imaging, self-paced walking test, and stenosis ratio (SR) were employed. For the SR, quartile analysis was applied for classifying LSCS and the Hufschmidt-grade was modified into a 4-grade score. An initial score was assigned to each metric based on the severity of LSCS. Using the inverse-variance weighting method, the relative weights of these domains and their categories were determined. The score for all of the cases was obtained based on their weight by summing up the points of the four variables. Quartile analysis was used and a CLSCS score was proposed. Finally, intra- and interobserver reliability, and validity were assessed. RESULTS: A total of 357 patients were studied. The final CLSCS score for each case ranged from 4 to 16.5. Based on the quartile analysis, using the new criteria set, the CLSCS score was divided into four categories: CLSCS<7 (grade 0); 7< or =CLSCS<10 (grade 1); 10< or =CLSCS<13 (grade 2); and 13< or =CLSCS< or =16.5 (grade 3). The kappa values of for the CLSCS score indicated a perfect agreement. The CLSCS was correlated with the ODI and NCOS. All patients with grade 3 CLSCS were observed in the surgical group. CONCLUSIONS: The CLSCS score can be helpful for classifying LSCS patients and in the decision-making process.
Case-Control Studies ; Classification* ; Constriction, Pathologic* ; Humans ; Magnetic Resonance Imaging ; Spinal Canal* ; Walking ; Weights and Measures

STUDY DESIGN: Cross-sectional. PURPOSE: Clinical outcome study comparing the Copenhagen Neck Functional Disability Scale (CNFDS) and modified Japanese orthopedic association (mJOA) assessment scales in patients with cervical spondylotic myelopathy (CSM). OVERVIEW OF LITERATURE: Comparison of instruments that measure patient-reported outcomes is needed. METHODS: A cross-sectional analysis was conducted. Ninety five patients with CSM were entered into the study and completed the CNFDS and the mJOA preoperatively and postoperatively. Correlation between the CNFDS and the mJOA was evaluated preoperatively and at the end of follow-up. Responsiveness to change of CNFDS and mJOA was also assessed. Clinical outcomes were also measured with the recovery rate of mJOA score at end of follow-up. RESULTS: The mean age of patients was 58.2 (standard deviation, SD=8.7) years. Mean follow-up was 2.1 years (range, 1 to 4 years). The mJOA correlated strongly with the CNFDS score preoperatively and postoperatively (r=-0.81 and -0.82, respectively; p<0.001). The CNFDS and the mJOA were able to detect changes after the surgery (p<0.001). The mean mJOA recovery rate was 51.8% (SD=13.1%). CONCLUSIONS: Surgery for the treatment of patients with CSM is an efficacious procedure. CNFDS and mJOA scores have a strong correlation in measuring disability among CSM patients.
Asian Continental Ancestry Group* ; Cross-Sectional Studies ; Follow-Up Studies ; Humans ; Neck* ; Orthopedics* ; Outcome Assessment (Health Care) ; Spinal Cord Diseases* ; Weights and Measures*

STUDY DESIGN: Cross-sectional. PURPOSE: Clinical outcome study comparing the Copenhagen Neck Functional Disability Scale (CNFDS) and modified Japanese orthopedic association (mJOA) assessment scales in patients with cervical spondylotic myelopathy (CSM). OVERVIEW OF LITERATURE: Comparison of instruments that measure patient-reported outcomes is needed. METHODS: A cross-sectional analysis was conducted. Ninety five patients with CSM were entered into the study and completed the CNFDS and the mJOA preoperatively and postoperatively. Correlation between the CNFDS and the mJOA was evaluated preoperatively and at the end of follow-up. Responsiveness to change of CNFDS and mJOA was also assessed. Clinical outcomes were also measured with the recovery rate of mJOA score at end of follow-up. RESULTS: The mean age of patients was 58.2 (standard deviation, SD=8.7) years. Mean follow-up was 2.1 years (range, 1 to 4 years). The mJOA correlated strongly with the CNFDS score preoperatively and postoperatively (r=-0.81 and -0.82, respectively; p<0.001). The CNFDS and the mJOA were able to detect changes after the surgery (p<0.001). The mean mJOA recovery rate was 51.8% (SD=13.1%). CONCLUSIONS: Surgery for the treatment of patients with CSM is an efficacious procedure. CNFDS and mJOA scores have a strong correlation in measuring disability among CSM patients.
Asian Continental Ancestry Group* ; Cross-Sectional Studies ; Follow-Up Studies ; Humans ; Neck* ; Orthopedics* ; Outcome Assessment (Health Care) ; Spinal Cord Diseases* ; Weights and Measures*

STUDY DESIGN: Cross-sectional. PURPOSE: To translate and culturally adapt an Iranian version of the Pain Sensitivity Questionnaire (PSQ) in Iran. OVERVIEW OF LITERATURE: Instruments measuring patient reported outcomes should satisfy certain psychometric properties. METHODS: The PSQ was translated following cross-cultural adaptation guidelines. A total of 101 patients with lumbar disc herniation (LDH), and 39 healthy cases were included in the study. All participants completed the PSQ and the Pain Catastrophizing Scale (PCS). The internal consistency, test-retest reliability, known group comparison, criterion validity and item-scale correlations were assessed. RESULTS: The mean age of participants was 51.7 years. Reliability, validity and correlation of PSQ and PCS showed satisfactory results. Cronbach's alpha coefficients were 0.81 for PSQ-total, 0.82 for PSQ-minor, and 0.82 for PSQ-moderate. The intraclass correlation coefficients value was 0.84 (0.616-0.932) indicating an excellent test-retest reliability. The instrument discriminated well between sub-groups of patients who differed in a standard predictive measure of LDH surgery (the Finneson-Cooper score). Total PSQ were also significantly correlated with the total scores of the PCS, lending support to its good convergent validity. Additionally, the correlation of each item with its hypothesized domain on the PSQ indicated acceptable results, suggesting that the items had a substantial relationship with their own domains. CONCLUSIONS: The adapted Iranian PSQ is a valid and reliable questionnaire for the assessment of pain in patients with LDH.
Catastrophization ; Humans ; Iran ; Outcome Assessment (Health Care)* ; Psychometrics ; Reproducibility of Results