Shunting for idiopathic normal pressure hydrocephalus improved gait in randomised trials, with bleeding risk unresolved

The edition in brief

A meta-analysis of four randomised trials (224 patients aged 60 or older) found that CSF shunting for idiopathic normal pressure hydrocephalus improved gait velocity (SMD 0.73, 95% CI 0.45 to 1.01) and functional independence, with positional headache more frequent and an imprecise but concerning subdural haematoma estimate (OR 4.07, 95% CI 0.62 to 26.94). A retrospective study of 1,926 pancreatoduodenectomies found that severe frailty on either the 11-item or 5-item modified Frailty Index was associated with 90-day mortality (OR 4.1 and 2.8), with similar discrimination (AUC about 0.76), so the shorter index is easier to use. A French two-centre cohort of 465 ventral hernia repairs found similar infection and recurrence rates in 27 immunosuppressed patients given long-term absorbable mesh, but higher overall morbidity than non-immunosuppressed patients with synthetic mesh (44% vs 18%). A single-centre trial of 146 laparoscopic cholecystectomies found less nausea and vomiting at 24 hours with ciprofol than remimazolam anaesthesia (31.5% vs 58.9%). The pearl restates the subtotal cholecystectomy bailout for a hostile gallbladder.