- Risk Factors, Causes, and Costs of Hospital Readmission After Head and Neck Cancer Surgery Reconstruction. [Journal Article]
- JFJAMA Facial Plast Surg 2018 Nov 08
- CONCLUSIONS: Using the Nationwide Readmissions Database, we demonstrate that approximately 1 in 5 patients undergoing head and neck cancer surgery reconstruction is readmitted within 30 days of surgery. Readmissions are most commonly associated with wound complications. Socioeconomic status, complex ablative procedures, and patient comorbidities are independent risk factors for readmission. These findings may be useful to clinicians in developing perioperative interventions aimed to reduce hospital readmissions and improve quality of patient care.
- Acute ischemic stroke in a trauma cohort: Incidence and diagnostic challenges. [Journal Article]
- AJAm J Emerg Med 2018 Nov 03
- CONCLUSIONS: Acute ischemic stroke in trauma patients was a frequent diagnosis albeit with delay. Routine craniocervical vascular imaging at the time of presentation could potentially facilitate early diagnosis. A prospective study with routine craniocervical vascular imaging in trauma patients will be needed to further explore this hypothesis.
- Prospective evaluation of psychological burden in patients with oral cancer. [Journal Article]
- BJBr J Oral Maxillofac Surg 2018 Nov 06
- The high morbidity and mortality that is associated with oral cancer places a huge psychological burden on patients. The purpose of this prospective study was to evaluate levels of depression, anxiet...
The high morbidity and mortality that is associated with oral cancer places a huge psychological burden on patients. The purpose of this prospective study was to evaluate levels of depression, anxiety, and stress, at three time points using DASS-21 (Depression, Anxiety and Stress Scale-21). We also compared DASS-21 with HADS (Hospital Anxiety and Depression Scale). A total of 111 patients were enrolled and 75 of them completed the questionnaires at diagnosis, one month after treatment, and three months after discharge. Scores were high for stress at diagnosis, and for depression at the other time points, but were low for anxiety at all three. The results of Friedman's ANOVA showed that mean ranks for depression and stress were significant (p<0.05). Scores for depression and stress rose significantly between diagnosis and three months after operation, but those for anxiety (which had increased between diagnosis and operation p>0.05), were stable three months postoperatively. The DASS-21 was a useful method of evaluating stress. Correlation of the results from the two questionnaires showed a strongly positive association. We therefore recommend psychological intervention to improve overall outcome.
- Microsurgical Clipping of a Ruptured Basilar Apex Aneurysm: 3-Dimensional Operative Video. [Journal Article]
- ONOper Neurosurg (Hagerstown) 2018 Nov 08
- A 59-yr-old woman presented with a sudden onset of headache with neck pain and stiffness, Hunt and Hess grade 2. Brain computed tomography (CT) showed subarachnoid hemorrhage, Fisher Grade 2. Intra-a...
A 59-yr-old woman presented with a sudden onset of headache with neck pain and stiffness, Hunt and Hess grade 2. Brain computed tomography (CT) showed subarachnoid hemorrhage, Fisher Grade 2. Intra-arterial digital subtraction angiography (IADSA) showed a basilar artery apex aneurysm, dome size 9 mm and neck 3 mm, leaning towards the right, and a dominant right artery of Percheron. Endovascular treatment and microsurgical clipping were both explained to the patient, but she decided to undergo microsurgery due to the durability of treatment.She underwent a right frontotemporal craniotomy and orbital osteotomy. We performed optic nerve decompression and intradural anterior clinoidectomy to enhance the exposure. Working through the carotid-oculomotor space, the posterior communicating artery was traced back to the posterior cerebral artery. The basilar artery was temporarily occluded for aneurysm dissection after burst suppression to protect the brain. The aneurysm was irregular, multilobulated, and projecting upward. The dominant thalamoperforate artery (artery of Percheron) was arising from the right P1, and densely adherent to the sac of the aneurysm. After dissection of the artery of Percheron away from the aneurysm, it was completely occluded by a side-curved titanium clip. The patient had right oculomotor nerve paresis and headache postoperatively, but at discharge 2 wk later the headache and paresis had completely resolved. The postoperative IADSA showed total occlusion of the aneurysm with patency of the artery of Percheron.This 3-dimensional video shows the technical nuances of microsurgical clipping of a ruptured basilar apex aneurysm and intraoperative dissection of the artery of Percheron.Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.
- Proximal middle cerebral artery aneurysms: microsurgical management and therapeutic results. [Journal Article]
- WNWorld Neurosurg 2018 Nov 04
- CONCLUSIONS: Our current treating strategy may provide a benefit for patients with proximal middle cerebral artery aneurysms.
- Implementation of Physiological Scoring to Determine Discharge Readiness for Patients Undergoing Otolaryngology Head and Neck Procedures. [Journal Article]
- JPJ Perianesth Nurs 2018 Nov 03
- CONCLUSIONS: These results suggest that physiological scoring protocols are safe and appropriate to determine discharge readiness for patients who have surgery proximal to the airway.
- The unsolved problem of otitis media in indigenous populations: a systematic review of upper respiratory and middle ear microbiology in indigenous children with otitis media. [Review]
- MMicrobiome 2018 Nov 05; 6(1):199
- CONCLUSIONS: There are high rates of otopathogen colonization in indigenous children with OM. Chronic suppurative OM appears to be associated with a different microbial profile. Beyond the main otopathogens, the data are limited. Further research is required to explore the entire upper respiratory tract/middle ear microbiota in relation to OM, with the inclusion of healthy indigenous peers as controls.
- Endovascular Treatment of Ruptured Tiny Intracranial Aneurysms with Low-Profile Visualized Intraluminal Support Device. [Journal Article]
- JSJ Stroke Cerebrovasc Dis 2018 Oct 31
- CONCLUSIONS: Stent-assisted coiling of rTIAs with LVIS device provides high rates of technical success and complete occlusion at mid-term follow-up with an excellent safety profile.
- Transoral Point-of-Care Ultrasound in the Diagnosis of Parapharyngeal Space Abscess. [Journal Article]
- JEJ Emerg Med 2018 Oct 31
- Parapharyngeal space abscesses (PPSA) are deep-space neck infections that are associated with significant morbidity and, rarely, mortality if not promptly diagnosed and treated. The diagnosis is ofte...
Parapharyngeal space abscesses (PPSA) are deep-space neck infections that are associated with significant morbidity and, rarely, mortality if not promptly diagnosed and treated. The diagnosis is often difficult, as the clinical presentation can mimic peritonsillar abscesses (PTA). Transoral point-of-care ultrasound (POCUS) may be a useful tool to help distinguish PTAs from other deep-space infections such as PPSAs.
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- A young woman with traumatic vertebral artery occlusion: a case report. [Journal Article]
- JCJ Cardiovasc Thorac Res 2018; 10(3):177-179
- Vertebral artery occlusion (VAO) may result from closed head or neck trauma and can be lifethreatening due to brain-stem and cerebellar infarction. CT angiography is recommended as a screening diagno...
Vertebral artery occlusion (VAO) may result from closed head or neck trauma and can be lifethreatening due to brain-stem and cerebellar infarction. CT angiography is recommended as a screening diagnostic tool in selected patients after blunt cervical trauma. A 24-year-old woman was admitted to our emergency department with left hemiplegia two days after motor vehicle collision. Final diagnosis of occlusion of the right vertebral artery was made in CT angiography. She was treated with anticoagulant for 4 days then discharged with 5/5 muscle forces. She was advised to continue warfarin and atorvastatin for her after discharge.