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Financial impact of a attention pack to stop surgical web site contamination soon after craniotomy: any cost-analysis study.
OBJECTIVE To testify whether lateral lumbar interbody fusion (LLIF) decreases the grading of Lenke-Silva classification and determines the optimal fusion level in adult degenerative scoliosis (ADS) of global imbalance. METHODS Thirty-seven patients with ADS of level V and VI based on Lenke-Silva classification were included. After the first-stage LLIF, patients received reassessment and were divided into group A (the grading of Lenke-Silva classification changed) and group B (the grading unchanged). Posterior fixation was performed according to the reassessment. CP-690550 ic50 The demographic, operative, radiographic and clinical data were compared between the two groups. RESULTS Twenty-five patients of level V and 12 patients of level VI were included, with a mean follow-up of 29.6 months. After first-stage LLIF, the grading of Lenke-Silva classification changed in 22 patients (group A), with remaining 15 cases unchanged (group B). There were significant differences in preoperative grading of Lenke-Silva classification, use of anterior column realignment (ACR) and hyperlordotic cage and high-grade cage subsidence between the two groups. The posterior fusion levels in the second surgery were less and the rate of fusion to thoracic spine region was lower in group A. The visual analog scale and Oswestry disability index were significantly improved and restorations of coronal and sagittal balance were found at the latest follow-up in both groups. CONCLUSION LLIF could decrease the grading of Lenke-Silva classification and determine the optimal fusion level in patients with severe ADS. Change of Lenke-Silva classification may be associated with preoperative grading of Lenke-Silva classification, use of ACR and hyperlordotic cage. BACKGROUND Chiari 1 malformation is a structural abnormality of the hindbrain and posterior fossa characterised by herniation of the cerebellar tonsils through the foramen magnum. Although asymptomatic in some cases, hindbrain herniation may be associated with disruption of cerebrospinal fluid flow dynamics at the craniovertebral junction and syrinx formation leading to symptoms. Foramen magnum decompression with or without duraplasty is the most commonly performed surgical procedure in the management of this condition. Management of syringomyelia associated with Chiari malformation is more challenging and controversial. Although associated syrinx can significantly improve following craniovertebral decompression and restoration of cerebrospinal fluid flow, in some cases it persists despite decompressive surgery and may even continue to enlarge. CASE DESCRIPTION We describe a 4 year old boy with non-craniosynostotic Chiari malformation and extensive cervical syrinx who despite foramen magnum decompression and a further revision, continued to deteriorate clinically and radiologically. Posterior calvarial augmentation was performed as a salvage procedure with resolution of tonsillar herniation and syrinx. CONCLUSION Posterior calvarial augmentation is a viable option in Chiari cases refractory to foramen magnum decompression. OBJECTIVE To identify the rates, risks, and complications of red blood cell (RBC) transfusion in metastatic spinal tumor surgery (MSTS). METHODS The multicenter prospective American College of Surgeons National Quality Improvement Program database was queried for the years 2012 to 2016. Adult patients with disseminated cancer who underwent MSTS were identified. Transfusion was defined as having received at least one intraoperative/postoperative RBC transfusion within the first 72 hours of surgery start time. A stepwise multiple logistic regression model with backward elimination was used. RESULTS Out of 1,601 patients identified, 631 patients (38.9%) received a RBC transfusion. Independent predictors of RBC transfusion included higher ASA class (OR 1.54), preoperative anemia (OR 3.10), instrumentation (OR 1.63), and longer operative time (OR 1.52). The overall complication rate was significantly higher in transfused compared to nontransfused patients (22.3% vs. 15.0%, p less then 0.001). Sepsis (3.5% vs 1.9%, p=0.050), deep vein thrombosis (6.1% vs 3.3%, p=0.007), and prolonged ventilation (3.9% vs 1.3%, p=0.001) were individual complications that were more common in transfused patients. RBC transfusion (OR 1.65), hypoalbuminemia (OR 1.53), and anterior/anterolateral approaches for corpectomy (OR 2.11) were all independent risk factors for developing a postoperative complication. CONCLUSION RBC transfusion after MSTS may increase the risk of early postoperative complications. Future research into preoperative patient optimization and decreasing intraoperative blood loss is needed. BACKGROUND Congenital glioblastoma multiforme (cGBM) is an infrequent primary central nervous system tumor occurring within the first few months of life with a reported poor overall prognosis. OBJECTIVE To describe our own clinical case of cGBM and review the literature with prolonged survival. METHODS We report our case of cGBM with prolonged survival at 4 years. A systematic review was conducted on cases of cGBM with long-term childhood survival. We searched online databases until August 2019 for relevant articles. RESULTS Our patient underwent an emergency right hemicraniectomy with excision and biopsy of the right cerebral hemisphere mass and insertion of a ventriculoperitoneal shunt. At present, she is a 52-month-old child with good speech and minimal left hemiparesis and able to ambulate, with a Functional Independence Measure (WeeFIM) score of 109. Out of 160 articles screened, there were 10 articles included. A total of 15 patients, including our case, were analyzed qualitatively. The age at presentation ranged from 30 weeks age of gestation to 35 days. Most patients underwent surgical excision (86.7%) and adjuvant chemotherapy (66.7%). The reported range of survival of these patients was from 27 to 110 months. CONCLUSIONS Limited evidence from 15 cases of cGBM suggests that surgical excision and/ or chemotherapy may prolong the survival of patients. Therefore, these interventions may be offered and performed to patients with cGBM on a case-by-case basis. Larger clinical studies or registry-based information are necessary to substantiate the implications of our review.
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