Avoiding complications in endoscopic skull base surgery.

Purpose of review: Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence. Recent findings: Detailed preoperative planning based on imaging and histology can prevent major complications. Intraoperative use of image guidance and meticulous hemostasis provide the surgical field needed to avoid complications. Postoperative patient counseling, along with close and detailed nasal postoperative care are significant factors for an optimal outcome. Summary: Monitoring of complications after endoscopic skull base surgery is necessary in order to standardize protocols of management and improve our surgical techniques. The presence of late onset complications underlines the need of a special focus in postoperative care and follow-up. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Avoiding complications in endoscopic skull base surgery.

Purpose of review: Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence. Recent findings: Detailed preoperative planning based on imaging and histology can prevent major complications. Intraoperative use of image guidance and meticulous hemostasis provide the surgical field needed to avoid complications. Postoperative patient counseling, along with close and detailed nasal postoperative care are significant factors for an optimal outcome. Summary: Monitoring of complications after endoscopic skull base surgery is necessary in order to standardize protocols of management and improve our surgical techniques. The presence of late onset complications underlines the need of a special focus in postoperative care and follow-up. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Prevalence and Independent Risk Factors for Hearing Impairment Among Very Low Birth Weight Infants

Publication date: Available online 27 December 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Chien-Ho Wang, Chang-Yo Yang, Reyin Lien, Shih-Ming Chu, Jen-Fu Hsu, Ren-Huei Fu, Ming-Chou Chiang
BackgroundAlthough we've made big strides in perinatal and neonatal care, auditory handicap remains a serious complication in those who were born very premature.ObjectivesThe aim was to determine the prevalence and analyze possible risk factors of hearing impairment in very-low-birth-weight (VLBW) infants.Materials and MethodsThis was a retrospective study by reviewing medical records of all VLBW infants (BW ≤ 1500 g) admitted to NICU of Chang Gung Children's Hospital over 2 years period from Jan. 2010 to 2011. Brainstem auditory evoked potentials (BAEP) hearing screening was performed at 3 months postnatal corrective age and repeated if failed the 1st time, then refer to ENT doctor if BAEP confirmed abnormal. All VLBW infants examined for hearing impairment were included and data were retrieved retrospectively and analyzed for neonatal risk factors using logistic regression.ResultsOver the period, 309 VLBW infants were screened. Prevalence of uni- or bilateral hearing impairment was 3.9% (12/309; 95% CI 2.6-4.1). The mean corrective age on diagnosed of hearing impairment was 2.9±1.1 (range 1-5) months. Mean gestational age was 27.9 weeks (SD 1.4) and mean birth weight was 1028 g (SD 180). By univariant analysis for hearing impairment, severe birth asphyxia, craniofacial anomalies, ventilator dependence, patent ductus arteriosus ligation, and use of postnatal ototoxins yielded good prediction of hearing impairment in this population. However, using multivariate analysis revealed that the only independent risk factors for hearing impairment were ototoxins (OR: 3.62; CI: 1.67-7.82), PDA ligation (OR: 4.96; CI: 2.34-10.52) , craniofacial anomalies (OR: 3.42; CI: 1.70-6.88)and assisted prolonged use of oxygen at gestational age of >36 weeks (OR: 5.94; CI: 2.61-13.54).ConclusionThe incidence of hearing impairment among VLBW infants was 3.9%. Prolonged supplemental oxygen use is a marker for predicting hearing impairment; this requires detailed analysis of the pathophysiologic features, to reduce the prevalence of hearing impairment.



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qSOFA should replace SIRS as the screening tool for sepsis

No description available

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qSOFA should replace SIRS as the screening tool for sepsis

No description available

http://ift.tt/2i5UNre

qSOFA should replace SIRS as the screening tool for sepsis

No description available

http://ift.tt/2i5UNre

qSOFA should replace SIRS as the screening tool for sepsis

No description available

http://ift.tt/2i5UNre