Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache (OH), low cerebrospinal fluid (CSF) pressure, and diffuse pachymeningeal gadolinium enhancement (DPME). We present here the case studies of two patients. One patient demonstrated a CSF leak in the mid-thoracic region, and recovered completely with conservative treatment. The other patient in whom leak could not be demonstrated, developed dementia, rapidly worsening encephalopathy, and became comatose, necessitating urgent epidural blood patch (EBP) with 25 cc of autologous blood, after which immediate and complete symptomatic relief was obtained. A second EBP was required a few days later and also provided complete and sustained clinical benefit, without subsequent recurrence. Both patients had OH and showed bilateral subdural fluid collections, DPME and “sagging” of brain on MRI. A high index of suspicion, recognizing the orthostatic nature of headache, and typical findings on contrast enhanced MRI should point to the diagnosis of SIH. EBP can be effective treatment in patients unresponsive to conservative measures.
Anterior cervical microdiscectomy without bone grafting and instrumentation is a safe and effective procedure following single- and two-level discectomy for cervical disc disease, with a success rate of 97.7%. Bone grafting and instrumentation in every case following anterior cervical microdiscectomy is questionable and should only be used in a few selected cases with demonstrated instability.
World is under threat of COVID-19 pandemic, associated with many numbers of critically ill patients. To manage these intubated patients there are need of more ventilators but world is not prepared for this type of situation and there are lacunae of such arrangements in most of the countries. As we know patients cannot be intubated for long time and they should be given preference to alternative airway in the form of tracheostomy. COVID-19 is aerosol transmitted disease which lead to indeed challenge to health care providers to safely perform tracheostomy and provide post tracheostomy care to these patients with minimising risks of nosocomial transmission to themselves and accompanying nursing staff. There are so many guidelines and recommendations for the timing, desired place of tracheostomy, change in tracheostomy steps related to conventional method and the subsequent management of patients. So, the aim of this systematic review is to give a brief review of available data on COVID-19 related to the timing, personal protections, operative steps modifications, and subsequent post tracheostomy care during this pandemic.
Aim: Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about the timing and performance of tracheostomy and the subsequent management of patients. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure.Methods: MEDLINE (accessed from PubMed) from 6 august 2019 to 7 august 2020 were systematically searched using: “COVID 19” OR “CORONAVIRUS” OR “SARS COV-2” AND “TRACHEOSTOMY” with filters as ‘2020’ year of study, English language, full article available on 7/08/2020 at 11.30 Am.Results: Total of 56 articles were obtained on search and the final 15 articles extracted based on our selection criteria were reviewed. A synthesis of the current international literature and reported experience is presented with respect to timing of tracheostomy, ideal place for tracheostomy, staff safety, procedure modification and post tracheostomy care thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients and if indicated should be done in negative pressure isolated ICU room with full PPE protection with some modification during procedure.Conclusion: In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Tracheostomy can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment.
Background: In early December 2019, an outbreak of COVID-19, caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurred in Wuhan City, Hubei Province, China causing havoc all over the world. As clinicians, recognition of this disease is necessary to isolate these patients to prevent further human to human transmission. Due to its affinity to the respiratory tract and increased viral load in the nose and throat, we as practising otorhinolaryngologists are at increased risk of exposure to this life-threatening virus and warrants an in-depth knowledge on the symptomatology of this disease. This systematic review is intended to highlight the otorhinolaryngological manifestations of COVID-19.Methodology: The literature search was performed on PubMed database using Boolean operators ‘and ‘, ‘or’ as “otorhinolaryngological manifestations” or “rhinology” or “otology” or “larynx” or “hearing” or “olfaction” and “covid19” or “novel corona virus” or “SARS-CoV” with filters as ‘2020’ year of study on 7/08/2020 at 11.30 Am.Review Results: Total of 357 articles were obtained on search and the final 12 articles extracted based on our selection criteria were reviewed. The studies included 6825 laboratory confirmed COVID -19 patients with varying severity of disease. Olfactory dysfunction and taste dysfunction were noted in 2355 and 2224 patients respectively. Nasal obstruction was reported in 323 patients and sore throat in 261 patients. Rhinorrhoea was reported in 209 patients .158 patients complained of post nasal drip and 152 patients presented with facial pain.Conclusion: As a practising otorhinolaryngologist, a good insight into the otorhinolaryngological manifestations of COVID-19 is essential to differentiate between the prodromal symptoms of COVID-19 and non-COVID viral upper respiratory tract infection.
To compare the outcome of ossiculoplasty using 'lenticular process of incus replacement prosthesis [LPIRP]' with that of 'conventional autologous tissue ossiculoplasty techniques' in patients with lenticular process of incus necrosis [LPI] in terms of: 1. Hearing results. 2. Graft take-up. 3. Complications like extrusion. Total 16 patients found intraoperatively to have LPI necrosis were allocated randomly using (simple random sampling technique) in two groups. Total 8 patients in group A underwent ossicular chain reconstruction using titanium prosthesis-LPIRP (manufactured by Decibel's gold prosthesis pvt. ltd.) and total 8 patients in group B underwent ossicular chain reconstruction using autologous cartilage/cortical bone. At the end of 4 weeks status of graft uptake was assessed and follow up pure tone audiogram [PTA] was performed at average 4th, 12th and 24th postoperative week. No significant difference in mean hearing gain (i.e. air-bone conduction gap closure) between two groups at 1 month, 3 months and 6 months post operatively [p [ 0.05]. However postoperative 3 months and 6 months results have better air bone conduction gap closure in group A as compared to group B. Titanium LPIRP prosthesis can be a good alternative in patients undergoing ossiculoplasty where autografts are not available for ossicular reconstruction or there is inadequate surgical expertise for remodelling autologous bone/cartilage.
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