ICP monitoring-based treatment protocol helps in achieving faster recovery; lowers mortality rates in operated patients; and reduces ICU stay, radiation exposure, and the need for brain-specific treatment.
Background: Surgical site infections were considered to be the major contributor to increased morbidity and mortality in clean surgeries. Many studies prove that single dose prophylaxis is more effective than multiple dosing. No data currently exist about comparative efficacy of single dose prophylactic ceftriaxone with postoperative ciprofloxacin and metronidazole combination in reducing postoperative wound infection after clean surgeries. Hence the present study was done to compare their efficacy in terms rate of incidence of wound infection and side effects.Methods: This prospective study was done on 120 patients who were selected for clean surgeries at Sapthagiri Institute of Medical Science and Research Centre, Bengaluru during the period from April 2015 and March 2016. 60 patients received single dose of ceftriaxone prophylactically and considered as study group and other 60 patients received combination of ciprofloxacin and metronidazole postoperatively for 5-7 days and considered as control group. The efficacy of drugs was estimated in terms of reducing the incidence of wound infection.Results: The wound infection rate was 13.33% in the study group and 28.33% in control. Staphylococcus aureus was the most common organism isolated from wound discharge. However, gram negative organism accounted for majority of infections. There were no major side effects encountered in either of the groups.Conclusions: The study concludes that single dose ceftriaxone can be widely applied in the routine practice in clean surgeries. The single dose ceftriaxone showed many advantages over the control group in terms of Reduced the incidence of postoperative wound infection with no major side effects.
Objective: In this article, the authors systematically evaluated the efficacy and safety of tranexamic acid (TXA) in surgeries for spinal trauma.Methods: Potentially relevant academic articles were identified from the Cochrane Library, MEDLINE, PubMed, and Google Scholar. Secondary sources were identified from the references of the included literature. RevMan software was used to analyze the pooled data.Results: A total of 7 randomized controlled trials (RCTs) and 2 non-RCTs were included in the review. There were significant differences in total blood loss (standard mean difference [SMD] = −2.54 [95% CI, −3.72, −1.37], P = 0.0001), intraoperative blood loss (SMD = −0.96 [95% CI, −1.28, −0.64], P < 0.00001), postoperative blood loss (SMD = −1.42 [95% CI, −1.72, −1.11], P < 0.00001), and length of hospital stay (SMD = −3.73 [95% CI, −4.41, −3.06], P = 0.00001). No significant differences were found regarding transfusion requirement, operative duration, deep vein thrombosis, and pulmonary embolism between the 2 groups.Conclusions: The present meta-analysis indicates that the use of TXA in spinal surgery decreases blood loss and duration of hospital stay while not increasing the risk of side effects such as deep vein thrombosis and pulmonary embolism.Clinical Relevance: The study aims to provide clinicians who operate on spine trauma with information on the use of tranexamic acid to decrease blood loss and related complications.Level of Evidence: 1.
Objectives
This report seeks to highlight a pitfall that may be encountered in the management of patients with trigeminal neuralgia with imaging showing both neurovascular conflict as well as tumors.
Case presentation
A case of a 53 year old male with simultaneous neurovascular conflict and a vestibular schwannoma with trigeminal neuralgia is presented and the management is discussed with reference to managing this particular subset. Pain was noted to be likely generated by neurovascular conflict and not by the tumor, which is usually not the case.
Conclusions
It is suggested that in such cases, microvascular decompression should always be performed in addition to removal of the tumor.
Introduction
The surgical treatment of anterior cranial base traumatic CSF rhinorrhoea is challenging and is fraught with complications. Whether a person should be offered open craniotomy or endoscopic endonasal repair is a dilemma faced by most surgeons. This study is one of the few to directly compare the two forms of management.
Methods
Data was collected from two groups of 15 patients each who underwent transcranial CSF leak repair and endoscopic endonasal CSF leak repair respectively in a tertiary care hospital over a as a observational study. Information including demographics, recurrence rates, complications and hospital and ICU stay were recorded and analysed. Outcome was assessed up to 6 months.
Results
Recurrence was seen in 9/30 patients, 6 in the transcranial arm and 3 in the endoscopic arm. Hospital stay more than 1 week was present in all transcranially operated patients and only 73% of endoscopically operated patients (p=0.439) although the ICU stay was reduced in the endoscopic arm (p=0.066). Complications were most common with transcranial repair (7 of 8 patients who underwent transcranial repair p=0.035) with anosmia being the most common, (33.3%, p=0.042).
Conclusion
Transcranial open repair is a reasonable choice especially for leaks that occur through the frontal sinus and extend backward into the frontoethmoid region. However, this modality has the drawbacks of greater number of complications, higher recurrence rate, longer ICU and overall hospital stay. The endoscopic endonasal repair enjoys a lower morbidity profile although it may not be an adequate treatment for leaks that are placed far laterally in the frontal sinus.
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