Spinofacial anastomosis

Summary Removal of large acoustic neuromas may still be followed by facial nerve palsy. The results of fourteen cases of spinofacial nerve anastomosis have been studied and compared with the results of spinofacial and hypoglossalfacial anastomoses reported in the literature. Other standard treatments of facial palsy have been briefly reviewed and criteria developed by which the most appropriate therapy for facial paralysis may be selected.     

End-of-life care in end-stage renal disease: renal and palliative care

The numbers of patients with end-stage renal disease are growing, with a disproportionate increase among those who are elderly, dependent and with multiple co-morbidities. More of these patients are choosing to be managed conservatively, without dialysis. Palliative provision for these patients within UK renal services is limited, but the recent National Service Framework for Renal Services (Department of Health, 2005) has promoted service development. However, few models of service provision have been described. This article describes a retrospective review of a new service for conservatively-managed patients with end-stage renal disease. The range and complexity of the health needs of this population is demonstrated, and an example of service development described. A model of the stages of the conservative pathway and appropriate interventions was developed. The absence of research evidence prevented development of formal audit standards, and highlighted the urgent need for evaluation of models of care.