Craniofacial resection for anterior skull base tumours

Summary This study presents a series of 10 patients with anterior skull base tumours, treated by a team of neurosurgeons and head- and neck surgeons. The series included 7 malignant tumours of the nose and paranasal sinuses and 1 retinoblastoma, all with intracranial extension through the lamina cribrosa. There were also 2 patients with an anterior base meningioma, growing into the ethmoid sinus and the nasal cavity.8 tumours were resected by a combined bifrontal craniotomy and uni- or bilateral rhinotomy. In 2 cases a bifrontal craniotomy alone without facial incision sufficed. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath.There were no postoperative problems of wound infection, CSF-leakage or meningitis. Recurrent tumour growth or systemic metastasis occurred in 5 out of 7 patients with malignant tumours, 6 months to 2 years postoperatively.The related literature and especially questions of operative indications and technique, including different possibilities of closure and reconstruction of the skull base, are discussed.     

A Novel, Intensive Home-Visiting Intervention for Runaway, Sexually Exploited Girls

PURPOSE.  Few studies have examined interventions that help adolescents who run away. This study both describes a home-visiting intervention program for young, sexually assaulted runaways (10–14 years old) and provides preliminary outcomes from the first 20 female participants.
DESIGN AND METHODS.  Using a strengths-based approach, advanced practice nurses provided frequent home and school visits and case management, and assisted girls to access an empowerment group over a 1-year period.
RESULTS.  Teens' risk behaviors decreased, including truancy, runaway episodes, sexually transmitted infections, and substance use.
CONCLUSIONS.  Preliminary results suggest that this is an effective intervention for reducing risk behaviors and helping younger runaways reconnect to school and family.
PRACTICE IMPLICATIONS.  Client-centered interventions in community settings can address the complex health needs of vulnerable young runaways.     

Posterior approach for simultaneous access to the popliteal and anterior tibial arteries applications to distal arterial bypass

Abstract Arterial surgery to salvage the lower limb tends to make use of the great saphenous vein, harvested with the subject in the supine position. If this is not possible the small saphenous vein is used, harvested with the subject in the prone position, however this requires a peroperative modification of the procedure. A bypass between the popliteal and anterior tibial arteries can be performed using either a lateral or a medial and lateral approach with the patient supine. In the event of trophic disorders of the lateral compartment of the leg, these approaches are not applicable. In such cases we propose a single posterior approach. The single posterior approach was used on 10 lower limbs from 5 cadavers in the prone position. Approach to the lower part of the popliteal artery was undertaken posteriorly between the two heads of gastrocnemius. The small saphenous vein was entirely dissected 10cm above the lateral malleolus, the Achilles tendon and short fibular vessels were retracted medially to expose the interosseous fascia, which was divided over 10 cm. Medial rotation of the limb by 30° exposed the anterior tibial artery. For 3 of the lower limbs an 8 cm fibular resection was necessary, whereas on the remaining 7 medial rotation enabled excellent exposure of the anterior tibial artery. The single posterior approach to the anterior tibial artery can be applied in cases requiring distal bypass, using the small saphenous vein, between the inferior part of the popliteal artery and the anterior tibial artery.     

ACD/Log P method description

This study describes the development of the ACD/Log P calculation method. Analysis of 14 calculation methods revealed that the most accurate calculations are obtained when correction factors are used. We evaluated the correction factors used by Hansch and Leo in CLOGP in order to simplify their method. Most of the CLOGP structural factors are included in our fragmental increments. Aliphatic and aromatic factors are replaced with additive interfragmental increments. Missing increments are estimated by two empirical equations with simple physical interpretation. The final method uses three simple equations with several types of parameters. The training set included 3601 compounds and the correlation between experimental and calculated Log P values gave R = 0.992, S = 0.21. The method was validated by comparing it with 17 other methods on various data sets of independently selected drugs and other compounds. In all cases, our method produced the best results. The weakness of this method is that it uses a large number of individual increments for aromatic interactions. Each increment represents a combination of several effects which presently cannot be separated. This revised version was published online in August 2006 with corrections to the Cover Date.     

The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre

cutter j. & jordan s. (2012) Journal of Nursing Management
The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre Aim To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. Background Surgeons and peri-operative nurses risk acquiring blood-borne viral infections during surgical procedures. Appropriate first-aid and prophylactic treatment after an injury can significantly reduce the risk of infection. However, studies indicate that injuries often go unreported. The ‘systems approach’ to error reduction relies on reporting incidents and near misses. Failure to report will compromise safety. Methods A postal survey of all surgeons and peri-operative nurses engaged in exposure prone procedures in nine Welsh hospitals, face-to-face interviews with selected participants and telephone interviews with Infection Control Nurses. Results The response rate was 51.47% (315/612). Most respondents reported one or more percutaneous (183/315, 58.1%) and/or mucocutaneous injuries (68/315, 21.6%) in the 5 years preceding the study. Only 54.9% (112/204) reported every injury. Surgeons were poorer at reporting: 70/133 (52.6%) reported all or >50% of their injuries compared with 65/71 nurses (91.5%). Conclusions Injuries are frequently under-reported, possibly compromising safety in operating theatres. Implications for nursing management A significant number of inoculation injuries are not reported. Factors influencing under-reporting were identified. This knowledge can assist managers in improving reporting and encouraging a robust safety culture within operating departments.     

不同手术路径对脑室-腹腔分流手术效果的影响

目的探讨脑室-腹腔分流的手术路径的改进方法。方法对56例脑积水患者行脑室-腹腔分流术。根据手术路径不同，分成两组。实验组22例，采用经侧脑室额角穿刺、经耳前路径的方法。对照组34例，采用传统的侧脑室枕角穿刺、耳后路径。分析比较两组手术的治疗结果和并发症发生情况。结果术后早期CT检查，发现实验组脑室明显缩小者占86．4％，脑室内导管位置满意者占94．4％，均明显高于对照组（P〈0．05）。随访期内发现，实验组导管阻塞1例（4．5％），对照组导管阻塞9例（26．5％），两组比较有显著性差异（P〈0．05）。结论经侧脑室额角穿刺、经耳前路径的手术方法可能优于传统分流手术，值得临床推广应用。     

额颞颧入路海绵窦眶尖肿瘤切除及脑神经保护

目的探讨海绵窦眶尖肿瘤显微手术及脑神经保护的方法。方法回顾性分析8例海绵窦眶尖肿瘤临床资料,均采用额颞颧入路显微神经外科手术切除肿瘤及神经电生理检测保护脑神经,术后定期随访。结果肿瘤全切除4例,次全切2例,大部分切除1例,活检1例。脑神经继发损伤症状出现率22%,脑脊液漏1例,无脑内感染及死亡病例。结论掌握海绵窦眶尖区解剖及熟练的显微神经外科技术,再加上神经电生理检测保护脑神经,可提高肿瘤切除程度,减少脑神经继发损伤。     

垂体腺瘤切除术的护理体会

目的总结经额下入路垂体腺瘤切除术的护理及观察要点。方法分析23例行经额下入路垂体瘤切除术患者的临床资料。结果对23例患者术后回访1年,影像学检查示,垂体腺瘤消失,激素分泌恢复(或部分恢复)正常,临床症状治愈或得到一定程度缓解,恢复正常的工作和生活能力。结论垂体腺瘤切除术是一种必要的治疗手段,术前、术后的护理至关重要,特别是术后并发症的观察与护理,正确的护理对手术的成功有十分重要的辅助作用。