Plates with angular stability: our personal experience in surgical treatment of fractures of the proximal extremity of the humerus

We here report our experience in the use of locking proximal humerus plates that, compared to the old-generation ones, have shown a reduced incidence of complications, more manageability and higher preservation of soft tissues. Thirty-two patients underwent surgical treatment with plates with angular stability: 20 women and 12 men, with an average age of 52 years; in 6 cases they were fractures with 2 fragments, in 20 cases they were with 3 fragments and in 6 cases with 4 fragments. Results, evaluated according to the Constant Score, with a minimum follow-up of 6 months and the longest of 2 years, have revealed a 79-point Constant Score one year after surgery (min 42, max 94). In 2 cases we have observed necrosis of the epiphysis while there have not been any cases of secondary mobilisation of the synthesis equipment. Our findings, if we consider the low necrosis percentage, show the good adaptability and the preservation of the soft tissues as guaranteed by the synthesis equipment and by the surgery performed.     

The role of cesium-131 brachytherapy in brain tumors: a scoping review of the literature and ongoing clinical trials

Journal of Neuro-Oncology - Cesium-131 radioactive isotope has favored the resurgence of intracavitary brachytherapy in neuro-oncology, minimizing radiation-induced complications and maximizing...     

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Background: Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. Results: We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1–C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12–252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1–252). Conclusions: Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.     

Visiting hours policies in New England intensive care units: strategies for improvement

OBJECTIVE: Dying patients often feel isolated and alone, and restricted visiting hours in the intensive care unit (ICU) has been shown to increase anxiety and dissatisfaction in both critically ill patients and their families. Unrestricted visiting has been identified as a top-ten need by families of patients in the ICU. Because emotional distress experienced by patients and families may persist well beyond the ICU stay, an open visiting policy, by meeting the needs of patients and families, may improve the quality of end-of-life care in the ICU. This two-part study included a survey to determine the visiting hours policies of New England-area hospital ICUs, and nursing focus groups to describe challenges and barriers that nursing staff working in an open ICU have experienced and to provide solutions that will facilitate implementation of an open visiting hours policy. DESIGN: Two-part study: survey and focus groups. SETTING: ICUs in New England and one medical ICU in a tertiary care hospital. SUBJECTS: Registered nurses employed in medical ICUs. INTERVENTIONS: Adult ICUs in the six New England states were located using a library listing of all regional hospitals. A telephone questionnaire interview was used to ascertain visiting hours policies in each ICU. Six focus-group sessions were conducted with nursing staff who work in an urban, northeastern ICU with 8 yrs of experience with an unrestricted visiting hours policy. MEASUREMENTS AND MAIN RESULTS: A total of 171 hospitals completed the questionnaire (96%). From all ICUs surveyed, 62 (32%) had unrestricted, open visiting hours. Out of these, 57 (92%) were medical ICUs or mixed medical/surgical ICUs. Nursing staff identified three major areas of concern with an open visiting hours policy: space, conflict, and burden. Strategies for resolution that are either employed or advocated by nursing staff are described. CONCLUSIONS: The majority of ICUs in New England have restricted visiting hours. Only one third of ICUs have open visiting policies. Nursing concerns with an unrestricted ICU were identified and solutions were offered that may provide guidance for other ICUs considering adopting an open visiting hours policy.     

Emergency Department Visits for Pediatric Trampoline-related Injuries: An Update

Objectives: To describe the epidemiology of emergency department (ED) visits for trampoline-related injuries among U.S. children from January 1, 2000, to December 31, 2005, using the National Electronic Injury Surveillance System (NEISS) and to compare recent trampoline injury demographics and injury characteristics with those previously published for 1990–1995 using the same data source.
Methods: A stratified probability sample of U.S. hospitals providing emergency services in NEISS was utilized for 2000–2005. Nonfatal trampoline-related injury visits to the ED were analyzed for patients from 0 to 18 years of age.
Results: In 2000–2005, there was a mean of 88,563 ED visits per year for trampoline-related injuries among 0–18-year-olds, 95% of which occurred at home. This represents a significantly increased number of visits compared with 1990–1995, when there was an average of 41,600 visits per year. Primary diagnosis and principal body part affected remained similar between the two study periods.
Conclusions: ED visits for trampoline-related injuries in 2000–2005 increased in frequency by 113% over the number of visits for 1990–1995. Trampoline use at home continues to be a significant source of childhood injury morbidity.     

Usefulness of Computerized Pediatric Motor Vehicle Safety Discharge Instructions

OBJECTIVES: To determine whether providing child motor vehicle safety recommendations on computerized discharge instructions (CDIs) were useful to parents and modified their use of child-restraint devices (CRDs). METHODS: The subjects were guardians of children seen in an urban pediatric emergency department (ED). An intervention group was given computerized ED discharge instructions that included the National Highway Traffic Safety Administration recommendations for motor vehicle CRDs. A control group was given CDIs without the recommendations. All subjects were subsequently called within four days of the ED visit and asked questions about their knowledge and use of CRDs. They also were queried if the recommendations affected their knowledge or changed their behavior. RESULTS: There were 52 subjects in the control group and 58 in the intervention group. Fifty-seven percent of the intervention group remembered reading a safety tip (p < 0.001, 95% confidence interval [CI] = 0.32 to 0.62), and 82% of that subset correctly identified it pertaining to motor vehicle safety. Forty-five percent (n = 33) of those who remembered the safety recommendation in the intervention group supported it being educational (p = 0.067, 95% CI = 0.28 to 0.64). Ten percent of the subjects in the intervention group said the CDIs changed their behavior regarding buckling-up their child, compared with 0% of the control group (p = 0.473, 95% CI = 0.05 to 0.32). CONCLUSIONS: Including CRD information on CDIs is a convenient method of educating guardians of patients about motor vehicle safety in a pediatric ED setting. The data suggest that parents find it educational and a smaller subgroup change their behaviors after receiving them.     

Stereotactic radiosurgery in the management of petroclival meningiomas: a systematic review and meta-analysis of treatment outcomes of primary and adjuvant radiosurgery

Journal of Neuro-Oncology - To summarize the clinical features and outcomes of petroclival meningioma patients treated with stereotactic radiosurgery (SRS) as either a primary or an adjuvant...     

Injuries in Youth Football: National Emergency Department Visits during 2001–2005 for Young and Adolescent Players

Objectives:  Limited research exists describing youth football injuries, and many of these are confined to specific regions or communities. The authors describe U.S. pediatric football injury patterns receiving emergency department (ED) evaluation and compare injury patterns between the younger and older youth football participants.
Methods:  A retrospective analysis of ED data on football injuries was performed using the National Electronic Injury Surveillance System–All Injury Program. Injury risk estimates were calculated over a 5-year period (2001–2005) using participation data from the National Sporting Goods Association. Injury types are described for young (7–11 years) and adolescent (12–17 years) male football participants.
Results:  There were an estimated total of 1,060,823 visits to U.S. EDs for males with football-related injuries. The most common diagnoses in the younger group (7–11 years) were fracture/dislocation (29%), sprain/strain (27%), and contusion (27%). In the older group (ages 12–17 years), diagnoses included sprain/strain (31%), fracture/dislocation (29%), and contusion (23%). Older participants had a significantly higher injury risk of injury over the 5-year study period: 11.0 (95% confidence interval [CI] = 9.2 to 12.8) versus 6.1 (95% CI = 4.8 to 7.3) per 1,000 participants/year. Older participants had a higher injury risk across all categories, with the greatest disparity being with traumatic brain injury (TBI), 0.8 (95% CI = 0.6 to 1.0) versus 0.3 (95% CI = 0.2 to 0.4) per 1,000 participants/year.
Conclusions:  National youth football injury patterns are similar to those previously reported in community and cohort studies. Older participants have a significantly higher injury risk, especially with TBI.     

Thalamic gliomas in adults: a systematic review of clinical characteristics,treatment strategies,and survival outcomes

Journal of Neuro-Oncology - Thalamic gliomas are rare neoplasms that pose significant surgical challenges. The literature is limited to single-institution retrospective case series. We...