Articles: surgery.
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The risk-to-benefit ratio of transopercular awake resection for recurrent insular diffuse gliomas is poorly studied. We assessed feasibility, safety, and efficacy of awake surgical resection of recurrent insular diffuse gliomas in patients with previous treatments (resection and/or radiotherapy and/or chemotherapy and/or combination). ⋯ Function-based transopercular awake resection seems feasible and safe at recurrence of a previously treated insular diffuse glioma, with similar resection rates and outcomes than first-time surgery.
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The global average life expectancy has been increasing steadily as the quality of healthcare continues to improve. However, there is a paucity of data looking at surgical fixation of thoracolumbar spine fractures in patients ≥80 years (super-elderly). Aim of this study is to look at whether there is higher rate of complications from surgical fixation of thoracolumbar fractures in this group of patients. ⋯ The super-elderly had a higher incidence of osteoporosis and worse comorbidities, but there was no significant difference regarding implant complications, revision surgery required, or all-cause mortality. Hence, surgical fixation of thoracolumbar spine fractures in people older than 80 years should be considered despite their advanced age.
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Traumatic brain injury is a major cause of disability and mortality worldwide. Acute traumatic subdural hematoma (TSDH) accounts for a large proportion of all traumatic brain injury cases. However, factors to predict postoperative prognosis in patients with acute TSDH are limited. Recently, it has been reported that inflammatory markers increase the accuracy of prognosis in various diseases. The neutrophil-to-lymphocyte ratio (NLR) is a marker for inflammation, which is easy to test, inexpensive, and can be performed quickly. However, the prognostic value of NLR in patients with acute TSDH remains controversial. This study therefore aimed to assess the predictive value of the admission and postoperative NLR in patients with acute TSDH who underwent surgical treatment. ⋯ Initial NLR was not strongly associated with 1-month mortality in patients with acute TSDH who underwent surgery. However, the postoperative 48-hour NLR was associated with 1-month mortality.
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Hydrocephalus is a common neurosurgical condition treated primarily through ventriculoperitoneal (VP) shunt placement. This study aims to investigate the relationship between the timing of VP shunt surgery (on-call vs regular hours) and shunt failure rates. ⋯ The rate of shunt failure was significantly greater in surgeries conducted during on- call hours as opposed to regular hours, but this was not statistically significant after adjusting for confounders. Therefore, the timing of VP shunt surgery may not be an independent risk factor for shunt failure. High-risk scenarios still deserve added caution, and further research is needed to identify factors influencing shunt outcomes and develop strategies to minimize failure rates.
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Tranexamic acid is an anti-fibrinolytic agent routinely used during hip and knee joint replacement surgery to minimize bleeding. Chronic kidney disease is a common chronic health problem seen among adults requiring major arthroplasty surgery. Tranexamic acid is renally cleared and may accumulate in chronic kidney disease. Optimal tranexamic acid dosing and dose adjustment for chronic kidney disease patients needing major arthroplasty is unknown. The objective of this study was to serially measure plasma tranexamic acid concentrations in patients with varied kidney function undergoing hip or knee replacement surgery for population pharmacokinetic modelling and to guide new dosing recommendations. ⋯ Using population pharmacokinetic modelling and simulation, we recommend a new dosing regimen to optimize the anti-fibrinolytic effect of tranexamic acid and avoid excessive dosing.