Articles: surgery.
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A systematic literature review and consensus using Delphi method. ⋯ The consensus statements created by a collaborative work provide useful information for surgeons treating CM worldwide in order to achieve better surgical outcomes and avoid complications.
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A systematic literature review and consensus using Delphi method. ⋯ Pediatric age is a modifier for the management of Chiari Malformation (CM). Prompt diagnosis and appropriate decompressive surgery with duraplasty before puberty are essential to mitigate the impact of the condition on the child's well-being. Increased awareness among healthcare professionals, timely access to specialized expertise in neurosurgical interventions are crucial, especially for type 2 CM patients that require urgent decompression of CVJ and cervical spine.
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Systematic literature review plus expert opinion framed on Delphi method. ⋯ In patients with BI, concomitant CMI is a modifier of surgical management. In BI with AAD, an additional foramen magnum decompression should be added to posterior C1-C2 realignment and fusion. In BI without AAD, whether treatment is restricted to FMD or C1/2 fusion is required on top or alternatively, demands further studies. Odontoid resections are reserved for patients with insufficient alignment after posterior surgery.
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Data on the incidence of recurrent adhesive small bowel obstruction (ASBO) following index admission for ASBO in children are limited. We sought to determine if operative management was associated with a lower rate of recurrence compared to non-operative management (NOM). ⋯ Although the rate of recurrent ASBO in children is nearly 15% within one year, this rate does not differ based on the initial management strategy. Among children with recurrent ASBO, one-third underwent an urgent or emergent operation at readmission. NOM appears to be as effective in preventing recurrent ASBO as surgery.
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After cardiac surgery, complete heparin reversal with protamine is essential. Accordingly, there is a need for an accurate and precise point-of-care device to detect possible residual heparin after protamine administration. ⋯ Both the ACT-LR and ACT+ tests of Hemochron Signature Elite device and the INTEM:HEPTEM CT ratio of ROTEM Sigma device have poor ability to detect residual heparin shortly after protamine administration.