Articles: cations.
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Case Reports
A Perforating Artery Compressing the Nerve Rootlet and Causing Glossopharyngeal Neuralgia.
A surgical procedure for glossopharyngeal neuralgia (GPN) was selected from microvascular decompression, glossopharyngeal and upper vagal rhizotomy, or a combination of these procedures based on the presence of arteries compressing the glossopharyngeal and vagal rootlets. The offending artery is usually a main trunk or branch of the cerebellar arteries. A perforating artery is a known but uncommon variation of the offending artery that causes GPN. The appropriate procedure for such cases is unknown. ⋯ Even a small perforating artery can cause GPN when it compresses the rootlet. In such cases, mobilization of the perforating artery with no additional rhizotomy is an effective surgical option.
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Supplementary motor area (SMA) syndrome occurs after surgery involving the SMA and is characterized by contralateral hemiparesis with or without speech impairment (dependent on involvement of the dominant SMA), which is transient and characteristically resolves over the course of weeks to months. Recurrent SMA syndrome after repeat craniotomy has not been previously described. ⋯ This series demonstrates that recurrent SMA syndrome occurs in patients undergoing repeat resection of tumors involving the SMA. The presence of recurrent SMA syndrome provides support for reorganization of SMA function to adjacent ipsilateral cortex after resection. Patients with recurrent neoplasms of the SMA should be counseled on the possibility of recurrent SMA syndrome.
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The goals of quality improvement are to partner with patients and loved ones to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste, yet few programs have successfully worked on of all these in concert. ⋯ Our trust-based accountability model, which included both senior hospital leadership and frontline providers, provided an enabling structure to rapidly implement an integrated recovery pathway and quickly improve outcomes, value, and experience of patients undergoing colorectal surgery. The study findings have significant implications for spreading surgical quality improvement work.
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A standard format for reporting observational surgical studies does not exist. This creates difficulties in comparing studies and in performing synthesis through systematic reviews and meta-analyses. This article proposes a method called "standard tabular reporting" and illustrates its use in a case series of bile duct reconstructions for biliary injuries occurring during cholecystectomy. ⋯ Presentation of data in a standard format would facilitate comparison and synthesis of observational studies on the same subject. The biliary reconstructive methods used resulted in very satisfactory outcomes.
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Recent analyses of gastrointestinal operations document that complications are a key driver of readmissions. Pancreatectomy is a high outlier with respect to readmission. This analysis sought to determine if a multifactorial approach could reduce readmissions after pancreatectomy. ⋯ All-cause 30-day readmissions after pancreatectomy decreased without increasing length of stay. Efforts by surgeons to decrease complications and an increased emphasis on coordination of care may be useful for reducing readmissions.