Peripheral facial palsy following ventriculoperitoneal shunt. The lesson we have learned

The most frequent complications after shunt surgery are infective and obstructive. Other types are less common, and eventually occur due to technical errors during brain ventricular puncture, opening the intraperitoneal cavity or the tunnelling of the catheter between the two points. Although rare, there are well-reported complications related to the poor positioning of the distal catheter, with perforation of organs and tissues.We report a very rare case of a male patient with normal pressure hydrocephalus submitted to ventriculoperitoneal shunt. During tunnelling of the shunt stylet, a peripheral facial palsy due to injury to the extra cranial segment of the facial nerve occurred.To the best of our knowledge this is the second case described in Literature.The patient and the surgeon should be aware of this very rare but possible complication in shunt surgery being careful to the course of the facial nerve in the mastoid region. Keywords: Normal pressure hydrocephalus, Ventriculoperitoneal shunt complications, Facial nerve paralysi

Aportación al estudio de la teoría vírica en la parálisis facial idiopática por métodos de diagnóstico serológico

Descripció del recurs: 4 octubre 201

Bell's Palsy - Medical Treatment and Influence of Prognostic Factors

Bell’s palsy is an acute onset of peripheral facial nerve dysfunction. Despite extensive research the aetiology is unclear. The most prevailing theory is that reactivation of viruses such as Herpes simplex type-1 or Varicella zoster may cause Bell’s palsy. The natural course is favourable but at least 30% of patients will suffer sequelae such as residual paresis, synkinesis and/or contracture. The most commonly used medical treatment to reduce sequelae has been corticosteroids and/or antiviral agents, the usefulness of which has been debated since earlier studies have shown diverging results. The aim of this thesis was to evaluate the effect of treatment with prednisolone and/or valaciclovir in a large number of Bell’s palsy patients and study how prognostic factors such as age, severity of palsy at baseline, and time to treatment start may influence outcome. Data from the Scandinavian Bell’s Palsy Study (SBPS), a prospective, randomised, double-blind, placebo-controlled multicentre study with 12-month follow-up, were evaluated. In total, 829 patients, aged 18−75, were included in the intention to treat (ITT) analysis: 210 patients received prednisolone plus placebo, 207 valaciclovir plus placebo, 206 prednisolone plus valaciclovir and 206 placebo plus placebo. Outcome was measured using the Sunnybrook facial grading system (SFGS) and House-Brackmann scale (HBS) at baseline and each follow-up. Follow-ups were scheduled for day 11–17 and 1, 2, 3, 6 and 12 months after palsy onset. Significantly better outcome was seen in patients treated with prednisolone (72%) compared with patients who did not receive prednisolone (57%) (P<0.0001). Time to complete recovery was also significantly shorter in patients treated with prednisolone compared with patients not treated with prednisolone (P<0.0001). Synkinesis at 12 months was less frequent in patients treated with prednisolone (14%) compared with patients not receiving prednisolone (29%) (P<0.0001). Where treatment started within 48 hours, patients in the prednisolone group had shorter time to complete recovery, higher complete recovery rates and less synkinesis compared with the group not treated with prednisolone. Patients aged ≥40 years had significantly higher complete recovery rates if treated with prednisolone. This was not seen in patients <40 years, but synkinesis was less prevalent in patients <40 years old given prednisolone. All patients, regardless of severity at baseline, showed significantly higher complete recovery rates if treated with prednisolone compared with no prednisolone. In patients with moderate and mild palsy at baseline, significantly fewer prednisolone-treated patients had synkinesis at 12 months. Valaciclovir alone showed no effect on recovery rates, time to recovery or synkinesis and did not show any additive effect to prednisolone. In conclusion, prednisolone treatment in Bell’s palsy is recommended for use in adult patients regardless of severity of palsy and age, and should be started as early as possible, as long as no contraindications for steroid treatment is present

bell s palsy a narrative account of the illness and a short presentation of the disease

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Osteopathic Digest (January 1, 1928)

The January 1, 1928 issue of the Osteopathic Digest includes the following articles: Faculty Meeting PCOS Meeting Christmas Program Dr. H. R. Bynum To Visit College NYC Society Dec Meeting Prof. Erb to Speak at Ursinus College P. C. O. Five Loses, 38-28 Calendar An Unusual Case Case Reports Saturday Morning Surgical Clinic Who’s Who: DR. D. S.D. Pennock, D.O., M.D. Osteopathic Lesions in Facial Paralysis Controversy Mendel\u27s Law Hospital Statistics Alumni Cholecystography Around the Campus Book .Reviews Book Reviews to Be Regular Featurehttps://digitalcommons.pcom.edu/digest/1006/thumbnail.jp

Microcirugía reconstructiva

RESUMEN Las transferencias libres de tejidos son por naturaleza técnicamente complejas, por las condiciones de infraestructura y equipos que se requieren y porque cada caso clínico varía por la localización de las lesiones, así como la cantidad y tipos de tejidos necesarios para transferir. Otra característica es que la reconstrucción con colgajos libres es un proceso tridimensional que requiere considerable planeamiento preoperatorio. El mejor sitio donante debe ser escogido y el colgajo precisamente diseñado para cumplir las necesidades del sitio receptor. Igualmente estos tipos de cirugías son diferentes porque se trabaja en dos campos quirúrgicos separados durante una porción de tiempo importante en cada uno de ellos y requiere de un esfuerzo en equipo con una adecuada organización. Palabras clave: microcirugía, colgajos libres, reimplantes, parálisis facial ABSTRACT The tissue free transfer is a complex technically for infrastructure conditions and equipments and for every clinic case is different in type injuries and tissues disposable for transplant. The reconstruction with free flaps is a tridimentional process to require preoperative planning in best donant area and design flap. This surgeries are different because the work is in two operative fields for prolonged times and effort in one team with precise organization. Key words: microsurgery, free flaps, reimplant, facial paralysi