Surgical Management of Spinal Epidural Disease: An Update

Management of spinal cord compression from metastatic malignant disease remains unsatisfactory. Results of surgical decompression are at best less than those of radiation therapy alone. However, new surgical approaches now focus on removing the anterior-situated tumor tissue which produces neural compression in about 85% of the cases. The results of these procedures that allow removal of the ventrally compressing tumor show significant improvement in the management of patients with spinal epidural disease. We review the surgical strategy of these new approaches and the attendant results

Pituitary Metastasis: Lung Cancer Presenting as Bitemporal Hemianopsia with Diabetes Insipidus and Anterior Pituitary Deficiency

Symptoms and signs of pituitary disease are rarely the first manifestations of malignancy originating in another organ. We present a case which exemplifies the key points that suggest a diagnosis of metastatic pituitary disease. Our patient\u27s diagnosis was adenocarcinoma of the lung with a metastasis to the intrasellar and suprasellar regions, which caused diabetes insipidus, anterior pituitary deficiency, and visual field defects. The metastasis had a dumbbell appearance and extended from the sella turcica into the suprasellar region. Diabetes insipidus was the initial clinical manifestation of lung cancer in this patient. A metastasis to the pituitary should be suspected if diabetes insipidus is the initial manifestation of an intrasellar mass

Functional reconstruction of the glenoid fossa utilizing a pedicled temporal osteomuscular flap

Current techniques in management of end stage pathology of the temporomandibular joint (TMJ) include the use of alloplastic joint reconstruction. A polyethylene glenoid fossa prosthesis is a necessity of this treatment as it provides a stable platform for function of the metal alloy condylar head. Additionally, the fossa prosthesis limits superior and posterior movement of the reconstructed joint which prevents complications such as migration of the condylar prosthesis into the middle cranial fossa and ear, ankylosis, and pain. When a pathologic process affects the glenoid fossa alone, alloplastic joint reconstruction becomes a less desirable treatment option. Lack of osseous structure along the temporal bone and zygomatic arch can impact the surgeon\u27s ability to fixate a glenoid fossa prosthesis. Additionally, resection of an uninvolved condylar head in situations where there is no advanced pathology would provide a functional solution, but may be overly aggressive and potentially unnecessary. The following is our experience with utilizing a pedicled temporal osteomuscular flap to reconstruct an acquired defect of the glenoid fossa in a 42-year-old male with a diffuse-type tenosynovial giant cell tumor. In this case the mandibular condyle was not affected by the pathology

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700