A comprehensive overview of radioguided surgery using gamma detection probe technology

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

A retrospective analysis of surgical outcomes for acute subdural hematoma in an elderly cohort

Background: Acute subdural hematoma (aSDH) in the elderly is an increasingly important public health issue. Mortality rate in this population can be as high as 90% (Copper et al., 1976; Cagetti et al., 1992; Taussky et al., 2012; Hanif, 2009; Raj et al., 2016; Luerssen et al., 1988). Objective: The goal of this study is to examine outcomes for patients 70 years and older who underwent craniotomy for aSDH. Methods: This is a retrospective study of patients 70 years and older who underwent craniotomy for evacuation of aSDH between 2006 and 2016. Patients with subacute, chronic, acute-on-chronic SDH and those considered too neurologically devastated to benefit from surgery were excluded. A multivariable logistic regression was performed to identify independent clinical factors associated with mortality. Results: A total of 1953 elderly patients with SDH were seen between 2006 and 2016. 1325 patients had non-surgical SDH, 307 were too neurologically devastated to benefit from surgery, and 321 elderly patients had surgery. 112 patients had a craniotomy for aSDH. The overall mortality rate was 42%. 24% of patients were discharged to home or a rehabilitation facility. Multivariable logistic regression analysis showed that age, Glasgow Coma Scale (GCS) score, and surgery type had a significant impact on mortality. Conclusion: Elderly patients with aSDH requiring surgery have a high likelihood of mortality. 24% of surgical patients were functional enough to go home or to a rehabilitation facility from the hospital. Age over 80 years old, GCS <9, or cerebral edema significant enough to warrant decompressive craniectomy were associated with an increased risk of death. Keywords: Acute subdural hematoma (aSDH), Long term acute care (LTAC), Rehabilitation facility (rehab), Skilled nursing facility (SNF