Schwannoma of intermediate supraclavicular nerve: Case report

Schwannoma of supraclavicular nerve is very rare tumour occurring in head and neck region. This case is reported as a rare case of intermediate supraclavicular nerve schwannoma. A 48-year-old female patient presented to the outpatient department with right supraclavicular swelling for 5 years. She was diagnosed differently initially as having connective tissue neoplasm, tuberculous lymphadenitis, and granulomatous lymphadenitis by different surgeons. After all investigations, she was subjected to enucleation of mass and the histopathological report was suggestive of schwannoma. Post-op no neurological deficit was observed. She was discharged on fourth post-operative day

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Functional outcome after central corpectomy in poor-grade patients with cervical spondylotic myelopathy or ossified posterior longitudinal ligament

Objective: We studied the long-term functional outcome in poor-grade patients (Nurick Grades 4 and 5) with cervical spondylotic myelopathy (CSM) or ossified posterior longitudinal ligament after central corpectomy (CC). We sought to determine whether there were any prognostic factors that could predict functional outcome in these patients. Methods: Functional outcome data were collected for 72 patients (68 men and 4 women; mean age, 49.7 yr; range, 30-67 yr) with CSM (60 patients) or OPLL (12 patients) of Nurick Grades 4 (55 patients) and 5 (17 patients). Uninstrumented CC was performed at 1 level in 12 patients, at 1 level combined with a discoidectomy at another level in 4 patients, at 2 levels in 50 patients, and at 2 levels plus a discoidectomy in 5 patients. The age at presentation (≤50 yr or >50 yr), grade before surgery (4 or 5), the number of levels operated (1 or >1), diagnosis (CSM or ossified posterior longitudinal ligament), and duration of myelopathic symptoms (≤12 mo or >12 mo) were studied for their effect on the functional outcome noted at the last follow-up. Functional outcome was graded as poor (no change in Nurick grade), fair (improvement of one Nurick grade), good (improvement of two Nurick grades), and cure (follow-up Nurick grade of 0 or 1). Results: The follow-up ranged from 9 to 104 months (mean, 36.3 mo). One patient died 3 weeks after CC after surgery for a perforated duodenal ulcer. There was transient operative morbidity in 12 patients (16.9%). The mean Nurick score improved from 4.24 to 2.47 (P < 0.001). Of the 54 patients (76%) who improved in their Nurick grade, the functional outcome was graded as fair in 13 patients (18.3%), good in 24 patients (33.8%), and cure in 17 patients (23.9%). The functional outcome was poor in 17 patients (23.9%). Functional improvement after CC was uniformly correlated with myelopathic symptoms of 12 months' duration or shorter. The other favorable prognostic indicators for improvement after CC were a diagnosis of CSM and preoperative Nurick Grade 5; however, patients with a preoperative Nurick grade of 4 were more likely to experience a cure. Conclusion: More than three-fourths of patients with poor-grade CSM improve in their functional status after CC, with nearly 24% of patients obtaining a cure. Because patients with a duration of myelopathic symptoms of 12 months or less had the best functional outcome, early decompressive surgery should be offered to patients with poor-grade CSM

Changes in cervical spine curvature after uninstrumented one- and two-level corpectomy in patients with spondylotic myelopathy

Objective: We studied changes in the cervical spine curvature in patients with cervical spondylotic myelopathy who underwent one- or two-level central corpectomy and iliac bone grafting without the use of instrumentation. Methods: Curvature of the fused segment and of the whole cervical spine was evaluated on preoperative and follow-up x-rays in 93 patients (30 underwent one-level corpectomy, and 63 underwent two-level corpectomy). In 59 patients, the changes in the cervical spine curvature were studied using one follow-up x-ray; in the other 34 patients, the changes were studied on x-rays obtained at two or more follow-up visits. The sagittal alignment of the fused segment was categorized as lordotic (>+5 degrees), straight (+5 to -5 degrees) or kyphotic (>-5 degrees). The whole spine curvature also was recorded as lordotic, straight, or kyphotic. Results: At a mean follow-up of 22.2 months (range, 6-71 mo), there was a mean change of -10.4 degrees in the segmental curvature (P < 0.001). The fused segment sagittal alignment also worsened (lordotic angles becoming straight or kyphotic and straight angles becoming kyphotic) in 44 patients (47%)(P < 0.001). However, serial studies in 34 patients (mean first and last follow-ups, 11.9 and 30.8 mo, respectively) did not demonstrate significant worsening of the kyphotic angle or the sagittal alignment over time (P = 0.9). Whole spine curvature worsened in 33 (35%) of the 93 patients (P < 0.001); serial studies did not reveal a significant change (P = 0.9). Patients improved in their functional status from a preoperative mean Nurick grade of 2.9 (range, 1-5) to a follow-up mean Nurick grade of 1.5 (range, 0-4) (P < 0.001). Patients with a kyphotic change in their whole spine curvature (n = 33) and those without such change (n = 60) had a similar functional outcome (mean change in Nurick grade, 1.5 and 1.4, respectively). Conclusion: Cervical spine curvature tended to undergo a kyphotic change at the fused segment in 47% of patients and a kyphotic change of the whole spine curvature in 35% of patients who underwent one- or two-level uninstrumented central corpectomy. This kyphotic change in the cervical spine, which stabilizes within 1 year after surgery, is not progressive, and it does not affect neurological outcome in these patients

A computed tomography-based localizer to determine the entry site of the ventricular end of a parietal ventriculoperitoneal shunt

Background: One of the major principles of shunt insertion into the brain involves choosing an entry site that avoids eloquent cortex. Objetive: We describe a novel tool to accurately locate the burr hole for insertion of the ventricular end of a catheter during parietal ventriculoperitoneal shunt surgery. Methods: Computed tomography (CT)-based measurements in 2 dimensions were used to mark the entry point with the help of an indigenously designed Vellore burr hole localizer (VL). Patients underwent surgery with either the conventional method to localize the burr hole (Keen point; group A; n = 28) or the VL (group B; n = 28). An independent observer determined the accuracy of shunt placement on postoperative CT scans. The VL is designed with a fixed horizontal arm that can be aligned with the CT or magnetic resonance reference plane and a vertical arm with a flexible sliding horizontal arm that is attached to it with an adjustable screw. By manipulating the flexible arm along the contour of the skull and using the scale provided on both the vertical and horizontal arms, we can mark the burr hole site for placement of a parietal ventriculoperitoneal shunt. Results: Overall accuracy in group A was 32.1%, whereas in group B, an accuracy of 82.1% could be achieved (P < .01). Conclusion: Placement of a burr hole guided by the VL increases the accuracy of the desired entry point of the ventricular catheter

Ten golden rules for optimal antibiotic use in hospital settings : the WARNING call to action

Abstract: Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine