Contemporary Management of Traumatic Parotid-Cutaneous Communications and Fistulae

2020 ◽  
pp. 667-671
Author(s):  
John Blythe ◽  
Peter A. Brennan
Keyword(s):  
Contemporary Management

Management and outcomes of isolated interhemispheric subdural hematomas associated with falx syndrome

2019 ◽  
Vol 131 (6) ◽  
pp. 1920-1925
Author(s):  
Daniel A. Tonetti ◽  
William J. Ares ◽  
David O. Okonkwo ◽  
Paul A. Gardner
Keyword(s):  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Study Cohort ◽  
Venous Infarction ◽  
Nonsurgical Management ◽  
Subdural Hematomas ◽  
Poor Outcomes ◽  
Contemporary Management

OBJECTIVELarge interhemispheric subdural hematomas (iSDHs) causing falx syndrome are rare; therefore, a paucity of data exists regarding the outcomes of contemporary management of iSDH. There is a general consensus among neurosurgeons that large iSDHs with neurological deficits represent a particular treatment challenge with generally poor outcomes. Thus, radiological and clinical outcomes of surgical and nonsurgical management for iSDH bear further study, which is the aim of this report.METHODSA prospectively collected, single-institution trauma database was searched for patients with isolated traumatic iSDH causing falx syndrome in the period from January 2008 to January 2018. Information on demographic and radiological characteristics, serial neurological examinations, clinical and radiological outcomes, and posttreatment complications was collected and tallied. The authors subsequently dichotomized patients by management strategy to evaluate clinical outcome and 30-day survival.RESULTSTwenty-five patients (0.4% of those with intracranial injuries, 0.05% of those with trauma) with iSDH and falx syndrome represented the study cohort. The average age was 73.4 years, and most patients (23 [92%] of 25) were taking anticoagulants or antiplatelet medications. Six patients were managed nonoperatively, and 19 patients underwent craniotomy for iSDH evacuation; of the latter patients, 17 (89.5%) had improvement in or resolution of motor deficits postoperatively. There were no instances of venous infarction, reaccumulation, or infection after evacuation. In total, 9 (36%) of the 25 patients died within 30 days, including 6 (32%) of the 19 who had undergone craniotomy and 3 (50%) of the 6 who had been managed nonoperatively. Patients who died within 30 days were significantly more likely to experience in-hospital neurological deterioration prior to surgery (83% vs 15%, p = 0.0095) and to be comatose prior to surgery (100% vs 23%, p = 0.0031). The median modified Rankin Scale score of surgical patients who survived hospitalization (13 patients) was 1 at a mean follow-up of 22.1 months.CONCLUSIONSiSDHs associated with falx syndrome can be evacuated safely and effectively, and prompt surgical evacuation prior to neurological deterioration can improve outcomes. In this study, craniotomy for iSDH evacuation proved to be a low-risk strategy that was associated with generally good outcomes, though appropriately selected patients may fare well without evacuation.

Review of Prelabor Rupture of the Membranes: Pathophysiologic Concepts and Novel Therapeutic Strategies

2020 ◽  
Vol 16 ◽  
Author(s):  
Saadia Ghafoor
Keyword(s):  
Management Strategies ◽  
Signs And Symptoms ◽  
Cochrane Library ◽  
Main Body ◽  
Scientific Publications ◽  
Timely Diagnosis ◽  
Narrative Literature Review ◽  
Contemporary Management ◽  
Online Library ◽  
Novel Therapeutic Strategies

Background:: Prelabor rupture of membrane (PROM) refers to the breakage of fetal membranes before the onset of labor, resulting in the leakage of amniotic fluid. PROM affects approximately 3% and 8% of preterm and term pregnancies. Because of associated high maternal and perinatal mortality, correct and timely diagnosis together with effective management is highly recommended to prevent adverse fetal and maternal outcomes. Objective:: To provide an overview of the novel concepts in the understanding of PROM including etiology, pathophysiology, risk factors, complications, assessment, diagnostic modalities, and contemporary management strategies for PROM at preterm and term. Methodology:: This narrative literature review was conducted through a literature search using the Cochrane library and electronic databases including PubMed, Web of Science, Medline, Scopus, Crossref, Google Scholar, Wiley online library, ScienceDirect with specific search terms in scientific publications published from March 1980 to March 2020. Main Body:: Preterm PROM has the potential to cause prenatal morbidity and mortality. It is imperative to monitor the signs and symptoms of an impending infection due to the risk of infectious morbidity with PROM at preterm and preterm. PROM at preterm and term requires prompt diagnosis followed by an appropriate management strategy. Conclusion:: The correct and timely diagnosis of PROM is essential for efficacious management. Furthermore, it can reduce avoidable emergent health care visits and related costs in a clinical setting subjected to pregnancy with suspected PROM. Further studies are needed to fill the gaps in identifying better diagnostic predictive tools in high- risk pregnancies.

scholarly journals Contemporary management of locoregionally advanced melanoma in Australia and New Zealand and the role of adjuvant systemic therapy

2021 ◽  
Vol 91 (S2) ◽  
pp. 3-13
Author(s):  
B. Mark Smithers ◽  
Robyn P. M. Saw ◽  
David E. Gyorki ◽  
Richard C. W. Martin ◽  
Victoria Atkinson ◽  
...  
Keyword(s):  
New Zealand ◽  
Systemic Therapy ◽  
Advanced Melanoma ◽  
Adjuvant Systemic Therapy ◽  
Contemporary Management

scholarly journals Gender Stereotypes and Their Impact on Women’s Career Progressions from a Managerial Perspective

2021 ◽  
pp. 227797522097551
Author(s):  
Naznin Tabassum ◽  
Bhabani Shankar Nayak
Keyword(s):  
Gender Studies ◽  
Gender Stereotypes ◽  
Theoretical Understanding ◽  
Management Culture ◽  
Women In Management ◽  
Critical Theories ◽  
The Social ◽  
Prejudice And Discrimination ◽  
Contemporary Management ◽  
Managerial Perspective

Gender stereotypes continue to exist and are transmitted through media, and through social, educational and recreational socialization, which promote gender prejudice and discrimination. This paper argues that contemporary management culture does not critically engage with the social theories of gender studies, which could help in developing gender-neutral affirmative action-oriented managerial perspectives. The paper outlines different aspects of gender stereotyping and their impact on women’s career progressions from a managerial perspective, which engages with the critical theories of gender studies. The paper contributes to existing literature by identifying the antecedents of gender stereotypes and their impacts on the career progressions of women in management. It advances theoretical understanding of three clear conceptual shifts, that is, (a) Women in Management, (b) Women and Management and (c) Gender and Management. The theoretical transition from Women in Management to Women and Management led to progressive conceptual shifts in management literature but gender stereotypes continue to exist in society.

How mortality risk estimated by MAGGIC-HF, SHFM and BCN-Bio HF scores is modified after 12-month management in a multidisciplinary HF Clinic

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Codina ◽  
M De Antonio ◽  
E Santiago-Vacas ◽  
M Domingo ◽  
E Zamora ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Risk Estimation ◽  
Risk Scores ◽  
Paired Data ◽  
Web Based ◽  
Risk Of Death ◽  
Estimated Risk ◽  
Contemporary Management ◽  
One Year ◽  
Missing Variables

Abstract Background Heart failure (HF) contemporary management has significantly improved over the past two decades leading to better survival. How application of the contemporary HF management guidelines affects the risk of death estimated by available web-based risk scores is not elucidated. Objective To assess changes in mortality risk prediction after a after a 12-month management period in a multidisciplinary HF Clinic. Methods Out of 1,689 consecutive patients with HF admitted at our ambulatory HF Clinic from May 2006 to November 2018, those who completed one year follow-up were considered for the study. Patients without NTproBNP measurement or with more than 3 missing variables for risk estimation were excluded. Three contemporary web-based HF risk scores were evaluated: MAGGIC-HF, Seattle HF Model (SHFM) and the Barcelona Bio-HF Calculator containing NTproBNP (BCN Bio-HF). Risk of all-cause death at one year and at 3 years were calculated at baseline and re-evaluated after 12-month management in a multidsisciplinary HF Clinic. Wilcoxon paired data test was used to compare changes in mortality risk estimation over time and test equality of matched pairs for comparing estimated change among tools. 442 patients used to derive the Barcelona Bio-HF Calculator were excluded for discrimination purposes. Results 1,157 patients were included (age 65.7±12.7 years, 70.4% men). A significant reduction in mortality risk estimation was observed with the three HF risk scores evaluated at 12-months (Table). The BCN Bio-HF model showed significantly different changes in risk estimation, fact that indeed was partnered with numerically better discrimination. AUC at 1 and 3 years, respectively, were: BCN Bio-HF (0.773 and 0.775), MAGGIC HF (0.686 and 0.748) and SHFM (0.773 and 0.739). Conclusions The three web-based risk scores evaluated showed a significant reduction in mortality risk estimation after 12 month management in a multidisciplinary HF Clinic. The BCN Bio-HF score showed higher reduction in estimated risk, together with better discrimination, likely because it incorporates contemporary treatment and use of biomarkers. Funding Acknowledgement Type of funding source: None

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