One Thousand Endoscopic Skull Base Surgical Procedures Demystifying the Infection Potential: Incidence and Description of Postoperative Meningitis and Brain Abscesses

2011 ◽  
Vol 32 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Yuriko Kono ◽  
Daniel M. Prevedello ◽  
Carl H. Snyderman ◽  
Paul A. Gardner ◽  
Amin B. Kassam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skull Base ◽  
Medical Center ◽  
External Ventricular Drain ◽  
Csf Leak ◽  
University Of Pittsburgh ◽  
History Of ◽  
Brain Abscesses ◽  
Postoperative Meningitis ◽  
The University

Background.Endonasal endoscopic skull base surgery (ESBS) is perceived as having a high risk of infection because it is performed through the sinuses, which are not sterile.Objective.To identify the bacteriological characteristics, incidence, mortality, and risk factors for intracranial infection after ESBS.Methods.A retrospective analysis of the first 1,000 ESBS procedures performed at the University of Pittsburgh Medical Center from 1998 to 2008.Results.In 18 cases (1.8%), the patient developed meningitis. In 2 cases, the patient died within 2 months after surgery, of noninfectious causes. In 11 cases, cerebrospinal fluid (CSF) cultures had positive results. There were no predominant pathogens. Male sex (odds ratio [OR], 3.97 [95% confidence interval {CI}, 1.21-13.03]; P = .02), history of a craniotomy or endonasal surgery (OR, 4.77 [95% CI, 1.68-13.56];P = .003), surgerywith higher levels of complexity (OR, 6.60 [95% CI, 1.77-24.70];P = .005), the presence of an external ventricular drain or ventriculoperitoneal shunt at the time of surgery (OR, 6.38 [95% CI, 1.07-38.09]; P = .04), and postoperative CSF leak (OR, 12.99 [95% CI, 4.24-39.82]; P<.001) were risk factors for infection.Conclusion.The incidence of infection of 1.8% in ESBS is comparable to that in open craniotomy. The most important risk factor was a postoperative CSF leak. All patients recovered from their infection.

scholarly journals Nasoseptal flap necrosis: a rare complication of endoscopic endonasal surgery

2018 ◽  
Vol 128 (5) ◽  
pp. 1463-1472 ◽  
Author(s):  
Joseph D. Chabot ◽  
Chirag R. Patel ◽  
Marion A. Hughes ◽  
Eric W. Wang ◽  
Carl H. Snyderman ◽  
...  
Keyword(s):  
Skull Base ◽  
Final Analysis ◽  
Csf Leak ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
University Of Pittsburgh ◽  
The University ◽  
Pittsburgh Medical

OBJECTIVEThe vascularized nasoseptal flap (NSF) has become the workhorse for skull base reconstruction during endoscopic endonasal surgery (EES) of the ventral skull base. Although infrequently reported, as with any vascularized flap the NSF may undergo ischemic necrosis and become a nidus for infection. The University of Pittsburgh Medical Center’s experience with NSF was reviewed to determine the incidence of necrotic NSF in patients following EES and describe the clinical presentation, imaging characteristics, and risk factors associated with this complication.METHODSThe electronic medical records of 1285 consecutive patients who underwent EES at the University of Pittsburgh Medical Center between January 2010 and December 2014 were retrospectively reviewed. From this first group, a list of all patients in whom NSF was used for reconstruction was generated and further refined to determine if the patient returned to the operating room and the cause of this reexploration. Patients were included in the final analysis if they underwent endoscopic reexploration for suspected CSF leak or meningitis. Those patients who returned to the operating room for staged surgery or hematoma were excluded. Two neurosurgeons and a neuroradiologist, who were blinded to each other’s results, assessed the MRI characteristics of the included patients.RESULTSIn total, 601 patients underwent NSF reconstruction during the study period, and 49 patients met the criteria for inclusion in the final analysis. On endoscopic exploration, 8 patients had a necrotic, nonviable NSF, while 41 patients had a viable NSF with a CSF leak. The group of patients with a necrotic, nonviable NSF was then compared with the group with viable NSF. All 8 patients with a necrotic NSF had clinical and laboratory evidence indicative of meningitis compared with 9 of 41 patients with a viable NSF (p < 0.001). Four patients with necrotic flaps developed epidural empyema compared with 2 of 41 patients in the viable NSF group (p = 0.02). The lack of NSF enhancement on MR (p < 0.001), prior surgery (p = 0.043), and the use of a fat graft (p = 0.004) were associated with necrotic NSF.CONCLUSIONSThe signs of meningitis after EES in the absence of a clear CSF leak with the lack of NSF enhancement on MRI should raise the suspicion of necrotic NSF. These patients should undergo prompt exploration and debridement of nonviable tissue with revision of skull base reconstruction.

Hemorrhage rates after external ventricular drain placement

2009 ◽  
Vol 110 (5) ◽  
pp. 1021-1025 ◽  
Author(s):  
Paul A. Gardner ◽  
Johnathan Engh ◽  
Dave Atteberry ◽  
John J. Moossy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Operating Room ◽  
Medical Center ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Neurosurgical Procedures ◽  
University Of Pittsburgh ◽  
Drain Placement ◽  
The University

Object External ventricular drain (EVD) placement is one of the most common neurosurgical procedures performed. Rates and significance of hemorrhage associated with this procedure have not been well quantified. Methods All adults who underwent EVD placement at the University of Pittsburgh Medical Center between July 2002 and June 2003 were evaluated for catheter-associated hemorrhage. Patients without postprocedural imaging were excluded. Results Seventy-seven (41%) of 188 EVDs were associated with imaging evidence of hemorrhage after either placement or removal. Most of these were insignificant, punctate intraparenchymal, or trace subarachnoid hemorrhages (51.9%). Thirty-seven (19.7%) were associated with larger hemorrhages, which were divided into 3 groups according to volume of hemorrhage: 16 patients (8.5%) had < 15 ml of hemorrhage, 20 (10.6%) had hemorrhages of > 15 ml or associated intraventricular hemorrhage, and in 1 case there was a subdural hematoma that required surgical evacuation. No hemorrhages larger than punctate or trace were seen after EVD removal. Hemorrhage was associated with 44.3% of EVDs placed in an intensive care unit compared with 34.8% in EVDs placed in the operating room (p > 0.10). Conclusions External ventricular drain placement has a significant risk of associated hemorrhage. However, the hemorrhages are rarely large and almost never require surgical intervention. There is a favorable trend, but no significant risk reduction when EVDs are placed in the operating room rather than the intensive care unit.

Thyrsa Wealtheow Amos: The Dean of Deans

NASPA Journal ◽  
2004 ◽  
Vol 41 (2) ◽  
Author(s):  
Richard J. Herdlein
Keyword(s):  
Higher Education ◽  
Student Affairs ◽  
Historical Research ◽  
University Of Pittsburgh ◽  
Student Personnel ◽  
Dean Of Women ◽  
History Of ◽  
Personnel Administration ◽  
The University

The scholarship of student affairs has neglected to carefully review its contextual past and, in the process, failed to fully integrate historical research into practice. The story of Thyrsa Wealtheow Amos and the history of the Dean of Women’s Program at the University of Pittsburgh,1919–41, helps us to reflect on the true reality of our work in higher education. Although seemingly a time in the distant past, Thyrsa Amos embodied the spirit of student personnel administration that shines ever so bright to thisd ay. The purpose of this research is to provide some of thatcontext and remind us of the values that serve as foundations of the profession.

Clearing the Way: Using Turbines to Reclaim or Remediate Acid Mine Drainage

2006 ◽  
Author(s):  
Amy L. Miller ◽  
Alyson Stegman
Keyword(s):  
Acid Mine Drainage ◽  
Mine Drainage ◽  
Undergraduate Research ◽  
Precious Metals ◽  
University Of Pittsburgh ◽  
Acid Mine ◽  
Technology Students ◽  
History Of ◽  
The University ◽  
Paint Pigment

Pennsylvania has a long history of coal mining. Unfortunately, it has left many scars. The Pennsylvania Department of Environmental Protection (PA DEP) is looking at the potential of using micro hydro turbines in acid mine drainage streams. They hope to make it profitable for business to "clean-up" the streams by providing seed money to initiate the hydro turbine projects. It is believed that businesses can profit from both the energy created by the turbines and the extraction of the acid mine drainage (AMD) minerals. The minerals and concentrations vary with each stream. Some possess precious metals, others contain minerals that are used in paint pigment, and still others are being researched for use in powder metallurgy. The paper outlines an undergraduate research project done at the University of Pittsburgh at Johnstown. The study is to create a comprehensive diagnostic spreadsheet to be used by the PA DEP to determine viable economical turbines based on waterway conditions. The study has parallel phases: one addressing issues related to turbine parameters and a second dealing with waterway variables. Also to be discussed in the paper is the use of the project as an undergraduate research study for technology students. For students interested in research or graduate school, it is immensely important to introduce them to research. By guiding them through the process they are better prepared for their future.

scholarly journals Curatorial Practice as Production of Visual and Spatial Knowledge: Panelists Respond

2015 ◽  
Vol 4 ◽  
pp. 158-163
Author(s):  
Alison Langmead ◽  
Dan Byers ◽  
Cynthia Morton
Keyword(s):  
Graduate Students ◽  
Information Science ◽  
Spatial Knowledge ◽  
University Of Pittsburgh ◽  
Visual Knowledge ◽  
Curatorial Practice ◽  
History Of Art ◽  
History Of ◽  
The University ◽  
Art And Architecture

Three participants in the panel “Curatorial Practice as Production of Visual and Spatial Knowledge” reflect upon the ideas raised in their discussion about curating, both in their respective fields and as a general practice. The panel was a part of Debating Visual Knowledge, a symposium organized by graduate students in Information Science and History of Art and Architecture at the University of Pittsburgh, October 3–5, 2014. A transcription of the panel is available in this issue. 

A TEACHING PROGRAM IN COMMUNITY PEDIATRICS

PEDIATRICS ◽  
1960 ◽  
Vol 25 (2) ◽  
pp. 336-339
Author(s):  
Kenneth D. Rogers
Keyword(s):  
Medical Center ◽  
Group Discussion ◽  
Outpatient Service ◽  
Field Trip ◽  
Teaching Program ◽  
Exceptional Children ◽  
University Of Pittsburgh ◽  
School Of Medicine ◽  
Informal Discussion ◽  
The University

AT THE School of Medicine of the University of Pittsburgh, the Department of Pediatrics has organized a series of field experiences intended to acquaint future physicians with programs and facilities outside the confines of the Medical Center which are concerned directly or indirectly with the health and welfare of normal and exceptional children. During their pediatric outpatient service, senior medical students in groups of six to eight spend 6 half-days in "community pediatric" training. Each student is loaned a collection of selected reprints, booklets and mimeographed material pertinent to the areas covered in the community experiences. They are urged to read the appropriate material before each field trip in order that their observations may be meaningful and productive. Additional preparation is given at the visit site by approximately an hour's group discussion of the general area to be covered, specific items to be noted, and questions to be considered during the experience. No attempt is made to cover all aspects of the program being viewed. Informal discussion and interpretation are maintained by the instructor throughout the field trip.

Leiomyoma of the Male Urethra

2000 ◽  
Vol 124 (2) ◽  
pp. 302-303 ◽  
Author(s):  
Jose L. Mira ◽  
Guang Fan
Keyword(s):  
Urethral Stricture ◽  
English Language ◽  
Medical Literature ◽  
Medical Center ◽  
Male Urethra ◽  
Surgical Specimen ◽  
Cord Injury ◽  
History Of ◽  
The University ◽  
Epithelioid Leiomyoma

Abstract We describe the case of a 48-year-old quadriplegic black man with history of C4-C5 cervical spine and cord injury secondary to a fall, who presented to the University of Cincinnati Medical Center Urology Service with obstructive symptoms at urination. A bulbous urethral stricture was diagnosed and subsequently resected with primary urethral reanastomosis. On pathologic examination, the surgical specimen contained an epithelioid leiomyoma at the site of the urethral stricture. Although leiomyomas of the female urethra are relatively common, we identified only 2 previously reported cases of leiomyomas of the male urethra in the English-language medical literature. To the best of our knowledge, we describe the third case of leiomyoma of the male urethra, the first of the epithelioid type.

Implementation of the Acute Care Nurse Practitioner Role

1994 ◽  
Vol 5 (3) ◽  
pp. 404-407
Author(s):  
Lynn A. Kelso ◽  
Lori M. Massaro
Keyword(s):  
Acute Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Medical Center ◽  
Care Nurse ◽  
University Of Pittsburgh ◽  
Acute Care Nurse Practitioner ◽  
The University ◽  
Pittsburgh Medical ◽  
Practitioner Role

In this article, the experiences of two new acute care nurse practitioners working at the University of Pittsburgh Medical Center arc described. Included are the experiences they encountered in initiating the role and some of the responsibilities they assumed.

scholarly journals History of Depression and Increased Risk of Sternal Wound Infection After Cardiothoracic Surgery: A Novel and Potentially Modifiable Risk Factor

2019 ◽  
Vol 6 (3) ◽  
Author(s):  
Deborah A Theodore ◽  
Renee D Goodwin ◽  
Yuan (Vivian) Zhang ◽  
Nancy Schneider ◽  
Rachel J Gordon
Keyword(s):  
Risk Factors ◽  
Wound Infection ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cardiothoracic Surgery ◽  
Sternal Wound Infection ◽  
Composite Variable ◽  
Increased Risk ◽  
History Of ◽  
History Of Depression

Abstract Background Sternal wound infection (SWI) is a leading cause of postoperative disease and death; the risk factors for SWI remain incompletely understood. The goal of the current study was to investigate the relationship between a preoperative history of depression and the risk of SWI after cardiothoracic surgery. Methods Among patients undergoing cardiothoracic surgery in a major academic medical center between 2007 and 2012, those in whom SWI developed (n = 129) were matched, by date of surgery, with those in whom it did not (n = 258). Multivariable logistic regression was used to examine the strength of relationships between risk factors and development of infection. History of depression was defined as a composite variable to increase the sensitivity of detection. Results History of depression as defined by our composite variable was associated with increased risk of SWI (adjusted odds ratio, 2.4; 95% confidence interval, 1.2–4.7; P = .01). Staphylococcus aureus was the most common organism isolated. Conclusions History of depression was associated with increased risk of SWI. Future prospective studies are warranted to further investigate this relationship. Depression is highly treatable, and increased efforts to identify and treat depression preoperatively may be a critical step toward preventing infection-related disease and death.

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