scholarly journals Elective neurosurgical humanitarian care in a deployed setting

2018 ◽  
Vol 45 (6) ◽  
pp. E8 ◽  
Author(s):  
Jonathan A. Forbes
Keyword(s):  
Surgical Care ◽  
Residual Tumor ◽  
Metastatic Lesion ◽  
Neurosurgical Procedures ◽  
Radiological Data ◽  
The Us ◽  
War Effort ◽  
Air Force Base ◽  
Battlefield Injuries ◽  
Age Range

OBJECTIVEActive-duty neurosurgical coverage has been provided at Bagram Air Force Base in Afghanistan since 2007. Early operative logs were reflective of a large number of surgical procedures performed to treat battlefield injuries. However, with maturation of the war effort, the number of operations for battlefield injuries has decreased with time. Consequently, procedures performed for elective neurosurgical humanitarian care (NHC) increased in number and complexity prior to closure of the Korean Hospital in 2015, which resulted in effective termination of NHC at Bagram. Monthly neurosurgical caseloads for deployed personnel have dropped precipitously since this time, renewing a debate as to whether the benefits of providing elective NHC in Afghanistan outweigh the costs of such a strategy. To date, there is a paucity of information in the literature discussing the overall context of such a determination.METHODSThe author retrospectively reviewed his personal database of all patients who underwent neurosurgical procedures at Bagram during his deployment there from April 17 to October 29, 2014. Standardized clinical parameters had been recorded in the ABNS NeuroLog system. All cases of nonelective surgical care for battlefield injuries were identified and excluded. Records of all other procedures, which represented elective NHC delivered during this period, were accessed to extract salient clinical and radiological data.RESULTSDuring the 6-month deployment, 49 patients (29 male and 20 female, age range 18 months to 63 years) were treated by the author in elective NHC. Procedures were performed for spinal degenerative disease (n = 28), cranial tumors (n = 11), pediatric conditions (n = 6), Pott’s disease (n = 2), peripheral nerve impingement (n = 1), and adult hydrocephalus (n = 1). The duration of follow-up ranged from 3 to 23 weeks. Complications referable to surgery included asymptomatic, unilateral lumbar screw fracture detected 3 months postoperatively and treated with revision of hardware (n = 1); wound infection requiring cranial flap explantation and staged cranioplasty (n = 1); and unanticipated return to the operating room for resection of residual tumor in a patient with a solitary metastatic lesion involving the mesial temporal lobe/ambient cistern (n = 1). There were no instances of postoperative neurological decline.CONCLUSIONSElective NHC can be safely and effectively implemented in the deployed setting. Benefits of a military strategy that supports humanitarian care include strengthening of the bond between the US/Afghan military communities and the local civilian population as well as maintenance of skills of the neurosurgical team during the sometimes-lengthy intervals between cases in which emergent neurosurgical care is provided for treatment of battlefield injuries.

Neurosurgery in Afghanistan during “Operation Enduring Freedom”: a 24-month experience

2010 ◽  
Vol 28 (5) ◽  
pp. E8 ◽  
Author(s):  
Brian T. Ragel ◽  
Paul Klimo ◽  
Robert J. Kowalski ◽  
Randall R. McCafferty ◽  
Jeannette M. Liu ◽  
...  
Keyword(s):  
Surgical Care ◽  
Operation Enduring Freedom ◽  
Pressure Monitor ◽  
Global War On Terror ◽  
Spine Stabilization ◽  
War Effort ◽  
Global War ◽  
Battlefield Injuries ◽  
Battle Injuries ◽  
Humanitarian Work

Object “Operation Enduring Freedom” is the US war effort in Afghanistan in its global war on terror. One US military neurosurgeon is deployed in support of Operation Enduring Freedom to provide care for both battlefield injuries and humanitarian work. Here, the authors analyze a 24-month neurosurgical caseload experience in Afghanistan. Methods Operative logs were analyzed between October 2007 and September 2009. Operative cases were divided into minor procedures (for example, placement of an intracranial pressure monitor) and major procedures (for example, craniotomy) for both battle injuries and humanitarian work. Battle injuries were defined as injuries sustained by soldiers while in the line of duty or injuries to Afghan civilians from weapons of war. Humanitarian work consisted of providing medical care to Afghans. Results Six neurosurgeons covering a 24-month period performed 115 minor procedures and 210 major surgical procedures cases. Operations for battlefield injuries included 106 craniotomies, 25 spine surgeries, and 18 miscellaneous surgeries. Humanitarian work included 32 craniotomies (23 for trauma, 3 for tumor, 6 for other reasons, such as cyst fenestration), 27 spine surgeries (12 for degenerative conditions, 9 for trauma, 4 for myelomeningocele closure, and 2 for the treatment of infection), and 2 miscellaneous surgeries. Conclusions Military neurosurgeons have provided surgical care at rates of 71% (149/210) for battlefield injuries and 29% (61/210) for humanitarian work. Of the operations for battle trauma, 50% (106/210) were cranial and 11% (25/210) spinal surgeries. Fifteen percent (32/210) and 13% (27/210) of operations were for humanitarian cranial and spine procedures, respectively. Overall, military neurosurgeons in Afghanistan are performing life-saving cranial and spine stabilization procedures for battlefield trauma and acting as general neurosurgeons for the Afghan community.

Ultrasound-Guided Insertion of the Ventricular Catheter in Ventriculoperitoneal Shunt Surgery: Evaluation of Accuracy and Feasibility in a Prospective Cohort

2020 ◽  
Vol 82 (01) ◽  
pp. 009-017
Author(s):  
Severina Leu ◽  
Maria Kamenova ◽  
Luigi Mariani ◽  
Jehuda Soleman
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Perioperative Complications ◽  
Univariate Analysis ◽  
Ventricular Catheter ◽  
Neurosurgical Procedures ◽  
Anatomical Landmarks ◽  
Ultrasound Guided ◽  
The Us ◽  
Evans Index ◽  
Shunt Survival

Abstract Objective Ventriculoperitoneal shunt (VPS) placement is one of the most frequent neurosurgical procedures. The position of the proximal catheter is important for shunt survival. Shunt placement is done either without image guidance (“freehand”) according to anatomical landmarks or by use of various image-guided techniques. Studies evaluating ultrasound-guided (US-G) VPS placement are sparse. We evaluate the accuracy and feasibility of US-G VPS placement, and compare it to freehand VPS placement. Methods We prospectively collected data of consecutive patients undergoing US-G VPS placement. Thereafter, the US cohort was compared with a cohort of patients in whom VPS was inserted using the freehand technique (freehand cohort). Primary outcome was accuracy of catheter positioning, and secondary outcomes were postoperative improvement in Evans' index (EI), rates of shunt dysfunction and revision surgery, perioperative complications, as well as operation, and anesthesia times. Results We included 15 patients undergoing US-G VPS insertion. Rates of optimally placed shunts were higher in the US cohort (67 vs. 49%, p = 0.28), whereas there were no malpositioned VPS (0%) in the US cohort, compared with 10 (5.8%) in the freehand cohort (p = 0.422). None of the factors in the univariate analysis showed significant association with nonoptimal (NOC) VPS placement in the US cohort. The mean EI improvement was significantly better in the US cohort than in the freehand cohort (0.043 vs. 0.014, p = 0.035). Conclusion Based on our preliminary results, US-G VPS placement seems to be feasible, safe, and increases the rate of optimally placed catheters.

scholarly journals Ganglioneuroma as the phenomenon of neuroblastoma maturation

2020 ◽  
Vol 19 (4) ◽  
pp. 133-142
Author(s):  
S. B. Babakhanova ◽  
D. Yu. Kachanov ◽  
A. P. Shcherbakov ◽  
V. Yu. Roshchin ◽  
A. E. Druy ◽  
...  
Keyword(s):  
Nervous System ◽  
Sympathetic Nervous System ◽  
De Novo ◽  
Residual Tumor ◽  
Metastatic Lesion ◽  
Poorly Differentiated ◽  
Undifferentiated Tumors ◽  
Sympathetic Nervous ◽  
Well Differentiated ◽  
Histological Verification

Ganglioneuroma (GN) represents a mature, well-differentiated tumor arising from the sympathetic nervous system. Mostly developing de novo, GN can appear during the treatment course of poorly differentiated or undifferentiated tumors of the sympathetic nervous system, such as neuroblastoma, or as a result of their spontaneous maturation. In this article we report three clinical cases of spontaneous and induced maturation of neuroblastoma (primary tumor and metastatic lesion) to GN. Histological verification of long-lasting stable or progressing residual tumor mases in patients with neuroblastoma stratified to the observation group plays a pivotal role as it may significantly affect the treatment course. The patients' parents gave their consent to the use of their child's data, including photographs, for research purposes and in publications.

Religion

2016 ◽  
Author(s):  
David J. Bettez
Keyword(s):  
Southern Baptist ◽  
Religious Leaders ◽  
Theological Seminary ◽  
The Us ◽  
Southern Baptist Theological Seminary ◽  
War Effort

This chapter examines the role religious leaders played in persuading Kentuckians to support the war effort and in ministries at Camp Taylor during the war. For many religious leaders, the war was a righteous crusade against the German “Huns,” who embodied evil. Key religious figures included Louisville’s Southern Baptist Theological Seminary professor William J. McLaughlin and Patrick Henry Callahan. Most denominations, even those that normally opposed war, fell in line and supported the US war effort.

Women and the US War in Vietnam

2018 ◽  
Author(s):  
Jessica M. Frazier
Keyword(s):  
Gender Roles ◽  
Social Welfare ◽  
Foreign Affairs ◽  
Service Personnel ◽  
War Zone ◽  
Speaking Out ◽  
The Us ◽  
War Effort ◽  
The Military ◽  
Insight Into

Women on all sides of the US war in Vietnam pushed for an end to the conflict. At a time of renewed feminist fervor, women stepped outside conventional gender roles by publicly speaking out, traveling to a war zone, and entering the male-dominated realm of foreign affairs. Even so, some claimed to stand squarely within the boundaries of womanhood as they undertook such unusual activities. Some American women argued that, as mothers or sisters of soldiers and draft-age men, they held special insight into the war. They spoke of their duty to their families, communities, and nation to act in untraditional, but nevertheless feminine, ways. But women did not act uniformly. Some joined the military as nurses or service personnel to help in the war effort, while others protested the war and served as draft counselors. By the end of the war, some anti-war protestors developed feminist critiques of US involvement in Vietnam that pointed to the war as a symptom of an unjust society that prioritized military dominance over social welfare. As in wars past, the US war in Vietnam created upheavals in gender roles, and as nurses, mothers, lovers, officers, entertainers, and activists, women created new spaces in a changing society.

scholarly journals Lasting impact: a qualitative study of perspectives on surgery by adult recipients of free mission-based surgical care in Benin

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e028235
Author(s):  
Kristin L Close ◽  
Floor T.E. Christie-de Jong
Keyword(s):  
Elective Surgery ◽  
Surgical Care ◽  
Interview Data ◽  
Quality Initiatives ◽  
Semistructured Interviews ◽  
Patient Database ◽  
Positive Experiences ◽  
Surgical Teams ◽  
Age Range ◽  
Surgical System

ObjectivesThis study aimed to explore how adult patients who received free mission-based elective surgery experienced surgery and its outcomes, in order to provide recommendations for improved service delivery, measurement of impact and future quality initiatives for the humanitarian organisation Mercy Ships and other mission-based surgical platforms.SettingData were collected in June 2017 in Cotonou, Benin, where the participants had previously received free mission-based elective surgery aboard the Africa Mercy, a non-governmental hospital ship.ParticipantsSixteen patients (seven male, nine female, age range 22–71, mean age 43.25) who had previously received surgical care aboard the Africa Mercy hospital ship between September 2016 and May 2017 participated in the study.MethodsUsing a qualitative design, 16 individual semistructured interviews were conducted with the assistance of two interpreters. Participants were recruited using purposive sampling from the Mercy Ships patient database. Interview data were coded and organised into themes and subthemes using thematic content analysis in an interpretivist approach.FindingsAnalysis of interview data revealed three main themes: barriers to surgery, experiences with Mercy Ships and changes in perspectives of surgery after their experiences. Key findings included barriers to local surgical provision such as cost, a noteworthy amount of fear and distrust of local surgical teams, exceptional positive experiences with the care at Mercy Ships, and impactful surgery, resulting in high levels of trust in foreign surgical teams.ConclusionsWhile foreign surgical teams are meeting an immediate need for surgical care, the potential enduring legacy is one of trusting only foreigners for surgery. Patients are a critical component to a well-functioning surgical system, and mission-based surgical providers must formulate strategies to mitigate this legacy while strengthening the local surgical system.

scholarly journals Modified surgical safety checklist (mSSC)- a must to avoid disaster in neurosurgical procedures!

2017 ◽  
Vol 14 (3) ◽  
pp. 7-12
Author(s):  
Amit Thapa ◽  
Bidur KC ◽  
Bikram Shakya ◽  
Shusma Bhurtyal
Keyword(s):  
Surgical Care ◽  
World Health ◽  
Surgical Patient ◽  
Neurosurgical Procedures ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Emergency Procedures ◽  
Machine Failure ◽  
Neurosurgical Patients ◽  
Health Organization

The World Health Organization (WHO) introduced surgical safety checklist (SSC) as a part of Second Global Patient Safety Challenge: Safe Surgery Saves Lives to address the safety of surgical care. Althoughfound to be benefi cial for general surgical patient, we introduced certain modification to suit neurosurgical patients and hereby present our experience with the modified checklist.We introduced the modified SSC in July 2012 for neurosurgical purpose after we identified minor but common errors in carefully audited 100 patients in our operating theatre. Modification included checklists in pre procedure room, during sign in enquiring for pulse oximeter (for local anesthetic procedures) and lastly during sign out an elaborated list of items to guarantee safe transfer of the patients. Nurses and doctors were trained and SSC was methodically administered.Outcome as number of complications was evaluated and graded according to no harm, low harm, moderated harm, severe harm and death. During last 5 years (July 2012 to June 2017), 1310 patients undergoing surgical procedures in neurosurgical theatre at KMCTH were studied. Modified SSC was used in both routine (50.5%) and emergency cases (49.5%), of which compliance was 80% and 55% respectively. Poor compliance was due to ignorance of its use, emergency nature of procedure, change of staff. Completeness of mSSC was found in 70% cases with most left out part of mSSC was during signing out (i.e during transfer of patients). Use of mSSC identified many common but minor negligent acts on part of doctors, nurses and OR technicians which could be rectified in time and hence avoided any major mishaps. Age of the patients ranged from newborn to 98 year old. There were no major mishaps including death on table events. Despite confirming during mSSC checklist, machine failure occurred in 10 cases (0.8%) which were of low harm category. The total time taken for performing and filling the checklist took roughly 7 minutes.We modified WHO surgical safety checklist to include post operative transfer out to recovery room and used it in both routine and emergency procedures. This has helped us to avoid major mishaps during and after the neurosurgical procedures. We recommend stringent use of SSC in all neurosurgical centre and advise suitable local modifications according to prevailing conditions for special procedures or locations.Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, page: 7-12

scholarly journals Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions: indications, technique, and outcomes

2015 ◽  
Vol 123 (4) ◽  
pp. 1045-1054 ◽  
Author(s):  
Bradley N. Bohnstedt ◽  
Charles G. Kulwin ◽  
Mitesh V. Shah ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Extent Of Resection ◽  
Metastatic Lesion ◽  
Related Complication ◽  
Postoperative Mri ◽  
Underlying Malignancy ◽  
Radiological Data ◽  
Data Points ◽  
Patient Series ◽  
The Mean

OBJECT Surgical exposure of the peritrigonal or periatrial region has been challenging due to the depth of the region and overlying important functional cortices and white matter tracts. The authors demonstrate the operative feasibility of a contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA) to this region and present a series of patients treated via this operative route. METHODS Fourteen consecutive patients underwent the PITTA and were included in this study. Pre- and postoperative clinical and radiological data points were retrospectively collected. Complications and extent of resection were reviewed. RESULTS The mean age of patients at the time of surgery was 39 years (range 11–64 years). Six of the 14 patients were female. The mean duration of follow-up was 4.6 months (range 0.5–19.6 months). Pathology included 6 arteriovenous malformations, 4 gliomas, 2 meningiomas, 1 metastatic lesion, and 1 gray matter heterotopia. Based on the results shown on postoperative MRI, 1 lesion (7%) was intentionally subtotally resected, but ≥ 95% resection was achieved in all others (93%) and gross-total resection was accomplished in 7 (54%) of 13. One patient (7%) experienced a temporary approach-related complication. At last follow-up, 1 patient (7%) had died due to complications of his underlying malignancy unrelated to his cranial surgery, 2 (14%) demonstrated a Glasgow Outcome Scale (GOS) score of 4, and 11 (79%) manifested a GOS score of 5. CONCLUSIONS Based on this patient series, the contralateral PITTA potentially offers numerous advantages, including a wider, safer operative corridor, minimal need for ipsilateral brain manipulation, and better intraoperative navigation and working angles.

scholarly journals (A129) A Pediatric Surgeon's Viewpoint of a Concealed Disaster

2011 ◽  
Vol 26 (S1) ◽  
pp. s36-s36
Author(s):  
A. Fette ◽  
K. Paya
Keyword(s):  
Surgical Care ◽  
Stress Disorders ◽  
Basic Knowledge ◽  
Junior Doctors ◽  
Post Traumatic Stress ◽  
Pediatric Surgeon ◽  
General Management ◽  
Psychological Harm ◽  
Traumatic Stress Disorders ◽  
Age Range

Childhood is one of the most vulnerable parts in a human's life. Thus, any physical and psychological harm against children requires special attention, especially if inflicted and not accidental. Such children should be considered multi-trauma victims and managed by a multidisciplinary team and trauma algorithm. In this team of specialized carers, the pediatric surgeon will import his/her expertise on general management and treatment and simultaneously refer basic knowledge to more junior doctors that might be in charge in the future. Fifty-eight injured victims (mean age = 1.5 years of age, range = 1 day–18 years of age, male:female ratio = 1:1) were analyzed in this study. Their injuries were subcategorized into battery (13), assault (11), neglect (3), sexual abuse (2), prevention failure (6), career-related (19), and miscellaneous (5). All victims were first seen by a pediatric surgeon before receiving multidisciplinary consultations. Treatment results and modalities varied according to the complexity of the diagnoses requiring a well-trained and skilled pediatric surgeon. Accompanying post-traumatic stress disorders within the children as well as psychological distress among the parents and grandparents were quite frequent. Besides medico-surgical treatment, empathic care is essential. In the majority of cases the children, benefited from pediatric surgical care.

The evolution of military neurosurgery in the Turkish army

2010 ◽  
Vol 28 (5) ◽  
pp. E16
Author(s):  
Yusuf Izci
Keyword(s):  
General Surgeon ◽  
Neurosurgical Procedures ◽  
Military Hospitals ◽  
Military Medical Academy ◽  
Medical Academy ◽  
The Us ◽  
History Of Neurosurgery ◽  
History Of ◽  
Military Neurosurgery ◽  
The Republic

The history of neurosurgery in the Turkish army is not long and complex. Neurosurgery was first practiced in the Ottoman army by Cemil Pasha, who was a general surgeon. After the fall of the Ottoman Empire, the Republic of Turkey was established and modern neurosurgical procedures were applied at the Gulhane Military Medical Academy (GMMA). Maj. Zinnur Rollas, M.D., was the founder of the Department of Neurosurgery at GMMA in 1957. A modern neurosurgical program and school was established in 1965 by Col. Hamit Ziya Gokalp, M.D., who completed his residency training in the US. Today, 26 military neurosurgeons are on active duty in 11 military hospitals in Turkey. All of these neurosurgeons work in modern clinics and operating theaters. In this paper, military neurosurgery in the Turkish army is reported in 3 parts: 1) the history of neurosurgery in the Turkish military, 2) the Department of Neurosurgery at the GMMA, and 3) the duties of a military neurosurgeon in the Turkish army.

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