Understanding the Cost-Effectiveness of Hearing Aids and Surgery for the Treatment of Otosclerosis

Purpose of Review To summarize and critically review recent literature on the relative cost-effectiveness of hearing augmentation versus stapes surgery for the treatment of otosclerosis. Recent Findings Otosclerosis leads to reduced patient quality of life, which can be ameliorated by either stapes surgery, or hearing aid usage. The success of stapes surgery is high, and the risks of serious postoperative complications are low. Hearing aids don’t have the complications of surgery but are associated with long-term costs. Cost-effectiveness models have shown that stapes surgery is a cost-effective method for treating otosclerosis. Summary Both stapes surgery and hearing aids can improve patient-reported quality of life in otosclerosis. Stapes surgery has larger upfront costs and surgical risks, but hearing aids are associated with longer lifetime costs. Stapes surgery is cost-effective for the treatment of otosclerosis.

Gamma Knife Radiosurgery in the Management of Hypothalamic Glioma: A Case Report with Long-term Follow-up

Background Optic pathway/hypothalamic gliomas are rare pediatric brain tumors. The management paradigm for these challenging tumors includes chemotherapy, radiotherapy, or surgical resection, but the optimal management strategy remains elusive. Gamma Knife radiosurgery (GKRS) has emerged as a promising treatment for such lesions as documented by a small number of cases in the literature. Case Presentation Herein, we present a rare case of hypothalamic glioma in a 13-year-old girl who was referred to our service due to growth of a an incidentally diagnosed hypothalamic lesion following head injury at the age of 8 years. The lesion demonstrated hypointensity on T1 and hyperintensity on T2 without enhancement. Given the growth of the lesion on serial imaging, a stereotactic biopsy was performed demonstrating low-grade glioma. The patient underwent GKRS treatment with a marginal dose of 15 Gy at 50% isodose line for a tumor volume of 2.2 ml. Annual radiological surveillance over the next 17 years demonstrated a gradual shrinkage of the lesion until it completely disappeared. The patient is currently a healthy 31-year-old female without any visual, endocrine, or neurocognitive complaints. Conclusion The outcome obtained after extended follow-up in our patient highlights the safety and efficacy of GKRS in the management of hypothalamic gliomas in pediatrics, which in turn can avoid potentially serious complications of surgery in this vulnerable patient population in this sensitive location.

Preoperative mechanical bowel preparation combined with oral antibacterials in the prevention of complications of surgery for rectal and rectosigmoid junction cancer

Aim: To evaluate the efficacy of mechanical bowel preparation (MBP) combined with oral antibacterials for the prevention of postoperative complications when preparing a patient for anterior rectal resection.Materials and methods: We analyzed shortterm results in 77 patients who had undergone anterior rectal resection for rectal and rectosigmoid junction cancer. Forty five (45) patients were prepared for surgery only with MBP. In 32 patients, in addition to MBP, oral antibacterial agents ciprofloxacin and metronidazole were used preoperatively.Results: The overall rate of postoperative complications was 6.25% (2/32 patients) in the group of combined preparation for surgery and 15.5% (7/45) in the group using only MBP. Surgical wound infection occurred in 1 patient in the combined preparation group and in 4 patients in the MBP only group. There was no anastomotic leak in the combined preparation group, whereas in the MBP only group, anastomotic leak occurred in 2 patients.Conclusion: Combined use of oral antibacterials and MBP before anterior rectal resection makes it possible to achieve an extremely low rate of the colorectal anastomosis leak. Further studies into the efficacy of this preparation regimen are needed, along with their discussion in the professional communities.

Evaluation of the Ophthalmotoxic Effect of Quantum Dots and Bioconjugates Based on Them in Terms of the Prospects for the Treatment of Resistant Endophthalmitis. Experimental Research (Stage 1)

Endophthalmitis remains one of the most formidable complications of surgery in ophthalmology, leading to significant functional and anatomical changes. The “gold” standard of treatment for this pathology is the installation of intravenous injections of antibacterial drugs, but taking into account the number and type of pathogens, the growth of antibiotic resistance, the search for alternative methods of treatment of endophthalmitis remains relevant. Colloidal quantum dots, which are nanoscale semiconductor crystals with simulated optical and electronic properties due to changes in their volume, composition, and surface connections, are of interest for research in this direction. This article presents the process of synthesis of CT and bioconjugates based on them in order to assess ophthalmotoxicity with the prospect of further use in the treatment of endophthalmitis. The study was divided into 4 stages, starting with the determination of the required technical specification in order to select the appropriate type of quantum dots taking into account the physical and chemical characteristics (Stage 1), the synthesis of quantum dots (Stage 2), the preparation and titration of a solution of quantum dots of various concentrations for implantation in the vitreous cavity (Stage 3). The final stage was to evaluate the toxic effect of the quantum dot solution in its pure form, as well as in combination with antibiotics (ceftazidime and vancomycin) when administered intravitreally on an animal model. As a result of the study, quantum dots were synthesized and a solution based on them was obtained for introduction into the vitreous cavity. Based on the testing of the animal model (rabbits), a safe dose of the solution was determined, as well as the possibility of its use in combination with antibiotics.

Relationship between Spinal Anesthesia and Hypothermia Incidence among Post Operative Patients in the Operating Recovery Room "JIH" Hospital Yogyakarta

Introduction: Complications of surgery may lead the patient to experience ill and even death. One of the complications in the patient after surgery with spinal anesthesia is the incidence of hypothermia. Hypothermia can occur as a result of a combination of anesthesia and surgery that causes disturbance in body temperature regulation that can make decreasing body temperature. Method: This research uses a descriptive correlational method with a retrospective approach, with total sampling technique amount of 106 respondents, using a checklist sheet research instrument.Data analysis techniques spearman rank. Results: The characteristics of surgery patients with spinal anesthesia in the operating room of Yogyakarta "JIH" Hospital were mostly female, 87.9%, most of whom were adults 74.1%, the highest frequency of surgery with spinal anesthesia duration >2 hours 55.7% and had an incidence of hypothermia 54.7%. Correlational statistical analysis obtained a Cramer's value of 0.371, a correlation coefficient value of 0.348 with a probability value (p-value) of 0.000. Conclusion: There is a relationship between spinal anesthesia and hypothermia incidence among postoperative patients in the operating recovery room "JIH" Hospital Yogyakarta. The direction of the correlation is positive and closeness is sufficient.

Pre-Procedural Patient Anxiety in Dermatologic Procedures: A Cross-Sectional Study of Dermatologists

As many as 73% of patients scheduled to undergo surgery have substantial preoperative anxiety [1]. Significant preoperative anxiety has also been reported in fast track and day-care patients [2]. Dermatologists perform a number of procedures ranging from skin biopsies to Mohs micrographic surgery. Patients may experience anxiety prior to such procedures, termed pre-procedural or preoperative anxiety. Patient anxiety prior to dermatologic surgery may be influenced by factors such as the sight of blood, perception of pain during the surgery, and potential complications of surgery. Given the role of preoperative anxiety in affecting tolerance of the procedure, intra- and postoperative complications, and overall satisfaction, further research is warranted to determine how best to reduce preprocedural anxiety in dermatologic procedures.

Surgical management of obesity: what you need to know

Obesity is a worldwide epidemic and official figures demonstrate a rising prevalence, both in the UK and globally. Increasingly, there is a recognised place for surgical intervention in carefully selected patients, but there is limited understanding of the pathway and process among non-specialist clinicians. This article summarises the available guidelines and literature on the surgical management of obesity for hospital physicians, surgeons and GPs. The focus is on appropriate referral criteria, key bariatric procedures, postoperative management and, most importantly, the complications of surgery and how to recognise them.