Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature

We present an update of the literature concerning long-term neuropsychological outcomes following surgery for refractory temporal lobe epilepsy (TLE). A thorough search was conducted through the PubMed and Medline electronic databases for studies investigating neuropsychological function in adult patients undergoing resective TLE surgery and followed for a mean/median > five years period. Two independent reviewers screened citations for eligibility and assessed relevant studies for the risk of bias. We found eleven studies fulfilling the above requirements. Cognitive function remained stable through long-term follow up despite immediate post-surgery decline; a negative relation between seizure control and memory impairment has emerged and a possible role of more selective surgery procedures is highlighted.

Iatrogenic Ocular Surface Diseases Occurring during and/or after Different Treatments for Ocular Tumours

The ocular surface represents a finely regulated system that allows the protection of the eye. It is particularly susceptible to different treatments for intraocular tumours, such as uveal melanoma and conjunctival cancers. Traditionally, the management of ocular tumours depends on the characteristics of the lesion, and is based on a combination of selective surgery, topical chemotherapy, and/or radiotherapy delivered through different mechanisms (e.g., charged-particle radiotherapy or brachytherapy). Possible complications involving the ocular surface range from transient dry eye disease or keratitis up to corneal melting and perforation, which in any case deserve careful evaluation for the risk of permanent sigh-threatening complications. Clinicians involved in the management of these patients must be aware of this risk, in order to reach an early diagnosis and promptly set up an adequate treatment. The present review of the literature will summarize acute and chronic complications affecting the ocular surface following different therapies for the treatment of ocular tumours.

The diagnostic threshold of Cornell assessment of pediatric delirium in detection of postoperative delirium in pediatric surgical patients

Background Cornell assessment of pediatric delirium (CAPD) showed advantage in diagnosis of pediatric delirium in Chinese critically ill patients. But its performance in surgical patients is still unclear. The present study was designed to validate the diagnostic performance of CAPD in surgical pediatric patients. Methods This is a prospective validation study. Pediatric patients who underwent selective surgery and general anesthesia were enrolled. Primary outcome was the incidence of delirium within postoperative three days. CAPD Chinese version was used to evaluate if the patient had delirium one time per day. At the meantime, a psychiatrist employed Diagnostic and Statistical Manual of Mental Disorders fifth edition to diagnose delirium, which was the “gold standard”, and the result was considered as reference standard. Sensitivity, specificity and area under receiver operating characteristic (ROC) curve were calculated to investigate the performance of CAPD. Results A total of 170 patients were enrolled. Median age was 4 years old. As diagnosed by psychiatrist, 23 (13.5 %) patients experienced at least one episode of delirium during the follow-up period. When diagnostic threshold was set at 9, CAPD showed the optimal sensitivity (87.0 %, 95 %CI 65.3 %-96.6 %) and specificity (98.0 %, 95 %CI 93.7 %-99.5 %) in comparison with other diagnostic thresholds. ROC analysis showed that CAPD was a good delirium assessment instrument with area under curve of 0.911 (95 % CI 0.812 to 1.000, P < 0.001). Agreement between CAPD and reference standard was 0.849 (Kappa coefficient, P < 0.001). Conclusions This study found that Cornell assessment of pediatric delirium could be used as an effective instrument in diagnosis of delirium in pediatric surgical patients. Trial registration www.chictr.org.cn Identifier: ChiCTR-DDD-17,012,231, August 3, 2017.

Was Lung Computed Tomography Necessary for Patients Receiving Selective Surgery From Low-risk Areas of COVID-19?

ObjectiveLung computed tomography (CT) image was considered as supplementary diagnostic criteria for COVID-19 in the newest diagnosis and treatment program; however, the diagnostic effectiveness of lung CT in patients that have a strict screening for symptoms, history and reverse transcription-polymerase chain reaction (RT-PCR) testing remain unclear. To share our experience about elective surgery during the COVID-19 pandemic and to analyze the effectiveness and necessity of lung CT for screening COVID-19 in elective surgery patients from low risk areas.MethodsBased on the database of our Hospital Information System, participants were all patients receiving elective surgery in departments of general surgery, hepatological surgery, orthopedics, neurosurgery and urology at our hospital from 11 January, 2020 to 11 May, 2020.ResultsIn total, 2375 patients (1150 females and 1225 males) were enrolled in this current study. The mean age was 52 years old, ranging from 6 to 94. All the RT-PCR results of these 2375 patients were negative, including the patients with fever. The most common features on lung CT were nodular lesions (n=624, 26.3%) and striplike lesions (n=467, 19.7%). While, there were only 120 patients (5.1%) with ground-glass opacities (GGO) and 54 patients (2.3%) with lung consolidations on the lung CT, which were ruled out the COVID-19 by the RT-PCR results, clinical manifestation, fever screen, contact history and travel history. During the hospital stay, a total number of 1085 patients were screened with temperature ≥ 37.3℃, which were ruled out COVID-19 by consultation of special fever clinic and respiratory department.ConclusionsAfter strict screening for symptoms, history (contact COVID-19 patients or travelling to high-risk areas) and RT-PCR testing, lung CT image was not recommended as routine examination in patients receiving selective surgery from the low-risk areas of COVID-19.