Preservation of Pituitary Function after Endonasal Craniopharyngioma Surgery: Case Report and Review of the Literature.

Craniopharyngiomas comprise approximately 3% of all intracranial tumors. Preservation of pituitary function after resection represents a significant challenge due to their location in the anterior skull base and aggressive local behavior. We report a case of a 79-year-old woman with a large suprasellar craniopharyngioma who presented with visual loss.

Changing Trends in Adenoidectomy.

Adenoid hypertrophy treatment is must to alleviate chronic nasal obstruction, mouth breathing, rhinosinusitis and eustachian tube dysfunction. For proper management of this clinical entity a thorough clinical examination along with radiological and endoscopic evaluation is mandatory. Although, few children having adenoid hypertrophy respond to medical treatment, surgery remains the mainstay.

Predicting readmission risk with institution-specific prediction models.

Objective: The ability to predict patient readmission risk is extremely valuable for hospitals, especially under the Hospital Readmission Reduction Program of the Center for Medicare and Medicaid Services which went into effect starting October 1, 2012. There is a plethora of work in the literature that deals with developing readmission risk prediction models, but most of them do not have sufficient prediction accuracy to be deployed in a clinical setting, partly because different hospitals may have different characteristics in their patient populations.

Methods And Materials: We propose a generic framework for institution-specific readmission risk prediction, which takes patient data from a single institution and produces a statistical risk prediction model optimized for that particular institution and, optionally, for a specific condition.

Draf III Extension in the Endoscopic Endonasal Transethmoidal, Transcribriform Approach Through the Back Wall of the Frontal Sinus: A Cadaveric Study.

Background: The Draf III (modified endoscopic Lothrop) procedure has been proposed to extend the endonasal transethmoidal, transfovea ethmoidalis, and transcribriform approach through the back wall of the frontal sinus. The exposure is time-consuming and increases the risk of cerebrospinal fluid leak, and the indications for use are not well described. There are few data quantifying the advantage it conveys over the approach without the Draf III procedure.

Endonasal endoscopic transsphenoidal chiasmapexy using a clival cranial base cranioplasty for visual loss from massive empty sella following macroprolactinoma treatment with bromocriptine: case report.

Visual deterioration after dopamine-agonist treatment of prolactinomas associated with empty sella syndrome and secondary optic apparatus traction is a rare event. Chiasmapexy has been described as a viable treatment option, although few cases exist in the literature. Here, a novel endonasal endoscopic approach to chiasmapexy is described and its efficacy is demonstrated in a case report.

An unusual toxicity with beta blocker and calcium channel blocker.

The increasing use of beta and calcium channel blockers for management of cardiac comorbidities has led to more frequent complications in the postoperative period. Anesthetic interaction with these drugs can lead to delayed manifestations of features of toxicity, even when administered in therapeutic doses. We report a case with an uneventful intraoperative period but profound bradycardia and hypotension postoperatively, only relieved with high-dose insulin therapy.

Sensitivity and specificity of intrathecal fluorescein and white light excitation for detecting intraoperative cerebrospinal fluid leak in endoscopic skull base surgery: a prospective study.

Objective: The intraoperative detection of CSF leaks during endonasal endoscopic skull base surgery is critical to preventing postoperative CSF leaks. Intrathecal fluorescein (ITF) has been used at varying doses to aid in the detection of intraoperative CSF leaks. However, the sensitivity and specificity of ITF at certain dosages is unknown.

Prophylactic lidocaine for myocardial infarction.

Background: Coronary artery disease is a major public health problem affecting both developed and developing countries. Acute coronary syndromes include unstable angina and myocardial infarction with or without ST-segment elevation (electrocardiogram sector is higher than baseline). Ventricular arrhythmia after myocardial infarction is associated with high risk of mortality.

Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches.

Objective: Although the endonasal endoscopic approach has been applied to remove olfactory groove meningiomas, controversy exists regarding the efficacy and safety of this approach compared with more traditional transcranial approaches. The endonasal endoscopic approach was compared with the supraorbital (eyebrow) keyhole technique, as well as a combined "above-and-below" approach, to evaluate the relative merits of each approach in different situations.

Methods: Nineteen cases were reviewed and divided according to operative technique into 3 different groups: purely endonasal (6 cases); supraorbital eyebrow (microscopic with endoscopic assistance; 7 cases); and combined endonasal endoscopic with either the bicoronal or eyebrow microscopic approach (6 cases).

Leveraging Electronic Tablets and a Readily Available Data Capture Platform to Assess Chronic Pain in Children: The PROBE system.

The Patient Risks Outcomes and Barriers Evaluation (PROBE) system is developed using a readily available data capture platform (REDCap) and iPads. PROBE performs complete and consistent assessment of pain at every patient visit in pediatric rheumatology practices of our very large healthcare system. Using evidence based clinical guidelines, it combines the following essential elements for care: 1) screening for behavioral risks for chronic pain such as anxiety, sleep deprivation, or painful conditions affecting a caregiver living in child's home, 2) capturing disease activity related measures and enabling 3) clinical decision support.

Laser tympanic neurectomy for post-cochlear implant pain: A new technique.

Objectives: To present the case histories and management by LASER tympanic neurectomy of two patients who presented with pain as their only symptom after cochlear implantation, avoiding the need for device removal.

Clinical Presentation: Two of our patients presented with otalgia, which appeared 6 months after cochlear implantation and resulted in their refusing to use the device. The pain was not controlled by repeated remapping or medical management.

Endoscopic endonasal clip ligation of cerebral aneurysms: an anatomical feasibility study and future directions.

Objective: The expansion of endovascular procedures for obliteration of cerebral aneurysms highlights one of the drawbacks of clip ligation through the transcranial route, namely brain retraction or brain transgression. Sporadic case reports have emerged over the past 10 years describing endonasal endoscopic clip ligation of cerebral aneurysms. The authors present a detailed anatomical study to evaluate the feasibility of an endoscopic endonasal approach for application of aneurysm clips.

Intranasal cross-sectional area and quality of life changes following endoscopic transsphenoidal skull base surgery.

Background: Endoscopic transsphenoidal surgical approaches to the skull base may produce alteration of intranasal architecture. Acoustic rhinometry (AR) can provide quantitative data on the nasal airway, which has not been previously applied to skull base surgery. We sought to employ AR to quantify the changes in nasal patency following endoscopic transsphenoidal surgery and identify the relationship between these changes and septal deviation, nasoseptal flap harvest, and sinonasal quality of life (QOL).

Endoscopic cerebrospinal fluid leak closure in an infected field.

Background: Sinonasal cerebrospinal fluid (CSF) leaks during an active infection present the unique challenge of preventing spread of infection without compromising the integrity of the closure. We describe the technique and clinical course of patients undergoing endoscopic CSF leak repair in an actively infected field.

Objective: To evaluate the safety and efficacy of endoscopic CSF leak repair in an actively infected field.

Anatomy and Complications: Safe Sinus.

Safe sinus surgery is predicated on a clear understanding and knowledge of the anatomy. The paranasal sinuses are surrounded by vital vascular and neurologic structures. In every step during the surgical procedure, one should know the regional surrounding anatomy and the potential complications that can be encountered if the procedures traverse these areas.

Endoscopic Endonasal Resection of Trigeminal Schwannomas.

The surgical management of trigeminal schwannomas (TNs) entails the use of a variety of cranial base approaches for their effective surgical management. Although an extended middle fossa or posterior petrosal approach may be more appropriate for disease with primarily posterior fossa involvement, the expanded endoscopic approaches are suited for tumors with predominately middle fossa and/or extracranial involvement along the V2 and V3 divisions and limited posterior fossa extension. The endoscopic endonasal resection of TNs within the middle fossa, pterygopalatine fossa, and infratemporal fossa is reviewed in this article with a brief discussion of reported outcomes.

Treatment for disseminated intravascular coagulation in patients with acute and chronic leukemia.

Background: Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by systemic intravascular activation of coagulation, leading to deposition of fibrin in the bloodstream. It may occur in patients with acute and chronic leukemia and is particularly associated with acute promyelocytic leukemia (a subtype of acute myeloid leukemia).

Objectives: To assess the clinical benefits and harms of any pharmacological intervention for treating DIC in patients with acute or chronic leukemia.

E-cigarette Use and Beliefs Among Urban Public High School Students in North Carolina.

Purpose: The aim of this study was to examine the prevalence, attitudes, and risk factors associated with electronic cigarette (e-cigarette) use among high school students in tobacco growing state.

Methods: A 47-item e-cigarette questionnaire modeled after Monitoring the Future with additional information about demographics, adolescent and family nicotine use, and school and health care interventions was designed, piloted, and administered to public high school students (N = 3,298) in May 2013, in an urban county in North Carolina.

Results: Completers (2,769/3,298) were aged 16.

Distinctive Treg associated CCR4-CCL22 expression profile with altered frequency of Th17/Treg cell in the immunopathogenesis of Pemphigus Vulgaris.

Pemphigus Vulgaris (PV), a relatively common autoimmune blistering disease in India, primarily mediated by anti-Desmoglein 3 (anti-Dsg3) autoantibodies. T-helper 17 (Th17) and T-regulatory (Treg) cells play significant role in regulating immune homeostasis in autoimmune disorders. To understand immunopathogenesis of PV, it is crucial to unfold the phenotypic expression and functional characteristics of these cells along with their specific homing chemokine receptor-ligand.

Endoscopic Endonasal Management of Metastatic Lesions of the Anterior Skull Base: Case Series and Literature Review.

Background: The anterior skull base is an uncommon site for brain metastases. A limited number of cases have been reported where a region of the skull base is accessed through an expanded/extended transsphenoidal route. In addition, reports of overall and progression-free survival rates are lacking.

Endoscopic endonasal approach to the lateral orbital apex: case report.

Although the medial and inferior orbital apex are considered safely accessible using the endonasal endoscopic approach, the lateral apex has been considered unsafe to access since the optic nerve lies between the surgeon and the pathology. The authors present the case of a 4-year-old girl with recurrent rhabdomyosarcoma attached to the lateral rectus muscle located lateral and inferior to the optic nerve in the orbital apex. The tumor was totally resected through an endoscopic endonasal transmaxillary transpterygoidal approach using a 45° endoscope.

Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection.

Object: Pituitary adenomas are well suited to resection by a minimal-access endoscopic technique. Validation of this approach requires prospective outcome studies to determine the impact on quality of life (QOL). This study aims to assess the effect of endoscopic pituitary adenoma resection on site-specific and sinonasal-related QOL before and after endoscopic surgery using validated instruments.

Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy.

Background:: Patients with brain tumour usually suffer from increased pressure in the skull due to swelling of brain tissue. A swollen brain renders surgical removal of the brain tumour difficult. To ease surgical tumour removal, measures are taken to reduce brain swelling, often referred to as brain relaxation.

The magnetic structure of EuCu₂Sb₂.

Antiferromagnetic ordering of EuCu2Sb2 which forms in the tetragonal CaBe2Ge2-type structure (space group P4/nmm #129) has been studied using neutron powder diffraction and (151)Eu Mössbauer spectroscopy. The room temperature (151)Eu isomer shift of -12.8(1) mm s(-1) shows the Eu to be divalent, while the (151)Eu hyperfine magnetic field (B(hf)) reaches 28.