Indication as a predictor for outcomes in anterior cervical discectomy and fusion: The impact of myelopathy on disposition.

Background: While the indication for Anterior Cervical Discectomy and Fusion (ACDF) may influence the expected postoperative course, there is limited data comparing how length of stay (LOS) and disposition for patients with myelopathy differ from those with radiculopathy. This study aimed to compare LOS and discharge disposition, in patients undergoing ACDF for cervical radiculopathy versus those for myelopathy.

Methods: A retrospective review of all adult ACDF cases between 2013 and 2019 was conducted analyzing sex, age, race, comorbidities, level of surgery, myelopathy measures when applicable, complications, dysphagia, hospital LOS, and discharge disposition.

Clinical Utility of Routine Postoperative Imaging in Spinal Fusion Surgery: A Systematic Review.

Objective: Following spinal fusion surgery, routine imaging is often obtained in all patients regardless of clinical presentation. Such routine imaging may include x-ray, computed tomography, or magnetic resonance imaging studies in both the immediate postoperative period and after discharge. The clinical utility of this practice is questionable.

Viscoelastic Hemostatic Assays and Outcomes in Traumatic Brain Injury: A Systematic Literature Review.

Background: Coagulopathy in traumatic brain injury (TBI) occurs frequently and is associated with poor outcomes. Conventional coagulation assays (CCA) traditionally used to diagnose coagulopathy are often not time sensitive and do not assess complete hemostatic function. Viscoelastic hemostatic assays (VHAs) including thromboelastography and rotational thromboelastography provide a useful rapid and comprehensive point-of-care alternative for identifying coagulopathy, which is of significant consequence in patients with TBI with intracranial hemorrhage.

Patient complaints in the postoperative period following spine surgery.

Objective: Patient complaints are associated with a number of surgical and medical outcomes. Despite high rates of patient complaints regarding spine surgeons and efforts to study patient complaints across medicine and surgery, few studies have analyzed the complaints of patients undergoing spinal surgery. The authors present a retrospective analysis that, to their knowledge, is the first study to directly investigate the complaints of spine surgery patients in the postoperative period.

Vision Deterioration and Hydrocephalus: Rare Presentations of Vestibular Schwannoma and Evolution of Management.

 The incidence of vestibular schwannoma is reported as 12 to 54 new cases per million per year, increasing over time. These patients usually present with unilateral sensorineural hearing loss, tinnitus, or vertigo. Rarely, these patients present with symptoms of hydrocephalus or vision changes.

Immediate Postoperative Imaging Following Elective Lumbar Fusion Provides Little Clinical Utility.

Study Design: Retrospective review at a single institution of all adult patients who underwent elective lumbar fusion surgery for degenerative spinal disease from 2013 to 2018. Reoperation rates and change in clinical management due to routine imaging findings were the primary outcomes.

Objective: To investigate what effects immediate routine postoperative imaging has on the clinical management of patients following lumbar fusion surgery.

Use of focused intensive care echo in the diagnosis of primary cardiac angiosarcoma.

Focused Intensive Care Echo can aid diagnosis in complex patients where initial investigations are non-diagnostic. FICE is an essential skill for critical care physicians, and bedside echocardiography should be a standard investigation for all critical care patients.

Diagnosis, Management, and Clinical Outcomes of Tandem Thoracic and Lumbar Stenosis: A Systematic Literature Review and Case Series.

Background: A scarcity of data has been reported on tandem thoracic lumbar stenosis, which might be related to either the rarity or underdiagnosis of the condition. We have presented a systematic review of the clinical presentation, diagnosis, and treatment patterns for patients with symptomatic tandem thoracic and lumbar stenosis.

Methods: A PubMed/MEDLINE search was performed to find reports of patients with symptomatic tandem thoracic and lumbar stenosis.

Extensive Pneumorrhachis Associated with Vaping-Induced Lung Injury.

Background: Pneumorrhachis refers to air within the spinal canal and is most commonly associated with traumatic spinal injuries or spine surgery. A link between pneumorrhachis and certain pulmonary diseases, such as asthma, has also been demonstrated in the literature; however, there are no previous reports of pneumorrhachis secondary to vaping-induced lung injury.

Case Description: A 15-year-old boy with vaping-induced lung injury experienced acute respiratory decompensation after straining.

Response properties of single neurons in higher level auditory cortex of adult songbirds.

The caudomedial nidopallium (NCM) is a higher level region of auditory cortex in songbirds that has been implicated in encoding learned vocalizations and mediating perception of complex sounds. We made cell-attached recordings in awake adult male zebra finches ( Taeniopygia guttata) to characterize responses of single NCM neurons to playback of tones and songs. Neurons fell into two broad classes: narrow fast-spiking cells and broad sparsely firing cells.

Preparation of size tunable giant vesicles from cross-linked dextran(ethylene glycol) hydrogels.

We present a novel chemically cross-linked dextran-poly(ethylene glycol) hydrogel substrate for the preparation of dense vesicle suspensions under physiological ionic strength conditions. These vesicles can be easily diluted for individual study. Modulating the degree of cross-linking within the hydrogel network results in tuning of the vesicle size distribution.

Is methylene blue of benefit in treating adult patients who develop catecholamine-resistant vasoplegic syndrome during cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether methylene blue (MB) is of benefit in treating adult patients who develop catecholamine-resistant vasoplegic syndrome (VPS) during cardiac surgery. Altogether 47 papers were found in Medline and 107 in Embase using the reported search.

Does use of aprotinin decrease the incidence of stroke and neurological complications in adult patients undergoing cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether aprotinin use was associated with a lower incidence of stroke and neurological complications in adult patients undergoing cardiac surgery. Using the reported search 224 papers were identified on Medline, 722 on Embase and 12 by hand-searching reference lists.

Does use of the Hepcon point-of-care coagulation monitor to optimise heparin and protamine dosage for cardiopulmonary bypass decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether use of the Hepcon point-of-care coagulation monitor (Medtronic, Minneapolis, MN) to optimise and monitor heparin and protamine dosage for cardiopulmonary bypass could decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery. Altogether 680 papers were identified on Medline, and 879 on Embase using the reported search strategy.

In patients undergoing cardiac surgery, thoracic epidural analgesia combined with general anaesthesia results in faster recovery and fewer complications but does not affect length of hospital stay.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of thoracic epidural anaesthesia (TEA) in combination with general anaesthesia during adult cardiac surgery resulted in a faster recovery, fewer complications and shorter length of hospital stay. Altogether 313 papers were identified on Medline and 368 on Embase using the reported search of which 15 represented the best evidence on the topic.

Does perioperative thyroxine have a role during adult cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of prophylactic perioperative thyroxine therapy during cardiopulmonary bypass in the euthyroid adult patient undergoing routine cardiac surgery can result in an improved cardiac output leading to better clinical outcomes. Altogether 86 papers were identified on Medline and 113 on Embase using the reported search.

Can the use of thromboelastography predict and decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether use of thromboelastography could predict and decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery. Altogether 170 papers were identified using the reported search strategy of which 14 represented the best evidence on the topic.

Is the Allen's test adequate to safely confirm that a radial artery may be harvested for coronary arterial bypass grafting?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the Allen's test, plethysmography, Doppler ultrasound or MRI imaging was the best method of assessing the presence of adequate collateral blood flow in the arm preoperatively prior to radial artery harvest for conduits during CABG surgery. Altogether 176 papers were identified using the reported search of which 15 represented the best evidence on the topic.

Bi-atrial pacing significantly reduces the incidence of atrial fibrillation post cardiac surgery.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether either right atrial or bi-atrial pacing effectively reduces the incidence of Atrial fibrillation post cardiac surgery. Altogether 458 papers were found using the reported search, of which 16 represented the best evidence on this topic.

What is the optimal level of anticoagulation in adult patients receiving warfarin following implantation of a mechanical prosthetic mitral valve?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was what is the optimal target INR for warfarin therapy in patients who have undergone implantation of a prosthetic mechanical mitral heart valves? Altogether 894 papers were identified on Medline and 1235 on Embase using the reported search including all major international guidelines. Twelve papers and publications represented the best evidence on the topic.