Search

Background: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology., Objective: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD., Methods: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD., Results: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P = .011), Klippel-Feil (2/10, P = .015), and basilar invagination (3/12, P < .001) were increased within the OCF group, whereas only basilar invagination (1/4, P < .001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P = .008) and OCF/VD (115.0 ± 11.6°, P = .025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups., Conclusion: Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD., (Copyright © 2020 by the Congress of Neurological Surgeons.)

Purpose: The purpose of this study was to determine whether volume-based tube feeding (VBTF) increased nutrient delivery to patients in a rehabilitation unit., Design: A cohort study with a prospective group and a historical control group was used as the study design., Methods: The intervention was VBTF, a change from the standard hourly rate-based enteral nutrition. Data were collected on 70 rehabilitation patients. Data on the control group (n = 35) were collected through retrospective chart review of rate-based tube-fed patients. Data on the VBTF intervention group (n = 35) were collected prospectively after implementation of VBTF in the inpatient medical rehabilitation unit at University of Utah Health., Findings: The results showed patients in the VBTF group received 82% of their prescribed feed whereas rate-based patients received 70%., Clinical Relevance: VBTF appears to increase the amount of nutrition inpatient medical rehabilitation patients receive, which may help with the intensive therapy sessions these patients must undergo.

A 59-year-old man with an inferolateral myocardial infarction and cardiogenic shock was found to have extensive intrathoracic hemorrhage in communication with the left ventricle. His remote pericardiectomy precluded hemopericardium and tamponade, and permitted the establishment of an unusual diagnosis and subsequent closure of the site of myocardial perforation.