Hyperperfusion and intracranial hemorrhage after burr hole surgery of chronic subdural hematoma

Background: Chronic subdural hematomas (CSDHs) mainly occur in elderly people and usually develop after minor head injuries. CSDH can be cured by a relatively simple burr hole surgery. Rarely reported, hemorrhagic postsurgical complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Case Description: We report the case study of an 89-year-old man with CSDH who presented with the right hemiparesis. He underwent burr hole surgery with a closed-drainage system. A computed tomography (CT) scan conducted the following day demonstrated an acute intraventricular hemorrhage and hyperperfusion of the ipsilateral hemisphere. Conclusion: This is a rare case of an acute hematoma in the ventricle following drainage of a CSDH. The likely mechanism of this intraventricular hemorrhage could be that the drainage of the hematoma produced a movement of the ventricle and hemisphere accompanied by hyperperfusion.

Clinical Presentation and Surgical Outcomes of Chronic Subdural Hematoma

Objective: The aim of this study was to access clinical presentation of chronic subdural hematoma and to evaluate the surgical outcome of evacuation of chronic subdural hematoma after single burrhole craniotomy with a close drainage system under local anesthesia. Material & Methods: A descriptive study conducted in the Neurosurgery Department of Khairpur Medical College Sindh. 30 patients of chronic subdural hematoma were included. Patients prepared for evacuation of chronic subdural hematoma through single burr hole followed by closed drainage system for two days. Results: The most common feature was gait disturbance followed by Hemiparesis and headache. Coexisting diseases were hypertension, Diabetes mellitus and Chronic Liver Disease, etc. and causes of CSDH were head injury (trivial trauma) and anticoagulant. Surgical decisions were taken on the bases of clinical presentation and radiological findings of patients. Surgical procedure single burrhole craniotomy followed by irrigation with normal saline and close drainage system for two days. On post-operative follow-up, a recurrence of CSDH occurred in two patients. Conclusion: Single burrhole craniotomy with close drainage system is a simple and safe procedure under local anesthesia for treatment of chronic subdural hematoma. Keywords: CSDH (chronic subdural hematoma), GCS (Glasgow coma score), Burrhole craniotomy, Neurosurgery & Subdural drain.

DRESSINGS INDICATED IN THE TREATMENT OF MEDIASTINITIS AFTER CARDIAC SURGERY: INTEGRATIVE REVIEW

ABSTRACT Objective: identify and describe which dressings are recommended in the treatment of mediastinitis after cardiac surgery in adult patients. Method: integrative review held in the databases MEDLINE/PubMed, LILACS, CINAHL, Web of Science, Cochrane, SCOPUS and manual search, between December 2017 and January 2018. It was selected studies on dressings used in the treatment of mediastinitis after cardiac surgery. Results: eight articles were included: three addressed the treatment of negative pressure wounds and reported that most of the patients analyzed were successful in treatment, reducing the need for other interventions; four compared the previous therapy with conventional dressings and concluded that the rates of sternal reinfection and hospital mortality were lower in the first group; and one compared vacuum assisted therapy with a closed drainage system and lower rates of sternal reinfection were seen in the group undergoing vacuum treatment. Conclusion: the evidence indicates that the use of vacuum therapy to treat mediastinitis after cardiac surgery was effective. However, despite the positive outcome, clinical trials with strict methodological description and significant samples are suggested to minimize the risk of bias and to evaluate the impact of dressings in the treatment of mediastinitis.

PRACTICAL ASPECTS ABOUT CLOSED CHEST DRAINAGE CARE: A LITERATURE REVIEW

Context: The drained pleural contents may vary, as well as their drainage, however closed drainage system is the most frequent one and reaches flaws along those who are in charge of their management. Objetive: Provide a comprehensive review about close chest drainage. Methods: A systematic search of the PubMed and Medline databases was conducted on closed drainage system using the following keyword combination: chest tubes AND drainage. Results: From eight hundred eight-three articles retrieved after our preliminary search, 17 articles were chosen for final analysis. Representative schemes were drawn to better understanding of the three types of chest drainage systems for pleura effusion: (i) the closed drainage system; (ii) the open drainage system; and (iii) the suction drainage system. Representative pictures were also developed in order to facilitate additional care in the field. Conclusions: Bringing information together about chest tube management in closed drainage system may imply in a better approach to the patients, minimize institutional cost, minimize material waste and promote efficient communication among the multidisciplinary staff. Understanding details about tubular tube, pig tail tube, one-way bag, one-way valve and collectors is the only way to perform a better approach to the patient who needs closed drainage system.

PRACTICAL ASPECTS ABOUT TRACHEOSTOMY CANNULA: A SYSTEMATIC REVIEW

Context: Since the first sterling tracheostomy cannula was developed, in the late 1800's, and some modernization has occurred, there have been several reports on flaws surrounding their care. Objetive: Provide a comprehensive review about tracheostomy cannulas. Methods: A systematic search of the PubMed and Medline databases was conducted on closed drainage system using the following keyword combination: tracheostomy AND cannula. Results: From eight hundred eight-three articles retrieved after our preliminary search, 17 articles were chosen for final analysis. Representative schemes were drawn to better understanding of the three distinguished materials types and ten different components (faceplate, cannula, radiopaque line in the cannula, inner cannula, universal hub 15mm, pressure line, pilot balloon, cuff, subglottic aspiration system, obturator), as well as their concerns. Conclusions: Knowing and understanding tracheostomy cannulas. particularities may imply in a better approach to the patients, and in minimizing institutional costs.

Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008-2012

ABSTRACT Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3%) were males and 31 (22.7%) females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%). The head trauma has been responsible for CSDH in 88 patients (64.3%), while the main symptom was headache (92 patients or 67.1%). One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%). The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety.

Lock-Out Valve to Decrease Catheter-Associated Urinary Tract Infections

Patients with long-term indwelling urinary catheters are at an increased risk for urinary tract infection due to bacteriuria. Catheter-associated urinary tract infections (CAUTIs) are a significant source of morbidity and mortality in long-term care facilities as well as in ambulatory patients requiring long-term catheterization. There is increased interest in the financial impact of CAUTI as Medicare no longer provides reimbursement for nosocomial CAUTIs. Ascending bacteria may in part enter the closed drainage system when the patient switches between leg and night collection bags. In an attempt to reduce this ascent, a double valve lock-out system was devised that maintains a closed system during bag exchange. The concept is introduced and CAUTIs are reviewed.