Odynophagia as the first symptom of monkeypox infection.

A 50-year-old patient with confirmed monkeypox infection presented with odynophagia and nocturnal dyspnea. Clinically, there was a lesion on the tongue without any skin lesions and fibrinous plaques on the right tonsil with asymmetry of the palatoglossal arch. Due to a suggested abscess in the CT scan, a tonsillectomy à chaud was performed. By pan-orthopox-specific polymerase chain reaction (PCR) the monkeypox infection was also confirmed in the tonsil tissue. Isolated oral findings may represent a monkeypox infection and should be considered as a currently important differential diagnosis, especially for patients at risks.

Preference matters: New aspects on how foreign bodies should and could be removed from a child's airway.

BACKGROUND: Foreign body aspiration in children is a potentially life-threatening event that can be diagnosed and treated by airway endoscopy. We aimed to analyze the influence of the examiner's experience and preference on the choice of the technique and the resulting complication rate. METHODS: In this international study, experts in the field documented their preferred and applied technique as well as the outcome of each case of foreign body removal. Personal data of the bronchoscopists and their medical center were collected via an online questionnaire separately from the case specifics. RESULTS: A total of 399 foreign body removals were performed by 64 examiners. A total of 279 removals were performed using rigid endoscopy, and 120 procedures were performed by flexible. When a difficulty was expected, flexible endoscopy was used significantly more often (χ2 (1) = 11.06, p < 0.001). Complications occurred significantly less often when the bronchoscopist used their preferred technique (χ2 (1) = 6.41, p = 0.011), had more than 5 years of experience (χ2 (1) = 5.13, p = 0.023) or performed more than 100 removals (χ2 (2) = 11.51, p = 0.003). In medical centers, complication rates significantly decreased if more than 200 bronchoscopies were performed in children, compared to the centers that perform 50-200 bronchoscopies per year (χ2 (1) = 24.56, p < 0.001). CONCLUSION: Preference and experience of a bronchoscopist and his/her medical center with flexible or rigid foreign body removal distinctively affect the outcome of the procedure and cannot be neglected in the discourse on the appropriate technique. This link also emphasizes the importance of a structured training program.

[Odynophagia as the first symptom of monkeypox infection]. / Odynophagie als erstes Symptom bei Affenpocken-Infektion.

A 50-year-old patient with confirmed monkeypox infection presented with odynophagia and nocturnal dyspnea. Clinically, there was a lesion on the tongue without any skin lesions and fibrinous plaques on the right tonsil with asymmetry of the palatoglossal arch. Due to a suggested abscess in the CT scan, a tonsillectomy à chaud was performed. By pan-orthopox-specific polymerase chain reaction (PCR) the monkeypox infection was also confirmed in the tonsil tissue. Isolated oral findings may represent a monkeypox infection and should be considered as a currently important differential diagnosis, especially for patients at risks.

High-dose preoperative glucocorticoid for prevention of emergence and postoperative delirium in liver resection: A double-blinded randomized clinical trial substudy.

BACKGROUND: Emergence delirium (ED) and postoperative delirium (POD) are associated with increased morbidity and mortality and occur in up to one-third of patients undergoing major non-cardiac surgery, where the underlying pathogenesis is multifactorial, including increased inflammation. We aimed to assess the effect of pre-operative high- versus low-dose glucocorticoid on the occurrence of ED and POD. METHODS: This was a substudy from a randomized, double-blinded clinical trial. Patients ≥18 years, undergoing open liver resection were randomized 1:1 to high-dose (HD, 10 mg/kg methylprednisolone) or low-dose (LD, 8 mg dexamethasone) glucocorticoid and assessed for ED and POD for a maximum of 4 days during hospitalization. The 3-min Diagnostic Interview for CAM-defined delirium (3D-CAM) was used for assessment, 15 and 90 min after arrival in the post-anesthesia care unit (PACU), and subsequently once daily in the ward. RESULTS: Fifty-three patients were included in this secondary substudy (26 HD-group and 27 LD-group). ED occurred in n = 5 HD versus n = 6 LD patients 15 min after PACU arrival. At 90 min after PACU arrival, 4 patients had ED, all from LD-group, and resulted in significantly longer PACU admission, 273 versus 178 min in ED versus Non-ED patients. During the first 4 days in the ward, n = 5 patients had at least one occurrence of POD, all from LD-group. CONCLUSIONS: The primary finding of the current substudy was a lower occurrence of ED/POD in the PACU 90 min after arrival and during the first four postoperative days in patients receiving high-dose glucocorticoid compared with patients receiving low-dose glucocorticoid. The two study groups were not evenly balanced concerning known explanatory factors, i.e., age and size of surgery, which calls for larger studies to elucidate the matter.

New software for three-dimensional visualization and calculation of volume of living cells.

We investigated the physical properties of head and neck cancer cells to develop new cell-selective treatment strategies for squamous cell carcinoma. For better characterization and subsequent differentiation of cancerous and healthy cells, we developed MATLAB-based software to analyze image stacks obtained using a confocal laser-scanning microscope. A confocal laser-scanning microscope was used for three-dimensional (3-D) imaging of a cell line from the head and neck area. The volume of cell organelles of interest was calculated using our newly developed software. Our software enables 3-D visualization and volume calculation as well as data analysis associated with cell morphology. Using filter and semi-automatic segmentation algorithms, our software recognizes individual cell organelles in each slice of an image stack. It matches the corresponding cell cross section areas to produce a 3-D image and to determine the volume of the imaged organelles. We calculated the volume of the nucleus, actin filaments and microtubules in relation to total cell volume. Our software enables 3-D visualization and calculation of organelle volume, which improves cell characterization and comparison of healthy and cancerous cell lines. Differences between cell lines can be observed in detail and used to develop new cancer treatment strategies.

Laryngeal sensation and its association with aspiration and cough in children with neurological impairment.

BACKGROUND: Aspirations are frequent in children with neurological impairment. They significantly increase the risk for acute and chronic respiratory insufficiencies leading to high morbidity and mortality. Laryngeal sensation deficits have been linked to aspirations in adults and are a suspected cause for dysphagia in children. In a similar neurological circuit as swallowing, laryngeal receptors trigger coughing as a protective airway reflex. The aim of this study was to examine the association between impaired laryngeal sensation (ILS), aspiration, and coughing in neurologically impaired children. DESIGN AND METHODS: In a retrospective study, 110 children with suspected dysphagia underwent a clinical evaluation of swallowing and a flexible endoscopic evaluation of swallowing (FEES) between 2013 and 2019 in the children's university clinic Düsseldorf were analyzed. Laryngeal sensation was tested by the endoscopic touch method. Associations were computed using χ2 -test. RESULTS: Fifty-four patients (49.1%) had a neurological impairment, 56 patients (50.9%) had no or other comorbidities and served as a control cohort. Children with neurological impairment suffered from ILS significantly more often than children with no or other comorbidities (χ²(1) = 4.63, p = .031). ILS was associated with all other FEES variables but did not correlate with coughing. The symptom coughing correlated with aspiration in the group of neurologically impaired children and in children ILS. CONCLUSION: ILS is a potential cause of aspirations in children with neurological impairment. Physicians need to pay special attention to the occurrence of coughing in children with neurological impairment and/or ILS since it signals aspirations that took place.

Retrospective in silico evaluation of optimized preoperative planning for temporal bone surgery.

PURPOSE: Robot-assisted surgery at the temporal bone utilizing a flexible drilling unit would allow safer access to clinical targets such as the cochlea or the internal auditory canal by navigating along nonlinear trajectories. One key sub-step for clinical realization of such a procedure is automated preoperative surgical planning that incorporates both segmentation of risk structures and optimized trajectory planning. METHODS: We automatically segment risk structures using 3D U-Nets with probabilistic active shape models. For nonlinear trajectory planning, we adapt bidirectional rapidly exploring random trees on Bézier Splines followed by sequential convex optimization. Functional evaluation, assessing segmentation quality based on the subsequent trajectory planning step, shows the suitability of our novel segmentation approach for this two-step preoperative pipeline. RESULTS: Based on 24 data sets of the temporal bone, we perform a functional evaluation of preoperative surgical planning. Our experiments show that the automated segmentation provides safe and coherent surface models that can be used in collision detection during motion planning. The source code of the algorithms will be made publicly available. CONCLUSION: Optimized trajectory planning based on shape regularized segmentation leads to safe access canals for temporal bone surgery. Functional evaluation shows the promising results for both 3D U-Net and Bézier Spline trajectories.

i3PosNet: instrument pose estimation from X-ray in temporal bone surgery.

PURPOSE: Accurate estimation of the position and orientation (pose) of surgical instruments is crucial for delicate minimally invasive temporal bone surgery. Current techniques lack in accuracy and/or line-of-sight constraints (conventional tracking systems) or expose the patient to prohibitive ionizing radiation (intra-operative CT). A possible solution is to capture the instrument with a c-arm at irregular intervals and recover the pose from the image. METHODS: i3PosNet infers the position and orientation of instruments from images using a pose estimation network. Said framework considers localized patches and outputs pseudo-landmarks. The pose is reconstructed from pseudo-landmarks by geometric considerations. RESULTS: We show i3PosNet reaches errors [Formula: see text] mm. It outperforms conventional image registration-based approaches reducing average and maximum errors by at least two thirds. i3PosNet trained on synthetic images generalizes to real X-rays without any further adaptation. CONCLUSION: The translation of deep learning-based methods to surgical applications is difficult, because large representative datasets for training and testing are not available. This work empirically shows sub-millimeter pose estimation trained solely based on synthetic training data.

Dexamethasone Dose and Early Postoperative Recovery after Mastectomy: A Double-blind, Randomized Trial.

BACKGROUND: Pain and nausea are the most common challenges in postoperative recovery after mastectomy. Preventive measures include multimodal analgesia with preoperative glucocorticoid. The aim of this study was to investigate whether 24 mg of preoperative dexamethasone was superior to 8 mg on early recovery after mastectomy in addition to a simple analgesic protocol. METHODS: In a randomized, double-blind trial, patients 18 yr of age or older having mastectomy were randomized 1:1 to 24 mg or 8 mg dexamethasone, and all received a standardized anesthetic and surgical protocol with preoperative acetaminophen, total intravenous anesthesia, and local anesthetic wound infiltration. The primary endpoint was number of patients transferred to the postanesthesia care unit according to standardized discharge criteria (modified Aldrete score). Secondary endpoints included pain and nausea at extubation, transfer from the operating room and upon arrival at the ward, length of stay, seroma occurrence, and wound infections. RESULTS: One hundred thirty patients (65 in each group) were included and analyzed for the primary outcome. Twenty-three (35%) in each group met the primary outcome, without significant differences in standardized discharge scores (odds ratio, 1.00 [95% CI, 0.49 to 2.05], P > 0.999). More patients had seroma requiring drainage in the 24 mg versus 8 mg group, 94% versus 81%, respectively (odds ratio, 3.53 [95% CI, 1.07 to 11.6], P = 0.030). Median pain scores were low at all measured time points, numeric rating scale less than or equal to 2 versus less than or equal to 1 in the 24 mg versus 8 mg group, respectively. Six patients in each group (9%) experienced nausea at any time during hospital stay (P > 0.999). Length of stay was median 11 and 9.2 h in the 24 and 8 mg group, respectively (P = 0.217). CONCLUSIONS: The authors found no evidence of 24 mg versus 8 mg of dexamethasone affecting the primary outcome regarding immediate recovery after mastectomy. The authors observed a short length of stay and low pain scores despite a simple analgesic protocol.

Patient quality of life after vestibular schwannoma removal: possibilities and limits to measuring different domains of patients' wellbeing.

PURPOSE: Since the 1980s, health-related quality of life (HRQOL) has been recognized in the assessment of medical treatment. To determine the health-related quality of life (HRQOL) of vestibular schwannoma (VS) patients, a specific questionnaire that has been validated in different languages is essential. METHODS: The Short Form-36 Health Survey (SF-36) and PANQOL questionnaires in German were evaluated in patients after removal of a VS via the translabyrinthine approach. Descriptive statistics of a comparison of the SF-36 results to those of a normal sample are illustrated. Criterion validity was investigated using Spearman's rank test to correlate the PANQOL domains with the SF-36 domains. A confirmatory factor analysis of the PANQOL was performed to determine the stability of the factor structure of the PANQOL questionnaire for our cohort. RESULTS: The criterion validity of the German PANQOL questionnaire is comparable to that of the original English version. The SF-36 domains values ranged from 49.31/100 (role physical) to 66.46/100 (physical functioning). Compared to the normal population, patients who underwent surgical removal of a VS showed a significantly reduced quality of life, mainly in domains such as physical and social functioning, as well as psychological wellbeing. CONCLUSION: The German PANQOL has been validated and is now available. Post-surgical treatment should be focused not only on physiological rehabilitation but also on improving the quality of life, especially aspects of psychological and social wellbeing.

Automatic Registration for Navigation at the Anterior and Lateral Skull Base.

OBJECTIVE: Navigation systems create a connection between imaging data and intraoperative situs, allowing the surgeon to consistently determine the location of instruments and patient anatomy during the surgical procedure. The best results regarding the target registration error (measurement uncertainty) are normally demonstrated using fiducials. This study aimed at investigating a new registration strategy for an electromagnetic navigation device. METHODS: For evaluation of an electromagnetic navigation system and comparison of registration with screw markers and automatic registration, we are calculating the target registration error in the region of the paranasal sinuses/anterior and lateral skull base with the use of an electromagnetic navigation system and intraoperative digital volume tomography (cone-beam computed tomography). We carried out 10 registrations on a head model (total n = 150 measurements) and 10 registrations on 4 temporal bone specimens (total n = 160 measurements). RESULTS: All in all, the automatic registration was easy to perform. For the models that were used, a significant difference between an automatic registration and the registration on fiducials was evident for just a limited number of screws. Furthermore, the observed differences varied in terms of the preferential registration procedure. CONCLUSION: The automatic registration strategy seems to be an alternative to the established methods in artificial and cadaver models of intraoperative scenarios. Using intraoperative imaging, there is an option to resort to this kind of registration as needed.

High-precision evaluation of electromagnetic tracking.

PURPOSE: Navigation in high-precision minimally invasive surgery (HP-MIS) demands high tracking accuracy in the absence of line of sight (LOS). Currently, no tracking technology can satisfy this requirement. Electromagnetic tracking (EMT) is the best tracking paradigm in the absence of LOS despite limited accuracy and robustness. Novel evaluation protocols are needed to ensure high-precision and robust EMT for navigation in HP-MIS. METHODS: We introduce a novel protocol for EMT measurement evaluation featuring a high-accuracy phantom based on LEGO[Formula: see text], which is calibrated by a coordinate measuring machine to ensure accuracy. Our protocol includes relative sequential positions and an uncertainty estimation of positioning. We show effects on distortion compensation using a learned interpolation model. RESULTS: Our high-precision protocol clarifies properties of errors and uncertainties of EMT for high-precision use cases. For EMT errors reaching clinically relevant 0.2 mm, our design is 5-10 times more accurate than previous protocols with 95% confidence margins of 0.02 mm. This high-precision protocol ensures the performance improvement in compensated EMT by 0.05 mm. CONCLUSION: Our protocol improves the reliability of EMT evaluations because of significantly lower protocol-inherent uncertainties. To reduce patient risk in HP-MIS and to evaluate magnetic field distortion compensation, more high-accuracy protocols such as the one proposed here are required.

Cochlear Implantation in Patients With Single-sided Deafness After the Translabyrinthine Resection of the Vestibular Schwannoma-Presented at the Annual Meeting of ADANO 2016 in Berlin.

OBJECTIVE: To evaluate effectiveness of the cochlear implant (CI) to facilitate single-sided deafness (SSD) rehabilitation following translabyrinthine resection of the vestibular schwannoma. STUDY DESIGN: Retrospective patient review. SETTING: Single center, University hospital. PATIENTS: Patients with SSD who underwent translabyrinthine resection of a vestibular schwannoma with anatomical preservation of the cochlear nerve and subsequent CI on the same ear. INTERVENTIONS: CI at post-translabyrinthine resection of the acoustic neuroma to treat SSD, and evaluation by retrospective individual case review in a period from 2009 to 2016. MAIN OUTCOME MEASURES: Individual patients' clinical outcome and speech understanding. RESULTS: Thirteen patients were provided CI. In all cases, complete removal of the tumor was achieved and the cochlear nerve was preserved; in one case, the CI was implanted simultaneously. In most cases, the follow-up interval was 2 years. In 9 of 13 cases, the implanted ear achieved capability to understand and discriminate monosyllabic words at 65 dB. Level of speech understanding of over 50% at 65 dB was possible in 7 patients at 12 months after the first fitting of CI. CONCLUSIONS: Under certain conditions, CI was an effective solution to restore hearing in patients with SSD following translabyrinthine access to the skull base. Study with prospective design is required to provide more significant results.

Toward an automatic preoperative pipeline for image-guided temporal bone surgery.

PURPOSE: Minimally invasive surgery is often built upon a time-consuming preoperative step consisting of segmentation and trajectory planning. At the temporal bone, a complete automation of these two tasks might lead to faster interventions and more reproducible results, benefiting clinical workflow and patient health. METHODS: We propose an automatic segmentation and trajectory planning pipeline for image-guided interventions at the temporal bone. For segmentation, we use a shape regularized deep learning approach that is capable of automatically detecting even the cluttered tiny structures specific for this anatomy. We then perform trajectory planning for both linear and nonlinear interventions on these automatically segmented risk structures. RESULTS: We evaluate the usability of segmentation algorithms for planning access canals to the cochlea and the internal auditory canal on 24 CT data sets of real patients. Our new approach achieves similar results to the existing semiautomatic method in terms of Dice but provides more accurate organ shapes for the subsequent trajectory planning step. The source code of the algorithms is publicly available. CONCLUSION: Automatic segmentation and trajectory planning for various clinical procedures at the temporal bone are feasible. The proposed automatic pipeline leads to an efficient and unbiased workflow for preoperative planning.

Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model.

PURPOSE: A recent clinical trial has shown the feasibility of robotic cochlear implantation. The electrode was inserted through the robotically drilled tunnel and an additional access through the external auditory canal was created to provide for means of visualization and manipulation. To obviate the need for this additional access, the utilization of multiple robotically drilled tunnels targeting the round window has been proposed. The objective of this study was to assess the feasibility of electrode insertion through a robotic multiport approach. METHODS: In four ex vivo human head specimens (left side), four trajectories through the facial recess (2x) and the retrofacial and suprameatal region were planned and robotically drilled. Optimal three-port configurations were determined for each specimen by analyzing combinations of three of the four trajectories, where the three trajectories were used for the electrode, endoscopic visualization and manipulative assistance. Finally, electrode insertions were conducted through the optimal configurations. RESULTS: The electrodes could successfully be inserted, and the procedure sufficiently visualized through the facial recess drill tunnels in all specimens. Effective manipulative assistance for sealing the round window could be provided through the retrofacial tunnel. CONCLUSIONS: Electrode insertion through a robotic three-port approach is feasible. Drill tunnels through the facial recess for the electrode and endoscope allow for optimized insertion angles and sufficient visualization. Through a retrofacial tunnel effective manipulation for sealing is possible.

Influence of patient-specific anatomy on medical computed tomography and risk evaluation of minimally invasive surgery at the otobasis.

PURPOSE: With the increasing use of new minimally invasive approaches in temporal bone surgery, the need arises for evaluation of the risk of injury to sensitive anatomical structures. The factors that influence the measurement uncertainty (variation in representation of position and shape of anatomical structures) of imaging are of relevance. We investigate the effect of patients' anatomy on the measurement uncertainty of medical CT. METHODS: Six formalin-fixed temporal bones were used, fiducial markers were bone-implanted, and 20 CT scans of each temporal bone were generated. Surgically threatened anatomical structures of importance were defined. Manual segmentation was performed to create 3D surface models, and different Gaussian filters were applied. Analysis points were established along the border of the superior semicircular canal to determine the deviation between the 3D images of the labyrinth. The standard uncertainty was calculated, and one-way analysis of variance was performed (significance level = 5%) to evaluate the effect of certain factors (patient, side, Gaussian filter) on the measurement uncertainty. RESULTS: The influence of patient-specific anatomy on the measurement uncertainty of medical CT (p = 0.049) was demonstrated for the first time. The applied Gaussian filter (p = 0.622) and the patient's side (p = 0.341) showed no significant effect. CONCLUSION: The applied method and the results of the statistical analysis suggest that the patient's individual anatomical conditions affect the measurement uncertainty of medical CT. Thus, the patient's anatomy must be considered as an important influencing factor during risk evaluation concerning minimally invasive and image-guided surgery.

Willingness of medical students to be examined in a physical examination course.

BACKGROUND: Physical examination courses are an essential part of the education of medical students. The aim of this study was to ascertain the factors influencing students' motivation and willingness to participate in a physical examination course. METHODS: Students were asked to complete a questionnaire subdivided into five domains: anthropometric data, religiousness, motivation to take part in physical examination courses, willingness to be physically examined at 11 different body regions by peers or a professional tutor and a field for free text. RESULTS: The questionnaire was completed by 142 medical students. The importance of the examination course was rated 8.7 / 10 points, the score for students' motivation was 7.8 / 10 points. Willingness to be physically examined ranged from 6 to 100% depending on body part and examiner. Female students were significantly less willing to be examined at sensitive body parts (breast, upper body, groin and the hip joint; p = .003 to < .001), depending on group composition and / or examiner. Strictly religious students showed significantly less willingness to undergo examination of any part of the body except the hand (p = .02 to < .001). Considering BMI, willingness to be examined showed comparable rates for normal weight and under- / overweight students in general (80% vs. 77%). Concerning the composition of the group for physical examination skills courses, students preferred self-assembled over mixed gender and same gender groups. CONCLUSIONS: Peer physical examination is a method to improve students' skills. While motivation to participate in and acceptance of the physical examination course appears to be high, willingness to be examined is low for certain parts of the body, e.g. breast and groin, depending on religiousness, gender and examiner. Examination by a professional medical tutor did not lead to higher acceptance. Most students would prefer to choose their team for physical examination courses themselves rather than be assigned to a group.

Quality of Life After Translabyrinthine Vestibular Schwannoma Resection-Reliability of the German PANQOL Questionnaire.

OBJECTIVE: To quantify the postoperative quality of life (QOL) of patients after translabyrinthine surgery for vestibular schwannoma (VS) using the German version of the Penn acoustic neuroma quality-of-life questionnaire (PANQOL) in a university hospital. METHODS: The PANQOL questionnaire was administered to 72 patients who were treated in our department with translabyrinthine surgery for VS between January 2007 and January 2017. Descriptive evaluations of results were performed in addition to analyses of the reliability and convergent validity of the results and a subgroup analysis. RESULTS: For the first time, QOL was measured in German-speaking VS patients after translabyrinthine surgery. Cronbach's alpha for internal consistency and Guttman's split half, used as measures of reliability, showed values between 0.39 and 0.92 (raw alpha) and 0.58 and 0.98 (Lambda 4), respectively. DESCRIPTIVE STATISTICS: The mean total PANQOL score of patients after translabyrinthine VS resection was 61.96. The domain "hearing" had the lowest score (50.87), while "facial dysfunction" had the highest score (74.88). Subgroup analysis showed that neither preoperative tumor size nor elapsed time postoperatively significantly influenced QOL outcomes. CONCLUSIONS: Depending on the different domains the German PANQOL questionnaire showed poor to good internal consistency, reliability, and convergent validity. Moreover, some VS patients suffer from reduced QOL for a long time after the translabyrinthine procedure, thus psycho-oncological care should be recommended in these cases.

Self-evaluated competence in trauma reception.

INTRODUCTION: No formal training requirements exist for trauma teams in Denmark. The aim of this study was to investigate the point prevalence level of training and the self-evaluated competence of doctors involved in trauma care. METHODS: On two nights, all doctors on call at departments involved in trauma care were interviewed and answered a structured questionnaire pertaining to their level of training and self-evaluated level of competence in relevant skills. These skills included the ability to perform diagnostics and interventions as mandated by the Advanced Trauma Life Support and Definitive Surgical Trauma Care curriculums. RESULTS: All contacted doctors replied to the questionnaire. 58% of doctors were specialists; most often anaesthesiologists (AN) (86%) and doctors working at hospitals with a dedicated trauma centre designation (100%). In total, 45% of orthopaedic (OS) and gastrointestinal surgeons (GS) were specialists. In terms of self-evaluated competence, 95% of AN felt competent performing damage control resuscitation, 82% of OS felt competent performing damage control surgery on extremities, whereas 55% of GS felt competent performing damage control surgery in the abdomen. A total of 20% of the respondents had not attended any relevant trauma course, the majority of these were GS. CONCLUSIONS: The results indicate that, at the point of sampling, trauma reception in Denmark was handled by AN specialists in the majority of cases, but by surgical trainees. Self-perceived competencies evaluation revealed preparedness to perform damage control resuscitation, but discrepancies in the ability to perform surgical damage control procedures. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Hearing rehabilitation with the cochlea implant following translabyrinthine CPA tumor removal ?] / Hörrehabilitation durch Cochlea-Implantation nach Vestibularisschwannom-Entfernung?

We present a quality analysis of 10 patients with an individual treatment trial for a simultaneous or consecutive cochlea implantation after translabyrinthine removal of a neurinoma at the cerebellopontine angle. The results show that most of the patients benefit from the cochlea implantation after unilateral deafness. Through a careful surgical preparation technique at the inner ear canal and its surroundings the morphological and functional integrity of the neurovascular structures can be guaranteed.