The Dura Split Technique in the Treatment of Craniosynostosis: Is It Still an Option?

BACKGROUND: The aim of this study was to report the outcome and the complications for patients operated on for craniosynostosis using the dura split technique. Specifically, the authors aimed to evaluate the safety of this technique, which is currently not in use, and to determine whether it is still useable. METHODS: The data was collected from the hospital patient records of all children surgically treated for craniosynostosis using the dura split technique in Turku University Hospital during the period 1975 to 2015. The data was analyzed to determine the clinical and radiological outcomes of the surgical procedure, the need for reoperations, and the rate of complications. RESULTS: During the study period, the dura split technique was used in the surgery of 65 patients. The outcome was either good or acceptable in most patients and reoperation was needed in only 2 patients (3.1%). Surgical complications included significant blood loss (26.2%), lesions on the inner layer of the dura (21.5%), leakage of cerebrospinal fluid (13.8%), and persistent bone defects (15.4% on palpation and 63.1% radiologically). CONCLUSIONS: Although the outcome of surgery for craniosynostosis using the dura split technique was mostly acceptable and the need for reoperations rare, the technique cannot, however, be recommended in the future due to high rates of bone defects, frequent problems with lesions on the inner layer of the dura, and consequent perioperative leakage of cerebrospinal fluid.

From cure to care: assessing the ethical and professional learning needs of medical learners in a care-based facility.

The purpose of this study was to assess the ethical and professional learning needs of medical trainees on clinical placements at a care-based facility, as they shifted from acute care to care-based philosophy. Using qualitative data analysis and grounded theory techniques, 12 medical learners and five clinical supervisors were interviewed. Five themes emerged as learning needs: the holistic approach to care, withdrawal of treatment and withholding investigations, the collaborative team model, violations to patient autonomy, Do Not Resuscitate and advance directives issues. The results illustrate the importance of preparing medical learners for a philosophical shift in their approach to patient care, as they move from the more cure-based approach of acute care to the care model of care-based facilities.

Symmetric deep cerebellar lesions after smoking heroin.

BACKGROUND: Acute symmetric deep cerebellar lesions suggest toxic exposure. OBJECTIVE: To describe a patient with striking neurologic and magnetic resonance image features. DESIGN: Case report. SETTING: Emergency department and office. METHODS: Personal observation. RESULTS: A middle-aged man had a day of unsteadiness, followed by acute and pronounced cerebellar signs. The degree of disability was remarkable. Magnetic resonance imaging showed almost perfectly symmetric deep cerebellar damage that ultimately became cavitated. Serial querying of the patient revealed the use of heroin by inhalation just prior to the emergence of the ataxic syndrome. CONCLUSIONS: An acute and purely ataxic syndrome with symmetric deep cerebellar lesions suggests toxic exposure, in this case, the smoking of heroin.