The timing and value of early postoperative computed tomography after head surgery in traumatic brain injury patients.

OBJECTIVE: To analyze the timing of the early postoperative computed tomography (CT) in traumatic brain injury (TBI) patients, and compare CT and neurological examination (NE) findings. METHODS: Retrospective analysis included 353 TBI patients admitted to two level 1 trauma centers (2016-2020) who underwent head surgery and postoperative CT within 24 h. Analyzed variables: age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), Abbreviated Injury Scale head (AISh), comorbidities, CT and NE findings and timing, head surgery type, and mortality. RESULTS: Patients mean age was 61.9 years, ISS 25.1, GCS 11.0, AISh 4.7. Postoperatively, mean time to first positive CT was 6.1 h and to first positive NE was 13.2 h. Positive CT alone was more accurate in identifying need for 2nd head surgery than positive NE alone (21.8 % vs 6.0 %, p = 0.04). There was no difference between patients with CT done earlier than 6 h compared to patients with CT done after 6 h in mortality (26.1 % vs 22.0 %, p = 0.4) or 2nd surgery rate (12.2 % vs 12.2 %, p = 1.0). Reversal of postoperative CT findings occurred in 1/6 of patients and was more common when CT was done earlier than 6 h compared to CT done later (25.7 % vs 0.8 %, p < 0.001). Early CT within 1 h rarely leads to the change of management but often is followed by another CT within 12 h. CONCLUSION: In TBI patients postoperative CT was more effective than NE in predicting a need for 2nd head surgery. Postoperative head CT at 6 h is recommended to allow timely detection of intracranial deterioration, reduce the number of CTs and reversal findings as it does not increase 2nd surgery rates and mortality.

Acute cardiac tamponade secondary to nonpenetrating injury from gunshot with beanbag round: A case report and literature review.

Over the past twenty years, "less-lethal" munitions have caused a variety of significant, life-threatening injuries. However, evidence of blunt cardiac injury due to these weapons is sparse. A healthy 44-year old man presented with hemodynamic instability due to cardiac tamponade after he was shot with a beanbag, ultimately requiring operative intervention. This case report describes a unique clinical presentation of blunt cardiac injury and the diagnostic and therapeutic steps that the trauma surgery team took to appropriately manage this rare injury.

Comorbid psychosocial issues seen in pediatric otolaryngology clinics.

Common disorders seen in frequently have related comorbid psychosocial issues and conditions. This article reviews the literature on these comorbidities in commonly seen otolaryngology conditions and heightens awareness of the cognitive, developmental, behavioral, emotional, and social correlates of these commonly treated conditions. Evidence-based practice would suggest identification and appropriate referrals would be helpful; therefore, a time-efficient and accurate screening mechanism is needed within the context of a busy clinical practice. A screening algorithm for identifying these issues and providing appropriate referrals is provided.

Activation of POMC neurons during general arousal but not sexual behavior in male rats.

Exogenous opioids influence male rat sexual behavior, suggesting that endogenous opioid peptides are released during mating. Supporting this hypothesis, the authors recently showed that mating induced activation of mu opioid receptors. However, it is unknown which ligand(s) is acting on these receptors during mating. The current set of experiments tested the hypothesis that beta-endorphin-producing neurons, that is, proopiomelanocortin (POMC) neurons, are activated during sexual behavior. Mating-induced activation of POMC neurons was investigated during either the dark phase or the light phase, following different components of male rat sexual behavior or following control manipulations that resulted in general arousal. Results show activation of POMC neurons in the mediobasal hypothalamus following general arousal but not specifically related to sexual behavior per se. In addition, mating did not activate the subpopulation of POMC neurons that project to the medial preoptic nucleus. These results suggest that it is unlikely that POMC neurons contribute to the action of endogenous opioids in the brain area during sexual behavior but instead may contribute to the change in arousal state essential for the expression of sexual behavior.

Mating activates NMDA receptors in the medial preoptic area of male rats.

Studies have emphasized the role of the medial preoptic area (MPOA) as an important site for the regulation of male sexual behavior. Indeed, ablations of the MPOA impair sexual behavior, whereas stimulation of the MPOA enhances behavior. Furthermore, neural activity in the MPOA increases with mating. The current study tested the hypothesis that activation of N-methyl-D-aspartate (NMDA) receptors occurs in MPOA neurons and is essential for the expression of male sexual behavior in rats. Results indicate that nearly all MPOA neurons that expressed Fos following mating also contained the NR1 subunit of NMDA receptors. Furthermore, mating increased phosphorylation, thus activation, of NR1 in the MPOA. Additionally, blocking NMDA receptors significantly decreased mating-induced Fos expression and mating-induced phosphorylation of NMDA receptors and impaired male sexual behavior. These results provide evidence that mating activates NMDA receptors in the MPOA and that this activation is important for the expression of male sexual behavior.

Resection of a benign brachial plexus nerve sheath tumor using intraoperative electrophysiological monitoring.

OBJECTIVE: Benign peripheral nerve sheath tumors arising from the brachial plexus are rare. Neurosurgeons often lack the clinical and surgical experience to optimize the management of these uncommon tumors. We filmed a video depicting the surgical resection of a benign peripheral nerve sheath tumor involving the brachial plexus. METHODS: An illustrative case was used to demonstrate the proper management of a brachial plexus nerve sheath tumor including the important role of intraoperative electrophysiological neuromonitoring during tumor resection. RESULTS: Using an illustrative case, we describe a systematic approach in the evaluation and surgical management of patients with a brachial plexus nerve sheath tumor. The importance of taking a thorough clinical history, performing a thorough physical examination, applying high-resolution magnetic resonance imaging techniques to visualize the pathology, and using intraoperative electrophysiological neuromonitoring during surgical exposure and resection of the tumor are stressed. Combined with appropriate postoperative treatment, these techniques minimize the risks and increase the likelihood of achieving a good clinical outcome. CONCLUSION: Brachial plexus nerve sheath tumors are challenging mass lesions that should be evaluated and surgically resected by an experienced team of physicians to optimize clinical outcome.