Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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For neurosurgeons, who are accustomed to the binocular microscope, there is a new learning curve that must be overcome for monocular endoscopic pituitary surgery. Different studies describe a learning curve between 15 and 200 procedures, after which both operative time and complications stabilize. In this retrospective study, we evaluate the endoscopic learning curve of our group, already trained in microsurgical transsphenoidal surgery, with the assistance of ear, nose, and throat (ENT) surgeons. ⋯ Over time, blood transfusions discrepantly increased from the E group to the L group (11% vs. 31%). Because of the pivotal role of ENT in the transnasal stage of 50 endoscopic procedures, we obtained an operative time comparable to that of microscopic procedures, with similar complication rate and gross total resections. Neurosurgical-ENT combined follow-up proved to be a fundamental protection from late complications.
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Early hospital readmission has become a proxy for quality of care and contributes significantly to high health care costs in the United States, with more than $20 billion health care dollars are spent on 30-day readmission annually. Cranial neurosurgical procedures (i.e., craniotomy, craniectomy) are associated with high readmission rates; however, studies examining readmission after cranial procedures are limited and relatively unknown. The aim of this study is to identify the drivers of 30-day unplanned readmission in consecutive patients undergoing craniotomies and craniectomies. ⋯ The majority of patients presented to the emergency department from home (80%), while 10% were readmitted from a skilled nursing facility and 10% were readmitted from an acute rehabilitation institution. The most common presented symptoms for readmitted patients were fever/presumed infection (40%) and altered mental status (40%), followed by new sensory/motor deficits (30%). This study suggests that infection, altered mental status, and new sensory/motor deficits were the primary complications leading to unplanned 30-day readmission after cranial neurosurgery.
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Geriatric depression is a major public health problem and has an especially large effect on health when comorbid with a chronic medical condition. Hypertension, coronary heart disease, and diabetes are accompanied by a high incidence of depression and can affect the treatment and prognosis. Depression is a highly prevalent risk factor for incident of and is associated with morbidity and mortality of cardiovascular disease. ⋯ Current evidence on antidepressive therapy in patients with coronary diseases is limited. A better understanding of pathophysiological mechanisms underpinning depression and cardiovascular disease as well as the complex biological crosstalk of cardiovascular disease complicated with depression is particularly important for future therapeutic strategies. The following review is on current understanding of geriatric depression and cardiovascular disease.