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y associated with a septic patient state or progression of disease, our data may call for an earlier and more aggressive treatment. Nevertheless, prospective clinical trials will be mandatory to better understand the pathogenesis and course of spinal infection, and to develop high quality, evidence-based treatment recommendations.

The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective.

A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management.

Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined future clinical trials.

The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.The cerebellum communicates with the cerebral cortex via the superior, middle, and inferior cerebellar peduncles (CPs). To preserve the structure and function of the brainstem and cerebellum, which is compressed in various pathological conditions, it is important to delineate the spatial interrelationship of the CPs for presurgical planning and intraoperative guidance. Diffusion tensor tractography (DTT) is a technique capable of depicting the major fiber bundles in CPs. However, routine use of this technology for brainstem visualization remains challenging due to the anatomical smallness and complexity of the brainstem and susceptibility-induced image distortions. Here, we attempt to visualize CPs using high-resolution DTT in a commercial equipment for the application of this technique in normal clinical settings. DTT and fast imaging employing steady-state acquisition-cycled phases (FIESTA) of the whole brainstem were performed. We rendered the DTT fiber bundle using a region-of-interest-based fiber tracking method onto the structural image generated in FIESTA by automatic image coregistration. Selleck CC-90011 Fibers of the CPs were clearly visualized by DTT. The DTT-FIESTA overlaid image revealed the cross-sectional and three-dimensional anatomy of the pyramidal tract and the ascending sensory fibers, in addition to the CPs. This could indicate a geometrical relationship of these fibers in the brainstem. The CPs could be visualized clearly using DTT within clinically acceptable scanning times. This method of visualizing the exact pathway of fiber bundles and cranial nerves in the skull base helps in the planning of surgical approaches.

Coronavirus disease 2019 (COVID-19) primarily affects adults, with a lower incidence in children.

To report our experience with critically ill children with COVID-19.

We reviewed the medical records of children with COVID-19 who were admitted Feb. 25 to May 1, 2020. We reviewed patient demographics, symptoms, comorbidities, requirement for respiratory support, evidence of acute myocardial injury, and chest radiographs.

The study included 19 children and adolescents (ages 2months to 18years, median 8years; 10 males, 9 females; 18 COVID-19-positive, 1 COVID-19-negative with positive exposure). Presenting symptoms included fever (89%), cough (68%), respiratory distress (68%) and vomiting/diarrhea (47%). Comorbidities were present in 12 (63%). Fourteen required intensive care; eight required intubation. Two children died. Five patients developed acute myocarditis (median age 7years); in all five, chest radiographs were notable for cardiomegaly and pulmonary congestion or interstitial edema. Of these five,n of lung opacities.

Myocarditis without pulmonary disease occurred in children in their first decade as a component of MIS-C, a newly described syndrome of multisystemic inflammation requiring further investigation. Pulmonary disease dominated the radiographic features of COVID-19-positive adolescents in their second decade in whom radiographs demonstrated predominantly perihilar and basilar distribution of lung opacities.

Infra-acetabular screws enhance the fixation strength in acetabular fractures with separation of both columns. Placement without iatrogenic femoral head violation is challenging.

To assess the impact of the acetabular configuration, the patients' age and gender on safe infra-acetabulum screw insertion.

In 112 patients (69 females; mean age 34years, range 17-88; n = 200 hips), the lateral center-edge angle (LCE) was measured on radiographs. Using corresponding axial CT scans the residual distance from (the lateral border) of the screw to (the medial border of) the femoral head ("Screw-to-Femoral Head distance"; "RD_SFH") was determined. Statistical analysis was carried out using linear regression, multiple linear regression and normal distribution estimation.

The mean (range) LCE angle was 30° (7°-51°) and the mean (range) "RD_SFH" was 5mm (1-14mm). The linear regression model shows a significant linear relation between LCE and "RD_SFH" with a slope parameter of - 0.15 (p value < 0.0001), the Pearsostill of utmost importance.

Mass-casualty incidents are always a particular challenge not only for healthcare providers and other emergency service responders at the scene but also for receiving hospitals. Terrorism-related mass-casualty incidents can result in a wide variety of different scenarios so that hospitals and their personnel must prepare for far more complex and demanding requirements.

In this article, we describe and discuss in-hospital aspects of mass-casualty terrorist incidents and focus on the special medical and in particular surgical care that is required in this setting.

The overview presented here is based on the Terror and Disaster Surgical Care (TDSC

) course. The TDSC

course was mainly developed from a comprehensive and structured analysis of the literature, single expert opinions, and expert consensus conferences. The objective of this course is to train clinical decision-makers in how to manage major incidents.

The management of a mass-casualty terrorist incident and the care of victims present multiple and unique challenges to hospitals.