Jeremy M. Hernandez

Do Peripheral Thermometers Accurately Correlate to Core Body Temperature

Seventy-five studies (8,682 patients) were included; 42 studies (56%) were conducted with adults, 32 (43%) were conducted with children, and 1 included both groups. Most studies possessed high or unclear risks of patient selection bias (74%). Considerable heterogeneity between studies was encountered, not all of which could be explained by differences in measurement techniques, equipment, temperature thresholds, or other variables. Agreement between peripheral and central thermometers did not vary depending on study quality.

Do Antiviral Medications Improve Symptoms in the Treatment of Bell’s Palsy?

Ten trials were included in the final analysis (N1⁄42,280). There was improvement in the recovery of facial function when combination therapy (antivirals plus corticosteroids) was used compared with corticosteroids alone or no treatment. Moreover, there was a reduction in long-term sequelae of Bell’s palsy, such as motor synkinesis and crocodile tears, when patients were treated with the combination of antivirals and corticosteroids. There was no difference in adverse events between any of the treatment groups (Table).

Self-Inflicted Nailgun-Induced Penetrating Penile Injury: Case Report and Discussion.

Penetrating penile injuries occur mostly in industrial/work accidents, automobile accidents, or as a result of sexual curiosity and attempts at self-expression/mutilation. In this case report, the authors describe an accidental nailgun injury to the penis of a 46-year-old man. We discuss the management of such injuries in the emergency department, including the utility of a dorsal penile block for regional anesthesia. Although exceptionally rare, familiarity with penetrating lower urinary tract injuries may reduce their long-term repercussions on genitourinary and sexual health.

Do Systemic Corticosteroids Improve Outcomes in Chronic Obstructive Pulmonary Disease Exacerbations

Sixteen studies with 1,787 participants comparing corticosteroid with placebo (mostly inpatients) and 4 studies with 298 inpatients comparing parenteral corticosteroid and oral corticosteroid were included. The mean age of study participants was 68 years. The median proportion of men was 82% and the mean forced expiratory volume at 1 second percentage predicted at study onset was 40% (n1⁄4633). Corticosteroid reduced the likelihood of treatment failure by more than 50% compared with placebo (odds ratio [OR] 0.48; 95% confidence interval [CI] 0.35 to 0.67; n1⁄4917). The likelihood of relapse at 1 month was also reduced with corticosteroid treatment (n1⁄4415; hazard ratio 0.78; 95% CI 0.63 to 0.97). However, there was no difference in mortality at 30 days with corticosteroid compared with placebo (n1⁄4 1,319;OR 1.00; 95%CI 0.60 to 1.66).

Are Antibiotics Effective in the Treatment of Acute Maxillary Sinusitis

LECTION controlled trials tibiotics with placebo or mdifferentclasses for the acutemaxillary sinusitis in lescents aged12yearsor cluded. In the included maxillary sinusitis was clinical signsor symptoms palpation, postnasal drip, l discharge, nasal nilateral facial pain, thache, or impaired ell); radiography, phy, or other imaging; culture from a sinus tained by puncture or nd irrigation/aspiration.

Undifferentiated sarcoma in the cerebellopontine angle of an 11-year-old boy.

intracranial neoplasms in the adult population; by contrast, these lesions constitute only 1% of pediatric central nervous system (CNS) tumors1. In adults, the vast majority (approximately 80%) of CPA lesions are vestibular schwannomas (VSs), commonly known as acoustic neuromas. The remainder are largely meningiomas, primary cholesteatomas, schwannomas, epidermoid cysts, ependymomas, other primary tumors of the skull base and inner ear, and metastases. In children, arachnoid cysts, choroid plexus papillomas, gliomas, craniopharyngiomas, and central primitive neuroectodermal tumors (cPNETs) have also been reported in the CPA1. Neoplasms in this CNS region are most commonly of low histological grade. In fact, high-grade extra-axial tumors of the CPA are exceedingly rare and thus carry a substantial risk of being misdiagnosed as benign disease. A high-grade undifferentiated sarcoma involving the CPA has only been described in two previous reports in the literature, both in adult subjects2,3. To the authors’ knowledge, the present case report is the first to describe a high-grade undifferentiated sarcoma of the cerebellopontine angle affecting a pediatric patient, an 11-year-old boy.

“SEARS”: A simple tool for clear documentation and communication of shunt histories in pediatric neurosurgery

Th e invention of cerebrospinal fl uid (CSF) shunts in the 1950s revolutionized the treatment of hydrocephalus. Th e original design by Nulsen and Spitz used a ball valve connected to a catheter to divert CSF from the ventricles to the jugular vein. Since then, there have been countless modifi cations and novel designs in shunt equipment. Over 50 years later, the mainstay of hydrocephalus treatment remains ventriculoperitoneal (VP) shunting. Cerebrospinal fl uid shunts have dramatically improved the mortality and morbidity of hydrocephalus. However, despite advances in shunt technology, these devices remain associated with a high rate of complication, mainly related to mechanical failure (8 – 64%) and infection (3 – 12%). 2 Shuntrelated complications are not benign, and they can pose a signifi cant risk of death. Hence, children with implanted CSF shunts tend to be followed very closely by a neurosurgeon over several years to monitor clinical status, hardware functionality, and need for revision surgery. Th is, plus the multidisciplinary team frequently involved in caring for these patients, necessitates clear and succinct documentation and communication between healthcare professionals regarding a patient ’ s CSF shunt history. In our experience, there is often a lack of appropriate documentation and/or communication regarding the details of a patient ’ s shunt, which has the potential to lead to serious consequences. We would like to share a simple tool for performing and recording shunt histories, which we have developed and adopted at our institution (Table I). Th e utility of this tool, which uses the abbreviation, “ SEARS ” ( S ite of shunt system, E tiology of hydrocephalus, A ge at initial shunt implantation, R evisions, S ettings of valve), is illustrated below through an example case.