- Computed tomographic angiography (CTA) has the advantage of being noninvasive, but there are very limited data to compare a CTA approach with the current standard diagnostic approach. A methodological review supported CTA in patients presenting within 48 hours of symptoms and with a neurologically intact examination. CTA has not replaced the current approach but has gained more acceptance; its use is center specific and more prevalent in continued management than initial diagnosis. CTA sensitivity decreases with aneurysms less than 4 mm in size and carries the risk of contrast-induced nephropathy, especially if digital subtraction angiography is performed after CTA.
- Current data suggest that very short courses of antifibrinolytics may reduce rebleeding without causing ischemia. Rapid diagnosis of SAH and early definitive repair probably remain the best strategy for prevention. Fibrinolytics should be used in consultation with the neurosurgeon and may be most beneficial in instances of delayed definitive repair.
- The mortality from aSAH appears to have declined in industrialized nations over the past 25 years. The case-fatality rate for aSAH, although still high worldwide, appears globally to be minimally on the decline despite significant regional differences in reporting of mortality.
Latest Updates
Surgical Treatment of the Infected Aortic Graft
- Discussion of the management of aortic endograft infections, which are increasing in incidence and prevalence and represent a particularly technically challenging subset of aortic graft infections (AGIs)
- Discussion of the management of aortoenteric fistula, with special attention paid to the disastrous effects of gastrointestinal complications
- Updated review of the various methods of arterial reconstruction for AGI, with updated summary of outcomes
- Although hospital-acquired pneumonia (HAP) is the second most common HAI in hospitalized patients, the diagnosis is far from straightforward in many cases. More than 80% of HAP is ventilator-associated pneumonia (VAP), defined as pneumonia diagnosed within 24 hours of any duration of mechanical ventilation. Unfortunately, there is no diagnostic gold standard, and other common conditions, such as acute respiratory distress syndrome (ARDS), chest trauma, and even volume overload, share the key features of VAP.
- Sterile technique is always required for catheter insertion. However, current data support a surgical approach to preparation of the insertion site, with the operator wearing a gown, gloves, a mask, and a hat for the procedure, for all central line.
- The gold standard for detecting CDAD is to send a stool sample for cytotoxin determination, a procedure that has a sensitivity of 70 to 100%. This labor- intensive cell culture assay has been largely replaced in laboratories for enzyme immunoassays for toxins A and B with same-day results, but at a cost of decreased sensitivity (39 to 73%). At the time of this publication, polymerase chain reaction testing for the presence of toxin B is emerging as a rapid, more sensitive and specific test that will likely become the new standard for clinical screening.
- Although hospital-acquired pneumonia (HAP) is the second most common HAI in hospitalized patients, the diagnosis is far from straightforward in many cases. More than 80% of HAP is ventilator-associated pneumonia (VAP), defined as pneumonia diagnosed within 24 hours of any duration of mechanical ventilation. Unfortunately, there is no diagnostic gold standard, and other common conditions, such as acute respiratory distress syndrome (ARDS), chest trauma, and even volume overload, share the key features of VAP.
- Sterile technique is always required for catheter insertion. However, current data support a surgical approach to preparation of the insertion site, with the operator wearing a gown, gloves, a mask, and a hat for the procedure, for all central line.
- The gold standard for detecting CDAD is to send a stool sample for cytotoxin determination, a procedure that has a sensitivity of 70 to 100%. This labor- intensive cell culture assay has been largely replaced in laboratories for enzyme immunoassays for toxins A and B with same-day results, but at a cost of decreased sensitivity (39 to 73%). At the time of this publication, polymerase chain reaction testing for the presence of toxin B is emerging as a rapid, more sensitive and specific test that will likely become the new standard for clinical screening.
- Although hospital-acquired pneumonia (HAP) is the second most common HAI in hospitalized patients, the diagnosis is far from straightforward in many cases. More than 80% of HAP is ventilator-associated pneumonia (VAP), defined as pneumonia diagnosed within 24 hours of any duration of mechanical ventilation. Unfortunately, there is no diagnostic gold standard, and other common conditions, such as acute respiratory distress syndrome (ARDS), chest trauma, and even volume overload, share the key features of VAP.
- Sterile technique is always required for catheter insertion. However, current data support a surgical approach to preparation of the insertion site, with the operator wearing a gown, gloves, a mask, and a hat for the procedure, for all central line.
- The gold standard for detecting CDAD is to send a stool sample for cytotoxin determination, a procedure that has a sensitivity of 70 to 100%. This labor- intensive cell culture assay has been largely replaced in laboratories for enzyme immunoassays for toxins A and B with same-day results, but at a cost of decreased sensitivity (39 to 73%). At the time of this publication, polymerase chain reaction testing for the presence of toxin B is emerging as a rapid, more sensitive and specific test that will likely become the new standard for clinical screening.
- Although hospital-acquired pneumonia (HAP) is the second most common HAI in hospitalized patients, the diagnosis is far from straightforward in many cases. More than 80% of HAP is ventilator-associated pneumonia (VAP), defined as pneumonia diagnosed within 24 hours of any duration of mechanical ventilation. Unfortunately, there is no diagnostic gold standard, and other common conditions, such as acute respiratory distress syndrome (ARDS), chest trauma, and even volume overload, share the key features of VAP.
- Sterile technique is always required for catheter insertion. However, current data support a surgical approach to preparation of the insertion site, with the operator wearing a gown, gloves, a mask, and a hat for the procedure, for all central line.
- The gold standard for detecting CDAD is to send a stool sample for cytotoxin determination, a procedure that has a sensitivity of 70 to 100%. This labor- intensive cell culture assay has been largely replaced in laboratories for enzyme immunoassays for toxins A and B with same-day results, but at a cost of decreased sensitivity (39 to 73%). At the time of this publication, polymerase chain reaction testing for the presence of toxin B is emerging as a rapid, more sensitive and specific test that will likely become the new standard for clinical screening.
Surgical Treatment of the Infected Aortic Graft
- Discussion of the management of aortic endograft infections, which are increasing in incidence and prevalence and represent a particularly technically challenging subset of aortic graft infections (AGIs)
- Discussion of the management of aortoenteric fistula, with special attention paid to the disastrous effects of gastrointestinal complications
- Updated review of the various methods of arterial reconstruction for AGI, with updated summary of outcomes
- The pneumococcal conjugate and influenza vaccines have been found to decrease the incidence of acute otitis media
- Oral antibiotics are associated with a higher rate of OME resolution; however, there is insufficient evidence regarding hearing and speech outcomes.
- Adenoidectomy should be considered with tympanostomy tube placement in children 4 years of age or older
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