67 research outputs found
System Safety in Healthcare: The Right and Wrong Ways to Perform Failure Mode and Effects Analysis (FMEA)
No full textThe objective of performing Failure Mode and Effects Analysis (FMEA) is to use sound risk management principles, coupled with innovative solutions that can assure high return on investment (ROI). Quality Guru Philip Crosby wrote in his book, Quality is Free, that quality is free if you do the right things at the right time. Essentially, the savings from avoiding fixes, process changes and lawsuits are much higher than the cost of doing things right. The principles of sound risk management, experienced by this paper’s co-author Dev Raheja as an international engineering management consultant over 30 years, include:
Identifying risks
Assessing risks
Mitigating risks
Orchestrating risk management
Aiming at high ROI without compromising safet
Editorial. Endoscopic sinus surgery in sinusitis-induced intracranial abscess: concepts and controversies
No full textUnruptured internal carotid artery aneurysm associated with functional pituitary adenoma: A true association
No full textDetection of incidental intracranial aneurysm on neuroimaging can be associated with pituitary adenoma; however, such association is extremely rare. However, aneurysm with extension into the sella is extremely rare, and increases the risk of inadvertent intraoperative rupture, if trans-sphenoidal decompression is attempted either using endoscopic or microscopic surgical approach. Hanak et al. in a literature review of intrasellar noniatrogenic aneurysms over PubMed search in 2012 could only collect 31 studies, of which only eight cases had pituitary adenoma associated with aneurysm extending into sella. Authors report an interesting case of 52-year-old male diagnosed as case of acromegaly, was put on dopamine agonist, bromocriptine and responding well to therapy, however the magnetic resonance imaging raised suspicion of vascular pathology, and underwent digital subtraction angiography at our center revealed presence of right supracliniod internal carotid aneurysm, which was coiled using endovascular technique with resultant good outcome.</jats:p
Correlation of biomarkers with cognitive deficits in young adults with mild traumatic brain injury
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Spontaneous chronic subdural hematoma development in chronic myeloid leukemia cases at remission phase under maintenance therapy, management strategy: A series with literature review
No full textChronic subdural hematoma (CSDH) is common squeal of trauma and rarely associated with anticoagulant therapy, antiplatelet, chemotherapeutic drugs, arterio-venous malformation, aneurysms and post-craniotomy. However its occurrence is very unusual with systemic haematological malignancy and mostly reported with acute myeloid leukemia; however incidence of SDH occurrence in chronic myelogenous leukemia (CML) is very rare. CML is a haematological malignancy characterized by chromosomal alteration, pathologically represents increased proliferation of the granulocytic cell line without loss of capacity to differentiate. CML has three phases – remission phase, accelerated phase and blast crisis. About 85 % of patients present in remission phase of disease and carries a favorable prognosis. As intracranial, subdural hematoma usually occur in the accelerated phase or blast crisis phase or extremely uncommon during chronic remission phase, although only those affected, who are neglecting therapeutic medication or discontinued therapy or rarely as an adverse effect of medications. However, important role of neurosurgeon lies in early detection and correction of platelet count and associated hematological abnormality as quite sizeable proportion of cases may not need surgical intervention instead can be managed conservatively under regular supervision in association with oncologist colleague, but few cases may need urgent surgical intervention. So, selecting a subgroup of CML cases in the remission phase requiring surgical intervention, presenting with CSDH is not only challenging, as failure to make an informed and timely precise decision can lead to catastrophic worse outcome and even mortality. So, purpose of current article is to formulate the management therapeutic plan. Authors report three cases of CML in chronic remission phase, receiving treatment under guidance of Haemto-oncologist at our institute presented with spontaneous chronic SDH. The mean age was 36 years (range 29- 44 years), 66% were male, headache was presenting feature in all 100% (n=3), 66% cases were hemiplegic and 33% unconscious each, in 66% cases CSDH were located on right fronto-temporal region and 33% had small left sided thin CSDH. About were 66% cases (n=2) were managed surgically by burr hole placement and drainage drain placement while 33% case (n=1), who had thin CSDH was managed conservatively. Favorable outcome was observed in 100% cases (n=3) Outcome was favorable in all of our cases
Management of Cavernous Sinus Involvement in Sinonasal and Ventral Skull Base Malignancies
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