In what is a major step towards the prevention of recurring bouts of Clostridium difficile (Cdiff) infection, an international team led by Dale Gerding, MD, Hines Veterans Administration (VA) research physician and professor of Medicine at Loyola University Chicago Stritch School of Medicine, has shown that giving spores of non-toxic Cdiff by mouth is effective in stopping repeated bouts of Cdiff infection which occurs in 25-30 percent of patients who suffer an initial episode of diarrhoea or colitis.

Providers of mental-health services still rely on intervention techniques such as physical restraint and confinement to control some psychiatric hospital patients, a practice which can cause harm to both patients and care facilities, according to a new study from the University of Waterloo.

The study, which appears in a special mental health issue of Healthcare Management Forum, found that almost one in four psychiatric patients in Ontario hospitals are restrained using control interventions, such as chairs that prevent rising, wrist restraints, seclusion rooms or acute control medications.

A technique called auditory brainstem implantation can restore hearing for patients who can’t benefit from cochlear implants. A team of US and Japanese experts has mapped out the surgical anatomy and approaches for auditory brainstem implantation.

Dr. Albert L. Rhoton, Jr., and colleagues of University of Florida, Gainesville, and Fukuoka University, Japan, performed a series of meticulous dissections to demonstrate and illustrate surgical approaches to auditory brainstem implant placement. Their article shares exquisitely detailed anatomic colour photographs, along with step-by-step descriptions of two alternative routes for neurosurgeons performing these demanding implant procedures.

Auditory brainstem implants can restore varying degrees of hearing to patients with ‘retrocochlear’ hearing loss. These patients have deafness caused by damage to the cochlear nerves — sometimes called the acoustic or auditory nerves — which transmit sound information from the inner ear to the brain. The cochlear nerve damage most commonly results from brain tumours associated with a genetic condition called neurofibromatosis type 2 (NF2).
Auditory brainstem implants are similar in principle to the more commonly placed cochlear implant, used in patients with damage to the cochlea — part of the inner ear. Because of the need to place the implant and electrodes in the brainstem, rather than the inner ear, the surgery required for auditory brainstem implantation is much more complex.

In a series of ten cadaver brainstem dissections, the researchers explored the anatomy of the region that the neurosurgeon must navigate to perform auditory brainstem implantation. They also mapped out the best neurosurgical approaches, both for surgery to remove the tumours and for auditory brainstem implant placement.

Based on their findings, Dr. Rhoton and colleagues detail two surgical approaches: a ‘translabyrinthine’ and a ‘retrosigmoid’ approach. They outline a step-by-step route for both approaches, designed to provide safe access to the area while minimizing trauma to the brainstem and surrounding structures. The authors highlight the value of using endoscopes to help in visualizing and accessing the target area for implant placement.

More than 1,000 auditory brainstem implant procedures have been performed worldwide so far. The procedure was previously approved only for patients with NF2 aged 12 years or older. Recently, clinical trials were approved for children with congenital malformations or other causes of retrocochlear deafness.

Minimizing damage to the brainstem and associated blood vessels appears to be a critical factor in achieving good speech recognition after auditory brainstem implantation. The hearing results are also better in patients with a shorter duration of deafness.

Dr. Rhoton and colleagues hope that their descriptions and illustrations will help to increase understanding of the anatomy and surgical approaches to auditory brainstem implantation, contributing useful hearing to adults and children with NF2 and other causes of retrocochlear deafness. EurekAlert

When a patient receives a new hip, it is usually adjusted only approximately to leg length. Greater accuracy requires a more precise measuring process as well as adjustable implants. Now, a new type of measurement method coupled with a modular implant should allow orthopaedic surgeons to precisely calibrate leg length after the operation so it matches its original length.

A painful hip that feels unstable and no longer has the same range of motion: For many patients, this means they need a prosthetic hip

Surgical robots allow doctors to improve recovery time and minimise scarring.  A study into the safety of surgical robots has linked the machines’ use to at least 144 deaths and more than 1,000 injuries over a 14-year period in the US.
The events included broken instruments falling into patients’ bodies, electrical sparks causing tissue burns and system errors making surgery take longer than planned. The report notes that the figures represent a small proportion of the total number of robotic procedures.

But it calls for fresh safety measures. ‘Despite widespread adoption of robotic systems for minimally invasive surgery, a non-negligible number of technical difficulties and complications are still being experienced during procedures,’ the study states. ‘Adoption of advanced techniques in design and operation of robotic surgical systems may reduce these preventable incidents in the future.’

Robotic surgery can reduce the risk of infections and help patients heal more quickly.
The work was carried out by researchers at the University of Illinois at Urbana-Champaign, the Massachusetts Institute of Technology and Chicago’s Rush University Medical Center.

Their paper says 144 deaths, 1,391 injuries and 8,061 device malfunctions were recorded out of a total of more than 1.7 million robotic procedures carried out between January 2000 and December 2013. This was based on reports submitted by hospitals, patients, device manufacturers and others to the US Food and Drug Administration, and the study notes that the true number could be higher.

Surgeons face the risk of broken parts causing injury or lengthening procedures
Its authors say the number of injuries and deaths per procedure has remained relatively constant since 2007. But due to the fact that the use of robotic systems is increasing ‘exponentially’, they add, this means that the number of accidents is increasing every year.

They highlight that when problems do occur, people are several times more likely to die if the surgery involves their heart, lungs, head and/or neck rather than gynaecological and urological procedures.

They acknowledge that the data does not pinpoint why, but suggest it is because the former are more complex types of operations for which robots are less commonly used, so there is less experience and expertise available.
The researchers did not, however, compare accident rates with similar operations in which robots were not used. Their study has not been peer reviewed.

Surgical robotic devices are typically expensive – costing millions of pounds – but offer advantages.
They can allow surgeons to use smaller instruments, letting them make smaller and more nimble cuts. That can mean patients recover faster, with less risk of infection and the promise of smaller scars.
In addition, the development of remote surgery means that doctors do not always need to be in the same room as their patients, allowing specialists who are in demand to treat more people.

The report acknowledges that the ‘vast majority of procedures’ involving robots were successful BBC