Main Outcome Measure: Facial function after 1 postoperative year

Main Outcome Measure: Facial function after 1 postoperative year. Independent variables included patient demographics,

presenting symptoms, tumor size and location, and serial postoperative function within the first year.

Results: Among 281 patients with postoperative facial weakness, 81% improved to a House-Brackmann (HB) III or better (good outcome) after 12 months of recovery, whereas 12% remained HB IV or worse (poor outcome). For patients starting with HB V or VI function, recovery rate was the most reliable predictor of poor outcome after 1 year. The resulting predictive model using rate of functional improvement as the independent variable was found to anticipate poor outcome before 1 year in more than LXH254 50% of cases with 97% sensitivity and 97% specificity. Although associated with facial nerve outcome, tumor size, tumor vascularity, selleck chemicals preoperative facial function, age at surgery, and ability to stimulate the nerve intraoperatively did not contribute significantly to the predictive model.

Conclusion: The rate of recovery within the first postoperative year serves as a useful early predictor of long-term facial nerve function. We present a novel predictive model using rate of recovery that can be used to select candidates

for reanimation surgery sooner than the traditional waiting period of 1 year, potentially improving the outcome of this intervention.”
“Introduction. The purpose of this study is to describe an in utero management strategy for fetuses with immune-mediated 28 or 38 atrioventricular (AV) block.

Methods and results. The management strategy as applied to 29 fetuses consisted of three parts. First, using fetal echocardiography and obstetrical ultrasound, we assessed fetal heart rate (FHR), heart failure, growth and a modified biophysical profile score (BPS) assessing fetal movement, breathing and tone. Second, we treated all fetuses with transplacental dexamethasone, adding terbutaline if the FHR was < 56 bpm. Digoxin and/or intravenous immune globulin (IVIG) was added for progressive fetal heart failure. Third, we delivered

fetuses by cesarean section for specific indications that included abnormal BPS, maternal/fetal conditions, progression of heart failure, or term pregnancy. We assessed perinatal survival, predictors of delivery and maternal/fetal complications in 29 fetuses with 3 degrees (n = 23) or 2 degrees (n = 6) AV block. There were no fetal deaths. In utero therapy included dexamethasone (n = 29), terbutaline (n = 13), digoxin (n = 3) and/or IVIG (n = 1). Delivery indications included term gestation (66%), fetal/maternal condition (14%), low BPS (10%) and progression of fetal heart failure (10%). An abnormal BPS correlated with urgent delivery.

Conclusion. These results suggest that applying this specific management strategy that begins in utero can improve perinatal outcome of immune-mediated AV block.”

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