Compared to controls, patients with ruptured aneurysm and surgical intervention show increase in symptoms of depression and lower cognitive performance, but their objective sleep is not affected.

OBJECTIVES: Patients with aneurysmal subarachnoid haemorrhage (aSAH) have impaired sleep and cognitive performance together with more difficulties in social and everyday life. Hypocortisolism has also been reported. However, a study assessing all dimensions between aSAH severity, objective and subjective sleep, cortisol secretion, cognitive performance and social and everyday life has not so far been performed. The aim of the present study was therefore two-fold: (1) to assess, in a sample of patients with aSAH, objective and subjective sleep, cognitive functioning, social skills and cortisol secretion concurrently, and (2) to compare patients on these variables with a control group. METHODS: Twenty-one patients (17 females; mean age: 58.80 years) with ruptured aneurysm and surgical intervention and 21 (14 females; mean age: 58.90 years) age- and gender-matched controls took part in the study. Assessments covered objective sleep-EGG recordings, subjective sleep, salivary cortisol analysis, and psychological functioning including memory performance, mood, and emotion recognition. RESULTS: Compared to healthy controls, patients had lower scores for verbal memory performance and emotion recognition; they also reported more marked depressive symptoms and complained of poor sleep. However, no differences were found for objective sleep or cortisol secretion. Subjective and objective sleep, cortisol secretion and psychological functioning were unrelated. CONCLUSIONS: Findings indicate that patients with aSAH face psychological rather than physiological issues.

Microsurgical reconstruction of the head and neck--current practice of maxillofacial units in Germany, Austria, and Switzerland.

Refinement in microvascular reconstructive techniques over the last 30 years has enabled an increasing number of patients to be rehabilitated for both functional and aesthetic reasons. The purpose of this study was to evaluate different microsurgical practice, including perioperative management, in Germany, Austria, and Switzerland. The DÖSAK collaborative group for Microsurgical Reconstruction developed a detailed questionnaire which was circulated to units in the three countries. The current practice of the departments was evaluated. Thirty-eight questionnaires were completed resulting in a 47.5% response rate. A considerable variation in the number of microsurgical reconstructions per year was noted. In relation to the timing of bony reconstruction, 10 hospitals did reconstructions primarily (26.3%), 19 secondarily (50%) and 9 (23.7%) hospitals used both concepts. In the postoperative course, 15.8% of hospitals use inhibitors of platelet aggregation, most hospitals use low molecular heparin (52.6%) or other heparin products (44.7%). This survey shows variation in the performance, management, and care of microsurgical reconstructions of patients. This is due in part to the microvascular surgeons available in the unit but it is also due to different types of hospitals where various types of care can be performed in these patients needing special perioperative care.