Repair of dural defects in awkward areas-technical note.

Dural tears located at the base of the skull are difficult to repair due to the difficulties in the appropriate access and the fragility of the dura in such areas. In our experience the biggest problem when attempting to perform a dural repair in a deep narrow field is not to place the stitches, but rather to set the knots. A newly designed, easy-to-learn technique has been developed for dural closure in these situations. We present here a new technique for dural suturing of special interest when the space available is limited. In our hands it is possible to obtain a watertight dural closure in most microsurgical operations performed through a small hole and/or into a narrow, deep surgical field. These techniques can also be applied during a secondary procedure following development of a postoperative CSF leak. While simple and easy to learn, these techniques require practice in the laboratory setting before clinical application.

Symptom prevalence in the last week of life.

Palliative care is the management of patients with progressive, far-advanced disease for whom the prognosis is limited and the focus of care is quality of life. During the last days of life, it is important to redefine the goals, as previously present symptoms may increase and new symptoms may appear. To assess these symptoms, 176 patients were evaluated. A questionnaire evaluated symptoms during the last week of life and compared these prevalences with those at the first evaluation. The patients comprised 121 men and 55 women. The mean age was 67.7 years. Metastases were present in 66.5% and were multiple in 52%. The most frequent symptoms at the end of life (> 50%) were anorexia, asthenia, dry mouth, confusion, and constipation. The majority of patients died at home (64.2%). We observed good control of "reversible" symptoms, but many symptoms were difficult to control at the end of life. Symptom assessment is important in this population.