Objective This study investigated the role of intravenous acetaminophen for alleviation of postoperative pain after surgical resection of head and neck cancers. Methods A single‐center study was conducted, which investigated a prospective group of 48 participants who underwent surgery between April 2016 and May 2017 and postoperatively received scheduled IV acetaminophen (1 g every 6 hours for 4 doses) plus the standard opioid PCA and breakthrough narcotics. These were compared to a similar retrospective cohort of 51 patients who had surgery between January 2014 to March 2015 and only received an opioid patient controlled analgesia (PCA) pump and breakthrough narcotics. Outcome measures included averaged pain scores, total amount of narcotics received (in morphine equivalents), and number of PCA attempts measured in 8‐hour intervals over the first 24 hours, as well as duration of PCA and length of stay. Statistical measures included descriptive analysis and gamma regression analysis. Results The acetaminophen group achieved equally low pain scores (0.8 ± 1.2 vs. 1.0 ± 1.3, P = .408) with significantly less total narcotics in the first 8 hours after surgery (13.5 ± 13.3 vs. 22.5 ± 21.5 MEs, P = .014). This group had a significantly decreased length of stay (7.8 ± 4.6 vs. 10.6 ± 7.6 days, P = .03). Conclusion This study demonstrates that intravenous acetaminophen may play a role in reducing the total narcotic requirement in the first 8 hours after surgery and contribute to a decreased length of stay and potentially decrease cost to the patient and hospital overall. Future research should be aimed at comparing these groups in a randomized control study/setting. Level of Evidence 3

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Objective To determine whether an enhanced recovery after surgery (ERAS) nutrition protocol is reasonably possible among our head and neck cancer (HNC) population with respect to system feasibility and patient compliance. Second, we aim to identify improvements in patient outcomes as a result. Methods Preexperimental research design among patients undergoing major HNC surgery after implementation of the ERAS nutrition protocol from July 2018 to July 2019 as quality improvement (QI). Preoperative clinical nutritional assessment and laboratory values were completed the same day as informed surgical consent in the clinic. Protocol focus was patient consumption of nutritional supplements perioperatively, monitored by our outpatient dietitian. Early postoperative enteral nutrition was initiated with monitoring of nutritional laboratory values. To support our model, we provide preliminary analysis of HNC patient outcomes after implementation of the ERAS nutritional protocol. Results Twenty-five patients were enrolled. Preoperatively, 40% of patients were malnourished, and 100% complied with perioperative nutrition supplementation. Health care provider compliance obtaining preoperative laboratory values was 56%. There was a strong negative correlation between modified Nutrition-Related Index (mNRI) and number of complications ( P = .01), specifically, fistula rate ( P = .04) and unplanned reoperation ( P = .04). Enrolled patient average length of stay was 7 ± 4.4 days. Discussion Our patients demonstrated compliance with implementation of an ERAS nutrition protocol likely facilitated by dietitian engagement. mNRI potentially reflects risk for head and neck surgery complications. Implications for Practice QI processes demand reassessment and modification to ensure efficient and targeted approaches to improving patient care.

The etiology of hemorrhage in the new-born, except in cases of hemorrhagic disease, is one of the puzzling problems of medicine. Whenever such hemorrhage occurs, trauma or syphilis is suspected, but frequently autopsy does not reveal either of these. In animals such causes are eliminated a priori. Hence, on discovering cerebral hemorrhage in young rats, it seemed expedient to make a biologic study of this subject.In our laboratory it has been found that certain synthetic diets containing a limited amount of vitamin B apparently are associated with hemorrhage, whereas stock diets are not. Female rats fed from the time of weaning on the minimum amount of vitamin B necessary for normal growth and conception, are unable usually to deliver and carry their young through the lactation period. None of the mothers have shown signs of avitaminosis unless excessive hemorrhage at delivery is considered an indication of this condition. Although a rat normally delivers her young without visible loss of blood, a number of mothers on this diet have died from hemorrhage, and many others have soaked their bedding during parturition. The ultimate penalty of an inadequate maternal diet, however, is vicariously paid by the young. With limited vitamin in the food of the mothers, one of three conditions results : ( 1 ) abortions or absorp¬ tions of the embryos, (2) death of the young at birth or (3) death during the nursing period. The deaths occurring at birth or during the first few days of life are characterized by hemorrhages varying in volume and location ; a certain number of those occurring during the second week exhibit, in addition, marked emaciation, gastric stasis and myelin degeneration of the vagus and phrenic nerves. Occasionally, after the first stage of paralysis has developed, one or two out of a litter are strong enough to eat from the mother's ration, and these usually recover.The majority of deaths occur at approximately twenty-one days, when weaning should normally take place. For a day or two before their

The earliest recorded description of craniotabes was made in 1843 by Els\l=a"\sser,1 who considered it a rachitic phenomenon. He defined this condition as areas of parchment-like bone found chiefly in the occipital and parietal regions. Friedleben,2 in 1860, was the first to note its presence during the early weeks of life. Bohn 3 believed this early softening to be nonrachitic, but that appearing after the second or third month to be rachitic. Wieland,4 after a study of 734 cases of craniotabes, most of which were found during the early months, concluded that none of the patients were rachitic, in spite of the fact that he found it more frequently in colored babies. He based his conclusions on the fact that the condition appeared when undisputed signs of rickets were few or absent and disappeared when other signs were progressing.Among the more recent writers, Hess 5 believes that craniotabesn appearing before the fifth or sixth month is not diagnostic of rickets, and regards this earlier softening as congenital osteoporosis. Huenekens 6 on the other hand, thinks it is the earliest sign of rickets and reports his findings in a group of rachitic twins and premature infants. DeBuys 7 also believes craniotabes to be a sign of rickets, and shows that from the second to the fifth month it is nearly twice as frequent among the col¬ ored as among the white children.In our study, all degrees of abnormal cranial softening have been considered as craniotabes. Some areas were so small as to be palpable with the tip of the finger only, others so large as to involve a considerable portion of the top and back of the head. We have found that the bone