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Nociforo N. The invasion of reality (or of negotiation): The psychoanalytic ethic and extinction anxiety. Int J Psychoanal 2016; 98:1311-1332. [PMID: 27859150 DOI: 10.1111/1745-8315.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 11/30/2022]
Abstract
Extinction anxiety is the expression used to describe a pervasive and ever more realistic sense of futurelessness. A group emotion characterized by terror of the extinction of the human race, the family, or professional or shared cultural group, it grips the individual with a sense of desperation and impotence through the internal groups present in the mind of every individual. The contribution presented here aims to demonstrate how extinction anxiety has also infected psychoanalysts and psychoanalytic institutions, thereby seriously weakening the ethics of psychoanalysis. The term ethics here should not be confused with morals, but is intended as the happiness that is derived from the capacity to be responsible for one's self and one's own professional identity. The contagion of extinction anxiety has, in fact, accentuated the crisis of psychoanalysts and their faith in psychoanalysis. The author relates a particularly tormented clinical experience in order to show how only the relationship with psychoanalysis and its capacity to interpret the manifestations of the unconscious, enables the recognition of the effects of what he defines as a true invasion of reality, thus restoring to thought the power to establish a deep, transformative, and fecund relationship between internal and external reality.
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Affiliation(s)
- Nicola Nociforo
- via Gabriele D'Annunzio 164, 95127, San Gregorio, Catania, Italy
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252
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Ho KM, Han HS, Yoon YS, Cho JY, Choi YR, Jang JS, Kwon SU, Kim S, Choi JK. Laparoscopic Total Caudate Lobectomy for Hepatocellular Carcinoma. J Laparoendosc Adv Surg Tech A 2016; 27:1074-1078. [PMID: 27855267 DOI: 10.1089/lap.2016.0459] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Caudate lobe is located in the deep dorsal area of the liver between the portal triad and the inferior vena cava (IVC). Torrential bleeding can occur from the IVC and short hepatic veins during dissection. Isolated total caudate lobe resection is still rare and technically demanding. We herein present a video on the technical aspect of laparoscopic total caudate lobectomy. METHOD A 61-year-old woman was admitted for recurrent hepatocellular carcinoma detected on imaging. She had history of multifocal hepatocellular carcinoma in July 2015 and underwent open cholecystectomy, segment 6 and segment 8 tumorectomy. Ten months later, the computed tomography scan and magnetic resonance imaging showed a 1 cm arterial enhancing lesion in segment I (S1) with no other foci of recurrence. Laparoscopic total caudate lobectomy was contemplated. RESULTS The operative time was 270 minutes. The intraoperative blood loss was 200 mL and blood transfusion was not necessary. The patient was discharged on the fourth postoperative day without any complications. CONCLUSION This report showed the safety and feasibility of laparoscopic total caudate lobectomy. Nonetheless, it is a technically demanding procedure. It should be performed in carefully selected patients and by experienced hepatobiliary surgeons proficient in laparoscopic liver resection.
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Affiliation(s)
- Kit-Man Ho
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea.,2 Department of Surgery, Kwong Wah Hospital , Hong Kong, China
| | - Ho-Seong Han
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Yoo-Seok Yoon
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Jai Young Cho
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Young Rok Choi
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Jae Seong Jang
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Seong Uk Kwon
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Sungho Kim
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Jang Kyu Choi
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
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253
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Le ST, Josephson SA, Puttgen HA, Gibson L, Guterman EL, Leicester HM, Graf CL, Probasco JC. Many Neurology Readmissions Are Nonpreventable. Neurohospitalist 2016; 7:61-69. [PMID: 28400898 DOI: 10.1177/1941874416674409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Reducing unplanned hospital readmissions has become a national focus due to the Centers for Medicare and Medicaid Services' (CMS) penalties for hospitals with high rates. A first step in reducing unplanned readmission is to understand which patients are at high risk for readmission, which readmissions are planned, and how well planned readmissions are currently captured in comparison to patient-level chart review. METHODS We examined all 5455 inpatient neurology admissions over a 2-year period to University of California San Francisco Medical Center and Johns Hopkins Hospital via chart review. We collected information such as patient age, procedure codes, diagnosis codes, all-payer diagnosis-related group, observed length of stay (oLOS), and expected length of stay. We performed multivariate logistic modeling to determine predictors of readmission. Discharge summaries were reviewed for evidence that a subsequent readmission was planned. RESULTS A total of 353 (6.5%) discharges were readmitted within 30 days. Fifty-five (15.6%) of the 353 readmissions were planned, most often for a neurosurgical procedure (41.8%) or immunotherapy (23.6%). Only 8 of these readmissions would have been classified as planned using current CMS methodology. Patient age (odds ratio [OR] = 1.01 for each 10-year increase, P < .001) and estimated length of stay (OR = 1.04, P = .002) were associated with a greater likelihood of readmission, whereas index admission oLOS was not. CONCLUSIONS Many neurologic readmissions are planned; however, these are often classified by current CMS methodology as unplanned and penalized accordingly. Modifications of the CMS lists for potentially planned neurological and neurosurgical procedures and for acute discharge neurologic diagnoses should be considered.
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Affiliation(s)
- Sidney T Le
- University of California San Francisco, San Francisco, CA, USA
| | | | - Hans A Puttgen
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lorrie Gibson
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elan L Guterman
- University of California San Francisco, San Francisco, CA, USA
| | | | - Carla L Graf
- University of California San Francisco, San Francisco, CA, USA
| | - John C Probasco
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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254
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Affiliation(s)
- James Castellano
- Department of Neurology, Montefiore Hospital and Medical Center, Bronx, NY, USA
| | - Robert Glover
- Department of Neurology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Julie Robinson
- Department of Neurology, Montefiore Hospital and Medical Center, Bronx, NY, USA
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255
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Tipirneni A, Koch S, Romano JG, Malik AM. A 27-Year-Old Man With Right-Sided Hemiparesis and Dysarthria. Neurohospitalist 2016; 6:174-180. [PMID: 27695601 DOI: 10.1177/1941874416648197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anita Tipirneni
- Cerebrovascular Division, Department of Neurology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Sebastian Koch
- Cerebrovascular Division, Department of Neurology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Jose G Romano
- Cerebrovascular Division, Department of Neurology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Amer M Malik
- Cerebrovascular Division, Department of Neurology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
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256
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Waheed SH, Mirbagheri S, Agarwal S, Kamali A, Yahyavi-Firouz-Abadi N, Chaudhry A, DiGianvittorio M, Gujar SK, Pillai JJ, Sair HI. Reporting of Resting-State Functional Magnetic Resonance Imaging Preprocessing Methodologies. Brain Connect 2016; 6:663-668. [PMID: 27507129 DOI: 10.1089/brain.2016.0446] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
There has been a rapid increase in resting-state functional magnetic resonance imaging (rs-fMRI) literature in the past few years. We aim to highlight the variability in the current reporting practices of rs-fMRI acquisition and preprocessing parameters. The PubMed database was searched for the selection of appropriate articles in the rs-fMRI literature and the most recent 100 articles were selected based on our criteria. These articles were evaluated based on a checklist for reporting of certain preprocessing steps. All of the studies reported the temporal resolution for the scan and the software used for the analysis. Less than half of the studies reported physiologic monitoring, despiking, global signal regression, framewise displacement, and volume censoring. A majority of the studies mentioned the scanning duration, eye status, and smoothing kernel. Overall, we demonstrate the wide variability in reporting of preprocessing methods in rs-fMRI studies. Although there might be potential variability in reporting across studies due to individual requirements for a study, we suggest the need for standardizing reporting guidelines to ensure reproducibility.
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Affiliation(s)
| | - Saeedeh Mirbagheri
- 2 Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Shruti Agarwal
- 2 Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Arash Kamali
- 2 Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Noushin Yahyavi-Firouz-Abadi
- 2 Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Ammar Chaudhry
- 2 Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Michael DiGianvittorio
- 2 Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Sachin K Gujar
- 2 Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Jay J Pillai
- 2 Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Haris I Sair
- 2 Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
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Abstract
BACKGROUND Stapling is becoming the method of choice for dividing the intersegmental plane during thoracoscopic segmentectomies. The technique however is controversial as it can impair re-expansion of preserved segments. We have analyzed the morbidity and lung re-expansion on a series of 175 thoracoscopic segmentectomies. METHODS A total of 175 patients underwent a thoracoscopic anatomic segmentectomy. Ten patients were excluded due to conversion into thoracotomy. There were 89 females (54%) and 76 males (46%). Mean age was 63 years (range, 18-83 years). Indications for segmentectomy were as follows: primary lung cancer (n=100, 61%), metastases (n=27, 16%), benign non-infectious lesions (n=20, 12%) and benign infectious lesions (n=18, 11%). The intersegmental plane was divided with an endostapler in all patients. Lung re-expansion assessment included chest roentgenograms at discharge and at one-month consultation. RESULTS The overall complication rate was 17%. There were 0.6% major complications and 16% minor complications. The average duration of drainage was 3 days (range, 1-13 days) and average length of stay was 5.7 days (range, 2-22 days). At discharge and at 1-month follow-up chest radiography, incomplete lung re-expansion was observed in 12 (7.4%) and 4 patients (2.8%) respectively. Patients who underwent upper lobe segmentectomy had significantly more incomplete re-expansion at discharge and at 1-month follow-up. On univariate analysis, mean drainage duration was significantly longer in patients who underwent upper segmentectomy (mean 3.7 days; range, 1-13) than those who underwent lower segmentectomy (mean 2.7 days; range, 1-5). CONCLUSIONS Although stapling of the intersegmental plane most likely slightly impairs lung re-expansion, clinical and radiological consequences are minimal.
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Affiliation(s)
- Amaia Ojanguren
- Thoracic Department, Institut Mutualiste Montsouris, Paris, France
| | - Dominique Gossot
- Thoracic Department, Institut Mutualiste Montsouris, Paris, France
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258
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Abstract
This article deals with a typology of 45 techniques of humor that I found when doing research on the mechanisms that generate humor in texts, lists the techniques and applies them to a Jewish joke. It references the work of Vladimir Propp on folktales as analogous in that both are concerned with mechanisms in text that generate meaning. It also deals with four theories about why people find texts humorous, defines the joke as a short narrative with a punch line that is meant to generate mirthful laughter and defines Jewish humor as being about Jewish people and culture as told by Jewish people. It offers a paradigmatic analysis of the joke, and offers some insights into why Jewish people developed their distinctive kind of humor. This article is an enhanced and expanded version of an article which was published in a Chinese semiotics journal (doi:10.1515/css-2015-0022).
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Affiliation(s)
- Arthur Asa Berger
- Broadcast and Electronic Communication Arts at San Francisco State University, San Francisco, CA, USA
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259
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Abstract
Distal radius fractures remain among the most common fractures of the upper extremity. The indications for operative management continue to evolve based on outcomes from the most recent clinical studies. Advancements over the past decade have expanded the variety of fixation options available; however, the clinical superiority of a particular treatment modality remains without consensus. Each approach requires the use of unique surgical techniques, and the choice of a particular implant system should be based on the surgeon's familiarity with the implant design and its limitations. As our understanding of the management of distal radius fractures improves, so will our indications for each specific treatment modality.
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Affiliation(s)
- Ram K Alluri
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - J Ryan Hill
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.
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260
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Nowakowski P, Bieryło A. Ultrasound guided axillary brachial plexus plexus block. Part 2 - technical issues. Anaesthesiol Intensive Ther 2016; 47:417-24. [PMID: 26401747 DOI: 10.5603/ait.2015.0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Indexed: 11/25/2022] Open
Abstract
Axillary brachial plexus block is one of the most frequently employed peripheral blocks. The popularity of axillary block stems from its success as a safe and relatively easy technique with numerous applications. The technique of axillary block has evolved. It was modified after the development of precise nerve localization modalities. Currently, ultrasound is the most important localization technique for regional anaesthesia. Ultrasound-guided axillary block encompasses a spectrum of techniques. The selection of a specific technique can be adjusted to an operator's individual level of skill and proficiency. Axillary block under US-guidance can be performed using a traditional perivascular method and by placing a selective blockade of individual nerves that supply the surgical area. Regardless of the selected method, it enables the incorporation of individual patient anatomical variation in an anaesthesia plan. This paper discusses the technical details and efficacy issues of US-guided axillary brachial plexus block techniques.
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Affiliation(s)
- Piotr Nowakowski
- Department of Anesthesiology and Intensive Care, Czerniakowski Hospital, Warsaw, Poland.
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261
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Kandil A, Subramanyam R, Hossain MM, Ishman S, Shott S, Tewari A, Mahmoud M. Comparison of the combination of dexmedetomidine and ketamine to propofol or propofol/sevoflurane for drug-induced sleep endoscopy in children. Paediatr Anaesth 2016; 26:742-51. [PMID: 27212000 DOI: 10.1111/pan.12931] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
AIM Examination of dynamic airway collapse in patients with obstructive sleep apnea (OSA) during drug-induced sleep endoscopy (DISE) can help identify the anatomic causes of airway obstruction. We hypothesized that a combination of dexmedetomidine and ketamine (Group DK) would result in fewer oxygen desaturations and a higher successful completion rate during DISE in children with OSA when compared to propofol (Group P) or sevoflurane/propofol (Group SP). METHODS In this retrospective study, we reviewed the records of 59 children who presented for DISE between October 2013 and March 2015. Data analyzed included demographics, OSA severity, and hemodynamics (heart rate and blood pressure). The primary outcomes were airway desaturation during DISE to <85% and successful completion of DISE; these were compared between the three groups: DK, P, and SP. RESULTS Preoperative polysomnography was available for 49 patients. There were significantly more patients with severe OSA in Group P as compared to the other two groups. The mean (±sd) bolus dose for ketamine, dexmedetomidine, and propofol were 2.0 ± 0.6 mg·kg(-1) , 1.9 ± 0.9 mcg·kg(-1) , and 1.8 ± 1.1 mg·kg(-1) , respectively. The mean (±sd) infusion rate for dexmedetomidine was 1.6 ± 0.7 mcg·kg(-1) ·h(-1) and for propofol was 248 ± 68 mcg·kg(-1) ·min(-1) in Group P and 192 ± 48 mcg·kg(-1) ·min(-1) in Group SP. Patients in Group DK had significantly fewer desaturations to <85% during DISE compared to Group P. Patients in Group DK had significantly more successful completion of DISE (100% Group DK, 92% Group P, and 79% Group SP) as compared to Group SP. CONCLUSIONS These results suggest that the described dose regimen of propofol used alone or in combination with sevoflurane appears to be associated with more oxygen desaturations and a lower rate of successful completion than a combination of dexmedetomidine and ketamine during DISE in children with OSA.
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Affiliation(s)
- Ali Kandil
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rajeev Subramanyam
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mohamed Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stacey Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Otolaryngology -Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sally Shott
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Otolaryngology -Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anurag Tewari
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mohamed Mahmoud
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Segal O, Segal-Trivitz Y, Nemet AY, Geffen N, Nesher R, Mimouni M. Survey of intravitreal injection techniques among retina specialists in Israel. Clin Ophthalmol 2016; 10:1111-6. [PMID: 27366050 PMCID: PMC4913990 DOI: 10.2147/opth.s96452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose The purpose of this study was to describe antivascular endothelial growth factor intravitreal injection techniques of retinal specialists in order to establish a cornerstone for future practice guidelines. Methods All members of the Israeli Retina Society were contacted by email to complete an anonymous, 19-question, Internet-based survey regarding their intravitreal injection techniques. Results Overall, 66% (52/79) completed the survey. Most (98%) do not instruct patients to discontinue anticoagulant therapy and 92% prescribe treatment for patients in the waiting room. Three quarters wear sterile gloves and prepare the patient in the supine position. A majority (71%) use sterile surgical draping. All respondents apply topical analgesics and a majority (69%) measure the distance from the limbus to the injection site. A minority (21%) displace the conjunctiva prior to injection. A majority of the survey participants use a 30-gauge needle and the most common quadrant for injection is superotemporal (33%). Less than half routinely assess postinjection optic nerve perfusion (44%). A majority (92%) apply prophylactic antibiotics immediately after the injection. Conclusion The majority of retina specialists perform intravitreal injections similarly. However, a relatively large minority performs this procedure differently. Due to the extremely low percentage of complications, it seems as though such differences do not increase the risk. However, more evidence-based medicine, a cornerstone for practice guidelines, is required in order to identify the intravitreal injection techniques that combine safety and efficacy while causing as little discomfort to the patients as possible.
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Affiliation(s)
- Ori Segal
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Segal-Trivitz
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; Department of Psychiatry, Geha Psychiatric Hospital, Petah Tikva, Israel
| | - Arie Y Nemet
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Geffen
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Nesher
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
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263
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Abstract
In the present research, we examined the effect of the starting and turning performances on the subsequent swimming parameters by (1) comparing the starting and turning velocities with the swimming parameters on the emersion and mid-pool segments and (2) by relating the individual behaviour of swimmers during the start and turns with subsequent behaviour on each swimming lap. One hundred and twelve 100 m performances on the FINA 2013 World Swimming Championships were analysed by an image-processing system (InThePool 2.0®). At the point of the start emersion, the swimming parameters of the 100-m elite swimmers were substantially greater than the mid-pool parameters, except on the breaststroke races. On the other hand, no diminution in the swimming parameters was observed between the turn emersion and the mid-pool swimming, except on the butterfly and backstroke male races. Changes on the surface swimming kinematics were not generally related to the starting or turning parameters, although male swimmers who develop faster starts seem to achieve faster velocities at emersion. Race analysts should be aware of a transfer of momentum when swimmers emerge from underwater with implications on the subsequent swimming kinematics, especially for male swimmers who employ underwater undulatory techniques.
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Affiliation(s)
- Santiago Veiga
- a Madrid Swimming Federation , Madrid , Spain.,b Faculty of Physical Activity and Sport Sciences, Health and Human Performance Department , Technical University of Madrid , Madrid , Spain
| | - Andreu Roig
- c Biomechanics Department , High Performance Centre , Sant Cugat del Vallés , Spain
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264
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Abstract
We explored the biomechanics of the 180° change-of-direction with the ball (half-turn) in soccer. We aimed at identifying movement strategies which enhance the players' half-turning performance, by characterising technique kinematics and understanding the structure of biomechanical and anthropometrics variables. Ten Under-13 sub-elite male players were recorded with an optoelectronic motion analyser while performing a 5-m straight dribbling followed by a half-turn with the sole. Joints kinematics differences between faster and slower trials were found in support-side hip rotation, driving-side hip adduction, trunk flexion and rotation, and arms abduction. To unveil the data-set structure, a principal component (PC) analysis and a stepwise linear discriminant analysis were performed using 30 biomechanical parameters and four anthropometric variables for each trial. Seven retained PCs explained 79% of the overall variability, featuring combinations of original variables that help in understanding the factors facilitating fast half-turns: keeping short steps, minimising lateral and forward body movements, and centre-of-mass lowering, even with ample lower limbs ranges of motion (RoM); abducting the upper limbs while limiting trunk flexion and pelvic inclination RoM. Balance and task-constrained exercises may be proposed to improve this technique. Moreover, a quantitative knowledge of the movement structure could give coaches objective insights to better instruct young players.
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Affiliation(s)
- Matteo Zago
- a Department of Biomedical Sciences for Health , University of Milan , Milan , Italy
| | - Marina Codari
- a Department of Biomedical Sciences for Health , University of Milan , Milan , Italy
| | - Massimo Grilli
- a Department of Biomedical Sciences for Health , University of Milan , Milan , Italy
| | - Giuseppe Bellistri
- a Department of Biomedical Sciences for Health , University of Milan , Milan , Italy
| | - Nicola Lovecchio
- a Department of Biomedical Sciences for Health , University of Milan , Milan , Italy
| | - Chiarella Sforza
- a Department of Biomedical Sciences for Health , University of Milan , Milan , Italy
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Dries B, Jonkers I, Dingemanse W, Vanwanseele B, Vander Sloten J, van Bree H, Gielen I. Musculoskeletal modelling in dogs: challenges and future perspectives. Vet Comp Orthop Traumatol 2016; 29:181-7. [PMID: 27102147 DOI: 10.3415/VCOT-15-08-0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/24/2016] [Indexed: 11/17/2022]
Abstract
Musculoskeletal models have proven to be a valuable tool in human orthopaedics research. Recently, veterinary research started taking an interest in the computer modelling approach to understand the forces acting upon the canine musculoskeletal system. While many of the methods employed in human musculoskeletal models can applied to canine musculoskeletal models, not all techniques are applicable. This review summarizes the important parameters necessary for modelling, as well as the techniques employed in human musculoskeletal models and the limitations in transferring techniques to canine modelling research. The major challenges in future canine modelling research are likely to centre around devising alternative techniques for obtaining maximal voluntary contractions, as well as finding scaling factors to adapt a generalized canine musculoskeletal model to represent specific breeds and subjects.
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Nakahara K, Haga-Tsujimura M, Sawada K, Kobayashi E, Schaller B, Saulacic N. Single-staged vs. two-staged implant placement in vertically deficient alveolar ridges using bone ring technique - Part 2: implant osseointegration. Clin Oral Implants Res 2016; 28:e31-e38. [PMID: 27090198 DOI: 10.1111/clr.12851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the osseointegration of implants placed in a single-staged compared to two-staged procedure using bone ring technique. MATERIAL AND METHODS In this study were used standardized, vertical alveolar bone defects in dogs. In the test group, dental implants (Straumann BL® , Basel, Switzerland) were inserted simultaneously with bone ring technique. As control group served implants inserted 6 months following grafting. Implants of both groups were left for an osseointegration period of 3 and 6 months. The peri-implant bone loss and bone-to-implant contact within the bone ring and native bone were analyzed morphometrically. An explorative statistical analysis was performed. RESULTS The peri-implant bone level remained relatively stable within groups and between groups per given time period. Most of bone apposite on the implant surface in two groups was composed of newly formed bone. A nonparametric analysis of variance (ANOVA) revealed no significant advantage for two-staged implant placement for new and total bone, except for residual bone (P = .0084). Furthermore, two groups of implants performed similarly in bone ring and in native bone throughout the observation period. CONCLUSIONS In terms of osseointegration, both techniques are likely equally efficient in the present defect model. The single-staged implant placement with cortical bone grafts warrants further documentation in clinical studies.
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Affiliation(s)
- Ken Nakahara
- Advanced Research Center, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Maiko Haga-Tsujimura
- Department of Histology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Kosaku Sawada
- Advanced Research Center, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Eizaburo Kobayashi
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Benoit Schaller
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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267
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Abstract
The purpose of this study was to compare kinetic, kinematic, and performance variables associated with full and shortened modern backswings in a skilled group of modern swing (one-plane) golfers. Shortening the modern golf backswing is proposed to reduce vertebral spine stress, but supporting evidence is lacking and performance implications are unknown. Thirteen male golfers performed ten swings of each swing type using their own 7-iron club. Biomechanical-dependent variables included the X-Factor kinematic data and spine kinetics. Performance-related dependent variables included club head velocity (CHV), shot distance, and accuracy (distance from the target line). Data were analysed with repeated measures ANOVA with an a priori alpha of 0.05 (SPSS 22.0, IBM, Armonk, NY, USA). We found significant reductions for the X-Factor (p < 0.05) between the full and shortened swings. The shortened swing condition ameliorated vertebral compression force from 7.6 ± 1.4 to 7.0 ± 1.7 N (normalised to body weight, p = 0.01) and significantly reduced CHV (p < 0.05) by ~2 m/s with concomitant shot distance diminution by ~10 m (p < 0.05). Further research is necessary to examine the applicability of a shortened swing for golfers with low back pain.
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Affiliation(s)
- R Barry Dale
- a Department of Physical Therapy, College of Allied Health Professions , University of South Alabama , Mobile , AL , USA
| | - Jason Brumitt
- b School of Physical Therapy , George Fox University , Newberg , OR , USA
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268
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Abstract
Effusions or body cavity fluids are amongst the most commonly submitted samples to the cytology laboratory. Knowledge of proper collection, storage, preservation and processing techniques is essential to ensure proper handling and successful analysis of the sample. This article describes how the effusions should be collected and proper conditions for submission. The different processing techniques to extract the cellular material and prepare slides satisfactory for microscopic evaluation are described such as direct smears, cytospins, liquid based preparations and cell blocks. The article further elaborates on handling the specimens for additional ancillary testing such as immunostaining and molecular tests, including predictive ones, as well as future research approaches.
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Affiliation(s)
- Claire W Michael
- Department of Pathology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
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269
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Yaghi S, Willey JZ, Andrews H, Boehme AK, Marshall RS, Boden-Albala B. The Itemized NIHSS Scores Are Associated With Discharge Disposition in Patients With Minor Stroke. Neurohospitalist 2016; 6:102-6. [PMID: 27366292 DOI: 10.1177/1941874416641466] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE The ability of the National Institutes of Health Stroke Scale (NIHSS) score to predict functional outcome in minor stroke is controversial. In this study, we examined the association of itemized NIHSS score with discharge outcome. METHODS We included all patients with final diagnosis of stroke with an NIHSS score of 0 to 5 untreated with thrombolysis enrolled in the "Stroke Warning Information and Faster Treatment" trial. Individual components of the NIHSS score were the primary predictors. Poor outcome was defined as not being discharged home. Logistic regression was used to identify predictors of outcome. RESULTS A total of 861 patients met the inclusion criteria; 162 (19%) were not discharged home. In multivariable regression, predictors of discharge other than home were age (odds ratio [OR] = 1.02 per year increase, P < .001) and total NIHSS score (OR per unit increase in the NIHSS = 1.51, P < .001). Motor (OR = 2.32, P < .001), level of consciousness (LOC; OR = 6.62, P = .004), and ataxia (OR = 3.10, P < .001) were also associated with not being discharged home. Motor (area under the curve [AUC] 0.623) appeared to be more predictive of poor outcome than ataxia (AUC 0.569) and LOC (AUC 0.517). The total NIHSS had a fair correlation with discharge outcome (AUC 0.683). CONCLUSION Total and itemized NIHSS components have a fair correlation with outcome in minor stroke highlighting the importance of other measures of stroke severity for clinical trials.
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Affiliation(s)
- Shadi Yaghi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University Medical Center, New York, NY, USA; Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joshua Z Willey
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Howard Andrews
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Amelia K Boehme
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Randolph S Marshall
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Bernadette Boden-Albala
- Division of Social Epidemiology, Department of Neurology, Global Institute of Public Health, NYU Langone Medical Center, New York, NY, USA; Department of Epidemiology, College of Dentistry, New York University, New York, NY, USA
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270
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Abstract
BACKGROUND Tracheal extubation in children with difficult airways may be associated with an increased risk of perioperative adverse events. AIMS The aim of this study was to describe the exubation techniques used/ success rates/ adverse events related to tracheal extubation practices in children with difficult airways. METHODS A retrospective analysis of tracheal extubation practices in the difficult airway population over a 78-month period was performed. Difficult airway was defined as a Cormack and Lehane Grade 3 view or greater, and/or tracheal intubation requiring ≥ 3 attempts, and/or the need for an alternate device to direct laryngoscopy for successful tracheal intubation, and/or difficult mask ventilation. Reasons for difficult airway, demographic/surgical data, technique(s) for tracheal extubation, success/failure of tracheal extubation, and adverse events were recorded. A failed tracheal extubation was defined as any adverse event related to the airway occurring within 6 h of extubation requiring reintubation. RESULTS A total of 519 patients were reported to have a difficult airway during this study period in a tertiary care pediatric center. Of these, 137 patients (26%) met inclusion criteria. Tracheal extubation was successfully performed in 130 patients (95%). The majority of tracheal exubations were performed without the use of additional airway adjuncts straight onto anesthesia face mask (121/137; 88%). Extubation failure occurred in seven cases (5%). Among the failed extubations, 6/7 children (85%) had evidence of severe upper airway obstruction and were <10 kg in weight. Of these children, one child required emergency tracheostomy, and two children (one with tracheal stenosis and other with spinal muscular atrophy) suffered from hypoxemic cardiac arrest and anoxic brain damage, respectively, and eventually died. CONCLUSIONS In the studied population of children with difficult airways handled in a tertiary center environment, the majority of tracheal extubations could be performed without the use of airway adjuncts. In a minority of patients, tracheal extubation was associated with severe adverse outcomes.
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Affiliation(s)
- Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Anesthesiology, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
| | - Armin Shivazad
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Anesthesiology, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Kolan
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Anesthesiology, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
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271
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Odei-Lartey EO, Boateng D, Danso S, Kwarteng A, Abokyi L, Amenga-Etego S, Gyaase S, Asante KP, Owusu-Agyei S. The application of a biometric identification technique for linking community and hospital data in rural Ghana. Glob Health Action 2016; 9:29854. [PMID: 26993473 PMCID: PMC4799390 DOI: 10.3402/gha.v9.29854] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/19/2015] [Accepted: 01/19/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. OBJECTIVE Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. DESIGN A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. RESULTS A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. CONCLUSIONS Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.
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Affiliation(s)
| | | | - Samuel Danso
- Kintampo Health Research Centre, Kintampo, Ghana
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272
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Akin Belli A, Dervis E, Kar S, Ergonul O, Gargili A. Revisiting detachment techniques in human-biting ticks. J Am Acad Dermatol 2016; 75:393-7. [PMID: 26944595 DOI: 10.1016/j.jaad.2016.01.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/23/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Early and complete removal of ticks using the right technique is important to reduce tick-transmitted diseases. Several chemical and mechanical detachment techniques have been described previously. OBJECTIVE We aimed to compare the performance of 4 tick-detachment techniques that are widely used in human beings and to determine the optimal method from these techniques. METHODS A cross-sectional study was conducted on 160 patients between April and June 2010. Patients with reported tick bite were reviewed retrospectively and divided into the following 4 groups according to the tick-detachment technique used: card detachment, lassoing, freezing, and tweezers. Performance of each technique was evaluated according to the number of fully detached, nondetached, and crushed ticks and the duration of application. RESULTS Of the 160 tick-bite cases assessed, we found the following efficacy rates: 82.5% (33/40), technique using tweezers; 47.5% (19/40), lassoing technique; 7.5% (3/40), card detachment; and 0% (0/40), freezing technique. The efficacy rate of the technique using tweezers was significantly higher than that of the other 3 techniques (P < .05). LIMITATIONS This was a relatively small sample size and not designed as a randomized clinical trial. CONCLUSION Tick detachment using tweezers, performed in an appropriate manner, is the easiest and most effective technique.
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Affiliation(s)
- Asli Akin Belli
- Department of Dermatology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey.
| | - Emine Dervis
- Department of Dermatology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sirri Kar
- Department of Biology, Namik Kemal University, Tekirdag, Turkey
| | - Onder Ergonul
- Department of Infectious Diseases, Koc University Medical School, Istanbul, Turkey
| | - Aysen Gargili
- Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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273
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Abstract
Central venous catheters are a popular choice for the initiation of hemodialysis or for bridging between different types of access. Despite this, they have many drawbacks including a high morbidity from thrombosis and infection. Advances in technology have allowed placement of these lines relatively safely, and national guidelines have been established to help prevent complications. There is an established algorithm for location and technique for placement that minimizes harm to the patient; however, there are significant short- and long-term complications that proceduralists who place catheters should be able to recognize and manage. This review covers insertion and complications of central venous catheters for hemodialysis, and the social and economic impact of the use of catheters for initiating dialysis is reviewed.
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Affiliation(s)
- Peter R. Bream
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Nephrology, Department of Internal Medicine, Vascular and Interventional Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
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274
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Hatzoglou V, Karimi S, Diamond EL, Lis E, Krol G, Holodny AI, Young RJ. Nonenhancing Leptomeningeal Metastases: Imaging Characteristics and Potential Causative Factors. Neurohospitalist 2016; 6:24-8. [PMID: 26753054 DOI: 10.1177/1941874415591702] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The diagnosis of leptomeningeal metastasis (LM) has increased in frequency, as new therapies have lengthened the survival of patients with cancer. Early diagnosis and intervention help improve quality of life and prevent further neurological deterioration in LM. The detection of LM is often established by magnetic resonance imaging examinations, cerebrospinal fluid analysis, or both. We present a series of cases where LM was identified on fluid-attenuated inversion recovery or T2-weighted image but was nonenhancing on the traditionally more sensitive postcontrast T1-weighted sequences. Nonenhancing LM is unusual and not yet fully understood but should be considered in the appropriate clinical context and may become more common with increased utilization of antiangiogenic therapies.
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Affiliation(s)
- Vaios Hatzoglou
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sasan Karimi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Eric Lis
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - George Krol
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Robert J Young
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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275
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Patel AA, Mahajan A, Benjo A, Jani VB, Annapureddy N, Agarwal SK, Simoes PK, Pakanati KC, Sinha V, Konstantinidis I, Pathak A, Nadkarni GN. A National Perspective of Do-Not-Resuscitate Order Utilization Predictors in Intracerebral Hemorrhage. Neurohospitalist 2016; 6:7-10. [PMID: 26753051 DOI: 10.1177/1941874415599577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Nontraumatic intracerebral hemorrhage (ICH) is associated with substantial morbidity and mortality. Do-not-resuscitate (DNR) orders are linked to poorer outcomes in patients with ICH, possibly due to less active management. Demographic, regional, and social factors, not related to ICH severity, have not been adequately looked at as significant predictors of DNR utilization. We reviewed the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database in 2011 for adult ICH admissions and DNR status. We generated hierarchical 2-level multivariate regression models to estimate adjusted odds ratios. We analyzed 25 768 ICH hospitalizations, 18% of which (4620 hospitalizations) had DNR orders, corresponding to national estimates of 126 254 and 22 668, respectively. In multivariable regression, female gender, white or Hispanic/Latino ethnicity, no insurance coverage, and teaching hospitals were significantly associated with increased DNR utilization after adjusting for confounders. There was also significantly more interhospital variability in the lowest quartile of hospital volume. In conclusion, demographic factors and insurance status are significantly associated with increased DNR utilization, with more individual hospital variability in low-volume hospitals. The reasons for this are likely qualitative and linked to patient, provider, and hospital practices.
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Affiliation(s)
- Achint A Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Alexandre Benjo
- Division of Cardiology, Oschner Clinic Foundation, New Orleans, LA, USA
| | - Vishal B Jani
- Department of Neurology, Michigan State University, East Lansing, MI, USA
| | - Narender Annapureddy
- Division of Rheumatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shiv Kumar Agarwal
- Division of Cardiology, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Priya K Simoes
- Department of Medicine, St. Luke's Roosevelt Medical Center at Mount Sinai, New York, NY, USA
| | | | - Vikash Sinha
- Division of Nephrology, University of Chicago, Chicago, IL, USA
| | | | - Ambarish Pathak
- Department of Public Health, New York Medical College, Valhalla, NY
| | - Girish N Nadkarni
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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276
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Abstract
Cortical spreading depression (CSD) has been associated with many pathological entities including migraine, trauma, hemorrhage, and mitochondrial disease. The clinical diagnosis remains challenging without the other concomitant features such as headache because CSD can mimic seizure or acute stroke. Wereport of a 77 year-old right handed man with a left subdural hematoma evacuation that subsequently developed episodic aphasia, slurred speech, right nasolabial fold flattening, and right pronator drift. In this case report, we discuss our multimodal diagnostic approach and treatment in a patient with episodic aphasia and neurological deficits in order to propose the diagnosis of cortical spreading depression. CSD should be considered when focal deficits in brief episodes occur after stroke and seizures have been ruled out. Treatment choices as illustrated by this case report can have an impact on outcome and resolution of episodes.
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Affiliation(s)
- Nirav H Shah
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David Adams
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
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277
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Hirji SA, Balderson SS, Berry MF, D'Amico TA. Troubleshooting thoracoscopic anterior mediastinal surgery: lessons learned from thoracoscopic lobectomy. Ann Cardiothorac Surg 2015; 4:545-9. [PMID: 26693151 DOI: 10.3978/j.issn.2225-319x.2015.07.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) lobectomy is safe, oncologically effective, and increasingly utilized for lung cancer resection. Lessons from VATS lobectomy experience can guide the use of a VATS approach to resect mediastinal masses. Exposure and dissection when using VATS to resect anterior mediastinal masses has unique challenges. Several maneuvers acquired from experience with VATS lobectomy can reduce the technical difficulty and often prevent conversion to an open approach. In this troubleshooting guide, we offer 'tips' to both avoid and manage numerous intra-operative technical difficulties that commonly arise during VATS anterior mediastinal procedures. Avoiding an open approach may improve outcomes, although conversion for safety or complete resection can be necessary. Techniques and experiences derived from VATS lobectomy can facilitate VATS resection of mediastinal masses.
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Affiliation(s)
- Sameer A Hirji
- 1 Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA ; 2 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott S Balderson
- 1 Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA ; 2 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark F Berry
- 1 Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA ; 2 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Thomas A D'Amico
- 1 Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA ; 2 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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278
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Abstract
BACKGROUND Lower airway foreign matter (FM) is uncommonly encountered in adults. This study reviews FM in the lower airway that required bronchoscopic intervention. METHODS A retrospective review of patients with FM in the lower airway seen at a tertiary hospital between 1996 and 2014 was undertaken. RESULTS Lower airway FM was removed in 80 out of 18,650 bronchoscopies performed. Forty-seven were males, with mean age of 50.8 (range, 29-78) years and mean symptom duration of 10.3 months (range, 1 day -20 years). The most common symptoms were persistent cough, followed by dyspnea, hemoptysis, episodes of choking and fever. Three-quarters of the patients had risk factors of either aspiration or iatrogenic cause for FM in the airway. FM identified following bronchoscopy was classified as: organic (31.3%), inorganic (46.3%) and endogenous matter (22.4%). Iatrogenic etiology was evident in four-fifths of the patients with inorganic FM (stents being the most common). Forty-eight (60.0%) patients had FM removed via flexible bronchoscopy, and the remainder via rigid bronchoscopy. The majority (27 out of 32) of FM removed by rigid bronchoscopy could not be removed using the flexible scope. This was primarily due to retrieval of stents [24] could only be done with the rigid bronchoscope. There were four FM-related complications (three bronchostenosis, one actinomycosis). CONCLUSIONS There is an increasing indication for bronchoscopists to retrieve FM, particularly of iatrogenic and endogenous sources, lodging in the lower airway of adults. There may be a reversing trend in the utilization of rigid bronchoscopy, mainly due to the increasing need to remove airway stents as more are deployed.
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Affiliation(s)
- Anne Ann Ling Hsu
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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279
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Abstract
Lung isolation is being used more frequently in both adult and paediatric age groups due to increasing incidence of thoracoscopy and video-assisted thoracoscopic surgery in these patients. Various indications for lung isolation and one-lung ventilation include surgical and non-surgical reasons. Isolation can be achieved by double-lumen endotracheal tubes or bronchial blocker. Different issues arise in prone and semi-prone position. The management of hypoxia with lung isolation is a stepwise drill of adding inhaled oxygen, adding positive end-expiratory pressure to ventilated lung and continuous positive airway pressure to non-ventilated side.
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Affiliation(s)
- Atul Purohit
- Department of Anaesthesiology, SIDSS, Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India
| | - Suresh Bhargava
- Department of Anesthesia and Critical Care, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
| | - Vandana Mangal
- Department of Anesthesia, SMS Medical College, Jaipur, Rajasthan, India
| | - Vinod Kumar Parashar
- Department of Anaesthesiology, SIDSS, Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India
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280
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Abstract
Three cases of longitudinally extensive cervical myelopathies temporally associated with neck injections are presented. The spinal cord injury was similar radiographically, despite a number of different needle approaches and substances injected. In recent years, there have been reports of an acute cervical myelopathy immediately following an injection procedure in the neck. Various explanations have been offered for this unfortunate complication, including (1) direct injection into the cord leading to traumatic injury, (2) injection of particulate matter into the arterial supply of the cord causing microvascular embolism and spinal cord infarction, and (3) intraneural injection of the chemical with centripetal spread of the injectant from the nerve trunk to the substance of the cord. The merits of each of these 3 mechanisms in explaining these cases are discussed. Albeit rare, acute cervical myelopathy should be considered a potential complication from any deep injection of chemicals into the neck.
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281
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Abstract
Data from randomized clinical trials have supported the safety and efficacy of intravenous tissue-type plasminogen activator (IV tPA) for acute ischemic stroke when administered within 3 hours of symptom onset, and regulatory approvals for this indication have been in place for almost 20 years. However, recent clinical trials have provided evidence that IV tPA may be safe and effective in selected patients up to 4.5 hours after symptom onset, thereby increasing the proportion of patients that may be eligible for treatment. Although professional organizations in the United States and many regulatory agencies internationally have supported this expanded time window for IV tPA, the US Food and Drug Administration has declined to approve this expanded indication and so this use of IV tPA has remained off-label in the United States. Here we review the current evidence for IV tPA in the standard and the expanded time windows and the data on current clinical practice in the United States as it relates to IV tPA treatment for acute stroke within 3 to 4.5 hours of symptom onset.
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Affiliation(s)
- Natalie T Cheng
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Anthony S Kim
- Department of Neurology, University of California, San Francisco, CA, USA
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282
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Hurley-Walker N, Galvin TJ, Duchesne SW, Zhang X, Morgan J, Hancock PJ, An T, Franzen TMO, Heald G, Ross K, Vernstrom T, Anderson GE, Gaensler BM, Johnston-Hollitt M, Kaplan DL, Riseley CJ, Tingay SJ, Walker M. GaLactic and Extragalactic All-sky Murchison Widefield Array survey eXtended (GLEAM-X) I: Survey Description and Initial Data Release. Publ Astron Soc Aust 2015; 32:e025. [PMID: 35494410 PMCID: PMC7612673 DOI: 10.1017/pasa.2015.26] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We describe a new low-frequency wideband radio survey of the southern sky. Observations covering 72-231MHz and Declinations south of +30° have been performed with the Murchison Widefield Array "extended" Phase I I configuration over 2018-2020 and will be processed to form data products including continuum and polarisation images and mosaics, multi-frequency catalogues, transient search data, and ionospheric measurements. From a pilot field described in this work, we publish an initial data release covering 1,447 deg2 over 4 h≤ RA≤ 13 h, -32.7° ≤ Dec ≤ -20.7°. We process twenty frequency bands sampling 72-231 MHz, with a resolution of 2'-45″, and produce a wideband source-finding image across 170-231MHz with a root-mean-square noise of 1.27 ± 0.15 mJy beam-1. Source-finding yields 79,124 components, of which 71,320 are fitted spectrally. The catalogue has a completeness of 98% at ~ 50 mJy, and a reliability of 98.2% at 5σ rising to 99.7% at 7σ. A catalogue is available from Vizier; images are made available on the GLEAM-X VO server and SkyView. This is the first in a series of data releases from the GLEAM-X survey.
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Affiliation(s)
- N Hurley-Walker
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - T J Galvin
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
- CSIRO Space & Astronomy, PO Box 1130, Bentley WA 6102, Australia
| | - S W Duchesne
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
- CSIRO Space & Astronomy, PO Box 1130, Bentley WA 6102, Australia
| | - X Zhang
- CSIRO Space & Astronomy, PO Box 1130, Bentley WA 6102, Australia
- Shanghai Astronomical Observatory, Chinese Academy of Sciences, 80 Nandan Rd, Shanghai, 200030, China
| | - J Morgan
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - P J Hancock
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
- Curtin Institute for Computation, Curtin University, GPO Box U1987, Perth WA 6845
| | - T An
- Shanghai Astronomical Observatory, Chinese Academy of Sciences, 80 Nandan Rd, Shanghai, 200030, China
| | - T M O Franzen
- ASTRON, Netherlands Institute for Radio Astronomy, Oude Hoogeveensedijk 4, 7991 PD, Dwingeloo, The Netherlands
| | - G Heald
- CSIRO Space & Astronomy, PO Box 1130, Bentley WA 6102, Australia
| | - K Ross
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - T Vernstrom
- CSIRO Space & Astronomy, PO Box 1130, Bentley WA 6102, Australia
- International Centre for Radio Astronomy Research, The University of Western Australia, 35 Stirling Hwy, 6009 Crawley, Australia
| | - G E Anderson
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - B M Gaensler
- Dunlap Institute for Astronomy and Astrophysics, 50 St. George St, University of Toronto, ON M5S 3H4, Canada
| | - M Johnston-Hollitt
- Curtin Institute for Computation, Curtin University, GPO Box U1987, Perth WA 6845
| | - D L Kaplan
- Department of Physics, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA
| | - C J Riseley
- CSIRO Space & Astronomy, PO Box 1130, Bentley WA 6102, Australia
- Dipartimento di Fisica e Astronomia, Università degli Studi di Bologna, via P. Gobetti 93/2, 40129 Bologna, Italy
- INAF - Istituto di Radioastronomia, via P. Gobetti 101, 40129 Bologna, Italy
| | - S J Tingay
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - M Walker
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
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283
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Abstract
Clinical educators face the challenge of simultaneously caring for patients and teaching learners, often with an unpredictable caseload and learners of varied abilities. They also often have little control over the organization of their time. Effective clinical teaching must encourage student participation, problem solving, integration of basic and clinical knowledge, and deliberate practice. Close supervision and timely feedback are also essential. Just as one develops an effective lecture through training and practice, clinical teaching effectiveness may also be improved by using specific skills to teach in small increments. The purpose of this paper is to identify potential teachable moments and to describe efficient instructional methods to use in the clinical setting under time constraints. These techniques include asking better questions, performing focused observations, thinking aloud, and modeling reflection. Different frameworks for teaching encounters during case presentations can be selected according to learner ability and available time. These methods include modeling and deconstructing the concrete experience; guiding the thinking and reflecting process; and providing the setting and opportunity for active practice. Use of these educational strategies encourages the learner to acquire knowledge, clinical reasoning, and technical skills, and also values, attitudes, and professional judgment.
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284
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Barbaric K, Rujevcan G, Labas M, Delimar D, Bicanic G. Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature. Open Orthop J 2015; 9:98-106. [PMID: 26157524 PMCID: PMC4484233 DOI: 10.2174/1874325001509010098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 02/19/2015] [Accepted: 03/28/2015] [Indexed: 11/22/2022] Open
Abstract
Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure.
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Affiliation(s)
- Katarina Barbaric
- Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, Salata 6, 10000, Zagreb, Croatia
| | - Gordan Rujevcan
- Department of Orthopaedic Surgery, General Hospital "Dr. Ivo Pedisic" Sisak, J. J. Strossmayera 59, 44000 Sisak, Croatia
| | - Marko Labas
- Department of Orthopaedic Surgery and Traumatology, General Hospital Varazdin, Ivana Mestrovica 2, 42000 Varazdin, Croatia
| | - Domagoj Delimar
- Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Salata 6-7, 10000 Zagreb, Croatia
| | - Goran Bicanic
- Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Salata 6-7, 10000 Zagreb, Croatia
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285
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Abstract
Lasers are the standard modality for tattoo removal. Though there are various factors that determine the results, we have divided them into three logical headings, laser dependant factors such as type of laser and beam modifications, tattoo dependent factors like size and depth, colour of pigment and lastly host dependent factors, which includes primarily the presence of a robust immune response. Modifications in the existing techniques may help in better clinical outcome with minimal risk of complications. This article provides an insight into some of these techniques along with a detailed account of the factors involved in tattoo removal.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Maulana Azad Medical College, Delhi, India
| | - Rashmi Ranjan
- Department of Dermatology, Maulana Azad Medical College, Delhi, India
| | - Sneha Ghunawat
- Department of Dermatology, Maulana Azad Medical College, Delhi, India
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286
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Abstract
The inferior alveolar nerve block is the most common injection technique used in dentistry and many modifications of the conventional nerve block have been recently described in the literature. Selecting the best technique by the dentist or surgeon depends on many factors including the success rate and complications related to the selected technique. Dentists should be aware of the available current modifications of the inferior alveolar nerve block techniques in order to effectively choose between these modifications. Some operators may encounter difficulty in identifying the anatomical landmarks which are useful in applying the inferior alveolar nerve block and rely instead on assumptions as to where the needle should be positioned. Such assumptions can lead to failure and the failure rate of inferior alveolar nerve block has been reported to be 20-25% which is considered very high. In this basic review, the anatomical details of the inferior alveolar nerve will be given together with a description of its both conventional and modified blocking techniques; in addition, an overview of the complications which may result from the application of this important technique will be mentioned.
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Affiliation(s)
- Hesham Khalil
- Department of Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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287
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Liu X, Zhu L, Wang Z, Cui D, Chen H, Wei L, Wu Y, Rong R, Wu Y, Yao Q, Zhang Z, Cibas ES, Alexander EK, Yang T. Comparison of two different standards of care in detecting malignant thyroid nodules using thyroid fine-needle aspiration. Mol Clin Oncol 2015; 3:682-686. [PMID: 26137287 DOI: 10.3892/mco.2015.491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/13/2015] [Indexed: 01/21/2023] Open
Abstract
The aim of the present study was to verify the optimal method to obtain enough fine-needle aspiration (FNA) materials for detecting thyroid malignancy. A prospective study was performed by comparing two different regional standards of care. In one group a traditional FNA method mainly used in Asian countries, including China, was performed in which a single pass of a 22-G needle was applied with or without aspiration. In the other group, the method mainly used in Western countries was performed in which three passes of a 25-G needle with non-aspiration were undertaken for thyroid nodules. The study included 718 thyroid nodules from 695 patients. These nodules were allocated for three different methods of performing thyroid FNA. There were 332 thyroid nodules subjected to the traditional Asian FNA method using a 22-G needle with aspiration for 142 nodules and non-aspiration for 190 nodules. FNA using the Western method was performed with three passes of non-aspiration using 25 G for 386 nodules. All the FNAs were performed with the guidance of ultrasound. The components of the nodules were documented. All the samples were reported using the Bethesda System for Reporting Thyroid Cytopathology. Among the 22 G group, the non-diagnostic rate in the aspiration group was as high as 76.76%, which was significantly higher than 44.21% in the non-aspiration group (P<0.01). For the non-aspiration group, the non-diagnostic rate in the 25 G group was 34.97%, which was significantly lower than 44.21% in the 22 G group. In general, the non-diagnostic rate for the 25-G needle was 34.97%, which was significantly lower than 58.13% in all the 22 G groups. For the solid and mixed nodules, the non-diagnostic rate was lower in the 25-G needle group compared to the 22 G groups with statistical significance. The non-aspiration method using a 25-G needle with multiple passes can result in a higher diagnostic rate for thyroid FNA.
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Affiliation(s)
- Xiaoyun Liu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Lijun Zhu
- Department of Children's Health Care, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Zhixiao Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Dai Cui
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Huanhuan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Ling Wei
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yunsong Wu
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Rong Rong
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yan Wu
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Qing Yao
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Zhihong Zhang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Edmund S Cibas
- Division of Cytology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Erik K Alexander
- Thyroid Unit, Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
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288
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Affiliation(s)
- Jonathan L Zande
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Muhammad U Farooq
- Division of Stroke and Vascular Neurology, Hauenstein Neuroscience Center, Saint Mary's Health Care, Grand Rapids, MI, USA
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289
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Burish MJ, Thoren KL, Madou M, Toossi S, Shah M. Hallucinogens causing seizures? A case report of the synthetic amphetamine 2,5-dimethoxy-4-chloroamphetamine. Neurohospitalist 2015; 5:32-4. [PMID: 25553227 DOI: 10.1177/1941874414528939] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although traditional hallucinogenic drugs such as marijuana and lysergic acid diethylamide (LSD) are not typically associated with seizures, newer synthetic hallucinogenic drugs can provoke seizures. Here, we report the unexpected consequences of taking a street-bought hallucinogenic drug thought to be LSD. Our patient presented with hallucinations and agitation progressing to status epilepticus with a urine toxicology screen positive only for cannabinoids and opioids. Using liquid chromatography high-resolution mass spectrometry, an additional drug was found: an amphetamine-derived phenylethylamine called 2,5-dimethoxy-4-chloroamphetamine. We bring this to the attention of the neurologic community as there are a growing number of hallucinogenic street drugs that are negative on standard urine toxicology and cause effects that are unexpected for both the patient and the neurologist, including seizures.
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Affiliation(s)
- Mark J Burish
- Department of Neurology, University of California-San Francisco, San Francisco, CA, USA
| | - Katie L Thoren
- Department of Laboratory Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Maura Madou
- Department of Neurology, University of California-San Francisco, San Francisco, CA, USA
| | - Shahed Toossi
- Department of Neurology, University of California-San Francisco, San Francisco, CA, USA
| | - Maulik Shah
- Department of Neurology, University of California-San Francisco, San Francisco, CA, USA
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290
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Kleine SA, Quandt JE, Hofmeister EH, Peroni J. The effect of midazolam on the recovery quality, recovery time and the minimum alveolar concentration for extubation in the isoflurane-anesthetized pig. Lab Anim 2014; 49:111-6. [PMID: 25378139 DOI: 10.1177/0023677214556668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are no reported studies evaluating the effect of midazolam on recovery quality, recovery time or minimum alveolar concentration (MAC) at which extubation occurs (MAC extubation). Our hypotheses were that midazolam administered prior to recovery would decrease MAC extubation, prolong recovery time but provide a smoother recovery. Sixteen Yorkshire pigs were anesthetized with isoflurane for approximately 5 h. The end-tidal isoflurane concentration was then stabilized at 1.4% for 20 min. Pigs were randomly assigned to receive midazolam or saline. The vaporizer was decreased by 10% every 10 min until extubation. Pigs were declared awake by a blinded observer and were assigned a recovery score by the same observer. Mean MAC extubation was not significantly different for pigs receiving saline prior to recovery compared with those pigs receiving midazolam. The overall mean MAC extubation for both groups was 0.6 ± 0.4 vol%. Time to extubation was not significantly longer with midazolam (124 ± 36 min) compared with the saline group (96 ± 61 min; P = 0.09). Recovery score was not significantly different between groups (midazolam, 0.86 ± 1.1; saline 0.5 ± 0.5; P = 0.26). In conclusion, midazolam did not affect MAC extubation. There was no advantage of administering midazolam in the recovery period when performing step-down titration of isoflurane anesthesia.
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Affiliation(s)
- S A Kleine
- Department of Small Animal Medicine and Surgery
| | - J E Quandt
- Department of Small Animal Medicine and Surgery
| | | | - J Peroni
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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291
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Abstract
The results of 144 congenital syndactyly releases over a 12-year period by a single surgeon using a modified Flatt technique (dorsal hourglass flap, interdigitating zigzag flaps, and full-thickness skin grafts) are analyzed considering the association of skin grafts and web creep. The mean follow-up was 5 years. There were seven cases of graft failure, only one of which developed web creep. Web creep occurred in 4.2% of web releases. The results suggest that avoiding longitudinal straight-line scars across the web space may be an important factor in avoiding web creep when performing the modified Flatt technique described.
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Affiliation(s)
- A G Barabás
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK
| | - M A Pickford
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK
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292
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Abstract
Five year survival rates for lung cancer patients are poor; however the development of new therapeutic options, which benefit subsets of the population, offer hope of improvement. These novel therapies frequently rely upon the analysis of biomarkers in pathology samples; in lung cancer patients, testing is now routinely carried out to identify small mutations and chromosomal rearrangements in order to predict response to treatment. The recent increase in biomarker analyses in pathology samples has lead to the development of a new specialty, molecular pathology. The use of molecular pathology assays in clinical samples is largely under the control of the histopathologist; who is likely to be asked, as a minimum, to select tissue sections for molecular analysis and mark areas of H&E stained slides for macro or microdissection. Many histopathologists will also be involved in the sourcing and implementation of new assays. This review aims to provide a guide to some of the most commonly used molecular pathology methods - their advantages and their limitations.
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Affiliation(s)
- Kathy Walsh
- Pathology, Division of Laboratory Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
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293
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Abstract
Trials are still on the way to evaluate different non-surgical techniques to treat early breast cancer with achieving maximum oncological control and aesthetic outcome. Also these techniques can help old patients to bypass surgical and radiation complications and facilitate the treatment of early breast cancer with minimum side effects.
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Affiliation(s)
- Alaa Hamza
- 1 General Surgery Department, Medical Research Institute, Alexandria University, Egypt ; 2 Division of Plastic Surgery, European Institute of Oncology, 435-20141 Milano, Italy ; 3 Faculity of medicine, Alexandria University, Egypt
| | - Shymaa Elrefaey
- 1 General Surgery Department, Medical Research Institute, Alexandria University, Egypt ; 2 Division of Plastic Surgery, European Institute of Oncology, 435-20141 Milano, Italy ; 3 Faculity of medicine, Alexandria University, Egypt
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294
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Alshamari M, Geijer M, Norrman E, Geijer H. Low-dose computed tomography of the lumbar spine: a phantom study on imaging parameters and image quality. Acta Radiol 2014; 55:824-32. [PMID: 24215904 DOI: 10.1177/0284185113509615] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lumbar spine radiography has limited diagnostic value but low radiation dose compared with computed tomography (CT). The average effective radiation dose from lumbar spine radiography is about 1.1 mSv. Low-dose lumbar spine CT may be an alternative to increase the diagnostic value at low radiation dose, around 1 mSv. PURPOSE To determine the optimal settings for low-dose lumbar spine CT simultaneously aiming for the highest diagnostic image quality possible. MATERIAL AND METHODS An ovine lower thoracic and lumbar spine phantom, with all soft tissues around the vertebrae preserved except the skin, was placed in a 20 L plastic container filled with water. The phantom was scanned repeatedly with various technical settings; different tube potential, reference mAs, and with different convolution filters. Five radiologists evaluated the image quality according to a modification of the European guidelines for multislice computed tomography (MSCT) quality criteria for lumbar spine CT 2004. In a visual comparison the different scans were also ranked subjectively according to perceived image quality. Image noise and contrast were measured. RESULTS A tube potential of 120 kV with reference mAs 30 and medium or medium smooth convolution filter gave the best image quality at a sub-millisievert dose level, i.e. with an effective dose comparable to that from lumbar spine radiography. CONCLUSION Low-dose lumbar spine CT thus opens a possibility to substitute lumbar spine radiography with CT without obvious increase in radiation dose.
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Affiliation(s)
- Muhammed Alshamari
- Department of Radiology, Örebro University Hospital and Department of Health and Medical Sciences, Örebro University, Sweden
| | - Mats Geijer
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Lund University, Sweden
| | - Eva Norrman
- Department of Medical Physics, Örebro University Hospital, Sweden
| | - Håkan Geijer
- Department of Radiology, Örebro University Hospital and Department of Health and Medical Sciences, Örebro University, Sweden
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295
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Abstract
Olecranon fractures are common upper extremity injuries. The vast majority are treated with operative fixation. Many treatment techniques have been described including tension band and plating. This review covers the most commonly used fixation techniques in detail, including pearls and pitfalls with case examples of both successful treatments and potential complications.
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296
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Varghese E, Kundu R. Does the Miller blade truly provide a better laryngoscopic view and intubating conditions than the Macintosh blade in small children? Paediatr Anaesth 2014; 24:825-9. [PMID: 24690084 DOI: 10.1111/pan.12394] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Both Miller and Macintosh blades are widely used for laryngoscopy in small children, though the Miller blade is more commonly recommended in pediatric anesthetic literature. The aim of this study was to compare laryngoscopic views and ease and success of intubation with Macintosh and Miller blades in small children under general anesthesia. MATERIALS AND METHOD One hundred and twenty children aged 1-24 months were randomized for laryngoscopy to be performed in a crossover manner with either the Miller or the Macintosh blade first, following induction of anesthesia and neuromuscular blockade. The tips of both the blades were placed at the vallecula. Intubation was performed following the second laryngoscopy. The glottic views with and without external laryngeal maneuver (ELM) and ease of intubation were observed. RESULTS Similar glottic views with both blades were observed in 52/120 (43%) children, a better view observed with the Miller blade in 35/120 (29%) children, and with the Macintosh blade in 33/120 (28%). Laryngoscopy was easy in 65/120 (54%) children with both the blades. Restricted laryngoscopy was noted in 55 children: in 27 children with both the blades, 15 with Miller, and 13 with Macintosh blade. Laryngoscopic view improved following ELM with both the blades. CONCLUSION In children aged 1-24 months, the Miller and the Macintosh blades provide similar laryngoscopic views and intubating conditions. When a restricted view is obtained, a change of blade may provide a better view. Placing the tip of the Miller blade in the vallecula provides satisfactory intubating conditions in this age group.
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Affiliation(s)
- Elsa Varghese
- Department of Anaesthesiology, Kasturba Medical College & Hospital, Manipal University, Manipal, India
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297
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Abstract
OBJECTIVE We sought to better understand the potential impact of the burgeoning neurohospitalist model of inpatient care on education of neurology residents and to better define possible roles for "neurohospitalists" in residency education. METHOD We designed a brief qualitative open-ended survey directed toward academic leaders in neurology and distributed it by e-mail to every academic neurology department in the United States and Canada. RESULTS Of 83 respondents, 36 (43%) had an active neurohospitalist program and only 10% felt certain they would not have 1 within the next 5 years. All respondents expected to have residents continue to be involved with inpatient care. The main perceived advantage for resident education associated with neurohospitalists was inpatient care expertise, and the main expected disadvantage was decreased exposure to subspecialty attendings. The majority anticipated positive impact on all Accreditation Council for Graduate Medical Education core competencies predominantly based on neurohospitalists' expertise in the inpatient setting. CONCLUSION The majority of academic neurology departments are expected to have a neurohospitalist program within the next 5 years. There are several perceived advantages and disadvantages to such a program for education of neurology residents. In general, the impact of these programs is expected to improve resident education. Regardless of expectations, neurohospitalists will likely play a prominent role in the education of the next generation of neurologists.
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Affiliation(s)
- Naymee Velez-Ruiz
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jaffar Khan
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - James G Greene
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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298
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Shaik S, Chhetri SK, Roberts G, Wuppalapati S, Emsley HCA. Reversible cerebral vasoconstriction syndrome with involvement of external carotid artery branches. Neurohospitalist 2014; 4:141-3. [PMID: 24982719 DOI: 10.1177/1941874413518639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 44-year-old woman presented with recurrent episodes of thunderclap headache. Neurological examination and computed tomography brain imaging were unremarkable. Cerebrospinal fluid findings were consistent with subarachnoid hemorrhage. Computed tomography angiography of the circle of Willis showed multiple areas of segmental vasoconstriction. This finding was confirmed on cerebral catheter angiography, with segmental vasoconstriction involving bilateral internal carotid, posterior cerebral, and external carotid branches. No aneurysm or other vascular abnormality was identified. She received treatment with nimodipine. A selective serotonin reuptake inhibitor, started 4 weeks earlier, was discontinued. Follow-up angiography after 3 months demonstrated complete resolution of the segmental vasoconstriction, confirming the diagnosis of reversible cerebral vasoconstriction syndrome (RCVS). She remained headache free at follow-up. To our knowledge, external carotid artery branch involvement in RCVS has been described only in one previous occasion.
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Affiliation(s)
- S Shaik
- Department of Neurology, Royal Preston Hospital, Preston, United Kingdom
| | - S K Chhetri
- Department of Neurology, Royal Preston Hospital, Preston, United Kingdom ; The University of Manchester, Manchester Academic Health Science Centre, UK
| | - G Roberts
- Department of Neurosurgery, Royal Preston Hospital, Preston, United Kingdom
| | - S Wuppalapati
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - H C A Emsley
- Department of Neurology, Royal Preston Hospital, Preston, United Kingdom ; School of Medicine, University of Manchester, United Kingdom
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299
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Abstract
Prognostication of patients who remain comatose following successful resuscitation after cardiac arrest has long posed a challenge for the consulting neurologist. With increasing rates of early defibrillation, out-of-hospital cardiopulmonary resuscitation, and expanding use of therapeutic hypothermia, prognostication in hypoxic-ischemic encephalopathy has become an increasingly common consult for neurologists. Much of the data we previously relied upon for prognostication were taken from patients who were not treated with therapeutic hypothermia. In this review, we examine useful prognostic tools and markers, including the physical examination, evaluation of myoclonus, electroencephalogram monitoring, somatosensory-evoked potentials, biochemical markers of neuronal injury, and neuroimaging. Neurologists must avoid overly pessimistic prognostic statements regarding survival, awakening from coma, or future quality of life, as such statements may unduly influence decisions regarding the continuation of life-sustaining treatment. Conversely, continuation of aggressive medical management in a patient without any hope of awakening should also be avoided. Thus, an understanding of the utility and the limitations of these prognostic tools in the era of therapeutic hypothermia is essential.
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Affiliation(s)
| | | | - Sandeep Khot
- Department of Neurology, Harborview Medical Center, Seattle, WA, USA
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Karnatovskaia LV, Wartenberg KE, Freeman WD. Therapeutic hypothermia for neuroprotection: history, mechanisms, risks, and clinical applications. Neurohospitalist 2014; 4:153-63. [PMID: 24982721 DOI: 10.1177/1941874413519802] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The earliest recorded application of therapeutic hypothermia in medicine spans about 5000 years; however, its use has become widespread since 2002, following the demonstration of both safety and efficacy of regimens requiring only a mild (32°C-35°C) degree of cooling after cardiac arrest. We review the mechanisms by which hypothermia confers neuroprotection as well as its physiological effects by body system and its associated risks. With regard to clinical applications, we present evidence on the role of hypothermia in traumatic brain injury, intracranial pressure elevation, stroke, subarachnoid hemorrhage, spinal cord injury, hepatic encephalopathy, and neonatal peripartum encephalopathy. Based on the current knowledge and areas undergoing or in need of further exploration, we feel that therapeutic hypothermia holds promise in the treatment of patients with various forms of neurologic injury; however, additional quality studies are needed before its true role is fully known.
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Affiliation(s)
| | - Katja E Wartenberg
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Germany
| | - William D Freeman
- Departments of Neurology, Neurosurgery, Critical Care, Mayo Clinic, Jacksonville, FL, USA
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