bluuebunny/crossref_metadata_2025 huggingface dataset:
Headache
Authors: Krel Regina , Mathew Paul G.
Published: May 2017

Migraine is a common disorder that affects women of menstruating age, and it is frequently the chief complaint of women presenting in the neurology clinic. The prevalence of menstrually related migraine can range from 20–60%, while pure menstrual migraine occurs in less than 10% of women. In addition to utilizing non–gender-specific abortive and preventative strategies, understanding migraine and its relationship to hormones, particularly estrogen, can have clinical implications for optimal treatment. This chapter seeks to provide insight into diagnosing menstrually related migraine, the role of decreased estrogen just prior to menstrual cycle onset and migraine, as well as the therapeutic options that are available to treat and possibly prevent menstrual migraine attacks.
Pain in the Back
Authors: O’Neal M. Angela
Published: May 2017

This case explores how bone health can be affected by antiepileptic drugs (AEDs), and why this is an important issue in women with epilepsy (WWE). AEDs affect bone health through activation of the cytochrome P450 system in the liver, leading to increased metabolism of vitamin D. The enzyme-inducing AEDs include phenytoin, carbamazepine, phenobarbital, and primidone. Risk factors for osteoporosis include female gender, low body mass, inadequate vitamin D intake, and smoking. The specific AEDs used and the length of treatment confer additional risks. Furthermore, in WWE, risks are magnified related to falls, either from seizures or related to medication toxicity. Screening with bone density and measures to promote bone health are extremely important in these at-risk women.
Newlywed with Headache, Morning Sickness, and Subjective Right-side Weakness
Authors: Gatson Na Tosha N. , Woodard Terri L.
Published: May 2017

The chapter on infertility associated with cancer treatment examines key ethical issues in delivery of cancer care. Early signs and symptoms of a developing brain tumor are not always disturbing enough to alarm the patient to seek medical attention. Cause for delay in time-to-diagnosis is usually multifactorial, and unfortunately, risks worsening of the tumor condition. Initiation of treatment, however, must always be deferred until the patient has been informed of the risks and benefits of available therapies. This is especially true when the therapy could limit the patient’s fertility. Physicians must be diligent in their understanding and communication of the medical, social, and ethical aspects of treating cancer, as treatment might impact the patient’s overall survivorship and quality of life.
Routine Long-Term Epilepsy Follow-up
Authors: Gatson Na Tosha N.
Published: May 2017

The chapter on teratogenic medication examines key clinical considerations for evaluating and treating reproductive-aged women on therapies with high reproductive risk factors. Physicians should frequently reexamine the appropriateness of using potentially harmful therapies in their patient population. The U.S. Food and Drug Administration (FDA) recently revised the “Pregnancy and Lactation Labeling Rule” to assist providers in evaluating drug risks to pregnant or nursing mothers. Reproductive-aged women on anti-epileptic drugs (AEDs) might experience challenges related to medication noncompliance, unknown drug–drug interactions, and unintended pregnancy. Therefore, it is important for clinicians to frequently educate and interview their patients about reproductive planning, prevention, and medication risks. Modifying, supplementing, or discontinuing medical therapy when appropriate should also be addressed at each visit.
A Young Woman with Infertility
Authors: Lovett Alexandra , Woodmansee Whitney W.
Published: May 2017

Prolactinomas are pituitary adenomas that are prolactin-secreting and can lead to galactorrhea, amenorrhea, and infertility. These symptoms often cause women to present earlier than their male counterparts, who are more likely to develop headaches and visual field deficits. Hyperprolactinemia warrants a thorough workup, which should include pregnancy testing, a thyroid-stimulating hormone level, and a thorough review of the patient’s medications. A pituitary-protocoled magnetic resonance image (MRI) with gadolinium should then be performed to look for an adenoma. Prolactinomas can be watched with surveillance levels and imaging or treated with dopaminergic agonists. Treatment resistance is uncommon, though if it occurs, transsphenoidal resection and/or radiation therapy can be considered.
What Imaging Test Do I Order?
Authors: O’Neal M. Angela
Published: May 2017

The case illustrates how to approach imaging in pregnancy. Some basic principles of radiation exposure are reviewed. The effects of radiation are divided into either deterministic, dose-related, or stochastic, where exposure determines the probability of an outcome. Deterministic effects have a threshold below which the effect does not occur. The threshold may be small and may vary from person to person; whereas stochastic effects occur by chance and may occur without a threshold level. Cancer caused by radiation is an example of a stochastic effect. The overall safety of magnetic resonance imaging is discussed. Determining which imaging modality to order depends on the acuity of the situation and the information needed to know in order to adequately treat the mother.
Postpartum Visual Disturbance
Authors: O’Neal M. Angela
Published: May 2017

Preeclampsia (PE) is a multi-organ system disorder defined as hypertension with blood pressures greater than 140/90 on two occasions and proteinuria of more than 300 mg/24 hours. Eclampsia is defined as when seizures occur in a woman with preeclampsia. The pathophysiology of preeclampsia/eclampsia is felt to be related to incomplete penetration of the cytotrophoblasts of the placenta into the myometrium, leading to local ischemia, propagation of ischemic factors causing hypertension, resulting in endothelial dysfunction. The clinical features are related to which end organ is involved: in the kidney, proteinuria; in the liver, coagulopathy; and in the brain, posterior white matter dysfunction. The involvement of the parietal and occipital lobes explains the associated neurological features of confusion and visual changes. MRI reflects the white matter changes associated with eclampsia in posterior reversible encephalopathy syndrome (PRES). Eclampsia is treated with blood pressure control and magnesium to treat the seizures.
Weakness in the Hand of a Woman During Pregnancy
Authors: Waters Janet
Published: May 2017

Carpal tunnel syndrome is the most common neuropathy experienced by pregnant women. It has an incidence of 3.4% in the general population in the United States. It occurs more frequently in pregnant women than in the general population, with an incidence of 17%. It is the most common mononeuropathy in pregnant women. This chapter covers the symptoms and signs that allow a clinician to make the diagnosis of carpal tunnel syndrome. Neuroanatomy and physiological changes that predispose pregnant women to this disorder are described. Management and prognosis of carpal tunnel syndrome in pregnancy are discussed: conservative management with wrist splints worn at night is effective in over 80% of patients. Local steroid injections can provide relief in patients with severe symptoms.
A Woman with Leg Weakness after Delivery
Authors: Waters Janet
Published: May 2017

This chapter on femoral neuropathy in pregnancy describes how to recognize the clinical syndrome of femoral neuropathy in the postpartum patient. Hallmarks of femoral neuropathy include legs buckling due to weakness in hip flexors and knee extensors, numbness and paresthesias in the anteromedial thigh, and reduced or absent patellar reflex. The chapter discusses how one can distinguish the disorder from other postpartum mononeuropathies, as well as from other, more ominous causes of postpartum leg weakness, such as epidural hematoma, retroperitoneal hematoma, anterior spinal artery syndrome, injury to the conus medullaris during administration of neuraxial block, and various obstetrical nerve injuries. Treatment and prognosis of femoral neuropathy are outlined.
A Young Woman with Double Vision and Fatigue
Authors: Waters Janet
Published: May 2017

This chapter describes the effects of pregnancy on the disease course of myasthenia gravis. It is unmasked or exacerbated in one-third of pregnant women, with worsening symptoms occurring most commonly during the first trimester, the last four weeks of gestation, during delivery, and in the postpartum period. The chapter lists options for treatment, including medications, IVIG, and plasmapheresis, and points out the risks and benefits of each choice. It discusses the effects of the disease on the child before and after delivery, as well as the teratogenic potential of many of the drugs commonly used to treat the disease. Finally, it discusses the dilemma of treating myasthenic patients who develop eclampsia/preeclampsia.
Involuntary Movements
Authors: Umeh Chizoba
Published: May 2017

Choreiform involuntary movements, “dyskinesia,” are a manifestation of chronic levodopa treatment in Parkinson’s disease. Levodopa-induced chorea presents as brief, irregular, non-rhythmic, flowing, involuntary movements. Risk factors for levodopa- induced dyskinesia include younger age of onset of Parkinson’s disease, greater disease severity, higher levodopa dose, longer duration of levodopa treatment, and female gender. Patients can have varying frequency and severity of dyskinesia. Treatment options for patients with disabling dyskinesia include adjusting the levodopa dose and daily dosing schedule, amantadine, intraduodenal levodopa, and deep brain stimulation.

In this chapter, a case of a 69-year-old woman with longstanding Parkinson’s disease on chronic levodopa treatment is discussed, including the disease course, differential diagnosis, workup, and treatment outcome.
Introduction to Telemental Health and Its Use in Resource-Limited Settings
Authors: Jefee-Bahloul Hussam
Published: May 2017

This chapter provides an introduction to telemental health and its applicability in global resource-limited settings. The chapter presents two case studies of applicable technology-based provision of mental health services in the world. Using two examples from low income settings, one marked by poverty and lack of access and the other by war and violence, the projects highlight how telemental health is addressing the gap between knowledge and delivery of evidence-based healthcare in the field of mental health. The discussion serves to introduce the rest of the book with a highlight of the main concepts to be discussed in later chapters.
Telemental Health in South Africa
Authors: Mars Maurice
Published: May 2017

South Africa is a large and diverse nation with the majority of the population living in rural areas. It was an early leader in telemedicine on the African continent, but telemedicine stagnated for nearly ten 10 years after failure of a National Telemedicine System. This chapter reviews the provision of mental health services through videoconference-based telemental health and mHealth in South Africa. The use of this technology to provide Tele-education to improve staff knowledge and raise awareness, and the provision of forensic services are also discussed. In addition, obstacles to implement these services in south African context, including political will, infrastructure, and legal and ethical issues discussed with possible solutions.
Telemental Health Services in Sri Lanka
Authors: Edirippulige Sisira , Marasinghe Rohana B.
Published: May 2017

This chapter reviews the rare use of telemental health modalities in Sri Lanka and challenges facing nationwide implementation of these services in this resource-limited setting. As in other developing countries, cost of, and access to, appropriate infrastructure are key constraints in using such advanced technologies in health service delivery. While healthcare providers and policymakers have realized the value of telemental health as a useful tool, challenges to its implementation remain. These challenges include lack of technology, appropriate infrastructure, knowledge, and skills. This chapter will delve into discussing the current approaches to implement TMH through educating the General public and disseminating mental health services in Sri Lanka.
Telemental Health in Postdisaster Settings
Authors: Augusterfer Eugene F. , Mollica Richard F. , Lavelle James
Published: May 2017

Low- and middle-income countries are disproportionately impacted by disasters, and the majority of medical providers in these countries are primary care providers (PCPs). PCPs do a tremendous job saving lives and addressing acute injuries and illnesses, but often are not trained to recognize and treat mental health problems. Telemental health (TMH) should be an important component in supporting those on the front lines of disaster response. Telemedicine and TMH have been deployed in postdisaster settings, but remain underused. A number of challenges must be overcome in the implementation of a comprehensive TMH postdisaster response program: educating providers to work in varied cultures, working through translators, time zone differences, and more. This chapter emphasizes the importance and great satisfaction of disaster response work and the important role of TMH in ensuring the delivery of evidence-based best practices to those in critical need.
Brain Death
Authors: Wijdicks Eelco F.M.
Published: May 2017

The core of the text of this book combines the theory and practice of determining brain death. The history and development of clinical criteria of brain death is revisited. The complex neurological evaluation and its pitfalls are discussed in great detail. Moreover, the many facets of brain death determination as well as its communication to family members are examined. These include cultures beliefs, bioethical problems, discussion with family members, and many of the issues associated with organ procurement. The process of organ procurement, which is separate from brain death determination, is also outlined, along with the role of an organ procurement coordinator. This monograph is exhaustively researched and provides answers to pressing and often repeated questions, in a chapter focused on 30 issues commonly encountered by physicians in determining brain death, maintaining the body in intensive care for organ donation, and dealing compassionately with family members and effectively with the media. Legal issues are also addressed here. The book includes several video clips pertaining to the neurological evaluation of brain death and accompanying pitfalls.
Critics and Brain Death
Authors: Wijdicks Eelco F.M.
Published: May 2017

Matters of life and death—and the physician’s role—invite criticisms and alternate interpretations. Commentaries against the clinical diagnosis of brain death or the concept of brain death have shifted their focus. These range from criticisms of the Harvard Committee (alleging conflict of interest, as shown by the presence of transplant physicians), to clinical examination (alleging injury with the apnea test), to critiques of the total brain necrosis criteria (alleging intact pituitary and hypothalamic function), to critiques on the difficulty of support (alleging long-term support in pregnant “brain-dead” women and children) and, most recently, to critiques on irreversibility (alleging possible recoveries). Philosophical arguments may reach the bedside, which may become consequential. In this chapter, a fair assessment of these criticisms, particularly those regarding determination of brain death, is provided, followed by a rebuttal. Practitioners should be aware of the existing body of literature analyzed herein.
Why Study Attending Physicians?
Authors: Harrod Molly , Saint Sanjay , Stock Robert W.
Published: May 2017

The hospitalist movement has been a key element in the transformation of American hospitals, aiding in the effort to shorten patients’ stay and reduce costs. The ranks of hospitalists have burgeoned to more than 40,000. They can be found in 70% of hospitals, and hospitalists have played a crucial supporting role in the drive toward higher quality, patient-centered care in the United States. Most of the attending physicians in this study are also hospitalists, specializing in the care of patients within the hospital. Although each attending had his or her own individual style of doctoring and teaching, the authors were able to identify qualities and attributes that they all shared. One of the most important attributes that all of the attendings shared was the conviction that they never stop learning.
How to Think About Thinking
Authors: Harrod Molly , Saint Sanjay , Stock Robert W.
Published: May 2017

Through clinical reasoning, seasoned physicians correctly diagnose patients’ problems and develop appropriate treatments. It has two main components. The first is the ability to mentally stockpile and integrate information gathered in the process of treating many patients and reading research, allowing physicians to recognize patterns of data and sometimes make automatic diagnoses. The process is intuitive and nonanalytical. The second major facet of clinical reasoning is analytical. Physicians painstakingly examine and weigh all evidence, including patients’ clinical history and physical examination, to develop hypotheses and management plans. Attendings viewed the use of “why” questions as teaching opportunities. Questions served multiple purposes, including guiding the learners through their thinking processes, building on knowledge through hypothetical questions, and using the Socratic method to foster critical thinking. Instilling the ability to think critically about one’s own decision-making process was the attendings’ ultimate goal for their learners.
Putting It All Together
Authors: Harrod Molly , Saint Sanjay , Stock Robert W.
Published: May 2017

In this chapter, the authors summarize the main strategies and approaches the attendings used to create safe, productive learning environments. First, they created supportive team environments by developing personal relationships, keeping their interactions positive, and tailoring their teaching to the level of the learner and being a learner themselves. Second, attendings created team-based learning by focusing on their team’s thought processes, sharing their own thought processes, and expanding the team to include allied health professionals. And third, they delivered not only patient-centered care but also patient-centered teaching by knowing their patients, developing rapport with them, and planning for their patients’ future outside the hospital.
Civil Commitment
Authors: Schouten Ronald , Candilis Philip J.
Published: May 2017

More than any other clinical intervention, civil commitment is subject to strict legal requirements and oversight. Although the rules and processes vary by jurisdiction, the legal proceedings in all jurisdictions are designed to balance the autonomy interests and constitutional rights of the patient against the state’s legitimate exercise of authority. This chapter reviews the legal principles underlying civil commitment and describes how those principles are applied in different ways, using examples from various jurisdictions. Using a case vignette, it explores a common scenario in which an emergency room physician who must make a decision regarding a patient’s need for hospitalization obtains a psychiatric consultation, and it follows the civil commitment process as it would play out in one jurisdiction. By its nature, civil commitment is both a clinical intervention and a legal process, and the chapter addresses some of the clinical challenges encountered in the course of involuntary hospitalization.
Confidentiality and Testimonial Privilege
Authors: Johnson Robert Scott , Schouten Ronald
Published: May 2017

This chapter describes the complex medicolegal issues surrounding the rules of confidentiality and privilege and their multiple exceptions. It lays out the underpinnings of confidentiality, then addresses its various exceptions, such as waiver, duty to protect third parties, civil commitment, and mandated reporting of child abuse, elder abuse, and intimate-partner violence. Psychotherapist–patient privilege is discussed, first with regard to its origins and then with regard to its exceptions, including various forms of waiver. Practical examples illustrate these concepts for the reader to make it easier to understand these ubiquitous, but at times perplexing, concepts and to illustrate the nuances of various aspects of the law. Practitioners should note that there is considerable overlap between confidentiality and testimonial privilege, and the division of this chapter into two sections creates, in some ways, an artificial divide between two closely related concepts.
Mental Health Professionals and the Criminal Justice System
Authors: Kapoor Reena , Buchanan Alec
Published: May 2017

This chapter provides guidance for mental health clinicians whose patients are involved in the criminal justice system. It describes the typical course for a person with mental illness as he or she progresses through the criminal justice system, with a focus on the various types of psychiatric evaluations that are performed. It discusses the legal basis and essential elements of competence to stand trial evaluations, the legal definition of insanity, jail diversion programs, and presentencing evaluations. The differences between treating clinicians and forensic evaluators in the criminal justice system are explained. Finally, it offers guiding principles and tips for avoiding common pitfalls.
Malingering and Factitious Disorder
Authors: Beach Scott R. , Lahaie Matthew
Published: May 2017

Malingering is the intentional feigning, induction, or exacerbation of symptoms to achieve a conscious, tangible goal; factitious disorder is the intentional manipulation of symptoms to achieve the subconscious goal of assuming the sick role. These disorders impose great costs in terms of dollars spent, inappropriate diversion of resources to unnecessary clinical care, and negative effects on clinicians faced with patient deception. They challenge the assumption that patients provide accurate histories and accounts of their symptoms and are motivated to address the symptoms and concerns that they report. Malingering and factitious disorder are typically diagnoses of exclusion. Signs of a deception syndrome include numerous prior hospital admissions and emergency department visits and a history of suspected deception. Evaluations require careful history taking and physical examination; prudent use of studies, tests, and consultation; gathering of collateral information; thorough review of available records; and monitoring of the patient’s behavior in the medical setting.
Delirium in Critically Ill Patients
Authors: van den Boogaard Mark , Rood Paul
Published: May 2017

This chapter addresses delirium in critically ill patients in the intensive care unit (ICU), especially the mixed subtype (alternating hyperactivity and hypoactivity). The Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist are discussed as useful delirium assessment tools in this setting. Several neurotransmitter pathways have been implicated in delirium, including cholinergic, GABAergic, and serotonergic pathways; cytokines and glucocorticoids also appear relevant. Risk factors for delirium in the ICU include older age, prior cognitive impairment, worse illness severity, recent delirium or coma, mechanical ventilation, admission category (especially trauma or neurological/neurosurgical admission), infection, metabolic acidosis, morphine and sedative administration, urea concentration, respiratory failure, and admission urgency. Prevention and treatment of delirium are discussed, including nonpharmacological interventions (frequent reorientation, providing eyeglasses and hearing aids if needed, promoting nighttime sleep, and early mobilization) and judicious use of opiate, sedative, and antipsychotic medications.
Psychological Impact of Critical Illness
Authors: Bienvenu O. Joseph , Jones Christina
Published: May 2017

This chapter explores the epidemiology and range of psychological distress phenomena experienced by survivors of critical illness. The phenomena most commonly reported on are posttraumatic stress disorder (PTSD), depressive, and general (or nonspecific) anxiety symptoms. Approximately 1 in 5 critical illness survivors has clinically significant PTSD symptoms, 1 in 3 has clinically significant depressive symptoms, and 1 in 3 has clinically significant anxiety symptoms. These phenomena are associated with diminished quality of life and functioning. Risk factors include pre-critical illness anxiety and depression, in-critical illness sedative doses and nightmare-like experiences, and post–critical illness psychological distress and poor coping early in the recovery period. Given the association between critical illness and psychological distress, it is important to address survivors’ mental health needs.
Rehabilitation Psychology Insights for Treatment of Critical Illness Survivors
Authors: Jutte Jennifer E. , Jackson James C. , Hopkins Ramona O.
Published: May 2017

This chapter discusses the role of rehabilitation psychologists in the care of the critically ill patient during and after a stay in intensive care unit (ICU). Since post-ICU cognitive impairments and psychiatric difficulties such as anxiety, depression, acute distress disorder, and post-traumatic stress disorder may not be preventable altogether, it is important to attempt to minimize long-term impairment and distress. Because of the thorough training rehabilitation psychologists receive in assessment and intervention practices in patients with a variety of complex medical conditions, rehabilitation psychologists are particularly well-suited to identify and address the complex post-ICU morbidities faced by critical illness survivors across the continuum of care environments. Interventions across settings to minimize delirium, reduce psychological distress, and shore up cognitive deficits could positively influence patients’ recovery trajectories and quality of life.
General surgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter covers topics a surgical trainee will find useful. Preoperative assessment covers ASA Grades, NICE guidance, cardiopulmonary exercise testing (CPEX), P-POSSUM. Preoperative medication review covers medications to continue, and medications to be stopped. Consent details test of materiality, Montgomery vs Lanarkshire Health Board, adults who lack capacity, best interests, Advanced Directive, Living Will, Lasting Power of Attorney, Independent Mental Capacity Advocate (IMCA), Gillick Competency, delegation of consent, and consent forms. Surgical site infections (SSIs), NICE guideline on antibiotic prophylaxis, and venous thromboembolism (VTE). The WHO surgery checklist explains team brief, sign in, time out, sign out, debrief. Types of skin preparation—chlorhexadine, betadine. Absorbable, non-absorbable sutures, synthetic, biological meshes. Enhanced recovery, day surgery. Diathermy, ultrasound devices, lasers. Duty of candour. Open and close midline laparotomy incision, induction of pneumoperitoneum, diagnostic laparoscopy. Lichtenstein, totally extraperitoneal (TEP), transabdominal preperitoneal (TAPP), Lockwood, Lothiesen, McEvedy femoral hernia repair, ventral and incisional hernia repair, excision biopsy, abscess incision and drainage, ingrowing toenails.
Breast surgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter provides essential information for common breast operations. Techniques of fine-needle aspiration cytology and core biopsy are described. Operations include incision and drainage of breast abscess, excision of benign breast lump, and wide local excision. Mastectomy, sentinel node biopsy, axillary clearance, and fine wire localization are described. Other operations include microdochectomy and the Hadfield–Adair procedure. Breast reconstruction operations include implant-based reconstruction, latissimus dorsi myocutaneous flap, transvers rectus abdominis myocutaneous pedicled flap (TRAM) and free TRAM, and deep inferior epigastric perforation (DIEP) free flap. Reduction mammoplasty operations described are inferior pedicle mammoplasty and medial pedicle breast reduction (Hall Findlay or Snowman technique).
Endocrine surgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter provides information on common endocrine operations. Techniques of ultrasound—guided fine-needle aspiration cytology of a thyroid nodule is described. Operations of total thyroidectomy, hemithyroidectomy, bilateral neck exploration, and minimally invasive parathyroidectomy (MIP), and open and both laparoscopic transperitoneal and retroperitoneal adrenalectomy are described.
Paediatric surgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter covers paediatric operations. Procedures like rigid bronchoscopy, chest drain insertion, and central venous catheter insertion are described. Common operations of abscess drainage, appendicectomy, laparoscopy, gastrostomy, circumcision, epigastric and umbilical hernia repair, external angular dermoid cyst excision, inguinal hernia, and hydrocele are all outlined. Other operations described are fundoplication, ileostomy formation, pyloromyotomy, small-bowel resection and anastomosis. Surgery for intussusception, small-bowel atresia, meconium ileus, and oesophageal atresia are included. Urological operations include orchidopexy, scrotal exploration, cystoscopy, endoscopic correction of vescico urteric reflux (VUR), insertion and removal of JJ stent, vesicostomy, suprapubic catheter insertion, nephrectomy, repair of hypospadias, bladder augmentation, and Anderson Hynes pyeloplasty.
Transplantation
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter on transplantation includes kidney transplantation, live donor nephrectomy, liver transplantation, and multi-organ retrieval.
Cardiothoracic surgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter on cardiothoracic surgery describes cardiac operations such as coronary artery bypass grafting, aortic and mitral valve replacement, atrial septal defect repair, and cardiac transplantation. Steps of sternotomy, saphenous vein harvest, and cardiopulmonary bypass are included. Thoracic operations described are intercostal drain insertion, thoracotomy, lung biopsy, pulmonary lobectomy, pneumonectomy, thymectomy, bullectomy, and pleurectomy. Rigid and flexible bronchoscopy are also described.
ENT
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter on ENT outlines procedures like aural microsuction, nasal endoscopy, nasolaryngoscopy, pharyngoscopy, microlaryngoscopy, Dix Hallpike test and Epleu manoeuvre, nasal cautery, reduction of nasal fracture, drainage of orbital abscess, drainage of a peritonsillar abscess (Quincy), sphenopalatine artery ligation, biopsy of oral lesion, changing tracheostomy tube, removal of foreign body from the nose of a child, myringotomy, and insertion of grommet. Operations included are myringoplasty, tympanoyomy and tympanoplasty, excision of external canal osteoma/exostosis, cortical mastoidectomy, mastoid exploration, cochlear implantation, pinnaplasty, stapedectomy and ossciculoplasty, septoplasty, middle meatal antrostomy, nasal polypectomy, ethmoidectomy, septorhinoplasty, dacrocystorhinostomy (DCR), Caldwell–Luc, tracheostomy, excision of neck node, branchial cyst excision, excision of thyroglossal cyst, uvulopalatopharyngoplasty, parotidectomy, submandibular gland excision, neck dissection, total laryngectomy, tonsillectomy, adenoidectomy, and laryngo-tracheal reconstruction.
Oral and maxillofacial surgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter on oral and maxillofacial surgery describes intra-oral and face nerve blocks. Operations include biopsies and excision of small lesions, simple and surgical tooth extraction, apicectomy, odontogenic cyst enucleation and marsupilialization, intra-oral implant insertion, maxillary sinus floor elevation, submandibular duct stone removal, sublingual gland excision, repair of facial laceration including parotid duct repair and facial nerve repair, lateral canthotomy and cantholysis, intermaxillary fixation, open reduction internal fixation (ORIF) of mandible, mandibular condyle, zygomatic complex, repair of orbital floor and wall, access for bicoronal flap, bilateral sagittal split osteotomy, maxillary osteotomy, temporal mandibular joint (TMJ) arthrocentesis, eminoplasty and condyloplasty and disc procedures, pectoralis major myocutaneous flap, radial forearm free flap harvest, osteocutaneous iliac crest flap harvest and, fibula free flap harvest.
Discovery of a dual active galactic nucleus with ∼8 kpc separation
Authors: Ellison Sara L. , Secrest Nathan J. , Mendel J. Trevor , Satyapal Shobita , Simard Luc
Published: May 2017

Targeted searches for dual active galactic nuclei (AGNs), with separations 1–10 kpc, have yielded relatively few successes. A recent pilot survey by Satyapal et al. has demonstrated that mid-infrared (mid-IR) pre-selection has the potential to significantly improve the success rate for dual AGN confirmation in late stage galaxy mergers. In this Letter, we combine mid-IR selection with spatially resolved optical AGN diagnostics from the Mapping Nearby Galaxies at Apache Point Observatory survey to identify a candidate dual AGN in the late stage major galaxy merger SDSS J140737.17+442856.2 at z = 0.143. The nature of the dual AGN is confirmed with Chandra X-ray observations that identify two hard X-ray point sources with intrinsic (corrected for absorption) 2–10 keV luminosities of 4 × 1041 and 3.5 × 1043 erg s−1 separated by 8.3 kpc. The neutral hydrogen absorption (∼1022 cm−2) towards the two AGNs is lower than in duals selected solely on their mid-IR colours, indicating that strategies that combine optical and mid-IR diagnostics may complement techniques that identify the highly obscured dual phase, such as at high X-ray energies or mid-IR only.
Effects of Conflicts of Interest on Practice Patterns and Complication Rates in Spine Surgery
Authors: Cook Ralph W. , Weiner Joseph A. , Schallmo Michael S. , Chun Danielle S. , Barth Kathryn A. , Singh Sameer K. , Hsu Wellington K.
Published: May 2017

Study Design.

Retrospective cohort study.

Objective.

We sought to determine whether financial relationships with industry had any impact on operative and/or complication rates of spine surgeons performing fusion surgeries.

Summary of Background Data.

Recent actions from Congress and the Institute of Medicine have highlighted the importance of conflicts of interest among physicians. Orthopedic surgeons and neurosurgeons have been identified as receiving the highest amount of industry payments among all specialties. No study has yet investigated the potential effects of disclosed industry payments with quality and choices of patient care.

Methods.

A comprehensive database of spine surgeons in the United States with compiled data of industry payments, operative fusion rates, and complication rates was created. Practice pattern data were derived from a publicly available Medicare-based database generated from selected CPT codes from 2011 to 2012. Complication rate data from 2009 to 2013 were extracted from the ProPublica-Surgeon-Scorecard database, which utilizes postoperative inhospital mortality and 30-day-readmission for designated conditions as complications of surgery. Data regarding industry payments from 2013 to 2014 were derived from the Open Payments website. Surgeons performing <10 fusions, those without complication data, and those whose identity could not be verified through public records were excluded. Pearson correlation coefficients and multivariate regression analyses were used to determine the relationship between industry payments, operative fusion rate, and/or complication rate.

Results.

A total of 2110 surgeons met the inclusion criteria for our database. The average operative fusion rate was 8.8% (SD 4.8%), whereas the average complication rate for lumbar and cervical fusion was 4.1% and 1.9%, respectively. Pearson correlation analysis revealed a statistically significant but negligible relationship between disclosed payments/transactions and both operative fusion and complication rates.

Conclusion.

Our findings do not support a strong correlation between the payments a surgeon receives from industry and their decisions to perform spine fusion or associated complication rates. Large variability in the rate of fusions performed suggests a poor consensus for indications for spine fusion surgery.

Level of Evidence: 3
Aminoglycosides Monotherapy as First-Line Treatment for Febrile Urinary Tract Infection in Children
Authors: Poey Nora , Madhi Fouad , Biscardi Sandra , Béchet Stéphane , Cohen Robert
Published: May 2017

We report a retrospective monocentric descriptive study performed in CHI Creteil for 20 months to describe the management and outcome of amikacin monotherapy as an alternative to third-generation cephalosporins for empiric treatment of febrile urinary tract infection (FUTI) in children. Data were analyzed for 151 children, and 90 selected cases were classified as certain or highly probable FUTI. Escherichia coli infection was found in 89 cases. In all patients, fever was resolved within 72 hours after beginning amikacin treatment. Only 5.3% of children were febrile after 48 hours. The mean amikacin treatment duration was 3.05 ± 0.13 days before oral treatment began (guided by antibiotic susceptibility testing). Amikacin monotherapy seems effective for the initial management of FUTI in children.
Successful Treatment of Post Kala-azar Dermal Leishmaniasis and Disseminated Tuberculosis Co-infection With Liposomal Amphotericin B and Anti-tubercular Drugs in Bangladesh
Authors: Rashid Md. Mahbubur , Nath Proggananda , Rahman Mizanur , Mondal Dinesh , Shamsuzzaman Abul Khair Mohammad , Basher Ariful
Published: May 2017

We report a case of a 40-year-old male patient residing in a hyperendemic area of Bangladesh. The patient was diagnosed with disseminated tuberculosis and post kala-azar dermal leishmaniasis at Surya Kanta Kala-azar Research Centre. He had thickening, furrowing, and hyperpigmentation of the skin over both lower limbs and had nodular lesions on the face and earlobes and macular lesion on the back of the chest and limbs with intact sensation. Right-sided moderate pleural effusion, mild ascites, and mild hepatosplenomegaly were also found. He had positive result of Xpert MTB/RIF test from pleural fluid and tuberculin skin test. The results of rapid diagnostic test rK39, slit skin smear microscopy for Leishman-Donovan bodies, and polymerase chain reaction for skin sample of post kala-azar dermal leishmaniasis were found positive. Liposomal amphotericin B and anti-tubercular (Category 1) drugs were used simultaneously without any serious adverse effect, and improvement was found at a follow-up visit after 6 months of the treatment.
Mycobacterium lentiflavum Infection in a Patient With Hyper-IgE Recurrent Infection Syndrome
Authors: Duzgol Mine , Cavusoglu Cengiz , Kara Ahu , Gülfidan Gamze , Ayhan Yüce , Bayram Nuri , Devrim Ilker
Published: May 2017

Mycobacterium lentiflavum is a recently described nontuberculous mycobacterium that has mainly clinical importance in young children with cervical lymphadenitis and in immunocompromised patients. We report here, along with a further case of diffused pulmonary nodules in a 12-year-old boy, the first isolations from bronchoalveolar lavage culture with hyper-IgE recurrent infection syndrome from Turkey.
Detection of New Virulence Genes in mecA-positive Staphylococcus aureus Isolated From Clinical Samples
Authors: Eshaghi Morteza , Bibalan Meysam Hasannejad , Pournajaf Abazar , Gholami Mehrdad , Talebi Malihe
Published: May 2017

Background

Methicillin-resistant Staphylococcus aureus (MRSA) has become a main clinical and epidemiological concern for the past decades. These isolates have spread worldwide, causing health care– and community-associated infections. The aim of the present work was the determination of antibiotic resistance profile and simultaneous detection of psm-α and sasX genes in the clinical MRSA strains isolated from Tehran—the first report from Iran.

Methods

This descriptive study was performed on hospitalized patients during August to February 2015. Antibiotic susceptibility test for all S. aureus isolates was conducted on Mueller-Hinton agar. The presence of mecA, sasX, and psm genes was detected by multiplex polymerase chain reaction method.

Results

Of 153 S. aureus, 79 (51.6%) of the strains carried the mecA gene. Molecular analysis of mecA-positive S. aureus showed that the prevalence of sasX and psm genes was 13.9% (11/79) and 7.6% (6/79), respectively.

Conclusions

This is the first report of sasX and psm genes among S. aureus isolates from Iran. Phenol-soluble modulins have recently appeared as a novel toxin family describing the virulence potential of vastly aggressive S. aureus. Current understanding is needed on S. aureus surface protein-encoding gene sasX, which plays a vital role in colonization and pathogenesis of MRSA.
A Case Report of Multiple Cerebral Abscesses Due to Nocardia in the Absence of Pulmonary Disease
Authors: Elliott Mark , Dixit Devika
Published: May 2017

A 64-year-old woman with Waldenström macroglobulinemia presented with seizures and was found to have multifocal Nocardia farcinica cerebral abscesses. Nocardia species are an uncommon cause of cerebral abscesses that can occur spontaneously via inoculation from the environment, especially in immunocompromised patients, and usually appear with concomitant pulmonary disease. Nocardia infections generally portend a worse prognosis than other organisms causing the same clinical syndrome because they are difficult to treat. Treatment of cerebral Nocardia consists of combination therapy upfront with a sulfonamide and another agent, with long treatment regimens of up to a year.
Involving People Who Self-Harm in Research Design
Authors: Walker Sandra
Published: May 2017

Background:

Involving service users in mental health research is expected in the United Kingdom.

Purpose:

This report outlines the process of exploring a proposed research project with a group of service users. The proposed research project is part of a doctoral pathway that was designed to explore the experiences in a general hospital of people who were admitted with self-harm in terms of their contact with mental health services.

Methods:

A consultation event was held where the researcher outlined the proposed format of the project and the expected aims and outcomes. The group members were asked to consider the validity of the question being asked and to consider questions they felt needed to be asked as part of the process.

Results:

The research question was amended in light of the consultation, and the process influenced the research methodology. Some interesting and unexpected linguistic points were noted during the consultation.

Conclusions/Implications for Practice:

Although the process was time consuming in terms of setup, it was immeasurably valuable in adding real-world value to the project and ensuring that the research outcomes would be more likely to be meaningful to both service users and professionals alike.
Transcanal Endoscopic Ear Surgery for Excision of a Facial Nerve Venous Malformation With Interposition Nerve Grafting: A Case Report
Authors: Wick Cameron C. , Sakai Mark , Richardson Timothy E. , Isaacson Brandon
Published: May 2017

Objective:

To illustrate a novel approach for the surgical management of a venous malformation of the facial nerve, including interposition nerve grafting, via an exclusively transcanal endoscopic ear surgery (TEES) approach.

Patient:

Thirty nine-year-old woman with a preoperative House–Brackmann (HB) grade IV facial paresis secondary to a facial nerve tumor.

Intervention(s):

Surgical excision and interposition nerve graft via a transcanal endoscopic approach.

Main Outcome Measure(s):

Completeness of resection, approach morbidities, and facial nerve outcome.

Results:

The TEES approach provided wide exposure of the facial nerve from the geniculate ganglion through the mastoid segment. This visualization facilitated gross total tumor resection, incus interposition ossicular reconstruction, and placement of an interposition nerve graft. The nerve graft was positioned in the fallopian canal and was secured at both ends with surgicel. The patient had no postoperative complications. At 11-month follow-up her facial function had returned to HB grade IV.

Conclusions:

This is the first report of resecting a venous malformation of the facial nerve with concomitant interposition nerve graft reconstruction via an exclusively endoscopic approach. This report adds to the growing body of evidence that TEES can manage diverse middle ear and lateral skull base pathology. Additional studies are needed to fully elucidate the risk-benefit profile of this technique.
Epidemiology of Dizzy Patient Population in a Neurotology Clinic and Predictors of Peripheral Etiology
Authors: Muelleman Thomas , Shew Matthew , Subbarayan Rahul , Shum Axel , Sykes Kevin , Staecker Hinrich , Lin James
Published: May 2017

Objective:

To compare the proportion of peripheral versus nonperipheral dizziness etiologies among all patients, inclusive of those presenting primarily or as referrals, to rank diagnoses in order of frequency, to determine whether or not age and sex predict diagnosis, and to determine which subgroups tended to undergo formal vestibular testing.

Study Design:

Retrospective cohort.

Setting:

Academic neurotology clinic.

Patients:

Age greater than 18 neurotology clinic patients with the chief complaint of dizziness.

Intervention(s):

None.

Main Outcome Measure(s):

Age, sex, diagnosis, record of vestibular testing.

Results:

Two thousand seventy-nine patients were assigned 2,468 diagnoses, of which 57.7 and 42.3% were of peripheral and nonperipheral etiologies, respectively. The most common diagnoses were Ménière's (23.0%), vestibular migraine (19.3%), benign paroxysmal positional vertigo (BPPV) (19.1%), and central origin, nonmigraine (16.4%). Peripheral diagnoses are more likely to be found in men than in women (odds ratio [OR] 1.59). Peripheral diagnoses were most likely to be found in the 60 to 69 age group (OR 3.82). There was not a significant difference in rate of vestibular testing between women and men. Among patients with two diagnoses, the most common combinations were vestibular migraine and BPPV then vestibular migraine and Ménière's.

Conclusions:

A large proportion of patients seen for the chief complaint of dizziness in the neurotology clinic were found not to have a peripheral etiology of their symptoms. These data challenge a prevalent dogma that the most common causes of dizziness are peripheral: BPPV, vestibular neuritis, and Ménière's disease. Age and sex are statistically significant predictors of peripheral etiology of dizziness.