bluuebunny/crossref_metadata_2025 huggingface dataset:
Female Troubles After Transplantation
Authors: Hsu Jack
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
If at First You Do Not Succeed, Try, Try, Again
Authors: Wingard John R.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
A Heat Wave
Authors: Wingard John R.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Wielding a Double-Edged Sword
Authors: Gowda Charitha , Grilliot Melissa A.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Don’t Judge a Book by Its Cover
Authors: Kahal Deborah , Aberra Faten N.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Hitting the Bull’s Eye
Authors: Gormley Rachel , Rosenbach Misha
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Multiple Sclerosis Treatments
Authors: Holtzman David , Pruitt Amy
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Can We Inject to Protect
Authors: Brickman Cristina
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Patch Clamp Recording in Brain Slices
Authors: Campagnola Luke , Manis Paul
Published: November 2017

Patch clamp recording in brain slices allows unparalleled access to neuronal membrane signals in a system that approximates the in-vivo neural substrate while affording greater control of experimental conditions. In this chapter we discuss the theory, methodology, and practical considerations of such experiments including the initial setup, techniques for preparing and handling viable brain slices, and patching and recording signals. A number of practical and technical issues faced by electrophysiologists are also considered, including maintaining slice viability, visualizing and identifying healthy cells, acquiring reliable patch seals, amplifier compensation features, hardware configuration, sources of electrical noise and table vibration, as well as basic data analysis issues and some troubleshooting tips.
Extracellular Single-Unit Recording and Neuropharmacological Methods
Authors: Coleman William L. , Burger R. Michael
Published: November 2017

Small biogenic changes in voltage such as action potentials in neurons can be monitored using extracellular single unit recording techniques. This technique allows for investigation of neuronal electrical activity in a manner that is not disruptive to the cell membrane, and individual neurons can be recorded from for extended periods of time. This chapter discusses the basic requirements for an extracellular recording setup, including different types of electrodes, apparatus for controlling electrode position and placement, recording equipment, signal output, data analysis, and the histological confirmation of recording sites usually required for in vivo recordings. A more advanced extracellular recording technique using piggy-back style multibarrel electrodes that allows for localized pharmacological manipulation of neuronal properties is described in detail. Strategies for successful signal isolation, troubleshooting advice such as noise reduction, and suggestions for general laboratory equipment are also discussed.
Fast-Scan Cyclic Voltammetry in Behaving Animals
Authors: Arnold Monica M. , Burgeno Lauren M. , Phillips Paul E. M.
Published: November 2017

Gaining insight into the mechanisms by which neural transmission governs behavior remains a central goal of behavioral neuroscience. Multiple applications exist for monitoring neurotransmission during behavior, including fast-scan cyclic voltammetry (FSCV). This technique is an electrochemical detection method that can be used to monitor subsecond changes in concentrations of electroactive molecules such as neurotransmitters. In this technique, a triangular waveform voltage is applied to a carbon fiber electrode implanted into a selected brain region. During each waveform application, specific molecules in the vicinity of the electrode will undergo electrolysis and produce a current, which can be detected by the electrode. In order to monitor subsecond changes in neurotransmitter release, waveform application is repeated every 100 ms, yielding a 10 Hz sampling rate. This chapter describes the fundamental principles behind FSCV and the basic instrumentation required, using as an example system the detection of in vivo phasic dopamine changes in freely-moving animals over the course of long-term experiments. We explain step-by-step, how to construct and surgically implant a carbon fiber electrode that can readily detect phasic neurotransmitter fluctuations and that remains sensitive over multiple recordings across months. Also included are the basic steps for recording FSCV during behavioral experiments and how to process voltammetric data in which signaling is time-locked to behavioral events of interest. Together, information in this chapter provides a foundation of FSCV theory and practice that can be applied to the assembly of an FSCV system and execution of in vivo experiments.
Optogenetics and Electrophysiology
Authors: Tseng Hua-an , Kohman Richie E. , Han Xue
Published: November 2017

Throughout the history of neuroscience, electrophysiological and imaging techniques have been utilized to observe neural signals at various spatial and temporal scales. However, it has been difficult to manipulate the activity of specific cells or neural circuits with the spatial and temporal resolutions relevant to neural coding. A novel technique called optogenetics, has recently been developed to control the activity of specific cells. This technique allows rapid and reversible optical activation or silencing of specific cells, which have been genetically transduced with light-sensitive molecules. The development of microbial opsin-based optogenetic molecular sensors has made optogenetics easily adaptable in various in vivo and in vitro preparations, and the technique has already been applied to understand neural circuit mechanisms of many behaviors and diseases. Here, we provide an introduction to optogenetics, the practical concerns in using the technique in vivo, and examples of applications that combine traditional electrophysiology techniques with optogenetics.
Case 4
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 5
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 6
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 8
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 17
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 21
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 24
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 27
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 28
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 31
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 46
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Retroperitoneum section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 52
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Retroperitoneum section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 57
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Adrenal section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 61
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Adrenal section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 62
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Adrenal section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 67
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ureter and Bladder section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 68
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ureter and Bladder section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 69
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ureter and Bladder section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 72
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ureter and Bladder section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 73
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ureter and Bladder section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 83
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Urethra, Vagina, and Penis section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 88
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Urethra, Vagina, and Penis section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 91
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Urethra, Vagina, and Penis section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 96
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Testis, Epididymis, and Scrotum section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 102
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Testis, Epididymis, and Scrotum section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 109
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Uterus and Fallopian Tube section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 110
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Uterus and Fallopian Tube section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 112
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Uterus and Fallopian Tube section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 115
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Uterus and Fallopian Tube section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 116
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Uterus and Fallopian Tube section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 119
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ovary section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 122
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ovary section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Infection Control
Authors: Vulfovich Michael
Published: November 2017

Infection control is a field concerned with the scientific study of nosocomial-associated infections and the development of protocols and interventions to reduce rates of transmission. Within the Emergency Department, multiple patients with a wide variety of potentially infectious and contagious diseases are in close proximity to other patients and in contact with health care providers caring for multiple patients concurrently. This can increase the risk of exposure and contamination for both patients and staff. In this setting, standardization and monitoring play an especially vital role in infection prevention and control. This chapter provides a broad overview of standard isolation precautions and environmental cleaning.
Infectious Disease Mimics
Authors: Martinez Tyler
Published: November 2017

Infection is not the only etiology of the triad of elevated temperature, increased heart rate, and an increased or decreased white blood cell (WBC) count. The diseases that can mimic sepsis fall into four main categories: malignancy, autoimmunity, xenobiotic-related, and others—notably pulmonary embolus (PE). These infection mimics can create a clinical picture that is often difficult to differentiate from infection, especially in the acute care setting. This can cause delays in appropriate treatment that can be detrimental. Therapy is based on the underlying disease process and should also address complications stemming from the underlying process. It is important to always maintain a broad differential diagnosis.
Pharyngitis, Tonsillitis, and Peritonsillar Abscess
Authors: Jacquet Gabrielle
Published: November 2017

Pharyngitis typically presents with sore throat, fever, and pharyngeal inflammation. More serious cases may progress to peritonsillar abscess (PTA). Infection or inflammation of the throat that primarily affects the palantine tonsils is considered tonsillitis, whereas infections involving the posterior pharynx are considered pharyngitis. Weber glands (a group of mucous salivary glands superior to the tonsil in the soft palate) have been implicated in the formation of PTA; one must consider their proximity to the trachea and to the carotid artery when pursuing fine needle aspiration. Treatment for all cases includes supportive care with antipyretics, analgesics, and fluids. Despite the much lower prevalence of group A beta-hemolytic Streptococcus infection (for which antibiotics is indicated), a staggering 49% to 57% of children and 64% of adults evaluated for pharyngitis receive an antibiotic prescription. Up to 90% of primary infections with HIV-1 are associated with acute retroviral syndrome, which can include pharyngitis 2 to 4 weeks after exposure.
Infectious Keratitis
Authors: DeAugustinas M. , Kiely A
Published: November 2017

Keratitis is an inflammation of the cornea, which can lead to corneal opacification or ulceration. The most common cause of infectious keratitis is herpes simplex virus type 1 (HSV-1). Noninfectious corneal infiltrates related to trauma, collagen vascular disease, autoimmune inflammation, vasculitis, or atopy (which predisposes to HSV keratitis) must be considered. HSV-associated stromal keratitis is the most common cause of infectious corneal blindness in the United States, yet its presentation can be fairly subtle. For this reason, symptoms out of proportion to exam findings or a history concerning for viral infection is an indication for prompt referral to ophthalmology. Topical antibiotic drops achieve high tissue concentrations and are the treatment of choice. Empiric coverage should be prescribed and tailored later under the care of an ophthalmologist. Other keys to effective treatment include discontinuing contact lens use and protecting the eye with a rigid shield without a patch, as patching provides a reservoir for infection.
Endophthalmitis
Authors: DeAugustinas M. , Kiely A
Published: November 2017

Endophthalmitis refers to inflammation of both the anterior and posterior intraocular chambers and their structures. This vision-threatening condition occurs in three principal scenarios: penetrating ocular trauma, after intraocular surgery, and in systemically infected (often immunocompromised) patients. Endophthalmitis presents with marked intraocular inflammation, often with hypopyon. Patients report pain and significant vision loss out of proportion to typical post-operative complaints. It is distinguished from uveitis by both history and slit lamp examination. Endophthalmitis is an ophthalmic emergency. Same day ophthalmology consult/referral is mandatory. Vision is threatened over the course of hours. Treatment includes prompt intravitreal injection of antibiotics by an ophthalmologist. Systemic therapy should occur only in in endogenous infections, continuing until cultures clear.
Catheter-Associated Infections
Authors: Eluri Swathi
Published: November 2017

Catheter-associated infections, which often present as sepsis, include primary bloodstream infections that occur in the presence of intravascular catheters. They are not related to an infection at another site and are defined as a primary bloodstream infection with documented colonization of the device and microbiologically proven, device-related bloodstream infection. Multiple hospitals have started to implement standardized quality control interventions to minimize catheter-related bloodstream infections. Ultrasound-guided line placement results in a decrease in mechanical complication and the number of attempts, which in turn reduces the risk of infection. Preparing the skin with 0.5% chlorhexidine or alcohol containing chlorhexidine solutions has been shown to reduce line-related infections. Antimicrobial lock solutions should be used in patients with recurrent catheter-associated infections and high-risk groups, such as those on total parenteral nutrition, dialysis, or oncologic patients. The preservation of skin integrity surrounding the device decreases the risk of infection.
Pelvic Inflammatory Disease and Tubo-Ovarian Abscess
Authors: Holst John
Published: November 2017

Pelvic inflammatory disease (PID) consists of inflammation in various parts of the upper genital tract and includes endometritis, salpingitis, tubo-ovarian abscess (TOA), and/or pelvic peritonitis. Overt acute PID patients typically present as ill-appearing with pain, fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cells. “Silent” PID presents with dyspareunia, irregular bleeding, and urinary and gastrointestinal complaints. Bacterial vaginosis (BV) and associated microorganisms are present in acute PID patients. PID coverage is focused on a polymicrobial infection. HIV patients typically have more severe symptoms and are more likely to have a TOA than an immunocompetent patient, but HIV alone does not mandate hospital admission nor does parenteral therapy improve outcomes compared to non-HIV patients. Gonorrhea and chlamydia cases must be reported to the local health department; it is not mandatory for PID patients to remove an intrauterine device at the time of diagnosis.
Necrotizing Soft Tissue Infections
Authors: Ehmann Michael
Published: November 2017

Necrotizing soft tissue infections (NSTI) are characterized by extensive and rapidly progressive necrosis that may involve the skin, subcutaneous tissue, fascia, or muscle and are associated with a high degree of morbidity and mortality. Preceding trauma, foreign body penetration, wound contamination, and surgical intervention are all risk factors for NSTI. Clinical examination often reveals extensive tissue involvement with pain but commonly without signs of cellulitis. Crepitant cellulitis occurs most commonly in patients with preexisting lower extremity peripheral arterial disease, decubitus ulcer, or a traumatic wound. Synergistic necrotizing cellulitis (ie, non-clostridial gangrene), in contrast, does involve deeper tissues. Early stabilization, including antibiotics and supportive measures, should be considered; consultation with a surgeon is key. Management must include aggressive resuscitative measures and hemodynamic support.
Dermatologic Manifestations of Infectious Disease
Authors: Cuttle Lisa
Published: November 2017

Toxic infectious exfoliative conditions include staphylococcal toxic shock syndrome (TSS), streptococcal toxic shock syndrome (STSS), and staphylococcal scalded skin syndrome (SSSS). All three are mediated by bacterial toxin production and are considerations in the differential diagnosis of a febrile, hypotensive patient with a rash. Meningococcemia is potentially fatal and extremely contagious with a short incubation period. Disseminated gonococcal infection (DGI) presents with tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis or with purulent arthritis but without skin lesions. Ecthyma gangrenosum (EG) is a cutaneous manifestation of Pseudomonas aeruginosa infection. Rocky Mountain Spotted Fever (RMSF) is caused by Rickettsia rickettsii, most commonly transmitted by the American dog tick. Patients present with nonspecific symptoms, such as fever, headache, myalgias, arthralgias, nausea, vomiting, and abdominal pain. Finally, vibrio vulnificus is a gram-negative bacterium that causes serious wound infections, sepsis, and diarrhea in patients exposed to shellfish or marine water.
Lyme Disease
Authors: Smith Zach
Published: November 2017

Lyme disease (LD) is a tick-borne illness caused by Borrelia burgdorferi that causes a range of symptoms, including rash, constitutional symptoms, arthritis, and neurologic or cardiac abnormalities. LD presents in three stages: primary, early disseminated, and tertiary disseminated. Each stage is highly variable in onset and presentation, and symptoms may manifest across multiple stages. Patients with early stages of LD are often seronegative, so the decision to treat is clinical. A history of a tick bite plus EM is a clear indication for antibiotics; early antibiotics may reduce the severity and duration of symptoms. A vaccine is not available at this time, and LD is not transmitted through people, food, water, or blood; however, B. Burgdorferi has been identified living in stored donated blood. If acquired during pregnancy, LD can be transmitted through the placenta to the fetus; after treatment, no known harm to the fetus has been identified.
Ehrlichia, Anaplasma, and Rickettsia
Authors: Tuddenham Susan
Published: November 2017

Rickettsia, Ehrlichia, and Anaplasma are infections primarily transmitted by ticks (but, in the case of certain Rickettsial species, are transmitted by other vectors as well), which can cause an abrupt, febrile, and flu-like illness often associated with headache, nausea, vomiting, abdominal pain, rash, elevated liver function tests, and thrombocytopenia. Disease can be severe, particularly when patients are infected with Rickettsia rickettsii (Rocky Mountain Spotted Fever); patients may develop central nervous system involvement, shock, and multiorgan failure. Diagnostic tests are imperfect, and prompt empiric treatment should be initiated if disease is suspected. Doxycycline is the treatment of choice, and coinfection with other vector-borne pathogens may need to be considered.
Infection in the Cancer Patient
Authors: Raghavan Sri
Published: November 2017

Cancer patients have increased susceptibility to a variety of both common and atypical infections due to the steady increase in outpatient chemotherapy regimens, these patients are presenting more often to the emergency department when acutely ill. Already immunocompromised, patients’ chemotherapy regimens lead to neutropenia, deficits in cellular and humoral immunity, and disruption of mucosal barriers that predisposing them to severe disease presentations with high morbidity and mortality rates. There are different subsets of oncologic patients predisposed to specific infections. One of the most common presentations of oncologic chemotherapy patients is neutropenic fever caused by bacterial infection; neutropenic patients are also highly susceptible to fungal infections. Patients with hematologic malignancies, particularly those undergoing chemotherapy or bone marrow transplant, can present with inflammation of the cecum with high risk for bacterial translocation and possible perforation. Patients who have indwelling catheters or mediports are at risk for catheter-associated bloodstream infections.
Infection in the Patient with Sickle Cell Anemia
Authors: Young Raymond
Published: November 2017

This chapter provides a brief overview of the clinical manifestations of and management strategies for infectious complications in the immunocompromised sickle cell disease patient. The chapter discusses infections in various organ systems, including the respiratory tract, central nervous system, bone, hematopoietic cell lineage, and blood-borne infections. Differentiating infections from noninfectious processes that often have similar presentations in the sickle cell patient may at times be difficult, and clinicians managing sickle cell patients should be keenly aware of this fact. This chapter discusses the common bacterial pathogens associated with infection and a notable viral agent known to profoundly worsen anemia in the sickle cell host, parvovirus B19. Additionally, fundamental antimicrobial regimens and primary and secondary prophylactic strategies are included in this concise summary prepared for clinicians involved in the acute care management of the sickle cell patient.
Fever of Unknown Origin
Authors: Antar Annie
Published: November 2017

This chapter on fever of unknown origin (FUO) begins by clarifying the definition of FUO and continues by listing and describing the major etiologies of FUO, providing guidance on clinical workup and discussing best management practices. Discussion of FUO etiologies emphasizes that most fall under a few categories—rheumatological, infectious, neoplastic, and other. Emergency management of stable, immunocompetent patients with FUO is best when focused on an appropriate diagnostic workup so that a definitive diagnosis can be established and treated with targeted therapy. Antibiotics should not be started in the emergency department for stable, immunocompetent patients with FUO unless the specific etiology is uncovered. This chapter is concise and targeted to the emergency medicine provider who needs to know how best to evaluate and manage the patient with a clinical history consistent with FUO.
Smallpox
Authors: Smith Rebecca
Published: November 2017

Symptoms of the smallpox virus include fever and a progressive papular rash that becomes vesicular and then pustular. A systemic inflammatory response syndrome (SIRS) leads to septic shock and death in 30% of cases. The definitive diagnosis can be confirmed via blood samples, lesion contents, or scrapings from crusts analyzed using electron microscopy, viral antigen immunohistochemistry, or polymerase chain reaction. The suspicion of a single smallpox case should lead to immediate notification of local public health authorities and the hospital epidemiologist. Because the disease does not exist in nature, smallpox should be considered the result of a bioterrorist attack until proven otherwise. An epidemiologic investigation is essential for determining the perimeter of the initial release so that tracking and quarantine of those exposed can be completed. Patients are extremely contagious and must be placed on contact, droplet, and airborne precautions in a negative pressure room.
The Development of an Academic Medical Center in Rochester
Authors: Fye W. Bruce
Published: November 2017

In 1915 the Mayo brothers created the Mayo Foundation for Medical Education and Research and established a formal relationship with the University of Minnesota, located ninety miles away in Minneapolis. Louis Wilson, a pathologist the Mayo brothers had hired in 1905, championed a more rigorous system of specialty training. An educational reformer, Wilson focused on the need to improve postgraduate training at a time when the emphasis in the United States was on closing or reforming substandard medical schools. The fellowship program established in Rochester, Minnesota, was unique in that it required candidates to have graduated from an acceptable medical school and to have completed an internship. Mayo fellows spent three years preparing for careers as medical or surgical specialists. Fear of competition led several physicians in the Twin Cities to attempt to end the affiliation between the Mayo Foundation and the University of Minnesota. Their efforts failed.
President Roosevelt’s Secret Hypertensive Heart Disease
Authors: Fye W. Bruce
Published: November 2017

Franklin D. Roosevelt’s health was a factor in the 1944 election. Presidential press secretary Stephen Early and White House physician Ross McIntire worried that Thomas Dewey might win if voters learned that Roosevelt had severe hypertension and had an episode of congestive heart failure. Three weeks before the election, Mayo cardiologist Arlie Barnes visited the Bethesda Naval Medical Center where he learned that some physicians suspected that Roosevelt had a “serious heart ailment.” When Barnes returned to Rochester he mentioned this to a few friends. Word of this conversation reached Early, and FBI agents interrogated Barnes and other Mayo physicians two weeks before the election. During the campaign’s closing days, White House insiders orchestrated events designed to showcase a healthy commander in chief. Stifling rumors about Roosevelt’s health was part of their strategy to defeat Dewey. Less than three months into his fourth term, Roosevelt had a stroke and died.
Beyond Mid-Century
Authors: Fye W. Bruce
Published: November 2017

Specialization in medicine grew in popularity after World War II when federal grants stimulated research into organ-specific diseases and the development of new diagnostic and treatment technologies. Mayo Clinic’s time-honored model of care involved having every internal medicine specialist devote significant time to general diagnosis. Mayo’s cardiologists produced a strategic plan in 1964 in which they expressed concern that this philosophy compromised their role as heart specialists. In 1965 Mayo’s internal medicine training program came under fire from a national group that insisted that it conform to the standard academic medical center model. This resulted in the creation of a Department of Medicine, which reduced the autonomy and influence of subspecialty sections such as cardiology. In 1969 Mayo decided to seek philanthropic support to help launch a medical school and to support its research and training programs. Despite Mayo’s changing structure, its main focus remained patient care rather than research.
GW170817: a neutron star merger in a mass-transferring triple system
Authors: Chang Philip , Murray Norman
Published: November 2017

The light curve of GW170817 is surprisingly blue and bright. Assuming that the event is a binary neutron star merger, we argue that blueness and brightness of the light curve is the result of ejecta that contains an substantial amount of thermal energy. To achieve this, the ejecta must be reheated at a substantial distance (1–2000 solar radii) from the merger to avoid losing the energy to adiabatic cooling. We show that this reheating can occur if the merger occurs in a hierarchical triple system where the outer star has evolved and filled its Roche lobe. The outer star feeds mass to the inner binary, forming a circumbinary disc, driving the inner binary to merge. Because the outer star fills its Roche lobe, a substantial fraction of the dynamical ejecta collides with the evolved star, reheating the ejecta in the process. We suggest that the process of mass transfer in hierarchical triples tends to form coplanar triple systems such as PSR J0337+1715, and may provide electromagnetic counterparts to binary black hole mergers.