bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimentation on Human Subjects
Authors: Veatch Robert M. , Haddad Amy , Last E. J.
Published: May 2017

This chapter examines ethical issues in research involving human subjects. The Nuremberg trials, which exposed to all humankind the outrageous things that could be done in the name of medical science, led to the Nuremberg Code, the first international document from public sources setting out an ethic for research on human subjects. Basic differences are outlined between the goals of therapy for the good of a patient and those of research that focus on attainment of knowledge and the good of society. To protect the interests of human subjects who take part in research, guidelines such as the Declaration of Helsinki have been established for assessing risks and benefits, voluntary consent, protection of privacy and confidentiality, and equity in subject selection. The chapter focuses on the difficulty in calculating harms and benefits to subjects and challenges of obtaining informed consent for participation in research.
Consent and the Right to Refuse Treatment
Authors: Veatch Robert M. , Haddad Amy , Last E. J.
Published: May 2017

This chapter is concerned with one of the major ethical issues in contemporary health care practice: informed or valid consent. The chapter defines the elements of informed consent—that is, the types of information that need to be transmitted for consent to be adequately informed. The second section looks at cases involving questions of the standards of consent, referring to the question of what standard of reference should be used in determining whether a sufficient amount of a particular type of information has been transmitted: the professional standard, the reasonable person standard, or the subjective standard. The third section examines questions of whether the information transmitted is comprehended and whether the consent is adequately voluntary. Finally, the fourth section addresses whether incompetent patients can be expected to consent and what role parents, guardians, and other surrogates can play in giving approval for medical treatments for those who are legally incompetent to do so themselves.
Prescribing and Overprescribing
Authors: Paris Joel
Published: May 2017

The development of effective pharmacological treatments for severe mental disorders between the 1950s and 1970s was one of the great triumphs of medical science. However, progress since then has been slow. Most drugs in current use are variants of those previously on the market, albeit with less worrisome side effects. Yet prescription rates have skyrocketed. Moreover, atypical antipsychotics, despite their side effects and warnings from watchdog organizations, are currently being widely used for sedation. Psychiatrists are prescribing these drugs for many, if not most, of their patients. All have a proper use—one cannot treat psychosis without antipsychotics. However, the situation in common mental disorders is different. Although antidepressants are essential in melancholic depressions, they are much less effective in mild to moderate cases. Moreover, protocols that advise drug combinations for “treatment-resistant” cases are not well based in evidence.
Seeing Spots
Authors: Krel Regina , Mathew Paul G.
Published: May 2017

Migraine and its association with stroke is a topic that has received much attention due to the high prevalence of migraine and the often devastating outcomes of stroke. There is a nearly two-fold increased risk of stroke in patients with migraine. In addition, this risk is higher in younger adults, particularly women under 45 years old, and in those with increased frequency of migraine with aura attacks. This chapter seeks to explore migraine-induced stroke, migrainous infarction, as well as the risk associated with ischemic stroke in patients with migraines. Furthermore, proposed mechanisms for stroke related to migraine, such as cortical spreading depression, arterial dissection, and patent foramen ovale, will be discussed.
Multiple Ovarian Cysts in a Woman with Epilepsy
Authors: O’Neal M. Angela
Published: May 2017

This chapter explores how epilepsy can affect reproductive function. The National Institute of Health consensus definition of PCOS includes the presence of menstrual dysfunction, clinical evidence of hyperandrogenism, and exclusion of other endocrinopathies, such as Cushing’s syndrome and hypothyroidism. The etiology of PCOS is felt to be heterogenous, related to a complex interaction between both genetic and environmental factors. PCOS develops when the ovaries are stimulated to produce excessive testosterone. The diagnosis and pathogenesis of polycystic ovarian syndrome is explored; in particular, how valproate contributes to the condition in women with epilepsy. Valproate is the AED most associated with PCOS, as it can directly increase ovarian testosterone production. It can also cause weight gain leading to insulin resistance, another mechanism contributing to PCOS.
A Woman with Weight Gain and Fatigue
Authors: Lovett Alexandra , Woodmansee Whitney W.
Published: May 2017

Cushing’s syndrome is a descriptive term of a syndrome secondary to elevated levels of steroids or cortisol, while Cushing’s disease is hypercortisolemia that results from an adrenocorticotropic (ACTH)-secreting pituitary adenoma. Patients will present with cushingoid features on physical examination and can be myopathic with proximal rather than distal muscle weakness. Diagnosis can be obtained by multiple avenues including but not limited to checking 24 hour urine cortisol, a dexamethasone suppression test, checking ACTH levels, a CRH (corticotrophin-releasing hormone) stimulation test, and inferior petrosal sinus sampling (IPSS). Once Cushing’s disease is confirmed, treatment is via transsphenoidal resection of the pituitary adenoma.
Postpartum Thunderclap Headache
Authors: O’Neal M. Angela
Published: May 2017

An illustrative case of reversible cerebral vasoconstriction syndrome (RCVS) is presented. The clinical and radiographic features are reviewed. There is an overlap between RCVS and posterior reversible encephalopathy syndrome due to their shared pathophysiology related to endothelial injury. Furthermore, preeclampsia/eclampsia (PEE) is often associated with RCVS. Thunderclap headache is the most characteristic feature of the disorder. RCVS may also cause subarachnoid hemorrhage, typically located over the cerebral convexities; intracranial hemorrhage; and ischemic stroke. The diagnosis is made by seeing vasoconstriction on vessel imaging, either magnetic resonance angiography or computerized tomography angiography. There are several medications that can precipitate the condition by increasing sympathetic activity. Treatment is similar to that of PEE, with antihypertensives and magnesium. Calcium channel blockers are helpful symptomatic therapy for the headache.
Postpartum Left-Sided Numbness and Right-Sided Shaking
Authors: O’Neal M. Angela
Published: May 2017

The chapter discusses cerebral venous thrombosis (CVT) in pregnancy. The signs and symptoms of the patient depend on which venous sinus is clotted. The clinical features may include headache, bilateral symptoms, hemorrhagic stroke, and seizures. The headaches are related to elevated intracranial pressure and can mimic those of idiopathic intracranial hypertension. Hematological changes that occur in pregnancy result in a hypercoagulable state; this normal physiology can predispose in certain situations to CVT. Other factors associated with an increase in the risk of clotting include infection, fluid loss, inactivity, and C-section. CVT is treated with anticoagulation, whereas seizures and other complications are managed symptomatically. The length of anticoagulation depends on whether additional clotting abnormalities are discovered. Anticoagulation is recommended for future pregnancies.
The Worst Headache of Her Life
Authors: O’Neal M. Angela
Published: May 2017

The case is an example of a ruptured arteriovenous malformation (AVM) causing an intracranial hemorrhage during pregnancy. Volume changes that occur during pregnancy predispose to AVM rupture. These changes peak at 25–30 weeks of gestation. An unruptured AVM if identified should be treated in the nonpregnant state. Once there has been a hemorrhage related to an AVM the risk of re-rupture is high. Therefore, treatment is dictated by best neurosurgical considerations rather than obstetric concerns. If an AVM ruptures near term an emergent caesarian-section and hemicraniectomy could be done in tandem.
A Woman in Labor with Hypotension and Dyspnea After Epidural Placement
Authors: Waters Janet
Published: May 2017

This chapter discusses neurological complications of the administration of epidural and spinal anesthesia in the obstetric population. It begins with a case report on a patient with a total spinal block, which occurs when large doses of local anesthetic intended for the epidural space are inadvertently injected into the subarachnoid space. The chapter reviews key points in recognizing and treating this potentially fatal complication. It discusses other complications, including epidural hematoma, epidural abscess, spinal cord injury, and meningitis, as well as complications from intravascular injection of local anesthetic. Lastly, it discusses how to recognize and treat the most common complication of neuraxial block, post dural puncture headache.
A Mother Who Could Not See Her Baby
Authors: Matiello Marcelo , Kaplan Tamara B.
Published: May 2017

Neuromyelitis optica spectrum disorders (NMOSD) belong to a group of relapsing neurological syndromes characterized by significant morbidity and mortality due to central nervous system (CNS) inflammation and necrosis. Most patients are seropositive for pathogenic antibodies targeting Aquaporin-4, and while this water channel is mostly expressed on the foot processes of astrocytes, it is also expressed in placental tissues. On planning a pregnancy, patients should be well informed about the increased risk of preeclampsia and miscarriages, and that most medications used to treat NMOSD have potentially severe toxicities to the fetus. There is also increased risk of relapses in the postpartum period, and immunosuppressive agents are the mainstream method of preventing attacks.
“I Am Pregnant; Why Can’t I Sleep?”
Authors: Horowitz Sandra L.
Published: May 2017

This chapter reviews the common sleep disorders of pregnancy. During pregnancy and postpartum, 84% of women report poor sleep at least a few nights a week. These problems are common, disruptive to daytime and nighttime activity, and may have multiple causes. This chapter covers aspects of insomnia and restless leg syndrome. It also discusses sleep apnea in pregnancy with related hormonal changes that may increase the incidence. There is an association of sleep apnea and pregnancy-induced hypertension, with increased adverse outcomes of pregnancy, including fetal growth retardation and premature birth. It has been suggested that treating nocturnal airflow limitation may improve gestational hypertension. The recommended therapies in this chapter may also be applied to non-pregnant patients with similar complaints.
Cognitive Concerns
Authors: O’Neal M. Angela
Published: May 2017

This chapter reviews the incidence and gender-specific risks for women developing Alzheimer’s disease, AD. The incidence of AD doubles every five years beginning at age 60. Furthermore, AD is 2–3 times more common in women. Observational trials suggested that estrogen could play a role in delaying the onset of AD. However, the Women’s Health Initiative Memory Study, WHIMS, published in 2003, demonstrated that estrogen, with or without medroxyprogesterone, substantially increased the risk of dementia of any cause, with AD being the most frequent etiology. Additional studies suggesting that there might be a window where hormonal therapy is beneficial have not been corroborated. The gender differences in AD may be partially explained by the finding that women have less ability to clear amyloid. This results in a larger amyloid burden. Maintaining a healthy lifestyle is the only clearly documented preventative treatment for AD.
“Will I Have a Stroke?”
Authors: O’Neal M. Angela
Published: May 2017

This chapter reviews stroke in women, their third leading cause of death. Complications of pregnancy are associated with a higher risk of cerebrovascular disease beyond pregnancy. Women with preeclampsia have 2–10-fold risk of chronic hypertension. Fifty percent of women with gestational diabetes mellitus will develop type II DM within 5–10 years of their pregnancy. Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure. In women with atrial fibrillation over the age of 75, there is a higher risk of stroke than in men. The American Heart and Stroke Association published a guideline in 2014 for stroke prevention in women. They defined the stroke risk factors that are sex-specific, such as pregnancy, preeclampsia, gestational diabetes, oral contraceptive use, and postmenopausal hormone use. There are several conditions associated with stroke in women, including: migraine with aura, AF, diabetes mellitus, and hypertension.
Convulsion in a Pregnant Woman
Authors: Lee Eudocia Q.
Published: May 2017

The management and treatment of brain tumors is the same regardless of patient gender, except when considering fertility and pregnancy. Fortunately, brain tumors are rare during pregnancy. Because the lives of the mother and the fetus may be at risk, the care of pregnant women with brain tumors has ethical implications and requires a multidisciplinary approach involving obstetrics, maternal-fetal medicine, neurosurgery, anesthesiology, neurology, medical oncology, and radiation oncology. Chemotherapy and radiation are generally considered incompatible with normal fetal development. Only a few chemotherapeutic drugs have been tested in pregnancy, and therefore most are considered contraindicated during pregnancy. Radiation can have long-term implications for the fetus, including increased risks of cancer and mental retardation. This chapter will review the management of low-grade gliomas in pregnancy.
Telemental Health in Africa
Authors: Wynchank Sinclair , Wynchank Dora
Published: May 2017

Although telemental health (TMH) in Africa shares much with TMH in well-resourced nations, significant differences exist. These mainly result from relatively small funds available for all forms of healthcare, inadequate infrastructure, lack of mental healthcare personnel, and cross-cultural difficulties. The majority of individuals with severe mental illness receive no treatment in most African countries. This lack has been alleviated in part by some “North–South” and “South–South” TMH programs, in addition to other locally initiated programs. African TMH has emphasized provision of a wide variety of TMH—education, managing psychotrauma in regions of violent upheavals, and the provision of other TMH services. Novel African telecommunications techniques and means of providing TMH, for example using broadcast media and diasporic mental healthcare personnel, are outlined. So, future African TMH will surely grow because of decreasing equipment costs, but principally because of proven effectiveness and the power of such interventions.
Telemental Health in the Middle East
Authors: Jefee-Bahloul Hussam , Zayour Zakaria
Published: May 2017

The Middle East (ME) has a high burden of mental disorder that is not addressed adequately with current services. This context makes it a prime target for Telemental health interventions. This chapter presents a review of the existing reports concerning implementation of telemental health in the Middle East. While telemental health programs can facilitate access to quality mental health services for patients and serve as a training and educational tool to advance mental health workers’ expertise, several barriers stand in the way of its implementation. Evaluation of each country’s unique cultural, financial, legal, and infrastructural conditions should guide the strategies for developing these systems.
Telemental Health in Taiwan
Authors: Tsai Hsiu-Hsin
Published: May 2017

This chapter reviews current mental health needs in Taiwan, and provides a summary of the history of Telemedicine and Telemental health services. In addition, Taiwan has a growing elderly population, and there is an increasing number of elderly living in nursing homes, which is considered a highly stressful event associated with depression and loneliness. To outline the implementation of telemental health in Taiwan, the authors of this chapter highlight a case of providing videoconferencing-based services to geriatric populations residing in nursing homes. Acceptance of the use of technology, the intervention’s efficacy in reducing loneliness and improving depression symptoms, and the challenges facing its scaling up are reviewed. The chapter goes on to provide recommendation for widespread application of TMH services.
Connecting the World
Authors: Guzman Juan Rodriguez , Barkil-Oteo Andres
Published: May 2017

This chapter builds on the knowledge gained from the reports and studies in this book to highlight the lessons learned, and identify some challenges and future directions for the telemental health field. The expansion of Telemental health projects in global low-income settings is a promising sign. This field should use the identified gaps in scientific knowledge, implementation and practice and the increased interest by the policy makers and the public to consolidate the field and move it forward… This technology will help in increasing access to mental health care and decrease the current gap that is most acute in low income settings globally.
International Criteria of Brain Death
Authors: Wijdicks Eelco F.M.
Published: May 2017

Brain death criteria have mostly developed when there are organ donation policies in place. The variability in criteria and practices around the world is striking but also inherently problematic, with no consensus in sight. This chapter surveys the criteria across the continents, including in Canada, Europe, South America, Africa, Asian and the Middle East, and Australia and New Zealand. There is a specific focus on the brain death criteria in the United Kingdom and alleged contrasts with U.S. guidelines. A discussion of how best to achieve uniform criteria, despite obstacles, is described. Toward that effort a case is made to and allow the diagnosis of brain death if, after excluding any possible confounder, all brainstem reflexes have disappeared and the patient has become demonstrably apneic.
Beliefs and Brain Death
Authors: Wijdicks Eelco F.M.
Published: May 2017

Globalization has increased cultural diversity in many communities. This has immediate implications for care of patients with catastrophic neurological injury and later discussions of brain death and organ donation. While the major religions in the United States—Christianity, Islam, and Judaism—have taken a tolerant position in these matters, some denominations within them are vigorously opposed to it. This chapter presents a range of cultural and religious views of brain death determination and organ donation. In addition to the three major religions, Buddhist and native American views regarding brain death determination as well as organ donation are discussed. Conflict resolution over organ donation is discussed along with the role of clergy in mediating such conflicts between families and medical staff.
Procurement after Brain Death
Authors: Wijdicks Eelco F.M.
Published: May 2017

This chapter discusses the practice of organ procurement, including the family’s, physician’s, and organ procurement organization’s roles in this process. Procurement of donated organs is a major clinical undertaking requiring close monitoring and treatment by transplantation coordinators. Most importantly, consent for organ donation is discussed with the family, after the patient has been declared brain dead, and this chapter provides a thorough summary of these discussions. There are many physiological challenges to maintaining the viability of the organ donor, and these are discussed in detail. Each of the major physiological derangements and respective care are discussed. Medical management of the donor is aimed at anticipating the normal physiological changes with brain death and achieving optimal organ perfusion and minimizing ischemic injury.
Building the Team
Authors: Harrod Molly , Saint Sanjay , Stock Robert W.
Published: May 2017

The team structure as a model for organizing work has in recent years won broad acceptance in industry, with studies demonstrating that teams performing high-intensity tasks make fewer mistakes than individual workers. This comports with modern educational theory, which tends to identify two basic varieties of learning: knowledge acquisition, which enables the individual to reproduce the information studied, and knowledge gained through participation in a dynamic community or team. Team learning is beneficial for hospitals where collaboration among clinicians is so vital. The attendings used multiple strategies to build and maintain team relationships. The attendings’ definition of the team extended beyond the learners and included other medical specialists. Attendings view the care of a patient as the team’s responsibility and not just that of the primary provider.
A Safe, Supportive Environment
Authors: Harrod Molly , Saint Sanjay , Stock Robert W.
Published: May 2017

The 12 attendings all created a safe and supportive learning environment but used various strategies to do so. The attendings provide positive feedback and are completely engaged during rounds. They make themselves available to learners and are eager to help them. The attendings also get to know their learners on a personal level in order to build trusting relationships with their teams. The attendings admit their own mistakes and welcome challenges from learners, demonstrating their conviction that a mistake is a prime learning experience. Learners engage in clinical decision-making, knowing that their attending will support and protect them in case of an oversight.
Violence Risk Assessment
Authors: Piel Jennifer L. , Schouten Ronald
Published: May 2017

The problem of violence in our society has received increasing attention from the public and mental health professions in recent years, and assessing the risk of violence has become a core skill for mental health clinicians and forensic specialists alike. In fact, mental health practitioners in all clinical settings are tasked with assessing and managing their patients’ risk of violence. Although research on the nature of violence and factors that increase the likelihood that a person will commit violent acts has grown in the past several decades, there is no single standard protocol or tool for assessing the risk of violence. This chapter reviews the key risk factors for violence that are supported by research, examines the relationship between mental disorders and violence, and describes approaches that mental health professionals can use to assess the risk of violence.
Informed Consent
Authors: Schouten Ronald , Kumer Kimberly D.
Published: May 2017

The contemporary doctrine of informed consent is one of the most important developments in modern medicine. Informed consent as we know it today is a fundamental principle of medical ethics, an essential aspect of clinical care, and a legal obligation enforced through case law, regulations, and statutes. A new concept when it was adopted in the middle of the 20th century in the United States, it has become an essential part of modern clinical care. This chapter explores the history and development of the doctrine of informed consent, as well as its application in clinical practice. Using a case vignette involving a common clinical situation, we examine the components of the informed-consent process, with a focus on the evaluation of decision-making capacity.
Guardianships, Conservatorships, and Alternative Forms of Substitute Decision Making
Authors: Schouten Ronald , Brendel Rebecca W.
Published: May 2017

To protect individuals who can no longer make the decisions and carry on the activities of adult life, society has provided processes including the appointment of alternative decision makers, traditionally referred to as guardians of the person (for personal decisions such as medical treatment) and conservators of the estate (for financial decisions). When a person has lost capacity, appointing an alternative decision maker can be problematic, as the person may not have previously expressed preferences regarding health care or financial matters, and there may be disagreement among interested parties such as family members. Advance directives, such as health care proxies, help alleviate these problems by providing a method for the person in question to document his or her preferences and appoint someone to act on their behalf in the event of incapacity. This chapter discusses traditional protections for incapacitated persons, advance directives, and capacities to engage in various decision-making activities.
Malpractice
Authors: Piel Jennifer L. , Resnick Phillip J.
Published: May 2017

A lawsuit for professional malpractice is an occupational hazard feared by many psychiatrists, psychologists, social workers, and counselors in the mental health field. Most actions against mental health clinicians are based on the concept of negligence. Medical negligence occurs when health care professionals fail to adhere to the standard of professional care, resulting in harm to a patient. Mental health professionals may also face legal action for certain intentional actions that cause injury to a patient. This chapter reviews the core legal concepts underlying malpractice claims against mental health clinicians. Presented here are the topics that are most likely to be the basis of liability suits against mental health providers. The chapter concludes with some strategies that mental health professionals can use to reduce the risk of malpractice liability.
Juveniles and the Law
Authors: Lahaie Matthew , Kinscherff Robert
Published: May 2017

This chapter discusses areas of law relevant to mental health clinicians working with juveniles. Clinicians must be aware of the law in the specific jurisdictions in which they practice. The chapter provides an overview of several areas of law that clinicians are likely to encounter in their professional practice with juveniles, including legal constructs concerning the relationship between juveniles and their parents, guardianships, custody considerations in divorce cases, decision making on behalf of juveniles, and separate provisions for juveniles in the criminal justice system. It discusses the state’s interest in promoting the healthy development and protection of maltreated juveniles, shaping the provision of clinical care or education, and providing protections for juveniles with disabilities. Intended as a guide for clinical care providers, the chapter considers the differences between clinical and forensic roles and strongly cautions clinicians to avoid blurring these roles, which involve distinctly different responsibilities and rules.
Testimonies in Understanding the Psychological and Cognitive Problems Faced by Survivors of Critical Illness
Authors: Jones Christina , Gibb Peter , Hopkins Ramona O.
Published: May 2017

Millions of patients are treated in intensive care units (ICUs) each year, and the number of survivors is growing as a result of advances in critical care medicine. Unfortunately, many survivors of critical illness have substantial morbidity. Physical, psychological, and cognitive impairments are particularly common—so much so that a group of clinicians coined the term “post-intensive care syndrome” (PICS) to help raise awareness. Patients surviving critical illnesses are often quite weak, and physical therapy, hopefully starting in the ICU, is vital. But weakness is only one of the problems critical-illness survivors and their loved ones face. Unfortunately, many survivors are left with cognitive impairment (e.g., impaired memory, attention, and executive functioning), as well as distress-related psychiatric phenomena such as posttraumatic stress and depression. Importantly, these problems are not limited to adult patients, and loved ones also suffer. In this chapter the authors describe their personal journeys in coming to understand the suffering and issues that critical-illness survivors and their families face.
Critical Illness and Long-Term Cognitive Impairment
Authors: Hopkins Ramona O. , Carlo Maria E. , Jackson James C.
Published: May 2017

Evidence from dozens of studies of thousands of individuals suggest that as many as half of critical illness survivors experience significant deficits in memory, executive functioning, attention, and processing speed that persist years after discharge from the intensive care unit (ICU). This chapter reviews the prevalence, characteristics, possible mechanisms, and risk factors for long-term cognitive impairment after critical illness. Some key risks factors—notably, delirium—may be modifiable, whereas others, such as genetic markers, are not. Cognitive impairments are associated with psychiatric disorders, including depression, anxiety, and posttraumatic stress disorder. The impact of critical illness–related cognitive impairment on individuals and society includes financial costs, inability to return to work, impairments in instrumental activities of daily living (financial management, medication management, shopping, home care), reduced quality of life, and caregiver burden. Efforts need to be directed not only at modifying risk factors but also at attempting to prevent, treat, and remediate deficits.
Prevention and Treatment of Posttraumatic Stress and Depressive Phenomena in Critical Illness Survivors
Authors: Jones Christina , Bienvenu O. Joseph
Published: May 2017

Patients recovering from critical illness can be left with significant psychological problems that have a profound effect on their quality of life. As yet, studies on prevention of posttraumatic stress disorder (PTSD) and/or depression are in their infancy. This chapter discusses multimodal rehabilitation strategies that can improve psychological recovery which are beginning to be established. Recognizing those patients needing further help and having a structured pathway for rehabilitation is the first step toward returning patients to as normal a life as possible after critical illness. Providing intensive care unit (ICU) diaries for as many patients as possible is a cost-effective way of helping patients come to terms with their ICU experience. Also discussed in the chapter are psychological therapies, which may be reserved for those survivors of critical illness who are experiencing more severe effects from critical illness and intensive care.
Supporting Pediatric Patients and Their Families during and after Intensive Care Treatment
Authors: Colville Gillian
Published: May 2017

This chapter shows how the observations and recommendations in the adult intensive care unit (ICU) literature are relevant to the provision of services for pediatric intensive care patients and their families. Two relevant models of service currently in use in pediatric settings are presented, illustrated with clinical examples. Models of care in pediatrics have traditionally been more family-focused than those in adult settings. In the acute stage of medical treatment in the pediatric ICU, the emphasis, from a psychological perspective, is primarily preventative and initially focused on parental reactions at a time when the child is usually too unwell or sedated to communicate with directly. As the child’s condition stabilizes, delirium and associated frightening experiences should be addressed. Children may cope better if provided an age-appropriate storybook explaining what has happened. In the longer term, it is important to speak to children directly about their critical illness experiences, and to monitor children’s and parents’ emotional reactions over time. Trauma-focused cognitive-behavioral and narrative therapies may be helpful.
Upper gastrointestinal surgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter covers oesophago-gastro-duodenoscopy, including operations like perforated peptic ulcer closure, laparoscopic cholecystectomy, surgery for bleeding peptic ulcer, antireflex surgery—Nissen, Dor, Toupet. It gives a classification of regional lymph nodes of the stomach and explains lymphadenectomy, and the steps of total and subtotal gastrectomy. Types of oesophagectomy and the steps of operations are explained. Details of the operative steps of Heller’s cardiomyotomy for achalasia are provided. Obesity surgery includes laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (LSG), and Roux-en-Y gastric bypass (RYGB). Managing oesophageal rupture and perforation includes non-operative and surgical and T tube repair.
Colorectal surgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter on colorectal surgery covers common anorectal operations, and open and laparoscopic colorectal resections. Operations for fissures, fistulae, haemorrhoids, pilonidal sinus, rectal prolapse, perianal abscess are described. The steps of appendicectomy, ileostomy and colostomy formation and closure, intestinal anastomosis, colonic and rectal resections, abdominoperineal excision, ileal pouch, and Hartmann’s operations are included. Also included is surgery for faecal incontinence, sphincteroplasty, and for obstructed defaecation like STARR (stapled transanal rectal resection) and LVMR (laparoscopic ventral mesh rectopexy). Endoscopic examination like flexible sigmoidoscopy and colonoscopy are described.
Plastic and reconstructive surgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

In this chapter on plastic and reconstructive surgery, the reconstructive ladder is introduced. Debridement of a complex wound, burns, and infected collection in hand are described. Steps of taking a split-skin graft, harvesting a full-thickness skin graft (FTSG), excision of malignant skin lesion and ganglion, tendon repair, nerve and tendon graft harvest, local skin flap, nail bed repair, repair of digital nerve and lip laceration, trigger digit repair, use of Z plasty, digital terminalization, reduction and fixation of hand fracture, insertion of tissue expander, execution of fasciocutaneous and muscle flaps, abdominoplasty, inguinal lymphadenectomy, correction of syndactyly, reconstruction of nipple, and selective fasciectomy are described. Also included is steroid injection of a scar.
Orthopaedics
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter on orthopaedics outlines the application of a secondary cast to a forearm or leg manipulation under anaesthetic (MUA) of distal radius fracture plus minus insertion of Kirschner wires, intra-articular injections, joint aspirations, and diagnostic arthroscopy. Operations included are fixation of Weber B fracture of ankle, dynamic hip screw (DHS) for extra-capsular neck of femur fracture, fixation of patella fracture by tension band wiring, insertion of traction pins, surgical debridement of traumatic wound, fasciotomy for compartment syndrome of leg, carpal tunnel decompression, surgical approaches to the hip, surgical approach to great toe metatarsophalangeal (MTPJ), and surgical approach to lumbar spine.
Multiple Subpial Transections for Medically Refractory Epilepsy: A Disaggregated Review of Patient-Level Data
Authors: Rolston John D , Deng Hansen , Wang Doris D , Englot Dario J , Chang Edward F
Published: May 2017

BACKGROUND

Multiple subpial transections (MST) are a treatment for seizure foci in nonresectable eloquent areas.

OBJECTIVE

To systematically review patient-level data regarding MST.

METHODS

Studies describing patient-level data for MST procedures were extracted from the Medline and PubMed databases, yielding a synthetic cohort of 212 patients from 34 studies. Data regarding seizure outcome, patient demographics, seizure type, surgery type, and complications were extracted and analyzed.

RESULTS

Seizure freedom was achieved in 55.2% of patients undergoing MST combined with resection, and 23.9% of patients undergoing MST alone. Significant predictors for seizure freedom were a temporal lobe focus (odds ratio 4.9; 95% confidence interval 1.71, 14.3) and resection of portions of the focus, when feasible (odds ratio 3.88; 95% confidence interval 2.02, 7.45). Complications were frequent, with transient mono- or hemiparesis affecting 19.8% of patients, transient dysphasia 12.3%, and permanent paresis or dysphasia in 6.6% and 1.9% of patients, respectively.

CONCLUSION

MST is an effective treatment for refractory epilepsy in eloquent cortex, with greater chances of seizure freedom when portions of the focus are resected in tandem with MST. The reported rates of seizure freedom with MST are higher than those of existing neuromodulatory therapies, such as vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation, though these latter therapies are supported by randomized-controlled trials, while MST is not. The reported complication rate of MST is higher than that of resection and neuromodulatory therapies. MST remains a viable option for the treatment of eloquent foci, provided a careful risk-benefit analysis is conducted.
Cerebrovascular Imaging: Which Test is Best?
Authors: Lin Amy , Rawal Sapna , Agid Ronit , Mandell Daniel M
Published: May 2017

Optimal diagnosis and characterization of cerebrovascular disease requires selection of the appropriate imaging exam for each clinical situation. In this review, we focus on intracranial arterial disease and discuss the techniques in current clinical use for imaging the blood vessel lumen and blood vessel wall, and for mapping cerebral hemodynamic impairment at the tissue level. We then discuss specific strategies for imaging intracranial aneurysms, arteriovenous malformations, dural arterial venous fistulas, and arterial steno-occlusive disease.
Endoscopic Transorbital Superior Eyelid Approach for the Management of Selected Spheno-orbital Meningiomas: Preliminary Experience
Authors: Dallan Iacopo , Sellari-Franceschini Stefano , Turri-Zanoni Mario , de Notaris Matteo , Fiacchini Giacomo , Fiorini Francesca Romana , Battaglia Paolo , Locatelli Davide , Castelnuovo Paolo
Published: May 2017

BACKGROUND

Feasibility and safety of spheno-orbital meningioma resection by means of endoscopic-assisted transorbital route.

OBJECTIVE

To evaluate the feasibility and outcomes of the transorbital endoscopic management of selected spheno-orbital meningiomas. As secondary aims, symptom improvement and tumor volume removed were evaluated.

METHODS

Retrospective chart evaluation of patients with spheno-orbital meningiomas treated by means of endoscopic transorbital superior eyelid approach in 3 referral centers over the last 4 yr.

RESULTS

Fourteen cases were included in this study. In 4 patients, the transorbital endoscopic approach was combined with an endonasal route. Mean age was 51 and male-to-female ratio was 1:6. In 8 patients (57.1%), an intraorbital involvement was observed, 3 of them (21.4%) showed significant intraconal disease. No patient presented significant cavernous sinus infiltration. Main presenting symptoms were proptosis, diplopia, and visual impairment in 14, 6, and 6 patients, respectively. Mean proptosis improvement was 2 mm (standard deviation 2.3). We observed no major postoperative complications.

CONCLUSION

Our preliminary clinical experience seems to demonstrate that selected spheno-orbital meningiomas can be safely managed by means of an endoscopic transorbital route through a superior eyelid approach. Patients with orbital or cavernous sinus infiltration are at highest risk of persistence.
Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic
Authors: Duchesne Elise , Dufresne Sébastien S. , Dumont Nicolas A.
Published: May 2017

Anti-inflammatory modalities are commonly used for the treatment of various musculoskeletal injuries. Although inflammation was originally believed to interfere with skeletal muscle regeneration, several recent studies have highlighted the beneficial effects of inflammatory cells on muscle healing. This discrepancy is attributable to an evolving understanding of the complex inflammatory process. To better appreciate the paradoxical roles of inflammation, clinicians must have a better comprehension of the fundamental mechanisms regulating the inflammatory response. In this perspective article, cellular, animal, and human studies were analyzed to summarize recent knowledge regarding the impact of inflammation on muscle regeneration in acute or chronic conditions. The effect of anti-inflammatory drugs on the treatment of various muscle injuries was also considered. Overall, this work aims to summarize the current state of the literature on the inflammatory process associated with muscle healing in order to give clinicians the necessary tools to have a more efficient and evidence-based approach to the treatment of muscle injuries and disorders.
ASDS Guidelines Task Force: Consensus Recommendations Regarding the Safety of Lasers, Dermabrasion, Chemical Peels, Energy Devices, and Skin Surgery During and After Isotretinoin Use
Authors: Waldman Abigail , Bolotin Diana , Arndt Kenneth A. , Dover Jeffrey S. , Geronemus Roy G. , Chapas Anne , Iyengar Sanjana , Kilmer Suzanne L. , Krakowski Andrew C. , Lawrence Naomi , Prather Heidi B. , Rohrer Thomas E. , Schlosser Bethanee J. , Kim John Y.S. , Shumaker Peter R. , Spring Leah K. , Alam Murad
Published: May 2017

BACKGROUND

Currently, the isotretinoin (13-cis-retinoic acid) package insert contains language advising the discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. It is common practice to follow this standard because of concerns regarding reports of sporadic adverse events and increased risk of scarring.

OBJECTIVE

To develop expert consensus regarding the safety of skin procedures, including resurfacing, energy device treatments, and incisional and excisional procedures, in the setting of concurrent or recent isotretinoin use.

MATERIALS AND METHODS

The American Society for Dermatologic Surgery authorized a task force of content experts to review the evidence and provide guidance. First, data were extracted from the literature. This was followed by a clinical question review, a consensus Delphi process, and validation of the results by peer review.

RESULTS

The task force concluded that there is insufficient evidence to justify delaying treatment with superficial chemical peels and nonablative lasers, including hair removal lasers and lights, vascular lasers, and nonablative fractional devices for patients currently or recently exposed to isotretinoin. Superficial and focal dermabrasion may also be safe when performed by a well-trained clinician.
Gardnerella vaginalis as a Cause of Abscesses and Bacteremias
Authors: Macedo-Viñas Marina , Petitpierre Nicolas , Cherkaoui Abdessalam , Wirth Gregory , Kaiser Laurent
Published: May 2017

Gardnerella vaginalis is infrequently reported as a cause of extragenital infections. Although the pathogenesis of G. vaginalis is not completely understood, available clinical data suggest that it is an opportunistic pathogen that can cause invasive infections.

We report a case of pyelonephritis imputed to G. vaginalis, with renal abscess and bacteremia in a diabetic nonpregnant woman with polycystic kidney disease. Gardnerella vaginalis was isolated from blood, the abscess, and urine obtained by direct placement of a pigtail into the kidney. Identification was made with molecular methods.

We present a review of the literature concerning G. vaginalis extragenital infections, with special focus on abscesses and bacteremias.

We searched PubMed for articles in English, French, German, and Spanish languages. Only 15 cases of abscesses from diverse body sites have been reported. We found 28 articles describing a total of 117 cases of bacteremia. Most of them occurred in women in the peripartum periods and in newborns. Cases in men have been described with lower frequency. The importance of this agent might be underestimated because microbiological diagnosis is difficult. Most cases in adults were nonfatal and without sequelae. There is no consensus on the antibiotic regimen and duration of treatment for these infections. New microbiological diagnosis tools may lead to prompt identification of this microorganism and help to elucidate its participation in localized and systemic infections.
Complicated Lymphogranuloma Venereum With Pelvic Peritonitis in Young Man
Authors: Pasquer Arnaud , Fanget Florian , Djeudji Filbert , Coppere Brigitte , Boibieux Andre , Barth Xavier
Published: May 2017

Chlamydia trachomatis–linked pelvic peritonitis occurs mainly in young women of childbearing age, most often in a context of salpingitis. Fitz-Hugh–Curtis syndrome and perihepatitis have been reported in only 2 men with acquired immunodeficiency syndrome. We present here the observation of these patients including clinical presentation, morphological examinations, and therapeutic decision with follow-up. No surgery was performed. Antibiotic therapy was successfully introduced. Chlamydia trachomatis–linked pelvic peritonitis rarely occurs in men and is often associated to immunodeficiency. Diagnosis must be evoqued in medical peritonitis with no etiology found when patient's anamnesis tends to suspect an important sexually transmitted disease risk.
An Unusual Case of Gardnerella vaginalis
Authors: Saikali Peter , Koff Alan , Missick Samardia , Munger David , Zelkowitz Richard , Kang Eunice
Published: May 2017

Gardnerella vaginalis bacteremia is an uncommon sequela of a common reproductive tract colonizer, usually related to obstetric or gynecologic procedures. We present a 54-year-old woman with metastatic breast cancer undergoing chemotherapy. She was hospitalized with fever and severe neutropenia and was found to have G. vaginalis on blood culture. The patient was treated with tbo-filgrastim, cefepime, and metronidazole, with resolution of neutropenia and rapid defervescence. This case documents the first case of G. vaginalis bacteremia in a female immunocompromised patient, with only a distant gynecologic history.
Completion Rate and Safety of 12-Dose Isoniazid and Rifapentine for Latent Tuberculosis in a Predominantly Refugee Cohort
Authors: Sweeney Tracey L. , Ahern John W. , Alston W. Kemper
Published: May 2017

Background

Latent tuberculosis infection treatment is a cornerstone of tuberculosis control. Standard treatment is 9 months of daily, self-administered isoniazid (9H). In 2011, the Centers for Disease Control and Prevention recommended 12 doses of isoniazid and rifapentine (3HP), administered once weekly and directly observed, based on a clinical trial demonstrating equal efficacy and higher completion rate than the standard of care (82% vs 69%). The infectious disease clinic at the University of Vermont Medical Center began using the 12-dose regimen in 2012. This study compares the completion rates and safety of the 2 treatments in a real-world setting.

Methods

Two matched cohorts of 82 patients were compared with matching based on age, sex, refugee, foreign birth, birth in Bhutan, and hospital employee.

Results

The completion rates did not differ between 3HP and 9H (71% and 75%, respectively; P = 0.51). For 3HP, males had a higher completion rate than did females (80% vs 56%, P = 0.02). For either cohort, the completion rate did not differ by age, foreign birth, refugee, Bhutanese, or hospital employment. Adverse reactions were the most common reasons to discontinue therapy (74%). The rates of permanent drug discontinuation due to an adverse event were 23% (3HP group) and 15% (9H group) (P = 0.17).

Conclusions

In a cohort of predominantly refugees, completion rates with the 12-dose regimen were not higher than daily, self-administered 9 months of isoniazid. The 12-week regimen was safe and efficient but did not have a higher completion rate.