bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing of Button Battery Removal From the Upper Gastrointestinal System in Children
Authors: Al Lawati Tawfiq Taki , Al Marhoobi Reem Mohammed 
Published: January 2019

Objective
The aim of the study was to investigate the appropriate time of removal of button batteries (BB) from the esophagus and stomach in children.

Methods
This is a retrospective descriptive single-center study reviewing the medical records of all children with BB ingestion seen in the Royal Hospital between January 1, 2011, and December 31, 2014. All children younger than 13 years with a history of BB ingestion were included. Biodemographic data including age and sex were obtained. In addition, time of ingestion of BB, location of BB, time of endoscopic removal, and any complications were recorded.

Results
Forty-six patients with BB ingestion were identified out of 385 who presented with foreign body ingestion (12%) during the study period. Twenty four (52%) were boys and 22 (48%) were girls. All children had BB of 20 mm in diameter. Two children had the BB in the esophagus, whereas 13 children had the BB in the stomach up on presentation. The mean time of presentation of children with BB in the esophagus was 1.75 hours after ingestion, whereas those with BB in the stomach presented on average 19.4 hours after ingestion (P < 0.035). An endoscopic intervention was done in only 8 of the 46 children. Two children had the BB in the esophagus and 6 children in the stomach. One child required intensive care unit with subsequent esophageal strictures. The mean time of esophageal BB removal was 1.7 hours from ingestion, whereas removal from the stomach was on average 27 hours after ingestion. Endoscopic injuries were noted in 87.5% of the children with BB in the esophagus or the stomach. No mortality occurred during the study period.

Conclusions
Button batteries ingestion is a common problem with variable time of presentation to the emergency department. Esophageal BB presents the highest risk of injury even in as short time as 2 hours. Gastric mucosal injury can occur within 10 hours of ingestion. Button batteries of 20-mm diameter need to be urgently removed from the esophagus and be considered for removal earlier than 24 hours if in the stomach.
Etiology, Management, and Outcome of Pediatric Epistaxis
Authors: Send Thorsten , Bertlich Mattis , Eichhorn Klaus Wolfgang , Ganschow Rainer , Schafigh Darius , Horlbeck Fritz , Bootz Friedrich , Jakob Mark 
Published: January 2019

Objective
Epistaxis in children is one of the most common causes for seeking professional medical help. Patients may be treated by several disciplines with various approaches to pediatric epistaxis. We reviewed cases of pediatric epistaxis from an otorhinolaryngologist's point of view.

Methods
A retrospective chart review was performed on all patients younger than 18 years presenting with epistaxis to the Department of Otorhinolaryngology at the University of Bonn, Germany.

Results
Sixty episodes of epistaxis in 58 patients were included in the study. Mean age was 10.1 ± 4.5 years. In terms of risk factors, 3 patients had a hemorrhagic diathesis, 3 had taken medication that interfered with hemostasis, and 8 had a history of previous trauma, most of which was digital manipulation. Twenty-six patients did not need invasive therapy. Twenty-six patients received cauterization to control the bleeding, and 4 patients needed surgery. The necessity for surgery was mainly noncooperation.

Conclusions
Epistaxis in children is seldom serious. However, hemorrhagic diathesis needs to be kept in mind as a potential cause of epistaxis. In most cases, careful instruction of the patients and the relatives concerning nasal mucosal care is sufficient. If cauterization is necessary, silver nitrate coagulation should be preferred over electrocoagulation.
Focused Cardiac Ultrasound in Pediatric Pulmonary Hypertension
Authors: Noorbakhsh Kathleen A. , Bell-Cheddar Yolandee R. , Marin Jennifer R. 
Published: January 2019

Abstract
We present 2 cases of pediatric pulmonary hypertension presenting with respiratory distress. Focused cardiac ultrasound revealed findings consistent with right ventricular dilatation and elevated right ventricular pressure. These findings, in conjunction with the clinical presentation, allowed for early identification and rapid evaluation of a pathologic process that can often go unidentified. In this report, we review the relevant aspects of focused cardiac ultrasound in the setting of pulmonary hypertension.
Morel-Lavallée Lesion of the Knee in the Young Athlete
Authors: Divjak Natalie , Kwiatkowski Barbara , Tercier Stéphane 
Published: January 2019

Background
Differential diagnosis of soft tissue swelling on exposed body parts in the young athlete is large and mostly includes benign self-limiting conditions, once underlying lesion to the bone, the cartilage, and the ligaments is excluded. Morel-Lavallée lesion represents a rare soft tissue injury requiring prompt intervention to ensure favorable outcome.

Cases
A 10-year-old boy presented with 2-week-old swelling of the medial side of the knee without recent traumatic event. Unawareness of Morel-Lavallée lesion in the differential diagnosis led to delayed diagnosis and treatment. A 16-year-old boy came to our pediatric tertiary care center with a similar presentation and history. Timely intervention allowed for favorable outcome and early return to play.

Conclusions
Morel-Lavallée lesion is a rare entity in the pediatric population, although underreporting due to unfamiliarity with the diagnosis is highly probable. Raising awareness among professionals in charge of young athletes should allow for better reporting as well as for elaboration of a standardized treatment plan, including rapid intervention and early return to play.
Subacute Gummy Vitamin Overdose as a Rare Manifestation of Child Neglect
Authors: Doyle Katherine G. , Blackstone Mercedes M. , Barrett Brett C. 
Published: January 2019

Abstract
We present a case of a 20-month-old girl who presented to the emergency department with anorexia, progressive weakness, and lethargy who was found to have severe hypercalcemia (20.7 mg/dL) and vitamin D hypervitaminosis. Further questioning revealed that this was secondary to a subacute toxic ingestion of “L'il Critters” calcium and vitamin D3 gummy vitamins that were being administered by the patient's mother multiple times a day for several weeks or even months. This occurred in the setting of child neglect due to the mother's mental illness. The patient required intensive care unit admission and had a prolonged hospital course complicated by hypomagnesemia, hyperphosphatemia, weight loss, and persistent weakness. Her hypercalcemia was initially refractory to standard treatment of intravenous fluids, prednisone, multiple trials of calcitonin, and zoledronic acid. Our patient had the highest calcium level we are aware of in a toddler and is the only case we know of that occurred as a result of a prolonged, intentional exposure in the setting of child neglect and a complex social situation. This case reviews the causes and management of hypercalcemia and vitamin D intoxication. It also highlights the need for a comprehensive social history and exposes the vulnerabilities of children living in homes afflicted by parental depression and severe mental illness.
Rest-Based Concussion Management of Pediatric Emergency Medicine Providers
Authors: Root Jeremy M. , Fong Jeanette , Badolato Gia , Madati Ponda Jamil 
Published: January 2019

ObjectivesThis study aimed to survey pediatric emergency medicine (PEM) providers on their management of 2 hypothetical acute concussion scenarios. We hypothesized that most providers would recommend a management strategy based on cognitive and physical rest.MethodsFifty-nine percent (46/78) of PEM providers that were surveyed completed the study. The survey consisted of 2 clinical scenarios—a female patient with a mild concussion and a male patient with a moderate concussion. Practitioners were asked questions regarding how they would hypothetically manage these patients in terms of recommendations for returning to school and returning to sports.ResultsEighty-six percent of providers recommended moderate time off from school for the moderate concussion scenario compared with 67% of providers in the mild concussion scenario (P= 0.008). In regard to return to sports, all providers recommended moderate time off in both scenarios, including 78% of providers who recommended clearance by a physician in the moderate concussion scenario.ConclusionsIn both of our hypothetical concussion scenarios, including a very mild head injury, most PEM providers surveyed recommended a management strategy that included a moderate degree of a delay of return to school and sports. Given recent evidence suggesting that prolonged rest does not reduce the risk of prolonged concussion symptoms, recommendations of periods of cognitive rest, particularly absences from school, should be approached cautiously. Future studies should examine why providers are recommending rest-based treatment strategies and the potential benefits of active rehabilitation.
Self-reported Functional Status in US Service Members After Combat-Related Amputation
Authors: Eskridge Susan L. , Clouser Mary C. , McCabe Cameron T. , Watrous Jessica R. , Galarneau Michael R. 
Published: January 2019

Abstract
The objective of this study was to describe the functional status of US service members after combat-related amputation. This was a cross-sectional analysis of data from a subsample of the Wounded Warrior Recovery Project, an ongoing, web-based, longitudinal examination of patient-reported outcomes of injured service members. The study sample included 82 Wounded Warrior Recovery Project participants with a combat-related lower extremity amputation who reported using a prosthetic device and completed the Orthotics and Prosthetics Users' Survey Lower Extremity Functional Status, which measures self-reported functional status in participants with a prosthetic device. Basic activities, such as walking indoors, getting on and off the toilet, and getting up from a chair, were reported by the majority of participants as “very easy/easy,” whereas higher-level activities, such as climbing stairs, walking long distances, or running, were more often reported as “slightly difficult/very difficult” or “cannot do this activity.” Functional status varied significantly by amputation site (unilateral below knee, unilateral above knee, or bilateral; P = 0.004), with significantly better function reported in those with unilateral below knee than bilateral amputation (P < 0.05). These findings highlight deficits in the functional status of US service members with combat-related amputation. Self-reported functional status of daily activities may help target important activities for patient-centered goals.
Possible Contributions of Ipsilateral Pathways From the Contralesional Motor Cortex to the Voluntary Contraction of the Spastic Elbow Flexors in Stroke Survivors
Authors: Chen Yen-Ting , Li Shengai , DiTommaso Craig , Zhou Ping , Li Sheng 
Published: January 2019

Objective
The contribution of the contralesional motor cortex to the impaired limbs is still controversial. The aim of this study was to investigate the role of descending projections from the contralesional hemisphere during voluntary elbow flexion on the paretic side.

Design
Eleven healthy and 10 stroke subjects performed unilateral isometric elbow flexion tasks at various submaximal levels. Transcranial magnetic stimulation was delivered to the hotspot of biceps muscles ipsilateral to the target side (paretic side in stroke subjects or right side in controls) at rest and during elbow flexion tasks. Motor-evoked potential amplitudes of the contralateral resting biceps muscles, transcranial magnetic stimulation–induced ipsilateral force increment, and reflex torque and weakness of spastic elbow flexors were quantified.

Results
The normalized motor-evoked potential amplitude increased with force level in both healthy and stroke subjects. However, stroke subjects exhibited significantly higher force increment compared with healthy subjects only at low level of elbow flexion but similar at moderate to high levels. The greater force increment significantly correlated with reflex torque of the spastic elbow flexors, but not weakness.

Conclusions
These results provide novel evidence that ipsilateral projections are not likely to contribute to strength but are correlated to spasticity of spastic-paretic elbow flexors after stroke.
Sensitized vasoactive C-nociceptors: key fibers in peripheral neuropathic pain
Authors: Forstenpointner Julia , Naleschinski Dennis , Wasner Gunnar , Hüllemann Philipp , Binder Andreas , Baron Ralf 
Published: January 2019

Abstract

Introduction:
Multiple mechanisms are involved in the development and persistence of neuropathic pain. Some patients with nerve damage will remain painless and develop a “loss of function” phenotype, whereas others develop painful neuropathies.

Objectives:
The aim of this study is to investigate the role of a peripheral nervous system sensitization by analyzing patients with and without pain.

Methods:
The topical application of capsaicin was investigated in peripheral nociceptors. Two groups of patients (painful vs painless) with length-dependent neuropathies and small-fiber impairment were tested. Quantitative sensory testing was assessed before and after topical application of 0.6% capsaicin in the affected skin. In addition, blood perfusion measurements and an axon reflex flare assessment were performed.

Results:
Quantitative testing revealed that heat hyperalgesia was induced in all patients and volunteers (P < 0.01) without observing any significant differences between patient groups. By contrast, the extent of the axon reflex flare reaction (P < 0.01) as well as the blood perfusion (P < 0.05) was significantly greater in patients with pain than in neuropathy patients not experiencing pain.

Conclusion:
Hyperexcitable vasoactive nociceptive C fibers might contribute to pain in peripheral neuropathies and therefore may serve as a key player in separating into a painless or painful condition.
The Burden of Opioid-Related Adverse Drug Events on Hospitalized Previously Opioid-Free Surgical Patients
Authors: Urman Richard D. , Seger Diane L. , Fiskio Julie M. , Neville Bridget A. , Harry Elizabeth M. , Weiner Scott G. , Lovelace Belinda , Fain Randi , Cirillo Jessica , Schnipper Jeffrey L. 
Published: January 2019

Objective
Opioid analgesics are a mainstay for acute pain management, but postoperative opioid administration has risks. We examined the prevalence, risk factors, and consequences of opioid-related adverse drug events (ORADEs) in a previously opioid-free surgical population.

Methods
A retrospective, observational, cohort study using administrative, billing, clinical, and medication administration data from two hospitals. Data were collected for all adult patients who were opioid-free at admission, underwent surgery between October 1, 2015, and September 30, 2016, and received postoperative opioids. Potential ORADEs were determined based on inpatient billing codes or postoperative administration of naloxone. We determined independent predictors of ORADE development using multivariable logistic regression. We measured adjusted inpatient mortality, hospital costs, length of hospital stay, discharge destination, and readmission within 30 days for patients with and without ORADEs.

Results
Among 13,389 hospitalizations where opioid-free patients had a single qualifying surgery, 12,218 (91%) received postoperative opioids and comprised the study cohort. Of these, we identified 1111 (9.1%) with a potential ORADE. Independent predictors of ORADEs included older age, several markers of disease severity, longer surgeries, and concurrent benzodiazepine use. Opioid-related adverse drug events were strongly associated with the route and duration of opioids administered postoperatively: 18% increased odds per day on intravenous opioids. In analyses adjusted for several covariates, presence of an ORADE was associated with 32% higher costs of hospitalization, 45% longer postoperative length of stay, 36% lower odds of discharge home, and 2.2 times the odds of death.

Conclusions
We demonstrate a high rate and severe consequences of potential ORADEs in previously opioid-free patients receiving postoperative opioids. Knowledge of risk factors and predictors of ORADEs can help develop targeted interventions to minimize the development of these potentially dangerous and costly events.
Acute exacerbations in chronic obstructive pulmonary disease: should we use antibiotics and if so, which ones?
Authors: Jacobs David M. , Pandit Ursula , Sethi Sanjay 
Published: January 2019

Purpose of review
Acute exacerbations are a major cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD) with evidence suggesting at least 50% of exacerbations involve bacteria that benefit from antibiotic treatment. Here, we review the most relevant data regarding the use of antibiotics in exacerbations of COPD and provide insights on the selection of initial antibiotic therapy for their treatment.

Recent findings
Identification of bacterial exacerbations still relies on clinical assessment rather than laboratory biomarkers. Several recent studies, including a meta-analysis and placebo-controlled trials, demonstrate improved outcomes with antibiotics in all but mild exacerbations of COPD, including both inpatient and outpatient. A broader antibiotic regimen should be used for patients who have risk factors for poor outcomes. A risk-stratification approach can guide antibiotic choice, although the stratification algorithm still needs to be validated in a randomized controlled trial.

Summary
The use of antibiotics for the treatment of moderate-to-severe suspected bacterial exacerbations in COPD is supported by published trials and evidence-based systematic reviews. Recent trials also show differences in outcomes based on antibiotic choice. More research is necessary to evaluate risk stratification approaches when selecting initial antibiotic therapy.
Hepatoblastoma Mimicking Hemangioma in Labeled Red Blood Cell Scintigraphy
Authors: Arçay Ayça , Kintrup Gülen Tüysüz , Gelen Mustafa Tekinalp , Arslan Gökhan , Karayalçin Binnur 
Published: January 2019

Abstract
Although 99mTc red blood cell (RBC) scintigraphy is a very specific method to differentiate a hemangioma from other hepatic masses, several cases of false-positive 99mTc RBC scintigraphy have been previously reported throughout the literature. We report an additional case that presented in a 15-month-old boy with hepatoblastoma showing increased labeled RBC activity mimicking hemangioma.
Initial Versus Follow-up Sequential Myocardial 123I-MIBG Scintigraphy to Discriminate Parkinson Disease From Atypical Parkinsonian Syndromes
Authors: Ryu Dong-Woo , Kim Joong-Seok , Lee Jee-Eun , Oh Yoon-Sang , Yoo Sang-Won , Yoo Ie Ryung , Lee Kwang-Soo 
Published: January 2019

Purpose
Previous single-center or meta-analysis studies analyzed myocardial 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy in a single image session and demonstrated low sensitivity and high specificity for discriminating Parkinson disease (PD) from atypical Parkinsonian syndromes (APS). This study aimed to assess diagnostic ability of myocardial 123I-MIBG scintigraphy at 2 phases to discriminate PD from APS.

Patients and Methods
This hospital-based prospective study enrolled 162 PD and 26 APS patients who underwent 2 sequential 123I-MIBG scintigraphy evaluations. Patients were stratified into normal and decreased 123I-MIBG groups according to early and delayed heart-to-mediastinum (H/M) ratios. Patients with PD and normal 123I-MIBG uptake (initial delayed H/M ratio, ≥1.78) were considered scans without evidence of cardiac norepinephrine deficit (SWEND). Early and delayed H/M ratios on the initial and 2-year follow-up scintigraphs were studied. The diagnostic sensitivity and specificity were calculated from these confusion matrices and were analyzed according to receiver-operating characteristic curve analysis. A repeated-measures general linear model was used to investigate differences among groups over time in H/M ratio changes and washout rates.

Results
Follow-up 123I-MIBG scintigraphy analysis had a higher diagnostic sensitivity (89.5%) than the initial imaging (72.2%). The improved sensitivity was associated with a steeper decrease in H/M ratio in the SWEND group than in the APS group.

Conclusions
Follow-up 123I-MIBG scintigraphy can identify cardiac sympathetic denervation and its progression in patients with PD and may be effective in discriminating PD from APS. A later decrease in myocardial 123I-MIBG uptake in the group with SWEND meets the Braak staging threshold hypothesis for synucleinopathy.
68Ga-DOTANOC PET/CT Detects Multifocal Hepatocellular Carcinoma
Authors: Tabacchi Elena , Campana Davide , Brighi Nicole , Fanti Stefano , Ambrosini Valentina 
Published: January 2019

Abstract

68Ga-DOTANOC PET/CT confirmed somatostatin receptor (SR) expression in hypervascularized liver lesions suggestive of neuroendocrine tumor that was later diagnosed as hepatocellular carcinoma (HCC). Being highly vascularized on CT, HCC lesions may mimic neuroendocrine tumors. Although HCC is not included among current indications for SR-PET/CT imaging, it may represent a pitfall in image interpretation when studying neuroendocrine tumor patients. Further studies are needed to better ascertain the potential diagnostic role of SR-imaging in HCC.
Myocardial Infarction With Nonobstructive Coronary Arteries Assessed by 11C-Acetate Cardiac PET
Authors: Cho Sang-Geon , Kim Yongcheol , Jeong Myung Ho , Bom Hee-Seung 
Published: January 2019

Abstract

11C-acetate PET can quantify myocardial blood flow and oxidative metabolism (k
mono) with a single imaging study. We present a 63-year-old man with myocardial infarction with nonobstructive coronary arteries due to vasospasm, who underwent 11C-acetate PET after antispastic medication. By quantifying myocardial blood flow and k
mono, 11C-acetate PET could detect the initial ischemic insult by vasospasm and sufficient amount of remaining viable myocardium, while excluding significant inducible ischemia. We suggest that 11C-acetate PET can be a clinically valuable tool for assessing the pathophysiology of myocardial infarction with nonobstructive coronary arteries.
Quality and Safety in Health Care, Part XLV
Authors: Harolds Jay A. 
Published: January 2019

Abstract
Burnout not only is a serious problem for physicians, but it also adversely affects the quality and safety of health care for the patients they care for. A doctor with burnout may commit more errors, exhibit unprofessional behavior and a callous attitude to others, have diminished productivity, and cause other problems for the health care system. Furthermore, the percentage of doctors who experience at least 1 symptom of burnout is increasing.
Variable 131I Activity in Multiple Hepatic Cysts in a Patient With Thyroid Cancer
Authors: Shao Fuqiang , Tang Jiali , Lan Xiaoli 
Published: January 2019

Abstract
Various etiologies could cause focal 131I accumulation. Hepatic cyst is one of these etiologies. Here we present a 59-year-old man with a history of papillary thyroid cancer resection who received radioiodine therapy for three times. The images after the 131I therapy of the second and third time showed variable activity uptake in the same hepatic cysts.