bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Procedures, Treatments, and Outcomes in Stroke Patients Admitted to Different Types of Hospitals
Authors: Asplund Kjell , Sukhova Maria , Wester Per , Stegmayr Birgitta 
Published: February 2015

Background and Purpose—
In many countries, including Sweden, initiatives have been taken to reduce between-hospital differences in the quality of stroke services. We have explored to what extent hospital type (university, specialized nonuniversity, or community hospital) influences hospital performance.

Methods—
Riksstroke collects clinical data during hospital stay (national coverage 94%). Follow-up data at 3 months were collected using administrative registers and a questionnaire completed by surviving patients (response rate 88%). Structural data were collected from a questionnaire completed by hospital staff (response rate 100%). Multivariate analyses with adjustment for clustering were used to test differences between types of hospitals.

Results—
The proportion of patients admitted directly to a stroke unit was highest in community hospitals and lowest in university hospitals. Magnetic resonance, carotid imaging, and thrombectomy were more frequently performed in university hospitals, and the door-to-needle time for thrombolysis was shorter. Secondary prevention with antihypertensive drugs was used less often, and outpatient follow-up was less frequent in university hospitals. Fewer patients in community hospitals were dissatisfied with their rehabilitation. After adjusting for possible confounders, poor outcome (dead or activities of daily living dependency 3 months after stroke) was not significantly different between the 3 types of hospital.

Conclusions—
In a setting with national stroke guidelines, stroke units in all hospitals, and measurement of hospital performance and benchmarking, outcome (after case-mix adjustment) is similar in university, specialized nonuniversity, and community hospitals. There seems to be fewer barriers to organizing well-functioning stroke services in community hospitals compared with university hospitals.
Imaging of a Clinically Relevant Stroke Model
Authors: Arnberg Fabian , Grafström Jonas , Lundberg Johan , Nikkhou-Aski Sahar , Little Philip , Damberg Peter , Mitsios Nicholas , Mulder Jan , Lu Li , Söderman Michael , Stone-Elander Sharon , Holmin Staffan 
Published: February 2015

Background and Purpose—
Ischemic stroke has been shown to cause hypermetabolism of glucose in the ischemic penumbra. Experimental and clinical data indicate that infarct-related systemic hyperglycemia is a potential therapeutic target in acute stroke. However, clinical studies aiming for glucose control in acute stroke have neither improved functional outcome nor reduced mortality. Thus, further studies on glucose metabolism in the ischemic brain are warranted.

Methods—

We used a rat model of stroke that preserves collateral flow. The animals were analyzed by [2-
18
F]-2-fluoro-2-deoxy-
d
-glucose positron emission tomography or magnetic resonance imaging during 90-minute occlusion of the middle cerebral artery and during 60 minutes after reperfusion. Results were correlated to magnetic resonance imaging of cerebral blood flow, diffusion of water, lactate formation, and histological data on cell death and blood–brain barrier breakdown.

Results—

We detected an increased [2-
18
F]-2-fluoro-2-deoxy-
d
-glucose uptake within ischemic regions succumbing to infarction and in the peri-infarct region. Magnetic resonance imaging revealed impairment of blood flow to ischemic levels in the infarct and a reduction of cerebral blood flow in the peri-infarct region. Magnetic resonance spectroscopy revealed lactate in the ischemic region and absence of lactate in the peri-infarct region. Immunohistochemical analyses revealed apoptosis and blood–brain barrier breakdown within the infarct.

Conclusions—

The increased uptake of [2-
18
F]-2-fluoro-2-deoxy-
d
-glucose in cerebral ischemia most likely reflects hypermetabolism of glucose meeting increased energy needs of ischemic and hypoperfused brain tissue, and it occurs under both anaerobic and aerobic conditions measured by local lactate production. Infarct-related systemic hyperglycemia could serve to facilitate glucose supply to the ischemic brain. Glycemic control by insulin treatment could negatively influence this mechanism.
Investigating visual attention during scene perception of safe and unsafe occupational performance
Authors: MacKenzie Diane E. , Westwood David A. 
Published: February 2015

Background. Occupational therapists routinely use observation for evaluation, intervention planning, and prediction of a client’s occupational performance and/or safety within the environment. Perception of safety contributes to the decision-making process for discharge or placement recommendations. Purpose. The purpose of this study was to determine if differences exist in safety ratings and eye movements between occupational therapists and nontrained matched individuals while viewing domain-specific versus non-domain-specific images. Method. Ten licensed occupational therapists and 10 age-, gender-, and education level–matched participants completed this eye-tracking study. Findings. For all image exposure durations, occupational therapists had more polarized safety ratings for stroke-related image content but little evidence of differences in eye movements between groups. Eye movement group differences did not emerge in the regions of interest identified by an independent expert panel. Implications. The results point to a complex relationship between decision making and observational behaviour in occupational assessment and highlight the need to look beyond image features.
Endoscopic Treatment of Benign Sinonasal Tumors
Authors: Jankee Vic , Srinivasan Venkat R. , Achar Priya 
Published: February 2015

Objective1) To assess the effectiveness of endoscopic surgery in the management of benign sinonasal tumors. 2) To compare our complication and recurrence rates with the literature.MethodWe performed a retrospective case note review of patients having endoscopic surgery for benign sinonasal tumors between 2001 to 2010. Our results in terms of success rate and complications were compared with similar studies in the literature. A systematic review was carried out including 5 case series studies and 1 meta‐analysis.ResultsFourteen patients were treated endoscopically (11 inverted papillomas, 1 pleomorphic adenoma, 1 oncocytoma, and 1 schwannoma). Exclusion criteria: Tumors eroding maxillary antrum, and extending into orbit, soft tissue, skull base, or intracranially. There were 9 men and 5 women; average age was 61 years (range, 42‐80 years). Minor complications were encountered in 20% of patients. Average follow‐up was 46 months (range, 13‐120 months). The recurrence rate was 7% (1 patient with inverted papilloma, revised endoscopically). A review of a case series in the literature showed an identical recurrence rate between the 2 types of surgery (9%), and a meta‐analysis showed greater difference (endoscopy 12% vs open 19.5%).ConclusionEndoscopic excision is an effective treatment modality and beneficial to patients with benign sinonasal tumors as it offers a similar, if not decreased, chance of recurrence with additional benefits of fewer complications and scarring.
Fast Track Head and Neck Referrals Audit
Authors: Davey Shaun , Dixon Hannah , Gibbins Nicholas , Lew‐Gor Simione , Weighill John , Harries Meredydd L. 
Published: February 2015

ObjectiveThe National Institute for Clinical Excellence (NICE) outlines 10 key urgent referral guidelines. The Department of Health in the UK requires all cancer referrals to be seen within 2 weeks. The audit’s aim was to assess the appropriateness of referrals to the Head and Neck Cancer Clinic.MethodA retrospective analysis of all “2‐week‐wait” fast track referrals to the department over a 1‐year period (starting August 2010). The referring diagnosis, time of consult, and initial management were recorded. A database of all referrals, the picture archiving and communications system (PACS), and computer and paper records were consulted.ResultsFor the period of the study a total of 446 referrals were received, 425 or 95% were seen within 14 days. The average wait was 9 days. The most common reasons for referral included neck lumps, dysphagia, and voice change. Referrals for inappropriate symptoms were not uncommon, however the main issue was duration of symptoms prior to referral, which averaged over 6 months. The diagnostic yield for malignancy was 6%, significantly lower when compared with a number of comparative studies. Although 59.5% of referrals were females, 70.4% of cancer diagnoses were in men.ConclusionThe use of the NICE guidelines by primary care physicians is far from common practice. A greater awareness of the guidelines would have several beneficial outcomes. The number of inappropriate referrals would be reduced and those with cancer should be picked up earlier, thus improving prognosis.
Gut Instinct: A Diagnostic Tool?
Authors: Iqbal Isma Z. , Kara Naveed , Hartley Chris 
Published: February 2015

ObjectiveIt is generally accepted that with experience, clinicians develop an ability to identify patients who present with neoplasia prior to any diagnostic procedure or investigation. However, this cannot be quantified, nor is it a plausible substitute to investigation. We aim to evaluate the association between instinct and diagnosis of cancer.MethodA prospective study of patients in the outpatient department between August and December 2010 was performed. Patients requiring urgent procedures for suspected cancer were included. Risk factors, symptoms, signs, and the clinicians’ impression were recorded. This was graded from 1 (highly unlikely) to 10 (very likely) and subsequently correlated with histology.ResultsTwenty‐seven patients underwent a diagnostic procedure. The mean age was 62.2 years. A total of 29.6% of the patients were referred under the 2‐week rule. Of the patients, 18.5% had a previous history of head and neck cancer. The number of patients presenting with 1 symptom was 40.7%, with 2 symptoms was 40.7%, with 3 symptoms 11.1%, and with 4 symptoms 7.4%. A total of 37% of the patients had a cancer diagnosis. The procedure was cancelled for one patient because of illness. There was a positive correlation between clinical suspicion and cancer diagnosis (Kendall’s tau b = 0.648749). However, the number of symptoms did not correlate with abnormal histology (Kendall’s tau = −0.333333).ConclusionThis study highlights the importance of clinical suspicion in diagnosis of cancer. Reliance on presence or absence of clinical signs alone may lead to missing a diagnosis. Although clinical suspicion cannot be quantified it should be regarded as an integral factor in patient management.
Nasal Valve Reconstruction: A Quality of Life Assessment
Authors: Alexander Richard L. , Goldman Neal D. 
Published: February 2015

Objective1) Evaluate patient reported outcomes of nasal valve repair using a survey. 2) Understand quality of life measures following nasal valve reconstruction.MethodThis retrospective study evaluated patients who underwent nasal valve reconstruction between December 2005 and December 2011. The study involved a 39‐question survey that measured quality of life, overall satisfaction with the surgical outcomes, and patient‐reported surgical outcomes in multiple symptoms including nasal obstruction, exercise tolerance, sleep, etc.ResultsForty‐four patients completed the survey, and 25 had prior nasal surgery. The most common postoperative complaint was breathing difficulties (36%). Seventeen patients (39%) reported no change in the size of the nose despite augmentation of the nasal valve. Of those patients who did notice a change, 52% stated they notice the increase in size occasionally and never hear comments from others (70%). Overall, patients were satisfied with the results (81%), and 98% would recommend the procedure to others. There was a statistically significant improvement in nasal blockage/obstruction, breathing through the nose, sleeping, and breathing through the nose during exercise.ConclusionOur data suggest that nasal valve reconstruction is a reasonable approach to patients with nasal obstruction and trouble breathing through the nose. This approach may be especially important in patients who have already had prior nasal surgery but refractory symptoms.
Life following Lateral Skull Base Tumor Treatment
Authors: Al‐hadad Ihsaan , Taha Omar 
Published: February 2015

ObjectiveTreatment advances have evolved to prolong the duration of life in lateral skull base tumor patients, but focus is now being placed more on quality of life. The aim of this study was to help elucidate the quality of life in participants following treatment for lateral skull base tumors.MethodA total of 21 participants agreed to take part in the study. Each completed a semistructured interview, focusing on quality of life following radiotherapy or surgical treatment for different lateral skull base tumor diagnoses. Interviews were recorded and transcribed verbatim, with a thematic analysis of the transcripts undertaken.ResultsFour overriding themes were identified and labeled: 1) perceptions of quality of life and coping strategies; 2) impact of specific symptoms on daily life activities; 3) initial recovery period posttreatment; 4) information surrounding treatment and administration. The majority of participants reported an indifferent or positive impact of treatment on quality of life, with various coping mechanisms such as adjustment, thinking positively, and selective attention used to deal with stressors. Many participants described frustration and concern at the lack of information surrounding management; however, others were aware of the risks of excessive information and tentative of receiving more.ConclusionAdjustment following treatment could possibly support the phenomena of cognitive adaptation or response shift. The positive role of social support and lack of information has highlighted the need for more support in this cohort of patients, but crucially within a patient‐centered holisitc framework. Implications for a tailored quality of life tool are discussed.
Liposarcoma of Nasopharynx
Authors: Bianco Andrea S. , Garcia Esperanza , Sanchez Mariana , Agostini Gabriela 
Published: February 2015

ObjectiveConsidering this rare entity, the clinical and morphological similarity with more common diseases, the aim of this publication is to understand and be able to aid in the diagnosis, avoiding the possibility of it going unnoticed.MethodA case of liposarcoma in the nasopharynx was presented, diagnosed, and treated in the Avila Clinic in Caracas, Venezuela. This was followed by a retrospective review of cases in the published literature.ResultsA 29‐year‐old white woman with a 2‐year history of bilateral chronic nasal obstruction and rhinolalia clausa on whom nasal endoscopy showed a 3 centimeter gray‐white lesion attached to the nasopharynx. Histopathological report confirmed the diagnosis of well‐differentiated liposarcoma. The incidence of liposarcoma of nasopharynx is extremely low, presenting as a painless, hard‐edged, slow growth, with the lesion usually going unnoticed. Though nonspecific, authors consider magnetic resonance imaging the gold standard radiologic tool. The role of radiotherapy and chemotherapy is still not clear.ConclusionBy the time of this report the patient was free of disease following surgical resection. There is no sufficient data for statistical significance on the prevalence, clinical aspects, treatment of choice, or prognosis of this unusual disease. Radiological studies may help to exclude other entities, but are nonspecific.
Metastatic Lymph Node Metastasis Has Predictive Values for Recurrence in Papillary Thyroid Carcinoma
Authors: Jang Min‐Seok , Son Young‐Ik , Baek Jeong‐Hwan , Park Ki‐Nam , Kim Dohun 
Published: February 2015

ObjectiveThe authors aimed to evaluate the significance of absolute number of lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC) and the metastatic lymph node ratio (the ratio between metastatic lymph node and harvested lymph nodes; MLNR) in the central neck for the prediction of locoregional recurrence.MethodThrough retrospective chart review between 2005 and 2009, 573 patients who underwent total thyroidectomy and central neck dissection and were followed‐up more than 36 months were enrolled. Regarding the risk of recurrence, multivariate analyses were performed with the following variables: multiplicity of tumor, extrathyroidal extension, number of harvested lymph nodes.ResultsBoth the number of LNM and MLNR exhibited predictive significance toward locoregional recurrence (P <. 001). The lowest cutoff value of MLNR for a meaningful separation of disease recurrence was 0.44 (HR = 8.86, 95% CI = 1.49‐52.58, P =. 001) when 3 or more lymph nodes were harvested.ConclusionBoth the number of LNM and MLNR in the central neck have predictive values for loco‐regional recurrence. When MLNR is higher than 0.44, there is an increased risk of locoregional recurrence with a HR of 8.86. These findings will supplement in further risk‐stratification of locoregional recurrence.
Midline Carcinoma with NUT Rearrangement
Authors: Wein Richard O. , Mosesso Kara 
Published: February 2015

Objective1) Report the clinicopathologic features of a rare, midline carcinoma. 2) Review the literature on NUT midline carcinoma and associated treatment protocols.MethodCase report with review of the literature on NUT midline carcinoma.ResultsA 23‐year‐old Chinese man presented with a 10‐day history of enlarging nontender cervical lymphadenopathy, dysphagia, and dysarthria. Clinical examination demonstrated right tongue atrophy and a 6‐cm ipsilateral level III neck mass. CT of the neck with contrast revealed an infiltrating hypopharyngeal lesion and bilateral necrotic cervical lymphadenopathy. At microlaryngoscopy, the patient was noted to have a friable postcricoid mucosal lesion that on multiple biopsies revealed only necrosis. Cytogenetic analysis of a lymph node biopsy demonstrated chromosomal rearrangements consistent with a translocation between chromosomes 15 and 19, ie, t(15;19), resulting in the fusion oncogene BRD4‐NUT consistent with diagnosis of NUT midline carcinoma (NMC). NMC is a newly recognized entity identified by the presence of chromosomal rearrangements involving the nuclear protein in testis (NUT) gene on chromosome 15q14. The clinical course is rapid and fatal and to date there is not a well‐established treatment protocol. NMC is likely under‐diagnosed and should be considered within the differential diagnoses in all poorly differentiated and undifferentiated midline carcinomas, particularly in young adult, nonsmokers. The patient presented is currently under treatment.ConclusionAccurate and prompt diagnosis of this rapidly progressing carcinoma is crucial to improving prognosis and identifying effective treatment regimens.
MRSA Thyroiditis and Thyrotoxicosis
Authors: Sweeney Alex D. , Pattisapu Prasanth , Parke Robert B. 
Published: February 2015

Objective1) Learn that methicillin‐resistant staphylococcus aureus (MRSA) thyroiditis causing thyrotoxicosis is a rare and potentially life‐threatening condition. 2) Understand the diagnosis and management of suppurative thyroiditis and related thyrotoxicosis. 3) Understand the rising incidence of both community‐acquired and hospital‐acquired MRSA infections.MethodWe present a patient with MRSA thyroiditis and thyrotoxicosis who was evaluated by the otolaryngology–head and neck surgery service of an academic, tertiary care hospital in 2012. The literature was also reviewed through a directed PubMed search, and a relevant case was identified and discussed.ResultsA patient was transferred from an outside hospital in respiratory failure with a recent history of progressive neck pain and dysphagia. Computed tomography of the neck revealed an enlarged and inflamed thyroid gland, which was causing airway compression. Thyrotoxicosis was subsequently identified. MRSA was cultured in samples from an ultrasound guided thyroid biopsy and a surgical debridement. Antibiotics were started, and the thyrotoxicosis was followed clinically. With this management, the thyrotoxicosis resolved, and hypothyroidism immediately ensued. A literature review revealed only one previously reported case of MRSA thyroiditis and thyrotoxicosis, which resolved with medical management.ConclusionMRSA thyroiditis with associated thyrotoxicosis represents a rare complication of a bacterium that is becoming more common in community and hospital settings. To our knowledge, this is the second reported case of this particular clinical entity. Prompt identification of a causative organism and thyrotoxicosis can allow for potentially life‐saving interventions.
Neurinoma of the Submandibular Space
Authors: Piccioni Lucia O. , Sarandria Daniela , Pilolli Francesco , Bussi Mario 
Published: February 2015

ObjectiveDescribe an uncommon lesion of the submandibular space.MethodWe describe the surgical approach to a submandibular mass in a young boy.ResultsThe patient had a preoperative evaluation with a ultrasound examination that showed a well‐defined, disomogeneous lesion of 50 × 36 × 36 mm of the left submandibular region. Magnetic resonance imaging showed a lesion of the submandibular space, extended to the left parapharyngeal space. This lesion had disomogeneous enhancement and a diameter of 6 cm. The patient underwent a fine needle aspiration cytology of the lesion that resulted compatible with a pleomorphic adenoma.The patient underwent the surgical excision of the lesion.The lesion occupied the left parapharyngeal space. The histological examination defined the lesion as a neurinoma of the parapharyngeal space.ConclusionA neurinoma of the parapharyngeal space should be considered in the evaluation of the submandibular masses.
Novel Techniques in Head and Neck Ultrasound
Authors: Meacham Ryan K. , Sebelik Merry E. 
Published: February 2015

Objective1) Report new uses of ultrasound within the head and neck. 2) Emphasize how the use of ultrasound can enhance patient management and alter treatment delivery.MethodPresent a series of 7 cases from the past year at a single academic institution where ultrasound was used in a novel way to enhance patient care. Compare the ultrasound images obtained with other imaging modalities.ResultsThree patients underwent ultrasound‐guided fine‐ needle aspiration (FNA) of tongue base tumors, which avoided the necessity of a tracheotomy in 1 patient with a difficult airway. Two patients underwent ultrasound‐guided FNA of supraglottic tumors through the thyrohyoid membrane, which obviated the need for biopsy with general anesthesia. One noncancer patient had a highly metabolic enlarged lymph node on PET/CT though it demonstrated benign characteristics on ultrasound. Both ultrasound‐guided FNA and incisional biopsy confirmed the lymph node’s benignity. One patient had a vallecular foreign body seen on ultrasound but not on flexible laryngoscopy, and it was retrieved in the operating room.ConclusionUltrasound can be used to guide FNA for tissue diagnosis from tongue base and larynx tumors. Ultrasound‐guided FNA may eliminate the need for biopsy under general anesthesia for some patients. Ultrasound has an expanding array of applications and is a useful tool in the otolaryngologist’s hands.