Comprehensive nursing case management. An advanced practice model.

PubMed

Taylor, P

1999-01-01

Under managed care and capitated reimbursement systems, case management is a core strategy for providing high-quality, cost-effective care by decreasing fragmentation, enhancing quality, ensuring efficient use of resources, and containing costs. Although case management is used in various areas of the healthcare arena, it suffers from a lack of consensus regarding its definition, essential components, and appropriate application. The purpose of this paper is to examine the components and limitations of existing case management models, outline the competencies of an effective case manager, and present a model of advanced practice nursing case management that focuses on a continuum of care that integrates medical and psychosocial resources to promote optimal clinical fiscal outcomes and enables patients to work as partners with the healthcare team in facilitating and maintaining their physical and emotional well-being.

A case management tool for occupational health nurses: development, testing, and application.

PubMed

Mannon, J A; Conrad, K M; Blue, C L; Muran, S

1994-08-01

1. Case management is a process of coordinating an individual client's health care services to achieve optimal, quality care delivered in a cost effective manner. The case manager establishes a provider network, recommends treatment plans that assure quality and efficacy while controlling costs, monitors outcomes, and maintains a strong communication link among all the parties. 2. Through development of audit tools such as the one presented in this article, occupational health nurses can document case management activities and provide employers with measurable outcomes. 3. The Case Management Activity Checklist was tested using data from 61 firefighters' musculoskeletal injury cases. 4. The activities on the checklist are a step by step process: case identification/case disposition; assessment; return to work plan; resource identification; collaborative communication; and evaluation.

[Pancreatic pseudocyst. Case report and literature review].

PubMed

Guardado-Bermúdez, Fernando; Azuara-Turrubiates, Armando Javier; Ardisson-Zamora, Fernando Josafat; Guerrero-Silva, Luis Alberto; Villanueva-Rodríguez, Estefanie; Gómez-de Leija, Nubia Alondra

2014-01-01

The most frequent etiology of pancreatic pseudocyst is acute pancreatitis and exacerbations of chronic pancreatitis, presenting spontaneous resolution in 50% of the cases. Treatment is indicated in symptomatic or complicated persistent pseudocysts. The OBJECTIVE of this article is to present a case and management options of pancreatic pseudocyst defined as a collection of fluid in the omental bursa. We present the case of a 59-year-old female patient with a history of laparoscopic cholecystectomy and necrotizing pancreatitis. She presented abdominal pain, early satiety, and nausea during the previous 2 months. Presence of pancreatic pseudocysts of 92 and 62 mm was demonstrated by computed tomography. The patient was submitted to a laparoscopic cyst-gastric anastomosis. Laparoscopic cyst-gastric anastomosis is the ideal treatment for pancreatic pseudocyst management because it offers continuous drainage, low rate of recurrence and few complications, exceeding the RESULTS of endoscopic management and imaging-guided drainage along with the benefits of a minimally invasive procedure.

Primary Spinal Intramedullary Neurocysticercosis: A Report of 3 Cases.

PubMed

Datta, Subramanya G S; Mehta, Ritu; Macha, Shrikant; Tripathi, Sanjog

2017-09-01

We describe a series of 3 cases of the rare intramedullary form of primary spinal neurocysticercosis. The cases were seen in varied age groups and showed different profiles at presentation. All the cases were thoroughly evaluated clinically and radiologically. Serologic tests were not conducted. In all cases, magnetic resonance imaging showed a large intramedullary lesion in the thoracic spinal cord consisting of a cystic lesion with a well-defined intramural nodule. One case was managed with steroids and cysticidal therapy, a second case was managed with steroids and surgery (2 emergency procedures), while the third case was managed without any medical or surgical intervention, as the patient was unwilling for either. All cases showed good neurologic recovery. In the second case where surgery was done, histologic examination of the resected specimen demonstrated the cysticercal parasite surrounded by mixed inflammatory infiltrate. As there were no intracranial lesions in all 3 cases, the final diagnosis was primary isolated intramedullary neurocysticercosis. Primary isolated intramedullary-neurocysticercosis remains a rare condition afflicting the spinal cord. It forms a small subset of cysticercal infestation of the neuraxis. Such evidence is rare, and only anecdotal reports are available. Our case series captures the wide spectrum of presentations, as well as the management options, and highlights the varied ways in which these cases were managed. Copyright © 2017 Elsevier Inc. All rights reserved.

Laser therapy in the management of dental and oro-facial trauma

NASA Astrophysics Data System (ADS)

Darbar, Arun A.

2007-02-01

This is a clinical presentation demonstrating the efficacy of laser therapy in the treatment of patients presenting with trauma to both the hard and soft tissue in the orofacial region. The use of laser therapy aids the management of these cases where the patients often present with anxiety and a low pain threshold. The outcomes in these cases indicate good patient acceptance of the treatment, enhanced repair and tissue response suggesting that this form of treatment can be indicated for these patients. A combination of hard and soft lasers are used for the comprehensive dental management and treatment of these cases. The lasers used are a 810nm diode and an Er.CrYSGG.

The mapping competences of the nurse Case/Care Manager in the context of Intensive Care.

PubMed

Alfieri, Emanuela; Ferrini, Anna Chiara; Gianfrancesco, Francesca; Lise, Gianluca; Messana, Giovanni; Tirelli, Lorenzo; Lorenzo, Ana; Sarli, Leopoldo

2017-03-15

Since the recent introduction of the Case/Care Manager's professional figure, it is quite difficult to identify properly his/her own particular features, which could be mainly be found revising mainly in American studies. Therefore, the present study intended to identify the Case/Care Manager's skills and professional profile in an Intensive Care Unit experience, taking into consideration the staff's activities, perception and expectations towards the Case/Care Manager. In particular, it has been compared the experience of an Intensive Care Units where the Case/Care Manager's profile is operational to a different Unit where a Case/Care Manager is not yet in force. a Levati's model was used to map the Case/Care Manager's skills, involving each unit whole working staff, executives and caregivers through semi-structured interviews. It has been taken into consideration the Anaesthesia Unit and Emergency Unit of Cesena's healthcare organisation (AUSL of Romagna) and a Cardiology Intensive Care Unit of Piacenza's healthcare organisation, where the Case/Care Manager's profile has not been experimented yet. Firstly, it a data collection in each healthcare organization has been organised. Subsequently, semi-structured interviews to doctors, unit nurses, caregivers, nurses' coordinators and medical staff have been used to compare each healthcare system. The interviewees' described their expectations in relation to the Case/Care Manager working in a critical area. Then, every data collected during interviews has been organised to map a Case/Care Manager's essential professional profile to work in a critical area together with medical staff. Piacenza's O.U. critical area experience reported a major demand for patients' and patient's families' assistance. On the other hand, the very same aspects seem to have been better achieved in Cesena's O.U., where a Case/Care Manager's recent introduction has actually helped to overcome the void in organising systems. a Case/Care Manager's profile has been drafted on the basis of the comparative analysis conducted. It has been noted how the Case/Care Manager's professional profile can really improve relationships and communications between medical staff and patients, promoting a major unity among the working team. According to the present research, the Case/Care Manager's profile has been proved helpful in positively influencing the team activity and to elicit major satisfaction both in patients and their family.

Case II: Conflict recognition--the case of the misdirected faculty.

PubMed

Hoelscher, Diane C; Comer, Robert W

2002-04-01

Early recognition is fundamental to managing conflict. Successful leaders rely upon their ability to recognize conflict before it escalates into crisis. This article reviews the signs and sources of conflict along with related management theories. Conflict management includes understanding the sources and types of conflict as well as the impact potential; in the case presented, the leaders were unaware of conflict. Dr. Forester, the faculty member "in the middle," was in a precarious position. Her performance evaluation reflected unacceptable accomplishments. However, her self-assessment, based on the hiring agreement, was successful. Her requests for guidance and clarification were unproductive. What does she do now? The management theories that apply to the case of "the misdirected faculty" include analysis and discussion of communication, feedback, and expectancy theory. Action alternatives are presented to explore some of the options available to stimulate discussion and to provide readers with an eclectic approach to applying a case analysis.

Nurse's Breakout Session Injury/Illness Case Management

NASA Technical Reports Server (NTRS)

Hesselgesser, Connie

2001-01-01

An overview of the work related injury and illness case management model developed at the Johnson Space Center was presented. The major accomplishments and the challenges of implementation were discussed.

Presentation and outcome of clinical poor performance in one health district over a 5-year period: 2002–2007

PubMed Central

Cox, Stephen J; Holden, John D

2009-01-01

Background The detection, assessment, and management of primary care poor performance raise difficult issues for all those involved. Guidance has largely focused on managing the most serious cases where patient safety is severely compromised. The management of primary care poor performance has become an increasingly important part of primary care trust (PCT) work, but its modes of presentation and prevalence are not well known. Aim To report the prevalence, presentation modes, and management of primary care poor performance cases presenting to one PCT over a 5-year period. Design of study A retrospective review of primary care poor performance cases in one district. Setting St Helens PCT administered 35 practices with 130 GPs on the performers list, caring for 190 110 patients in North West England, UK. Method Cases presenting during 2002–2007 were initially reviewed by the chair of the PCT clinical executive committee. Anonymised data were then jointly reviewed by the assessor and another experienced GP advisor. Results There were 102 individual presentations (20 per year or one every 2–3 weeks) where clinician performance raised significant cause for concern occurred over the 5-year period. These concerns related to 37 individual clinicians, a range of 1–14 per clinician (mean 2.7). Whistleblowing by professional colleagues on 43 occasions was the most common presentation, of which 26 were from GPs about GPs. Patient complaints (18) were the second most common presentation. Twenty-seven clinicians were GPs, of whom the General Medical Council (GMC) were notified or involved in 13 cases. Clinicians were supported locally, and remedying was exclusively locally managed in 14 cases, and shared with an external organisation (such as the GMC or deanery) in another 12. Conclusion Professional whistleblowing and patient complaints were the most common sources of presentation. Effective PCT teams are needed to manage clinicians whose performance gives cause for concern. Sufficient resources and both formal and informal ways of reporting concerns are essential. PMID:19401017

Crisis management with applicability on fire fighting plants

NASA Astrophysics Data System (ADS)

Panaitescu, M.; Panaitescu, F. V.; Voicu, I.; Dumitrescu, L. G.

2017-08-01

The paper presents a case study for a crisis management analysis which address to fire fighting plants. The procedures include the steps of FTA (Failure tree analysis). The purpose of the present paper is to describe this crisis management plan with tools of FTA. The crisis management procedures have applicability on anticipated and emergency situations and help to describe and planning a worst-case scenario plan. For this issue must calculate the probabilities in different situations for fire fighting plants. In the conclusions of paper is analised the block diagram with components of fire fighting plant and are presented the solutions for each possible risk situations.

Management of A Rare Case of Communicating Internal-External Inflammatory Resorption.

PubMed

Arora, Suraj; Gill, Gurdeep Singh; Saluja, Priyanka; Setia, Vikas

2015-05-01

The present case describes the successful management of a rare case of communicating internal-external resorption in which both internal and external resorption seem to develop independent of each other. The case report highlights the importance of correct diagnosis and need of revision of classification system of resorptive defects.

Management of A Rare Case of Communicating Internal-External Inflammatory Resorption

PubMed Central

Arora, Suraj; Saluja, Priyanka; Setia, Vikas

2015-01-01

The present case describes the successful management of a rare case of communicating internal-external resorption in which both internal and external resorption seem to develop independent of each other. The case report highlights the importance of correct diagnosis and need of revision of classification system of resorptive defects. PMID:26155588

Anesthetic management of Shah–Waardenburg syndrome: Experience of two cases and review of literature

PubMed Central

Ambi, Uday S.; Adarsh, E. S.; Hatti, Ramesh; Samalad, Vijaymahantesh

2012-01-01

Waardenburg syndrome (WS) is a rare autosomally inherited and genetically heterogeneous disorder of neural crest cell development. Literature regarding the anesthetic management of these cases is limited. We present 2 cases of Shah–Waardenburg syndrome and discuss them in the context of review of previously published cases. PMID:22754447

Airway management in laryngotracheal injuries from blunt neck trauma in children.

PubMed

Chatterjee, Debnath; Agarwal, Rita; Bajaj, Lalit; Teng, Sarena N; Prager, Jeremy D

2016-02-01

Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare, but can be potentially catastrophic. Early diagnosis and skillful airway management is critical in avoiding significant morbidity and mortality associated with these cases. We present a case of a patient who suffered a complete tracheal transection and cervical spine fracture following a clothesline injury to the anterior neck. A review of the mechanisms of injury, clinical presentation, initial airway management, and anesthetic considerations in laryngotracheal injuries from blunt neck trauma in children are presented. © 2015 John Wiley & Sons Ltd.

Clinical Presentation of Soft-tissue Infections and its Management: A Study of 100 Cases.

PubMed

Singh, Baldev; Singh, Sukha; Khichy, Sudhir; Ghatge, Avinash

2017-01-01

Soft-tissue infections vary widely in their nature and severity. A clear approach to the management must allow their rapid identification and treatment as they can be life-threatening. Clinical presentation of soft-tissue infections and its management. A prospective study based on 100 patients presenting with soft-tissue infections was done. All the cases of soft-tissue infections were considered irrespective of age, sex, etiological factors, or systemic disorders. The findings were evaluated regarding the pattern of soft-tissue infections in relation to age and sex, clinical presentation, complications, duration of hospital stay, management, and mortality. The most commonly involved age group was in the range of 41-60 years with male predominance. Abscess formation (45%) was the most common clinical presentation. Type 2 diabetes mellitus was the most common associated comorbid condition. Staphylococcus aureus was the most common culture isolate obtained. The most common complication seen was renal failure. Patients with surgical site infections had maximum duration of stay in the hospital. About 94% of the cases of soft-tissue infections were managed surgically. Mortality was mostly encountered in the cases of complications of cellulitis. Skin and soft-tissue infections are among the most common infections encountered by the emergency physicians. Ignorance, reluctance to treatment, economic constraints, and illiteracy delay the early detection and the initiation of proper treatment. Adequate and timely surgical intervention in most of the cases is of utmost importance to prevent the complications and reduce the mortality.

A case management agency and bank create a service innovation.

PubMed

Katz, K S; Stowe, A W

1992-01-01

Connecticut Community Care, Inc. (CCCI), a statewide, nonprofit case management agency, in collaboration with Connecticut National Bank (CNB), developed a unique model of delivering case management services to bank trust clients. No reports of such a collaborative model have been found in the published literature in the United States. The article presents a historical overview of this innovative initiative; the identification of the target population; the delivery of the assessment, coordination, and monitoring services; and the marketing techniques. Utilization statistics, a synopsis of the model outcomes as viewed by the trust officers, and suggestions for replication are also presented.

Case Report: Laparoscopic Approach for Orchiopexy in a 26-Year-Old Man with Accidentally Discovered Persistent Müllerian Duct Syndrome and Bilateral Undescended Testis.

PubMed

Noureldin, Mohamed Essam; Tawfik, Ahmed Mohamed; Shaker, Hassan S

2018-01-01

Background: Persistent Müllerian duct syndrome (PMDS) is not a common form of disorder of sex development in which Müllerian duct derivatives (fallopian tubes, uterus, and the proximal vagina) are present in an otherwise normally differentiated 46 XY male. In most of cases, the challenge comes in the procedure of orchiopexy. Case Presentation: We report a case of a 26-year-old man with PMDS. It was accidentally discovered when the patient presented to our outpatient clinic concerning about his empty scrotum as a premarital check. Diagnostic laparoscopy discovered Mullerian remnants in the form of uterus, cervix, and fallopian tubes with two attached testes to the fallopian tubes. Staged laparoscopic orchiopexy was done. We discuss the presentation, the management of this case in the literature, and our intervention. Conclusion: PMDS is not a common condition. Several concerns present in the management of these cases. Malignant transformation of the testis is the main risk facing those patients. Few literature studies discussed the risk of changing of these remnants into malignant tissue. Thus discussion with the patient, tissue histopathology, expert opinions, and literature review are the main clues in management of such cases.

A ten-step process to develop case management plans.

PubMed

Tahan, Hussein A

2002-01-01

The use of case management plans has contained cost and improved quality of care successfully. However, the process of developing these plans remains a great challenge for healthcare executives, in this article, the author presents the answer to this challenge by discussing a 10-step formal process that administrators of patient care services and case managers can adapt to their institutions. It also can be used by interdisciplinary team members as a practical guide to develop a specific case management plan. This process is applicable to any care setting (acute, ambulatory, long term, and home care), diagnosis, or procedure. It is particularly important for those organizations that currently do not have a deliberate and systematic process to develop case management plans and are struggling with how to improve the efficiency and productivity of interdisciplinary teams charged with developing case management plans.

Case management helps prevent criminal justice recidivism for people with serious mental illness.

PubMed

Leutwyler, Heather; Hubbard, Erin; Zahnd, Elaine

2017-09-11

Purpose The purpose of this paper is to discuss how case management can decrease recidivism for people with serious mental illness (SMI) because people with SMI are at high risk for incarceration and recidivism. Design/methodology/approach Examples of successful case management models for formerly incarcerated individuals with SMI found through a secondary analysis of qualitative data and an analysis of the literature are presented. Findings Currently, no international, national, or statewide guidelines exist to ensure that formerly incarcerated individuals with SMI receive case management upon community reentry despite evidence that such services can prevent further criminal justice involvement. Recommendations include establishment of and evaluation of best practices for case management. In addition, the authors recommend additional funding for case management with the goal of greatly increasing the number of individuals with SMI leaving the criminal justice system in their ability to access adequate case management. Originality/value Providing effective case management tailored to the needs of formerly incarcerated people with SMI improves their quality of life and reduces their involvement in the criminal justice system with clear positive outcomes for public safety and public health.

Integrated Project Management: A Case Study in Integrating Cost, Schedule, Technical, and Risk Areas

NASA Technical Reports Server (NTRS)

Smith, Greg

2004-01-01

This viewgraph presentation describes a case study as a model for integrated project management. The ISS Program Office (ISSPO) developed replacement fluid filtration cartridges in house for the International Space Station (ISS). The presentation includes a step-by-step procedure and organizational charts for how the fluid filtration problem was approached.

Responding to the Increased Needs of College Students: A Case Study of Case Management

ERIC Educational Resources Information Center

Shelesky, Kristin; Weatherford, Ryan D.; Silbert, Janelle

2016-01-01

The psychological needs of college students lead to overwhelming demand on college counseling centers' resources. In this article, we review models of case management in Higher Education including the administrative, behavioral intervention, and counseling center models. We also present a case study of the 3-year development of a counseling center…

Post-cholecystectomy biliary injuries: one center experience.

PubMed

Fathy, Omar; Wahab, Mohamed Abdel; Hamdy, Emad; Elshoubary, Mohamed; Kandiel, Tharwat; Elraof, Ahmad Abd; Elhemaly, Mohamed; Salah, Tarek; Elhanafy, Ehab; Atef, Ehab; Sultan, Ahmad Mohamed; Elebiedy, Gamal; Anwar, Nabieh; Sultan, Ahmad

2011-01-01

Post-cholecystectomy bile duct injuries (BDIs) represent a challenge in diagnosis and management. From March 1995 to August 2009, 274 patients with post-cholecystectomy BDIs were managed at our center. All patients were subjected to laboratory tests, sonography, ERCP and MRCP. The management varied according to the type of injury. Seventy-one (25.9%) LC and 203 (74.1%) OC were performed; 8(2.9%) were detected intraoperatively; 270 patients were referred from other hospitals. From those discovered intraoperatively, 7 had hepatico-jejunostomy and one died from severe peritonitis; 11 (4%) presented with generalized and 112 (40.9%) with localized peritonitis. The leak site was the cystic duct (57 cases), accessory duct in the liver bed (5 cases), right hepatic duct (4 cases) and lateral tear in the CBD (12 cases). Endoscopic stenting was performed for all of them. The remaining 34 patients had a completely ligated distal duct and therefore had hepatico-jejunostomy Roux loop; 143 patients (52.2%) presented with early (79 cases) and late (64 cases) jaundice; 126 cases had hepatico-jejunostomy. The remaining 17 patients were treated by balloon dilatation. Endoscopic stenting can manage cases with cystic or accessory duct leak while, hepatico-jejunostomy Roux loop represents the golden procedure for management of transected or ligated CBD.

Point-of-Care Ultrasonography to Assist in the Diagnosis and Management of Subluxation of the Radial Head in Pediatric Patients: A Case Series.

PubMed

Güngör, Faruk; Kılıç, Taylan

2017-05-01

A subluxation of the radial head (SRH) is a clinical condition that commonly occurs in children under 6 years of age. History and physical examination findings typically include a child who presents with an elbow held in extension and with forearm pronation, after having suffered significant longitudinal traction on the arm, or after a fall on an outstretched hand. The diagnosis is often clinically obvious. The injury responds dramatically to closed reduction, and usually no imaging is required. However, cases with atypical presentations and patients who do not respond favorably to a reduction maneuver present clinical challenges, because the initial diagnosis of SRH may seem to be questionable or erroneous. Point-of-care ultrasound (POCUS) can assist decision-making and clinical management for these patients. We report three cases of SRH that were diagnosed and managed with POCUS in the emergency department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS can assist in the diagnosis and management of patients with clinical suspicion of SRH, especially in cases of atypical presentations or cases in which the mechanism of injury is unknown. It is also an extremely valuable tool in determining postprocedure reduction success. Copyright © 2017 Elsevier Inc. All rights reserved.

An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

PubMed

Terra, Sandra M

2007-01-01

This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of reduction in LOS, improvement in quality, and delivery of care.

Prevalence, clinical features and management of pediatric magnetic foreign body ingestions.

PubMed

Tavarez, Melissa M; Saladino, Richard A; Gaines, Barbara A; Manole, Mioara D

2013-01-01

Foreign body (FB) ingestions are frequent in children. Whereas the majority of FBs pass spontaneously through the gastrointestinal tract, ingestion of magnetic FBs pose a particular risk for obstruction due to proximate attraction through the intestinal wall. We aimed to identify the prevalence, clinical presentation, and management of magnetic FB ingestions at our tertiary care institution. We performed a retrospective chart review of medical records of patients presenting to the pediatric Emergency Department (ED) or admitted to the hospital with FB ingestions from June 2003-July 2009. From those cases, patients with magnetic FB ingestions were identified. During the study period, 337,839 patients presented to the ED; 38 cases of magnetic FB ingestion were identified (prevalence 0.01%). Abdominal radiography was obtained in all cases. Ingestion of a single magnet occurred in 30 of 38 cases (79%). Of those, 4 patients underwent endoscopic removal due to signs of FB impaction in the esophagus or pylorus; no complications were noted. Ingestion of multiple magnets (range 2-6) occurred in 8 of 38 cases. Four of the 8 patients with multiple magnetic FBs (50%) presented with signs of peritonitis and required operative repair of multiple intestinal perforations. No deaths were identified. Although ingestion of a single magnetic FB may, in most cases, be managed as a simple FB ingestion, the ingestion of multiple magnetic FB is associated with a high risk of complication and requires aggressive management. We propose an algorithm for management of children with magnetic FB ingestions. Copyright © 2013 Elsevier Inc. All rights reserved.

ED breast cases and other breast emergencies.

PubMed

Khadem, Nasim; Reddy, Sravanthi; Lee, Sandy; Larsen, Linda; Walker, Daphne

2016-02-01

Patients with pathologic processes of the breast commonly present in the Emergency Department (ED). Familiarity with the imaging and management of the most common entities is essential for the radiologist. Additionally, it is important to understand the limitations of ED imaging and management in the acute setting and to recognize when referrals to a specialty breast center are necessary. The goal of this article is to review the clinical presentations, pathophysiology, imaging, and management of emergency breast cases and common breast pathology seen in the ED.

Ethics in an operations management course.

PubMed

Rudnicka, Ewa A

2005-10-01

Graduates of the management major at the University of Pittsburgh at Greensburg find employment in a variety of organizations. As future managers with employees from different professions, students expressed an interest in discussing ethics cases in the operations management class. The semester starts with students familiarizing themselves with various professional and corporate codes of ethics. Throughout the semester a number of short ethics' cases in operations' areas such as inventory management, scheduling, facility location, and product design are introduced to illustrate ethical issues that a manager and his/her employees might face. Students prepare individual responses before the in-class discussions. The semester ends with a long group ethics case discussion and formal case presentations. In the end-of-semester survey, students responded very favorably to an ethics component in the operations management class.

Managing Criticism in Ph.D. Supervision: A Qualitative Case Study

ERIC Educational Resources Information Center

Li, Sarah; Seale, Clive

2007-01-01

This article is part of a larger study which presents findings from an in-depth longitudinal case study of a student's Ph.D. journey. It shows how criticism is produced and managed in the supervisory relationship. As well as an overview of types of criticism produced across a range of supervisory interactions, the article presents a micro-analysis…

Water Resources Management in the Lerma-Chapala Basin, Mexico: A Case Study

ERIC Educational Resources Information Center

Villamagna, Amy M.; Murphy, Brian R.

2008-01-01

Water resources have become an increasingly important topic of discussion in natural resources and environmental management courses. To address the need for more critical thinking in the classroom and to provide an active learning experience for undergraduate students, we present a case study based on water competition and management in the…

Efficacy of spinal cord stimulators in treating peripheral neuropathy: a case series.

PubMed

Abd-Elsayed, Alaa; Schiavoni, Nick; Sachdeva, Harsh

2016-02-01

Peripheral neuropathy is a common cause of pain, and it is increasing in prevalence. Peripheral neuropathic pain is very hard to treat and can be resistant to multiple pain management modalities. Our series aimed at testing the efficacy of spinal cord stimulators (SCSs) in treating resistant painful peripheral neuropathy. Case 1: A 79-year-old man presented to our clinic with long-standing history of painful peripheral diabetic neuropathy resistant to conservative management. After failure of all possible modalities, we offered the patient an SCS trial that was very successful, and we proceeded with the permanent implant that continued to help with his pain and allowed the patient to wean down his medications. Case 2: A 60-year-old man presented with chronic peripheral neuropathy secondary to HIV, patient failed all conservative and procedural management. Patient then had an SCS trial that relieved his pain significantly. Unfortunately, we did not proceed with the implant due to deterioration of the patient general health. Case 3: A 39-year-old woman presented with painful peripheral neuropathy secondary to chemotherapy for breast cancer. After failure of medication management and procedures, patient had a SCS trial that improved her pain and we then proceeded with performing the permanent implant that controlled her pain. We presented 3 cases with chronic painful peripheral neuropathy secondary to HIV, diabetes mellitus, and chemotherapy that was resistant to conservative pain management and procedures that was successfully treated with neurostimulation. Copyright © 2016 Elsevier Inc. All rights reserved.

Persistent Mullerian Duct Syndrome: a rare entity with a rare presentation in need of multidisciplinary management.

PubMed

Da Aw, Lin; Zain, Murizah M; Esteves, Sandro C; Humaidan, Peter

2016-01-01

A typical male looking adolescent with a legal female gender assignment presented with haematuria. Investigations led to the diagnosis of Persistent Mullerian Duct Syndrome. The condition is indeed a rare entity that needs a multidisciplinar team management. Case hypothesis: A case of Persistent Mullerian Duct Syndrome undiagnosed at birth because karyotyping was defaulted, thus resulting in a significant impact on the legal gender assignment and psychosocial aspects. Promising future implications: The reporting of this case is important to create awareness due to its rarity coupled with the rare presentation with hematuria as a possible masquerade to menstruation. There were not only medical implications, but also psychosocial and legal connotations requiring a holistic multidisciplinary management. Copyright® by the International Brazilian Journal of Urology.

Effectiveness of hemodialysis in a case of severe valproate overdose.

PubMed

Nasa, Prashant; Sehrawat, Deepak; Kansal, Sudha; Chawla, Rajesh

2011-04-01

A case of severe sodium valproate overdose is presented in which medicinal management failed to reverse coma of the patient. High-flux hemodialysis was then used to eliminate sodium valproate. This case demonstrated the effectiveness of hemodialysis in not only decreasing valproate levels very rapidly but also as an effective anti-coma management.

Injectional anthrax at a Scottish district general hospital.

PubMed

Inverarity, D J; Forrester, V M; Cumming, J G R; Paterson, P J; Campbell, R J; Brooks, T J G; Carson, G L; Ruddy, J P

2015-04-01

This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.

Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part I.

PubMed

O'Donnell, Lolita T

2007-01-01

To describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute hospital setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice in case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

Diagnostic challenges in tuberculous otitis media.

PubMed

Tang, I P; Prepageran, N; Ong, C A; Puraviappan, P

2010-08-01

To demonstrate the different clinical presentations of tuberculous otitis media and the management of selected cases. We report four cases of tuberculous otitis media with different clinical presentations, encountered between 1998 and 2002. None of the cases showed improvement with local or systemic antibiotics. The diagnosis, complications and management of these cases are discussed. A high index of clinical suspicion of tuberculous otitis media is required in patients who do not respond to standard antibiotic therapy for (nontuberculous) chronic middle-ear infection. Early diagnosis and treatment of tuberculous otitis media is important to avoid irreversible complications, surgical intervention and propagation of the disease.

Conservative approach to tardive dyskinesia-induced neck and upper back pain.

PubMed

Reifsnyder, Jeremy W; Tettambel, Melicien A

2013-08-01

The management of schizophrenia typically involves the use of antipsychotics (neuroleptics). Use of such medications, however, can result in tardive dyskinesia, or the involuntary contracture of muscles, and associated symptomatic somatic dysfunction. The authors present a case of a 29-year-old woman who presented to a family medicine clinic for ongoing management of schizophrenia with noticeable tardive dyskinesia and complaints of neck and upper back pain. Conventional management of tardive dyskinesia involves either a change in or reduction of the offending antipsychotic. In the present case, the patient received osteopathic manipulative treatment in addition to conventional care for the management of her neck and upper back pain. Although not curative, osteopathic manipulative treatment can provide palliative relief for patients with tardive dyskinesia.

To Exist as a Case Manager Is to Constantly Change; to Be Successful, You Must Constantly Adapt.

PubMed

Tahan, Hussein M

Change is inevitable whether in personal or professional lives. Case management practice is always evolving on the basis of the dynamic nature of the U.S. health care environment. Effective case managers are those who possess an adaptive mind-set, recognize the importance to change to maintain success, and remain relevant. They also demonstrate a sense of accountability and responsibility for own learning, professional development, and acquisition of new skills and knowledge. This editorial discusses the nature of change and adaptation and presents key strategies for case managers to remain relevant and effective in dynamic practice environments.

Classroom Management for Kids Who Won't Sit Still and Other "Bad Apples"

ERIC Educational Resources Information Center

Cahill, Susan M.

2006-01-01

This article presents a case description of collaboration between an occupational therapist and a general education teacher to develop an effective classroom management system. The classroom management system described here was based on the Alert Program for Self-regulation: How Does Your Engine Run? In addition, the case description provides a…

Paper and Process: How Youth Programs Manage Program Intake, Individual Service Strategy Development, and Case Files.

ERIC Educational Resources Information Center

Callahan, Jim; McLaughlin, Brenda

This guide presents information and materials to help youth programs manage program intake, design an individual service strategy (ISS) as mandated in the Workforce Investment Act, and manage case files. The materials are based on information obtained from staff working in seven successful youth workforce investment programs in Maryland,…

Uncommon Case of a Post-Traumatic Portal Vein Pseudoaneurysm Treated with Percutaneous Transhepatic Stent Grafting

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ierardi, Anna Maria, E-mail: amierardi@yahoo.it; Berselli, Mattia, E-mail: mattia.berselli@ospedale.varese.it; Cuffari, Salvatore, E-mail: salvatore.cuffari@ospedale.varese.it

We describe a man who presented with a traumatic portal vein pseudoaneurysm, which was subsequently managed with a percutaneous transhepatic stent graft. This case demonstrates a rarely seen condition in the traumatic population and a novel management strategy, which should be considered in the management of this challenging injury.

Access Management Awareness Program. Phase II Report

DOT National Transportation Integrated Search

1997-01-01

This report presents the results of a number of detailed Iowa access management case studies. Case studies were selected to provide a cross-section of locations and community sizes in Iowa as well as a variety of project types. Projects were analyzed...

FoodCASE: A system to manage food composition, consumption and TDS data.

PubMed

Presser, Karl; Weber, David; Norrie, Moira

2018-01-01

Food and nutrition scientists, nowadays, need to manage an increasing amount of data regarding food composition, food consumption and Total Diet Studies (TDS). The corresponding datasets can contain information about several thousand different foods, in different versions from different studies. FoodCASE is a system that has been developed to manage these different datasets. It also support flexible means of linking between datasets and generally provide support for the different processes involved in the acquisition, management and processing of data. In this paper, the most important concepts to implement existing guidelines and standards for proper food data management are presented, as well as different use cases of data import and proofs of concepts demonstrating the ability to manage data in FoodCASE. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using MultiMedia Content to Present Business Ethics: An Empirical Study

ERIC Educational Resources Information Center

Stanwick, Peter A.

2010-01-01

The purpose of this study is to empirically examine whether presenting a multimedia case study enhances the learning experience of students in an undergraduate management class. A questionnaire was administered before and after the presentation of the case study and the results showed that the multimedia case did indeed enhance the learning…

Lymphoedema of the lower limbs: management problems in a developing country.

PubMed

Adigun, A I; Ogundipe, O K

2008-01-01

Lymphoedema is a clinical condition involving the extremities that is characterized by accumulation of protein rich fluid within the intercellular space of the skin and the subcutaneous tissue. It most frequently occurs in the extremities. Developing countries are mostly faced with cases of secondary lymphoedema where patients present lately. In addition to swollen limbs, there are lot of skin changes on the affected limb, these create a lot of problems to the managing clinician. We hereby present five cases out of several patients managed to highlight the challenges. We review the case notes of three patients managed by our unit and present the summary of each patient. Majority of our patients present late to the hospital, mainly because of the socio-cultural and spiritual beliefs concerning the aetiology of the condition. Most of them have visited the spiritualist, herbalist and the clergymen for solution. Clinicians in the developing countries are seriously handicapped by lack of modern equipment for both diagnostic and therapeutic management of these clinical conditions. Chronic lymphoedema is a major cause of permanent disability. Excisional surgery such as Charles procedure even though old is still very much relevant in our environment. Patients need to be enlightened on the need for early presentation, adequate post-operative care and prolonged follow-up.

Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report.

PubMed

St-Onge, Eric; MacIntyre, Ian G; Galea, Anthony M

2015-12-01

To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy.

Effectiveness of hemodialysis in a case of severe valproate overdose

PubMed Central

Nasa, Prashant; Sehrawat, Deepak; Kansal, Sudha; Chawla, Rajesh

2011-01-01

A case of severe sodium valproate overdose is presented in which medicinal management failed to reverse coma of the patient. High-flux hemodialysis was then used to eliminate sodium valproate. This case demonstrated the effectiveness of hemodialysis in not only decreasing valproate levels very rapidly but also as an effective anti-coma management. PMID:21814378

Management of Post-Traumatic Phlegmasia Cerulea Dolens via Right-to-Left Femoral Vein to Femoral Vein Bypass (Palma Procedure).

PubMed

Dua, Anahita; Heller, Jennifer; Lee, Cheong

2017-11-01

Phlegmasia cerulea dolens (PCD) is a rare condition resulting from venous occlusion that impairs arterial flow. We report a rare case of post-traumatic PCD after ligation of the iliac vein with successful treatment by right-to-left femoral vein to femoral vein bypass using left great saphenous vein (Palma procedure). The clinical presentation, diagnostic process, and approach to management along with a literature review on the operative management of PCD are presented in this case report.

Parinaud syndrome: a 25-year (1991-2016) review of 40 consecutive adult cases.

PubMed

Shields, Melissa; Sinkar, Swati; Chan, WengOnn; Crompton, John

2017-12-01

To characterize the clinical features, aetiology and management of ophthalmic symptoms in adult patients with Parinaud syndrome. This is a retrospective, non-comparative observational case series. We reviewed 40 consecutive charts of adult patients with the clinical diagnosis of Parinaud syndrome at the Royal Adelaide Hospital Department of Ophthalmology in Adelaide, South Australia, between 1991 and 2016. Charts were reviewed for the following: (1) demographic information, (2) clinical presentation, (3) neuro-ophthalmology signs, (4) aetiology of Parinaud syndrome, and (5) management. Examination findings were collected at initial evaluation, throughout the course of follow-up, and at last follow-up. All the cases were assessed by one of the authors (JLC). The commonest presenting symptoms were diplopia (67.5%) and blurred vision (25%) followed by visual field defect (12.5%), ataxia (7.5%) and manifest squint (7.5%). The commonest presenting signs were vertical gaze palsy (100%), convergence-retraction nystagmus (87.5%) and light-near dissociation (65.0%). Only 65.0% patients had the classical triad of vertical gaze palsy, convergence-retraction nystagmus and light-near dissociation. Midbrain pathologies including haemorrhage (30.0%), infarction (20.0%) and tumour (15.0%) were the commonest aetiology. Pineal region tumours accounted for 30.0% of presentations. Symptoms were managed conservatively in 45% of cases with temporary occlusion, prisms or refractive correction, and observation in 42.5% of cases. Surgical intervention for refractory diplopia was required in 12.5% of cases, of which 80% reported symptom resolution following surgery. Our series highlights the variable clinical presentation of Parinaud syndrome. The classic triad of conjugate upgaze paralysis, convergence-retraction nystagmus and light-near dissociation was only present in 65% of cases. Pineal neoplasms remain an important aetiological consideration; however, primary midbrain pathology including infarction and haemorrhage constituted the majority of our cases and should be considered in all patients. Conservative management approaches for ocular symptoms are sufficient in most cases although surgical treatment of upgaze palsy can be a useful option in refractory cases. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Exploring the effect of at-risk case management compensation on hospital pay-for-performance outcomes: tools for change.

PubMed

Granata, Randy L; Hamilton, Karen

2015-01-01

Acute care nurse case managers are charged with compliance oversight, managing throughput, and ensuring safe care transitions. Leveraging the roles of nurse case managers and social workers during care transitions translates into improved fiscal performance under the Affordable Care Act. This article aims to equip leaders in the field of case management with tools to facilitate the alignment of case management systems with hospital pay-for-performance measures. A quality improvement project was implemented at a hospital in south Alabama to examine the question: for acute care case managers, what is the effect of key performance indictors using an at-risk compensation model in comparison to past nonincentive models on hospital readmissions, lengths of stay, and patient satisfaction surrounding the discharge process. Inpatient acute care hospital. The implementation of an at-risk compensation model using key performance indicators, Lean Six Sigma methodology, and Creative Health Care Management's Relationship-Based Care framework demonstrated reduced length of stay, hospital readmissions, and improved patient experiences. Regulatory changes and new models of reimbursement in the acute care environment have created the perfect storm for case management leaders. Hospital fiscal performance is dependent on effective case management processes and the ability to optimize scarce resources. The quality improvement project aimed to further align case management systems and structures with hospital pay-for-performance measures. Tools for change were presented to assist leaders with the change acceleration process.

Managing Nonoperable Intracranial Bleeding Associated With Apixaban: A Series of 2 Cases.

PubMed

Faust, Andrew C; Tran, Dang M; Lo, Catherine; Lai, Sophia; Sheperd, Lyndsay; Liu, Mary; Denetclaw, Tina

2018-02-01

To report 2 cases of nonoperable intracranial bleeding associated with apixaban managed by 3-factor prothrombin complex concentrate (PCC3). Case 1 presented with a 1.3-cm left parieto-occipital hemorrhage and a thin subdural hematoma (SDH) on the left tentorium of the brain about 6 hours after his last dose of apixaban. Case 2 presented with a 4-mm left parafalcine SDH with time of most recent apixaban dose unknown. The patients received 24.9 to 25.5 U/kg of PCC3 with none to 1 U fresh frozen plasma (FFP) and demonstrated minimal or no progression in lesions measured by repeat computed tomography (CT) after treatment. One patient was discharged to a skilled nursing facility after 8 days; the other patient was discharged to home after 18 days. Apixaban has no specific antidote. Current bleeding management strategies are based on expert opinion. The risks and benefits for differing strategies are unclear, and little clinical experience for managing apixaban-associated intracranial bleeding has been reported to date. These cases describe the clinical use of PCC3 to manage parieto-occipital and subdural hemorrhage associated with apixaban in events not requiring surgical intervention. In these 2 cases, 25 U/kg PCC3, with none to one unit FFP, ceased apixaban-associated intracranial bleeding without apparent thrombogenic complications.

Idiopathic granulomatous mastitis masquerading as carcinoma of the breast: a case report and review of the literature

PubMed Central

Tuli, Richard; O'Hara, Brian J; Hines, Janet; Rosenberg, Anne L

2007-01-01

Background Idiopathic granulomatous mastitis is an uncommon, benign entity with a diagnosis of exclusion. The typical clinical presentation of idiopathic granulomatous mastitis often mimics infection or malignancy. As a result, histopathological confirmation of idiopathic granulomatous mastitis combined with exclusion of infection, malignancy and other causes of granulomatous disease is absolutely necessary. Case Presentation We present a case of a young woman with idiopathic granulomatous mastitis, initially mistaken for mastitis as well as breast carcinoma, and successfully treated with a course of corticosteroids. Conclusion There is no clear clinical consensus regarding the ideal therapeutic management of idiopathic granulomatous mastitis. Treatment options include expectant management with spontaneous remission, corticosteroid therapy, immunosuppressive agents and extensive surgery for refractory cases. PMID:17662130

Sustainability in Housing: A Curriculum Case Study.

ERIC Educational Resources Information Center

Parrott, Kathleen; Emmel, Joann M.

2001-01-01

Explores the influence of environmental issues on the field of housing, from the perspective of sustainable housing. Presents a case study of the development of a college course to address these issues by integrating energy management, air quality, water quality, and waste management. (Author)

Persistent hyperphagia in acquired brain injury; an observational case study of patients receiving inpatient rehabilitation.

PubMed

Rowell, Arleen M; Faruqui, Rafey A

2010-01-01

Morbid hunger or persistent hyperphagia is a relatively rare but potentially life threatening complication of acquired brain injury (ABI). This paper presents findings from an observational case study of patients with hyperphagia receiving inpatient neurobehavioural rehabilitation following their acquired brain injury. The case study has utilized dietetic and medical records of identified patients to confirm the persistent and serious nature of this presentation in order to extract important management principles. The findings confirmed that hyperphagia or morbid hunger posed potentially life-threatening health risks to the patient, primarily around weight control and fluid balance, and risks of aggression towards professional and family carers. Pharmacological or behaviour modification interventions were only partially successful in management of this presentation. The study identified a high need for environmental and cue exposure control in management of this condition.

Surgical management of lateral incisor with type II dens invaginatus and a periapical pathosis: A case report with 1-year follow-up.

PubMed

Lakshmi, V Naga; Varma, K Madhu; Sajjan, Girija S; Rambabu, Tanikonda

2017-01-01

Dens invaginatus is a relatively common dental malformation resulting from an infolding of enamel organ into the dental papilla varying in depth into the tooth tissues. Complex morphological anatomy associated with the pulpal pathology presents inaccessibility to completely remove the necrotic pulp tissues and hence poses challenges in rendering endodontic treatment. A combination of nonsurgical and surgical management in treating such cases is advisable depending on the presented variations. The present case reports the surgical endodontic treatment of an immature maxillary lateral incisor with type II dens invaginatus and periapical pathology.

Surgical management of lateral incisor with type II dens invaginatus and a periapical pathosis: A case report with 1-year follow-up

PubMed Central

Lakshmi, V. Naga; Varma, K. Madhu; Sajjan, Girija S.; Rambabu, Tanikonda

2017-01-01

Dens invaginatus is a relatively common dental malformation resulting from an infolding of enamel organ into the dental papilla varying in depth into the tooth tissues. Complex morphological anatomy associated with the pulpal pathology presents inaccessibility to completely remove the necrotic pulp tissues and hence poses challenges in rendering endodontic treatment. A combination of nonsurgical and surgical management in treating such cases is advisable depending on the presented variations. The present case reports the surgical endodontic treatment of an immature maxillary lateral incisor with type II dens invaginatus and periapical pathology. PMID:28761255

Retropharyngeal abscess with mediastinal extension in an infant--still existing?

PubMed

Bakshi, Rijuneeta; Grover, Gogia

2009-03-01

The objective of the present case report was to note that despite the low incidence of retropharyngeal abscess in the present antibiotic era, children, especially infants, can develop this condition. If early diagnosis is missed, the abscess may extend into the mediastinum and can be life threatening. Case reports of mediastinal abscess in the past literature along with the current case. The present case was successfully managed by surgical drainage of the abscess via transcervical route along with intravenous antibiotic therapy, and the recovery was uneventful. Although the incidence of retropharyngeal abscess has declined with the widespread use of antibiotics, the presenting symptom can be overlooked in a pediatric population, especially infants, and can extend along the fascial planes to the mediastinum when the recovery becomes difficult. The present report is an effort to draw attention to this life-threatening complication of retropharyngeal abscess, emphasize the role of early diagnosis, and prompt surgical management.

Multimedia case management system implemented in Java

NASA Astrophysics Data System (ADS)

Stewart, Howard D.; Davis, Midge L.; Handy, Dale L.; Kvarfordt, Kent B.; Ford, Glenn

1999-01-01

Managing the timely access of information is a major challenge facing law enforcement agencies. One of the areas of greatest need is that of the case management process. During the course of FY98, the Office of National Drug Control Policy (ONDCP), the Counterdrug Technology Assessment Center (CTAC), the Idaho National Engineering and Environmental Laboratory (INEEL), and the Criminal Investigative Bureau (CIB) of the state of Idaho, created a Northwest testbed to develop and integrate a multimedia case management system. A system was developed to assist investigators in tracking and maintaining investigative cases and improving access to internal and external data resources. In this paper, we discuss the results of our case management system development and the ability to present state and federal information incorporating object oriented and multimedia techniques. We then outline our plans for future research and development.

What ethics for case managers? Literature review and discussion.

PubMed

Corvol, Aline; Moutel, Grégoire; Somme, Dominique

2016-11-01

Little is known about case managers' ethical issues and professional values. This article presents an overview of ethical issues in case managers' current practice. Findings are examined in the light of nursing ethics, social work ethics and principle-based biomedical ethics. A systematic literature review was performed to identify and analyse empirical studies concerning ethical issues in case management programmes. It was completed by systematic content analysis of case managers' national codes of ethics. Only nine empirical studies were identified, eight of them from North America. The main dilemmas were how to balance system goals against the client's interest and client protection against autonomy. Professional codes of ethics shared important similarities, but offered different responses to these two dilemmas. We discuss the respective roles of professional and organizational ethics. Further lines of research are suggested. © The Author(s) 2015.

Complex and open fractures: a straightforward approach to management in the cat.

PubMed

Corr, Sandra

2012-01-01

Cats often present with traumatic injuries of the limbs, including complex and open fractures, frequently as a result of road traffic accidents. On initial assessment, complex and open fractures may appear to require expertise beyond the experience of the general practitioner and, in some cases, referral to a specialist may be indicated or amputation should be considered. Many cases, however, can be managed using straightforward principles. This review describes a logical and practical approach to treating such injuries. It discusses general principles of fracture management, highlights the treatment of open fractures, and describes the use of external skeletal fixation for stabilisation of both open and complex fractures. Most fractures can be stabilised using equipment and expertise available in general practice if the basic principles of fracture fixation are understood and rigorously applied. Many textbooks and journal articles have been published on the management of fractures in companion animals, presenting case studies, case series and original biomechanical research. The simple strategy for managing complex injuries that is provided in this review is based on the published literature and the author's clinical experience.

Reflective practice: a framework for case manager development.

PubMed

Brubakken, Karen; Grant, Sara; Johnson, Mary K; Kollauf, Cynthia

2011-01-01

The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.

Teaching Natural Resource Management-Teaching Techniques and Difficulties in Greek Vocational Lyceum: A Case Study

ERIC Educational Resources Information Center

Koutsoukos, Marios; Mouratidis, Antonios

2016-01-01

The aim of the present study is to investigate the teaching techniques applied, as well as the difficulties, with which educators in teaching Natural Resource Management are confronted. For research purposes, a case study was conducted on teaching Natural Resource Management in the Third Grade of Vocational Lyceum (EPAL) in Northern Greece. It was…

Surgical Management of Complex Lower-Extremity Trauma With a Long Hindfoot Fusion Nail: A Case Report.

PubMed

Jain, Nickul S; Lopez, Gregory D; Bederman, S Samuel; Wirth, Garrett A; Scolaro, John A

2016-08-01

High-energy injuries can result in complete or partial loss of the talus. Ipsilateral fractures to the lower limb increase the complexity of surgical management, and treatment is guided by previous case reports of similar injuries. A case of complex lower-extremity trauma with extruded and missing talar body and ipsilateral type IIIB open tibia fracture is presented. Surgical limb reconstruction and salvage was performed successfully with a single orthopaedic implant in a manner not described previously in the literature. The purpose of this case report is to present the novel use of a single orthopaedic implant for treatment of a complex, open traumatic injury. Previous case reports in the literature have described the management of complete or partial talar loss. We describe the novel use of a long hindfoot fusion nail and staged bone grafting to achieve tibiocalcaneal arthrodesis for the treatment of complex lower-extremity trauma. Therapeutic, Level IV: Case study. © 2015 The Author(s).

Laparoscopic-assisted management of traumatic abdominal wall hernias in children: case series and a review of the literature.

PubMed

Talutis, Stephanie D; Muensterer, Oliver J; Pandya, Samir; McBride, Whitney; Stringel, Gustavo

2015-03-01

Traumatic abdominal wall hernia (TAWH) is defined as herniation through a disrupted portion of musculature/fascia without skin penetration or history of prior hernia. In children, TAWH is a rare injury. The objectives of this study were to report our experience with different management strategies of TAWH in children and to determine the utility of laparoscopy. A retrospective chart review of all children treated by pediatric surgery at our institution for TAWH in a 5year interval was performed. Data were collected on mechanism of injury, initial patient presentation, surgical management, and outcomes. We present 5 cases of traumatic abdominal wall hernia; 3 were managed using laparoscopic assistance. One patient was managed nonoperatively. All patients recovered without complications and were asymptomatic on follow up. Traumatic abdominal wall hernias require a high index of suspicion in the cases of blunt abdominal trauma. Laparoscopy is useful mainly as a diagnostic modality, both to evaluate the hernia and associated injuries to intraabdominal structures. Its use may facilitate repair through a smaller incision. Conservative management of TAWH may be appropriate in select cases where there is a low risk of bowel strangulation. Copyright © 2015 Elsevier Inc. All rights reserved.

The work of case managers as experienced by older persons (75+) with multi-morbidity - a focused ethnography.

PubMed

Hjelm, Markus; Holst, Göran; Willman, Ania; Bohman, Doris; Kristensson, Jimmie

2015-12-17

Complex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Case management could be one way to address this difficulty. Currently, there is a need to extend the knowledge regarding case management as experienced by those utilising the services, namely older persons (75+) with multi-morbidity. The study aimed to explore older persons' (75+) with multi-morbidity experiences of case managers. The study design was qualitative and used a focused ethnographic approach. Data was collected through individual interviews with 13 older persons and by participant observations with accompanying field notes, all conducted in 2012-2013. The data revealed four themes illustrating the older persons' experiences of case managers: 1) Someone providing me with a trusting relationship; 2) Someone assisting me; 3) Someone who is on my side; and 4) Someone I do not need at present. This study illustrates the importance of establishing trusting relationships between older persons and their case managers in order to truly provide assistance. The older persons valued the case managers acting as informed but unbiased facilitators. The findings could be of help in the development of case management interventions better designed for older persons with multi-morbidity.

Case management and adherence to an online disease management system.

PubMed

Robertson, Lucy; Smith, Michael; Tannenbaum, Dennis

2005-01-01

Non-adherence to treatment presents a significant obstacle to achieving favourable health outcomes. We have studied consumers' adherence to an online disease management system for depression, called Recovery Road. Recovery Road was implemented on a pilot basis for mental health care in Western Australia. Recovery Road was available for use by consumers and clinicians to augment usual treatment. One hundred and thirty consumers who had been diagnosed with major depression were enrolled. Consumers who used Recovery Road (n = 98) were provided with education, progress monitoring, e-consultation, e-diary and online evidenced-based therapy. Consumers received either standard, automated adherence reminders by email (n = 69), or case management, which included personalized email and telephone follow-up in response to non-adherence (n = 29). After the first eight sessions, the adherence was 84% in the case management group and 55% in the automatic reminders group. The results suggest that case management increases adherence to online disease management systems.

Isolated mucosal fenestration with localized gingival recession: Closure with an acellular dermal graft. A rare case report with two years' follow-up.

PubMed

Balasubramanian, SaravanaKarthikeyan; Singh, Vishal; Bhat, G Subraya; Acharya, Shashi Rashmi; Nidambur Ballal, Vasudev; Saraswathi, Vidya; Vinayachanan, Divya

2016-01-01

Mucosal fenestrations are rarely encountered in clinical practice, and as such their management is not often reported. Their treatment might be further complicated due to a communication with the oral environment, making them more susceptible to accumulation of debris, plaque, and calculus, thereby reducing the probability of mucosal renewal. The aim of the present case report is to highlight one such rare clinical scenario and its apt and effective management. Surgical management of an uncommon presentation of concomitant gingival recession with an isolated mucosal fenestration in an atypical location, with an allograft matrix is presented here with 2 years' follow-up. A review of the literature reveals no previous application of AlloDerm graft for the management of a similar situation.

Congenital Lobar Emphysema: An Approach of Anesthetic Management.

PubMed

Mourya, Meenakshi; Meena, Dharam Singh

2016-08-01

Congenital Lobar Emphysema (CLE) is a medical condition which is quiet rarely seen especially in neonates. The disease is characterized by over inflation of lungs which is produced due to inhibition of escape of inspired air from lungs. This condition usually occurs in infants due to partial obstruction of the bronchus and can be reversed with timely and planned anaesthetic management. Here in, we are presenting a case of an infant who was merely four months of age. CLE was affecting his left upper lobe since birth which was being treated as lobar pneumonia outside at some peripheral health center. The case presented to hospital with the symptoms acute respiratory distress and was taken up for urgent surgical management. Left upper lobectomy was performed which relived his symptoms. Case was discharged from hospital after 10 days of uneventful hospital stay. The case was challenging, as it involved careful and planned anaesthetic management of lung separation as well as prevention of hyperventilation of the un-involved lung.

Delayed lead perforation: a disturbing trend.

PubMed

Khan, Mohammed N; Joseph, George; Khaykin, Yaariv; Ziada, Khaled M; Wilkoff, Bruce L

2005-03-01

Delayed lead perforation (occurring more than 1 month after implantation) is a rare complication. Its pathophysiology and optimal management are currently unclear. Three cases of delayed lead perforation (6-10 month) were identified in patients with low-profile active fixation leads. All cases presented in a subacute fashion with pleuritic chest pain with confirmatory chest x-ray and device interrogation. Given the potential complications of a perforated lead, all cases had the lead extracted under TEE observation with cardiac surgery backup in the operating room. All patients tolerated extraction without complication. Based on these cases, we recommend a management scheme for patients who present with delayed lead perforation.

Bladder Endometriosis and Endocervicosis: Presentation of 2 Cases with Endoscopic Management and Review of Literature

PubMed Central

Fuentes Pastor, Javier; Ballestero Diego, Roberto; Correas Gómez, Miguel Ángel; Torres Díez, Eduardo; Fernández Flórez, Alejandro; Ballesteros Olmos, Gerardo; Gutierrez Baños, Jose Luis

2014-01-01

Urinary tract endometriosis and endocervicosis are an uncommon pathologic finding, with a common embryological origin. We present 2 cases of female patients with bladder mass. The first one was a finding of a nodular formation in the bladder during study of a nonviable foetus and the second was an incidental finding of a neoformation in the fundus of the bladder during the realization of an ultrasound. In both cases, we performed a surgical management with transurethral resection. Histopathological examination revealed a bladder endometrioma in the first case and endocervicosis with associated endometriosis in the second. PMID:25184072

Retrotracheal Extraskeletal Ewing's Sarcoma: Case Report and Discussion on Airway Management.

PubMed

Van Der Meer, Graeme; Linkhorn, Hannah; Gruber, Maayan; Mahadevan, Murali; Barber, Colin

2017-03-01

Extraskeletal Ewing's sarcoma is a rare tumor, and the management of airway compromise in case of cervical Ewing's sarcoma has not been established. This report describes the case of a patient with retrotracheal Ewing's sarcoma and discusses a successful approach to airway management. A 12-year-old male presented with a 2-week history of sore throat and sleep-disordered breathing and 48 hours of stridor. Imaging confirmed a retrotracheal soft tissue mass with airway compromise. A planned and controlled approach to his airway management resulted in a secure airway prior to definitive treatment.

Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part II.

PubMed

O'Donnell, Lolita T

2007-01-01

The purpose of this study was to describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute care setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice of case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

Turning a hazardous waste lagoon into reclaimed land for wildlife management: A case study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leong, A.K.

Brownfields are turning back to green. This paper presents a case study of a former dump site for hazardous waste that has been remediated and will be developed into an enhanced wildlife management habitat. This successful remediation case combined various investigations, remedial designs, risk assessments, ecological studies, and engineering practices. 3 refs., 1 fig., 1 tab.

Pelvic packing with vaginal traction for the management of intractable hemorrhage.

PubMed

Naranjo-Gutiérrez, Leonardo A; Oliva-Cristerna, Joaquín; Ramírez-Montiel, Martha L; Ortiz, Mario I

2014-10-01

To present clinical cases examining the effectiveness and safety of pelvic packing with vaginal traction for inhibiting obstetric hemorrhage among women receiving treatment at a public obstetrics and gynecology tertiary care hospital in Mexico. In a retrospective observational descriptive study, eight cases of obstetric hemorrhage treated by pelvic packing with vaginal traction between January 2012 and December 2013 at Hospital de la Mujer, Mexico City, Mexico, were reviewed. The mean patient age was 28.8±6.8 years. The average blood loss was 4535±897 mL. Uterine atony was the cause of bleeding among six patients: histopathologic examination revealed two cases of placenta accreta, one case of placenta percreta, two cases of uteroplacental apoplexy, and one case of myomatosis. For two patients, placental separation was difficult and required surgical management. The packing technique was effective for all patients. No patients presented with infection or required re-operation for bleeding management. No deaths occurred. For management of bleeding among patients with underlying coagulation disorders, pelvic packing can be useful when standard techniques such as hysterectomy, tubal hypogastric ligation, and/or pharmacologic therapy are unsuccessful. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Women's experiences of nurse case management on a gynaecological oncology unit in a Swiss tertiary hospital. A thematic analysis.

PubMed

Grob, Silvia; Bläuer, Cornelia; Frei, Irena Anna

2017-12-01

Women with gynaecological cancer face various physical, social and emotional challenges concerning their health. Existing research shows that case management can improve patient satisfaction and reduce readmission rates. Although nurse case management was introduced on a gynaecological oncology unit in a Swiss university hospital in 2013, little is known about the experiences of female patients on a unit that uses this model of care. The aims were to explore women's experiences and to gain deeper understanding about hospital-based nurse case management on a gynaecological oncology unit and to qualitatively evaluate the concept of nurse case management. Sound research knowledge suggests that experiences are best explored with a qualitative research design. Ten participant interviews were conducted and inductively analysed between September 2014 and May 2015 as described by the thematic analysis method. Ethical approval was obtained, and the women signed a consent form. The first theme was named continuous relationship, with the nurse case manager as contact person and trusted partner. Study participants explained that friendliness and being present were essential qualities of nurse case management. Secondly, an essential support for women dealing with the situation of gynaecological cancer was described in the theme sharing information. The organisation of rehabilitation and other services by the nurse case management defined the third theme coordinating care. Trust was seen as the basis of the continuous relationship, marked by friendliness and presence of the nurse case manager. The helpful approach of persons practicing nurse case management made dealing with the situation of illness easier for women with gynaecological cancer. Coordination of information between the nurse case management and other healthcare services could be improved. Further evaluation is suggested to explore effects of the concept on family members. © 2017 Nordic College of Caring Science.

Solitary vertebral metastasis of primary clear cell carcinoma of the liver: a case report and review of literature

PubMed Central

Maharajan, Karthikeyan; Tham, Ivan; Thamboo, Thomas Paulraj; Wong, Alvin; Khan, Irfan Sagir; Kumar, Naresh

2017-01-01

Primary clear cell carcinoma of liver (PCCCL) is an uncommon variant of primary hepatocellular carcinoma. Though the literature describes a better prognosis in relation to the proportion of clear cells in the tumour when compared to the other variants, there is no general consensus in the management due to its rarity and unclear clinicopathological and prognostic factors. There is dearth of evidence with regard to the metastasizing nature of PCCCL and its management. In addition, the management of recurrent spinal tumours both primary and metastatic is not clear as the available evidence is mostly based on case reports. We describe an unusual presentation of PCCCL with solitary spinal metastasis and further complicated by tumour recurrence in a 71-year-old male. Such presentation has never been described before. He presented with low back pain and incomplete neurological deficits involving both lower limbs. On detailed evaluation, he was found to have a solitary metastasis at L3 vertebra secondary to PCCCL. He underwent radical excision of tumour and reconstruction for the solitary metastasis at L3 vertebral body and trans arterial chemo embolisation (TACE) for the hepatic lesion. Pt was asymptomatic until 9 months post operatively when he developed tumour recurrence at L3 vertebra. Patient subsequently underwent 2 stage palliative surgery followed by radiotherapy and chemotherapy. At his latest follow-up (1 year), the patient’s overall general condition has improved with residual neurological deficits in the lower limb. PCCCL is a rare type of hepatocellular carcinoma which can present as “solitary metastasis” to the spine. Although the literature suggests a good prognosis for this histological type, this case did not have a good outcome. In addition to providing information for the management of similar cases in the future, this case report highlights that every patient has to be managed on a case-by-case basis. PMID:28744515

Challenges in the Management of a Patient with Myxoedema Coma in Ghana: A Case Report.

PubMed

Akpalu, Josephine; Atiase, Yacoba; Yorke, Ernest; Fiscian, Henrietta; Kootin-Sanwu, Cecilia; Akpalu, Albert

2017-03-01

Myxoedema coma is a rare life-threatening disease, and it is essential that it is managed appropriately to reduce the associated high mortality. However, in the setting where efficient healthcare delivery is hampered by inadequacies, the management of such cases may pose a significant challenge. We present the case of a middle-aged woman diagnosed with myxoedema coma and severe hyponatremia. The case report highlights some of the challenges that may be encountered during the management of myxoedema coma in similar settings and outlines the management strategies undertaken to overcome them in the absence of national guidelines. It also brings to the fore the need for clinicians to look out for clinical features suggestive of hypothyroidism particularly among high risk individuals for early diagnosis and treatment. None declared.

COLLABORATE©: a universal competency-based paradigm for professional case management, part i: introduction, historical validation, and competency presentation.

PubMed

Treiger, Teresa M; Fink-Samnick, Ellen

2013-01-01

The purpose of this first of a three-article series is to provide context and justification for a new paradigm of case management built upon a value-driven foundation that Applicable to all health care sectors where case management is practiced. In moving forward, the one fact that rings true is there will be constant change in our industry. As the health care terrain shifts and new influences continually surface, there will be consequences for case management practice. These impacts require nimble clinical professionals in possession of recognized and firmly established competencies. They must be agile to frame (and reframe) their professional practice to facilitate the best possible outcomes for their patients. Case managers can choose to be Gumby or Pokey. This is exactly why the definition of a competency-based case management model's time has come, one sufficiently fluid to fit into any setting of care. The practice of case management transcends the vast array of representative professional disciplines and educational levels. A majority of current models are driven by business priorities rather than by the competencies critical to successful practice and quality patient outcomes. This results in a fragmented professional case management identity. While there is inherent value in what each discipline brings to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities, including a reflective clinical ladder.

Risk-based requirements management framework with applications to assurance cases

NASA Astrophysics Data System (ADS)

Feng, D.; Eyster, C.

The current regulatory approach for assuring device safety primarily focuses on compliance with prescriptive safety regulations and relevant safety standards. This approach, however, does not always lead to a safe system design even though safety regulations and standards have been met. In the medical device industry, several high profile recalls involving infusion pumps have prompted the regulatory agency to reconsider how device safety should be managed, reviewed and approved. An assurance case has been cited as a promising tool to address this growing concern. Assurance cases have been used in safety-critical systems for some time. Most assurance cases, if not all, in literature today are developed in an ad hoc fashion, independent from risk management and requirement development. An assurance case is a resource-intensive endeavor that requires additional effort and documentation from equipment manufacturers. Without a well-organized requirements infrastructure in place, such “ additional effort” can be substantial, to the point where the cost of adoption outweighs the benefit of adoption. In this paper, the authors present a Risk-Based Requirements and Assurance Management (RBRAM) methodology. The RBRAM is an elaborate framework that combines Risk-Based Requirements Management (RBRM) with assurance case methods. Such an integrated framework can help manufacturers leverage an existing risk management to present a comprehensive assurance case with minimal additional effort while providing a supplementary means to reexamine the integrity of the system design in terms of the mission objective. Although the example used is from the medical industry, the authors believe that the RBRAM methodology underlines the fundamental principle of risk management, and offers a simple, yet effective framework applicable to aerospace industry, perhaps, to any industry.

Development of hydronephrosis secondary to poorly managed neurogenic bowel requiring surgical disimpaction in a patient with spinal cord injury: A case report

PubMed Central

Downs, Jairon; Wolfe, Tracy; Walker, Heather

2014-01-01

Context Case of an adult patient with paraplegia managing neurogenic bladder with intermittent catheterization who was not performing a standard bowel program for management of neurogenic bowel. Findings Patient presented with increasing spasticity, fecal incontinence, and abdominal pain and ultimately was hospitalized for management. Imaging revealed massive fecal impaction, resulting in ureteral obstruction and hydronephrosis. Despite repeated aggressive bowel regimens, serial abdominal X-rays showed continued large stool burden. Ultimately surgical intervention was required to evacuate the colon and subsequently the hydronephrosis resolved. Conclusion/Clinical relevance This case illustrates the importance of proper management of neurogenic bowel, as significant medical complications, such as hydronephrosis can occur with poorly managed neurogenic bowel. PMID:24617444

A High-Grade Chondrosarcoma of Calcaneum Mimicking as a Benign Pathology: Delayed Diagnosis and Management.

PubMed

Baba, Muzamil Ahmad; Nazir, Naila; Shabeer, Maajid; Mir, Bashir Ahmed; Kawoosa, Altaf Ahmad

2016-10-01

This case is presented to highlight a rare case of chondrosarcoma of calcaneum in a young adult mimicking as a benign pathology and to highlight the diagnosis and early management of such cases to prevent complications and even death. Chondrosarcoma constitutes less than 10% of all primary malignancies of bone and occurs mostly in proximal locations such as pelvis, proximal femur, and proximal humerus. We present a case of high-grade chondrosarcoma at a very rare site, calcaneum of a 40-year-old male that was mimicking as a benign pathology. This case report highlights the importance of proper clinical examination, evaluation, and suspicion for benign occurring lesions to prevent complications related to a delay in diagnosis. Therapeutic, Level IV: Case study. © 2016 The Author(s).

Guillain-Barré syndrome in pregnancy: A case report

PubMed Central

Hukuimwe, Misai; Matsa, Tawanda T; Gidiri, Muchabayiwa F

2017-01-01

Guillain-Barré syndrome is a rare condition in pregnancy which is characterised by symmetrical progressive ascending polyneuropathy. A case of a 16-year-old nulliparous woman who presented with rapidly progressive limb paralysis following an upper respiratory tract infection a week prior to presentation is discussed. She was intubated as she had developed respiratory failure and managed in the intensive care unit by a multidisciplinary team. Plasma exchange and intravenous immunoglobulin were not readily available so she was managed conservatively. The management of Guillain-Barré syndrome, maternal and foetal outcomes have been discussed. PMID:28438080

Guillain-Barré syndrome in pregnancy: A case report.

PubMed

Hukuimwe, Misai; Matsa, Tawanda T; Gidiri, Muchabayiwa F

2017-04-01

Guillain-Barré syndrome is a rare condition in pregnancy which is characterised by symmetrical progressive ascending polyneuropathy. A case of a 16-year-old nulliparous woman who presented with rapidly progressive limb paralysis following an upper respiratory tract infection a week prior to presentation is discussed. She was intubated as she had developed respiratory failure and managed in the intensive care unit by a multidisciplinary team. Plasma exchange and intravenous immunoglobulin were not readily available so she was managed conservatively. The management of Guillain-Barré syndrome, maternal and foetal outcomes have been discussed.

A shark attack treated in a tertiary care centre: Case report and review of the literature.

PubMed

Roy, Mélissa; Plant, Mathew A; Snell, Laura

2018-01-01

Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman's contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries.

A shark attack treated in a tertiary care centre: Case report and review of the literature

PubMed Central

Roy, Mélissa; Plant, Mathew A; Snell, Laura

2018-01-01

Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman’s contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries. PMID:29076325

Submucosal lipoma of the sigmoid colon as a rare cause of mucoid diarrhea: a case report.

PubMed

Dassanayake, S U B; Dinamithra, N P; Nawarathne, N M M

2016-01-20

Symptomatic presentations of colonic lipomas are very rare in clinical practice, and may mimic colonic malignancy. The likelihood of presenting symptoms has been shown to depend on the size of the lesion. We describe the case of a 72-year-old Sinhalese man presenting with worsening mucoid diarrhea who was subsequently diagnosed to have a lipoma of the sigmoid colon. His disease was successfully managed with endoscopic resection. Confidently establishing the rare diagnosis of a colonic lipoma usually requires a combination of endoscopic, radiological, and histological evaluation, and is therefore very challenging. With the advancement of endoscopic procedures, endoscopic resection is widely practiced as the definitive management of these cases.

Two cases of cerebral aneurysms in HIV+ children.

PubMed

Fulmer, B B; Dillard, S C; Musulman, E M; Palmer, C A; Oakes, J

1998-01-01

Two cases of fusiform cerebral aneurysms in human immunodeficiency virus (HIV) positive children are presented. To our knowledge, only 9 patients with this association have been reported. One of our patients represents the first report of a patient with an aneurysm associated with varicella-zoster vasculitis. One patient presented with a subarachnoid hemorrhage, Hunt-Hess grade IV, and posed difficult surgical management. The other patient suffered a cerebral infarct with a resulting hemiparesis. The first patient had a ventriculostomy placed, initially improved, and subsequently died from rebleeding. The second patient improved with medical management. AIDS arteriopathy, and specifically fusiform aneurysms, are being increasingly reported. The various presentations of this surgically challenging entity in light of other AIDS-related syndromes pose difficult management decisions. On occasion, the intracranial aneurysm may be the initial form of presentation as was present in our first patient.

Learning through Participatory Resource Management Programs: Case Studies from Costa Rica

ERIC Educational Resources Information Center

Sims, Laura; Sinclair, A. John

2008-01-01

Based on an ongoing qualitative case study in Costa Rica, this article presents the participatory work that the Instituto Costarricense de Electricidad (ICE) is doing with farmers to protect watersheds from erosion and contamination. Specifically, it includes a description of ICE's Watershed Management Agricultural Programme and how farmers…

Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report

PubMed Central

St-Onge, Eric; MacIntyre, Ian G.; Galea, Anthony M.

2015-01-01

Objective: To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. Clinical Features: A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. Intervention: The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. Discussion: This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Summary: Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy. PMID:26816415

Endovascular Approach for Management of Bullet Embolization to the Heart.

PubMed

Mojtahedi, Alireza; Contractor, Sohail; Kisza, Piotr S

2018-05-01

Bullet embolization to the right heart through the vasculature is seen infrequently in cases presenting with penetrating trauma. Patients with unstable hemodynamic status are managed operatively. For a patient with stable hemodynamic parameters, diagnostic evaluation such as computed tomography angiogram, echocardiogram, or angiography could be performed to select the best treatment option. Endovascular treatment is employed infrequently in these cases but can be a viable option for select patients. We present a case of a bullet embolus to the right ventricle treated successfully with endovascular approach and discuss the technical aspects of this approach.

Bertolotti's syndrome: a case report.

PubMed

Mitra, Raj; Carlisle, Mark

2009-01-01

A case report and literature review is presented. To review relevant data for the management of Bertolotti's syndrome and to determine whether the transverse process-ilium articulation may be a pain generator. Bertolotti's syndrome is associated with axial low back pain secondary to arthritic changes; the pain generator in the disorder is unclear. We present a case report of symptomatic Bertolotti's syndrome managed with intra-articular steroid injections. A patient with Bertolotti's syndrome had significant relief of axial pain after steroid injection of the ilium-transverse process articulation. Steroid therapy may be a non-surgical alternative for the treatment of symptomatic Bertolotti's syndrome.

Cultural considerations in the diagnosis and treatment of schizophrenia: A case example from India.

PubMed

Dhanasekaran, Saranya; Loganathan, Santosh; Dahale, Ajit; Varghese, Mathew

2017-06-01

Culture plays an important role in the presentation, help seeking, treatment and outcomes of psychiatric illnesses like schizophrenia. We report a case of paranoid schizophrenia in a 35-year-old lady, from South India, whose clinical presentation was influenced by various sociocultural factors. These cultural constructs were taken into consideration to formulate an acceptable and effective management plan. A detailed case description using a cultural formulation to highlight the etic and emic perspectives and challenges in treatment and management are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

Successful Management of Neobladder Variceal Bleeding

DOE Office of Scientific and Technical Information (OSTI.GOV)

Atwal, Dinesh; Chatterjee, Kshitij, E-mail: kchatterjee@uams.edu; Osborne, Scott

Hematuria from a neobladder can occur due to a variety of pathologies including tumors, stones, and fistulas. Variceal bleeding in a neobladder is a very rare condition with only one case reported in literature. We present a case of a patient with cirrhosis and portal hypertension and an ileocolic orthotopic neobladder presenting with hematuria. Computed tomographic angiography showed dilated varices around the neobladder which were successfully embolized. To the best of our knowledge, this is the first report case of variceal bleeding in a neobladder successfully managed with the combination of TIPS (transjugular intrahepatic portosystemic shunt) procedure and embolization.

A sticky situation: management of spray polyurethane foam insulation in body orifices.

PubMed

Sowerby, Robert J; Sowerby, Leigh J; Vinden, Chris

2011-11-01

Spray polyurethane foam insulation is commonly used in the construction industry to fill gaps, seal, and insulate. We present three cases of intentional spray foam insertion in body orifices and discuss the management of such situations in the emergency department. This series includes a case of oral foam insertion used in a suicide attempt by suffocation and two cases of rectal insertion. All of these cases had potential long-term consequences; one was life-threatening. To our knowledge, this is the first published report on the medical management and removal of foam insulation from body orifices. In all three cases, the foam insulation material was successfully removed after allowing the material to harden.

Management of dental erosion induced by gastro-esophageal reflux disorder with direct composite veneering aided by a flexible splint matrix.

PubMed

Chockattu, Sherin Jose; Deepak, Byathnal Suryakant; Sood, Anubhav; Niranjan, Nandini T; Jayasheel, Arun; Goud, Mallikarjun K

2018-02-01

Dental erosion is frequently overlooked in clinical practice. The management of erosion-induced damage to the dentition is often delayed, such that extensive occlusal rehabilitation is required. These cases can be diagnosed by a careful clinical examination and a thorough review of the patient's medical history and/or lifestyle habits. This case report presents the diagnosis, categorization, and management of a case of gastro-esophageal reflux disease-induced palatal erosion of the maxillary teeth. The early management of such cases is of utmost importance to delay or prevent the progression of damage both to the dentition and to occlusal stability. Non-invasive adhesively bonded restorations aid in achieving this goal.

Effectiveness of Different Models of Case Management for Substance-Abusing Populations

PubMed Central

Vanderplasschen, Wouter; Wolf, Judith; Rapp, Richard C.; Broekaert, Eric

2007-01-01

Case management has been implemented in substance abuse treatment to improve (cost-) effectiveness, but controversy exists about its potential to realize this objective. A systematic and comprehensive review of peer-reviewed articles (n = 48) published between 1993 and 2003 is presented, focusing on the effects of different models of case management among various substance-abusing populations. Results show that several studies have reported positive effects, but only some randomized and controlled trials have demonstrated the effectiveness of case management compared with other interventions. Longitudinal effects of this intervention remain unclear. Although no compelling evidence was found for the effectiveness of case management, some evidence is available about the (differential) effectiveness of intensive case management and assertive community treatment for homeless and dually-diagnosed substance abusers. Strengths-based and generalist case management have proven to be relatively effective for substance abusers in general. Most positive effects concern reduced use of inpatient services and increased utilization of community-based services, prolonged treatment retention, improved quality of life, and high client satisfaction. Outcomes concerning drug use and psychosocial functioning are less consistent, but seem to be mediated by retention in treatment and case management. Further research is required to learn more about the extent of the effects of this intervention, how long these are sustained and what specific elements cause particular outcomes. PMID:17523588

Postcholecystectomy bile duct injuries: experience with 49 cases managed by different therapeutic modalities.

PubMed

Abdel Wahab, M; el-Ebiedy, G; Sultan, A; el-Ghawalby, N; Fathy, O; Gad el-Hak, N; Abo Elenin, A; Abo Zid, M; Ezzat, F

1996-01-01

In this study we present our experience in the management of iatrogenic biliary injuries. Forty-nine cases with iatrogenic biliary injuries were managed in our center during the period from 1984 to 1995. Forty patients were referred from other hospitals after cholecystectomy, and 9 cases underwent the original operation in our center. Four (0.3%) of our patients after 1300 conventional cholecystectomy, and 5 (0.9%) cases after 550 laparoscopic cholecystectomy. The injuries were recognized intraoperatively in 5 (10%) cases and were immediately repaired, 3 cases by axial anastomosis and T-tube drainage, 2 cases by hepatico-jejunostomy (Roux-en-Y). The injuries were detected in the remaining 44 patients postoperatively from one week up to 2 months, the mode of presentation was jaundice in 39 (89%) cases, biliary fistula with or without jaundice and biliary peritonitis were detected in 13 (30%) and in 4 (9%) cases respectively. Eleven (25%) cases were treated endoscopically by sphincterotomy, stent in 8 cases, dilatation and double stent in two cases, and dilatation using rigid dilators and stent in one case. The remaining 33 (75%) cases were treated surgically by hepatico-jejunostomy in 21 (64%) cases, and hepatico-duodenostomy in 12 (36%) cases. No hospital mortality occurred, but late mortality occurred in two (5%) patients after surgery due to biliary restricture with progressive cirrhosis in one case, and due to advanced colon cancer in the other case, an din one (9%) case after endoscopic treatment. We achieved 87% excellent surgical results during the period of follow-up (36 months), while 80% excellent results were achieved after endoscopic treatment. Good final results (95%, 83%) were achieved after hepatico-jejunostomy and after hepatico-duodenostomy respectively. Postcholecystectomy biliary injuries present a surgical problem needing extra efforts and careful management. Hepatico-jejunostomy appears to be the procedure of choice in repairing these injuries. Immediate surgical repair of bile duct injury offers excellent results with lower morbidity rates. Endoscopic treatment may be a less invasive technique and have a role in some types of injuries, but needs more time for accurate evaluation.

Mutism as the Presenting Symptom: Three Case Reports and Selective Review of Literature

PubMed Central

Aggarwal, Ashish; Sharma, Dinesh Dutt; Kumar, Ramesh; Sharma, Ravi C.

2010-01-01

Mutism, defined as an inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output, is a common clinical symptom seen in psychiatric as well as neurology outpatient department. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. It is often a focus of clinical attention, both for the physician and the relatives. Mutism occurs in a number of conditions, both functional and organic, and a proper diagnosis is important for the management. We hereby present three cases, who presented with mutism as the presenting symptom and the differential diagnosis and management issues related to these cases are discussed. The authors also selectively reviewed the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes. PMID:21799563

Mutism as the presenting symptom: three case reports and selective review of literature.

PubMed

Aggarwal, Ashish; Sharma, Dinesh Dutt; Kumar, Ramesh; Sharma, Ravi C

2010-01-01

Mutism, defined as an inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output, is a common clinical symptom seen in psychiatric as well as neurology outpatient department. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. It is often a focus of clinical attention, both for the physician and the relatives. Mutism occurs in a number of conditions, both functional and organic, and a proper diagnosis is important for the management. We hereby present three cases, who presented with mutism as the presenting symptom and the differential diagnosis and management issues related to these cases are discussed. The authors also selectively reviewed the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes.

Structuring Assignments to Improve Understanding and Presentation Skills: Experiential Learning in the Capstone Strategic Management Team Presentation

ERIC Educational Resources Information Center

Helms, Marilyn M.; Whitesell, Melissa

2017-01-01

In the strategic management course, students select, analyze, and present viable future alternatives based on information provided in cases or computer simulations. Rather than understanding the entire process, the student's focus is on the final presentation. Chickering's (1977) research on active learning suggests students learn more effectively…

COLLABORATE©, Part IV: Ramping Up Competency-Based Performance Management.

PubMed

Treiger, Teresa M; Fink-Samnick, Ellen

The purpose of this fourth part of the COLLABORATE© article series provides an expansion and application of previously presented concepts pertaining to the COLLABORATE paradigm of professional case management practice. The model is built upon a value-driven foundation that: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where case management is practiced. As an industry, health care continues to evolve. Terrain shifts and new influences continually surface to challenge professional case management practice. The need for top-performing and nimble professionals who are knowledgeable and proficient in the workplace continues to challenge human resource departments. In addition to care setting knowledge, professional case managers must continually invest in their practice competence toolbox to grow skills and abilities that transcend policies and processes. These individuals demonstrate agility in framing (and reframing) their professional practice to facilitate the best possible outcomes for their clients. Therefore, the continued emphasis on practice competence conveyed through the performance management cycle is an essential ingredient to performance management focused on customer service excellence and organizational improvement. Professional case management transcends professional disciplines, educational levels, and practice settings. Business objectives continue to drive work process and priorities in many practice settings. However, competencies that align with regulatory and accreditation requirements should be the critical driver for consistent, high-quality case management practice. Although there is inherent value in what various disciplines bring to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities.

Spontaneous Pneumomediastinum: Case Presentation to a College Student Health Clinic

ERIC Educational Resources Information Center

Spotts, P. Hunter

2017-01-01

The author describes a case of spontaneous pneumomediastinum (SPM) in a 19-year-old man presenting to a college student health clinic. The author also provides a review on SPM, including clinical manifestations, diagnostic evaluation, and management.

Mineral scale management. Part 1, Case studies

Treesearch

Peter W. Hart; Alan W. Rudie

2006-01-01

Mineral scale increases operating costs, extends downtime, and increases maintenance requirements. This paper presents several successful case studies detailing how mills have eliminated scale. Cases presented include calcium carbonate scale in a white liquor strainer, calcium oxalate scale in the D0 stage of the bleach plant, enzymatic treatment of brown stock to...

Role transition from caregiver to case manager--Part II.

PubMed

Schmitt, Nancy

2006-01-01

This two-part article explores the process of role transition as it pertains to nurses moving from roles of caregivers to roles of case managers. Part 1 of the article presented a theoretical model that demonstrated the interplay of significant factors in the process of role transition and discussed how this model could be used to examine nurses' experience of this transition. Part 2 presents findings from a qualitative study involving interview and focus group data contributed by nurses who have made the transition from caregiver to case manager. Data point to specific tensions experienced by these nurses, which are associated with time-task orientation, interactions and relationships, business culture and objectives, and self-image and professional identity. Recommendations for preparing and supporting nurses through this role are also offered.

Longitudinal bracketed epiphysis of proximal phalanx of the great toe with congenital hallux varus managed simultaneously with monorail external fixator: a case report.

PubMed

Verma, Vineet; Batra, Amit; Singla, Rohit; Gogna, Paritosh; Magu, Narender; Gupta, Rakesh

2014-02-01

Longitudinal bracketed epiphysis (delta phalanx) is a rare congenital anomaly that affects phalanges in the hand more commonly than toes. We present a rare case of congenital hallux varus with longitudinal bracketed epiphysis of proximal phalanx with bifid distal phalanx of the great toe, which was managed with monorail type of external fixator. To the best of our knowledge, this is the first report of its successful implementation in simultaneous treatment of longitudinal bracketed epiphysis of the proximal phalanx of the great toe and hallux varus. Apart from adding to the literature a case of rare subtype of delta phalanx with hallux varus, the present study highlights the role of a reliable alternative in its management.

Penetrating Brain Injury after Suicide Attempt with Speargun: Case Study and Review of Literature

PubMed Central

Williams, John R.; Aghion, Daniel M.; Doberstein, Curtis E.; Cosgrove, G. Rees; Asaad, Wael F.

2014-01-01

Penetrating cranial injury by mechanisms other than gunshots are exceedingly rare, and so strategies and guidelines for the management of PBI are largely informed by data from higher-velocity penetrating injuries. Here, we present a case of penetrating brain injury by the low-velocity mechanism of a harpoon from an underwater fishing speargun in an attempted suicide by a 56-year-old Caucasian male. The case raised a number of interesting points in management of low-velocity penetrating brain injury (LVPBI), including benefit in delaying foreign body removal to allow for tamponade; the importance of history-taking in establishing the social/legal significance of the events surrounding the injury; the use of cerebral angiogram in all cases of PBI; advantages of using dual-energy CT to reduce artifact when available; and antibiotic prophylaxis in the context of idiosyncratic histories of usage of penetrating objects before coming in contact with the intracranial environment. We present here the management of the case in full along with an extended discussion and review of existing literature regarding key points in management of LVPBI vs. higher-velocity forms of intracranial injury. PMID:25071701

Childhood intussusception: A prospective study of management trend in a developing country.

PubMed

Ogundoyin, Olakayode Olaolu; Olulana, Dare Isaac; Lawal, Taiwo Akeem

2015-01-01

The management of intussusception has evolved universally from the use of hydrostatic reduction through operative reduction to the use of pneumatic reduction for the acute and uncomplicated cases and surgical reduction for the complicated cases. However, the process of evolution has been very slow in the developing countries, especially sub-Saharan Africa, due to lack of requisite facilities and expertise to manage these patients nonoperatively. This study examined the trends in the management of childhood intussusception in a developing country, compared operative and nonoperative modalities of treatment, and assessed the impact of delayed presentation on the outcome of management. This was a prospective study of the management of children with intussusception at the University College Hospital, Ibadan, Nigeria. Fifty-five consecutive cases of intussusception that presented to the Children Emergency Unit of the University College Hospital between January 2005 and December 2011 were prospectively studied. Details of sex, age of the patients, clinical presentation, duration of symptoms, mode of treatment, and incidence of recurrence were recorded and analyzed. The median age was 7 months. Moreover, the duration of symptoms varied from 1 to 21 days with a mean of 4 days. Twenty-two patients (40%) had attempted hydrostatic reduction; this was successful in 14 patients (63.6%), whereas 8 patients (36.4%) had failed reduction. In all, 41 patients (74.6%) had operative management of intussusceptions; primary operative intervention was carried out in 33 patients (60%) and secondary surgical management in 8 patients (14.5%) with failed hydrostatic reduction. At surgery, manual reduction of intussusception was carried out on 17 patients (30.9%) and resection of devitalized bowel with end to end anastomosis was carried out on the remaining 24 patients (43.6%). The incidence of surgical intervention for intussusception was 74.6%, mortality was 3.6%, and recurrence rate was 3.6%. Nonoperative management of intussusception should be adopted in carefully selected cases of intussusception in this subregion as it will help to reduce the financial burden on the parents while surgical management should be reserved for the complicated cases.

Non-operative management of diverticular perforation in a patient with suspected Ehlers–Danlos syndrome☆

PubMed Central

Casey, M.C.; Robertson, I.; Waters, P.S.; Hanaghan, J.; Khan, W.; Barry, K.

2014-01-01

INTRODUCTION No consensus exists regarding definitive management of colonic perforation in Ehlers–Danlos syndrome (EDS), with various authors advocating different operative techniques. Spontaneous colonic perforation is a recognised complication of vascular-type EDS (type IV), with many reported cases in the literature. No such cases have been reported concerning classical-type EDS (type I/II). PRESENTATION OF CASE A 55-year-old male with a family history of EDS presented with acute lower abdominal pain and signs of localised peritonitis. Following resuscitation, computerised tomography identified perforation of a sigmoid diverticulum with localised intraperitoneal air. Considering the potential complications associated with laparotomy in a patient with EDS, a trial of conservative management was undertaken including image-guided drainage of a mesenteric abscess. Intensive care monitoring, nutritional support and intravenous antibiotics also facilitated successful non-operative management. Following discharge, molecular studies confirmed COL5A1 mutation, and a diagnosis of classical Ehlers–Danlos syndrome was established. DISCUSSION This is the first reported case of successful conservative management of colonic diverticular perforation in a patient with classical Ehlers–Danlos syndrome. CONCLUSION EDS is highly significant in the surgical context, with the causative genetic factors serving to further complicate the course of surgical intervention. In the absence of consensus regarding best surgical management, due consideration should be given to non-operative management of benign colonic perforation. PMID:24534685

A 3-year prospective study on ocular injuries with tennis or cricket ball while playing cricket: A case series.

PubMed

Mahapatra, Santosh Kumar; Malhotra, Kundan; Mendke, Rohit Ganapatrao

2018-02-01

The purpose of this study is to study the clinical features, visual outcome, management, and ocular complications of ocular injury, following trauma with tennis or cricket ball. A prospective, noncomparative case study of patients having injury with tennis/cricket ball while playing cricket was conducted between January 2013 and April 2016. Seventy-six eyes of 76 patients were studied. Presenting vision, age, gender, time since injury, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, B scan, and X-ray/computed tomography scan findings were noted. Patients were managed medically or surgically as per the need and followed up at least for 6 months. Seventy-six eyes of 76 patients were studied. All cases were male, except two. Majority (80.2%) were <25 years. Median presenting visual acuity (VA) was 6/36 and median final VA was 6/18. Significant findings in the decreasing order of frequency were sphincter tear (26.3%), retinal detachment (23.6%), angle recession (18.4%), choroidal rupture (17.1%), and Berlin's edema (15.7%). Most of the cases (69.7%) were managed medically. Only 30.2% cases needed surgical intervention. Final visual outcome in our study was depended on initial VA (P = 0.000). It was also correlating with presenting clinical feature (P = 0.010) and type of intervention (medical/surgical) (P = 0.001). Cricket-related ocular injury generally has a poor prognosis with most cases being closed globe injury; retinal detachment is the most common vision-threatening presentation. In spite of being a common event, cricket-related injury is sparingly documented and hence needs further studies for proper documentation, prognostication, and formulation of definitive management plan.

Bronchogenic cyst presenting as a symptomatic neck mass in an adult: case report and review of the literature.

PubMed

Al-kasspooles, Mazin F; Alberico, Ronald A; Douglas, Wade G; Litwin, Alan M; Wiseman, Sam M; Rigual, Nestor R; Loree, Thom R; Hicks, Wesley L

2004-12-01

We report the unusual clinical manifestation and subsequent management of a symptomatic congenital bronchogenic cyst that connected to the trachea and presented in the neck of an adult. The embryology, clinical presentation, diagnostic evaluation, and management options of this rare aberration are discussed.

[Face presentation: retrospective study of 32 cases at term].

PubMed

Ducarme, G; Ceccaldi, P-F; Chesnoy, V; Robinet, G; Gabriel, R

2006-05-01

To determine the etiologic factors, circumstances of diagnosis, obstetrical management and complications of face presentation and to value the maternal and foetal prognosis of this presentation. Thirty-two cases of face presentation have been observed in the maternity wards of Reims and Troyes over the last 12 years. The incidence of face presentation was 0.7 per 1000 deliveries. Spontaneous vaginal delivery occurred with mento-anterior presentation 73% of the time and caesarean section was performed in 100% of mento-posterior presentation. There was no increasing rate of foetal or maternal mortality and morbidity with vaginal delivery. Face presentation is an unusual complication of pregnancy with obstetric factors that predispose the foetus to face presentation. The low foetal and maternal mortality and morbidity substantiate the effectiveness of conservative management in face presentation.

Ready, Set, Go ... Again: Renewing an Academy-Agency Child Welfare Partnership

ERIC Educational Resources Information Center

Pierce, Barbara; McGuire, Lisa E.; Howes, Patricia

2015-01-01

This article presents a case study of the renewed partnership between a midwestern public child welfare agency and a midwestern university school of social work. The partnership, which includes educating BSW and MSW students, preparing frontline child welfare case managers, and providing leadership training for supervisors and managers,…

Case study and lessons learned for the Great Lakes ITS Program, Airport ITS Integration and the Road Infrastructure Management System projects, final report, Wayne County, Michigan

DOT National Transportation Integrated Search

2007-03-02

This report presents the case study and lessons learned for the national evaluation of the Great Lakes Intelligent Transportation Systems (GLITS) Airport ITS Integration and Road Infrastructure Management System (RIMS) projects. The Airport ITS Integ...

Case Management of Adolescents with Chronic Disease.

ERIC Educational Resources Information Center

Lankard, Bettina A.

This training guide presents a model for optimum delivery of the primary duties, tasks, and steps required in the comprehensive case management of adolescents with chronic disease. Using a team approach to coordinated health care, the guide involves the patient and family as key members of the care team along with the physician, nurse, dietitian,…

A Case Study of Conflict in an Educational Workplace: Managing Personal and Cultural Differences

ERIC Educational Resources Information Center

Torpey, Michael John

2006-01-01

This article is about conflict in an educational workplace setting. It reports on a case study investigating the emergence, development, and management of conflict among diverse native English speakers working as language instructors within a Japanese university. The example of conflict presented, which deals with divergent assumptions about the…

Localized Quality Assurance and Certification for Cross-Border Education: A Shanghai Case Study

ERIC Educational Resources Information Center

Yadong, Li; Yanqiao, Jiang

2009-01-01

The authors present a case study of Sino-foreign cooperation in education to illustrate how developments in the management of licensing and the approval of programs can contribute to better quality assurance. The study demonstrates how the Shanghai municipal education authority has jettisoned traditional dependence on administrative management and…

Fidget Spinner Ingestions in Children-A Problem that Spun Out of Nowhere.

PubMed

Reeves, Patrick T; Nylund, Cade M; Noel, James M; Jones, David S; Chumpitazi, Bruno P; Milczuk, Henry A; Noel, R Adam

2018-06-01

The Consumer Product Safety Risk Management System's injury and potential injury database records 13 cases of fidget spinner ingestion since 2016. In addition to a database query, we report 3 additional cases of fidget spinner ingestion to describe patient presentations and subsequent management strategies. Published by Elsevier Inc.

Knowledge Management Model: Practical Application for Competency Development

ERIC Educational Resources Information Center

Lustri, Denise; Miura, Irene; Takahashi, Sergio

2007-01-01

Purpose: This paper seeks to present a knowledge management (KM) conceptual model for competency development and a case study in a law service firm, which implemented the KM model in a competencies development program. Design/methodology/approach: The case study method was applied according to Yin (2003) concepts, focusing a six-professional group…

Traumatic lenticular abscess: clinical description and outcome.

PubMed

Rajaraman, Revathi; Lalitha, Prajna; Raghavan, Anita; Palanisamy, Manikandan; Prajna, Namperumalsamy Venkatesh

2007-07-01

To analyze cases with posttraumatic lenticular abscess and study the etiology, clinical presentation, management, and outcome. Retrospective case series. Seventeen eyes of 17 patients with traumatic lenticular abscesses were managed with extracapsular cataract extraction after aspirating the abscess. The mean age of the patients was 40.3 years, and males constituted 82%. The mean time to presentation after injury was 14.35 days (range, one to 60 days), and the patients had a mean follow-up of 125.94 days (range, 21 to 300 days). Culture of the lenticular abscess revealed bacterial growth in eight cases (47%) and fungi in four cases (23.5%). In five (29.4%) cases, culture was negative. Staphylococcus epidermidis grew in seven cases (41%). Thirteen eyes (77%) had best-corrected visual acuity better than 20/120. Surgical removal of the abscess, with systemic and local antimicrobial treatment is effective in cases of posttraumatic intralenticular abscess.

Management's Ecstasy and Disparity Over Job Enrichment

ERIC Educational Resources Information Center

King, Albert S.

1976-01-01

A case study analyzing job enrichment schemes and manager expectations of increased productivity is presented. It was found that it was the managers' expectations of increased productivity, not the reorganization of work, that led to higher productivity. (EC)

Esthesioneuroblastoma (Olfactory Neuroblastoma) with Ectopic ACTH Syndrome: a multidisciplinary case presentation from the Joan Karnell cancer center of Pennsylvania Hospital.

PubMed

Mintzer, David M; Zheng, Sarah; Nagamine, Michiko; Newman, Jason; Benito, Maria

2010-01-01

The case of a patient with recurrent esthesioneuroblastoma complicated by ectopic adrenocorticotropic hormone production is presented, including the workup and management of this uncommon complication of an uncommon disease.

Violent reinjury risk assessment instrument (VRRAI) for hospital-based violence intervention programs.

PubMed

Kramer, Erik J; Dodington, James; Hunt, Ava; Henderson, Terrell; Nwabuo, Adaobi; Dicker, Rochelle; Juillard, Catherine

2017-09-01

Violent injury is the second most common cause of death among 15- to 24-year olds in the US. Up to 58% of violently injured youth return to the hospital with a second violent injury. Hospital-based violence intervention programs (HVIPs) have been shown to reduce injury recidivism through intensive case management. However, no validated guidelines for risk assessment strategies in the HVIP setting have been reported. We aimed to use qualitative methods to investigate the key components of risk assessments employed by HVIP case managers and to propose a risk assessment model based on this qualitative analysis. An established academic hospital-affiliated HVIP served as the nexus for this research. Thematic saturation was reached with 11 semi-structured interviews and two focus groups conducted with HVIP case managers and key informants identified through snowball sampling. Interactions were analyzed by a four-member team using Nvivo 10, employing the constant comparison method. Risk factors identified were used to create a set of models presented in two follow-up HVIP case managers and leadership focus groups. Eighteen key themes within seven domains (environment, identity, mental health, behavior, conflict, indicators of lower risk, and case management) and 141 potential risk factors for use in the risk assessment framework were identified. The most salient factors were incorporated into eight models that were presented to the HVIP case managers. A 29-item algorithmic structured professional judgment model was chosen. We identified four tiers of risk factors for violent reinjury that were incorporated into a proposed risk assessment instrument, VRRAI. Copyright © 2017 Elsevier Inc. All rights reserved.

Facial nerve hemangioma: a rare case involving the vertical segment.

PubMed

Ahmadi, Neda; Newkirk, Kenneth; Kim, H Jeffrey

2013-02-01

This case report and literature review reports on a rare case of facial nerve hemangioma (FNH) involving the vertical facial nerve (FN) segment, and discusses the clinical presentation, imaging, pathogenesis, and management of these rare lesions. A 53-year-old male presented with a 10-year history of right hemifacial twitching and progressive facial paresis (House-Brackmann grading score V/VI). The computed tomography and magnetic resonance imaging studies confirmed an expansile lesion along the vertical FN segment. Excision and histopathologic examination demonstrated FNH. FNHs involving the vertical FN segment are extremely rare. Despite being rare lesions, we believe that familiarity with the presentation and management of FNHs are imperative. Laryngoscope, 2012. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Massive cerebral involvement in fat embolism syndrome and intracranial pressure management.

PubMed

Kellogg, Robert G; Fontes, Ricardo B V; Lopes, Demetrius K

2013-11-01

Fat embolism syndrome (FES) is a common clinical entity that can occasionally have significant neurological sequelae. The authors report a case of cerebral fat embolism and FES that required surgical management of intracranial pressure (ICP). They also discuss the literature as well as the potential need for neurosurgical management of this disease entity in select patients. A 58-year-old woman presented with a seizure episode and altered mental status after suffering a right femur fracture. Head CT studies demonstrated hypointense areas consistent with fat globules at the gray-white matter junction predominantly in the right hemisphere. This CT finding is unique in the literature, as other reports have not included imaging performed early enough to capture this finding. Brain MR images obtained 3 days later revealed T2-hyperintense areas with restricted diffusion within the same hemisphere, along with midline shift and subfalcine herniation. These findings steered the patient to the operating room for decompressive hemicraniectomy. A review of the literature from 1980 to 2012 disclosed 54 cases in 38 reports concerning cerebral fat embolism and FES. Analysis of all the cases revealed that 98% of the patients presented with mental status changes, whereas only 22% had focal signs and/or seizures. A good outcome was seen in 57.6% of patients with coma and/or abnormal posturing on presentation and in 90.5% of patients presenting with mild mental status changes, focal deficits, or seizure. In the majority of cases ICP was managed conservatively with no surgical intervention. One case featured the use of an ICP monitor, while none featured the use of hemicraniectomy.

Esthetic management of a primary double tooth using a silicone putty guide: a case report.

PubMed

Agarwal, Ravi; Chaudhry, Kalpna; Yeluri, Ramakrishna; Munshi, Autar Krishen

2013-03-01

The term double tooth is often used to describe fusion and gemination. The development of isolated large or joined teeth is not rare, but the literature is confusing when the appropriate terminology is presented. The objective of this paper is to present a case of a primary double tooth in a 5-year-old girl with a history of trauma. The tooth was endodontically treated and esthetic management was carried out using a silicone putty guide.

Traumatic anterior shoulder dislocation: a case study of nonoperative management in a mixed martial arts athlete.

PubMed

Sims, Kevin; Spina, Andreo

2009-12-01

To present an evidence-informed approach to the nonoperative management of a first-time, traumatic anterior shoulder dislocation. A 30-year-old mixed martial arts athlete, with no prior shoulder injuries, presented one day following a first-time, traumatic anterior shoulder dislocation. An eight-week, individualized, intensive, nonoperative rehabilitation program was immediately begun upon presentation. Management consisted of immobilization of the shoulder in external rotation and a progressive rehabilitation program aimed at restoring range of motion, strength of the dynamic stabilizers, and proprioception of the shoulder. Eight weeks post-dislocation the patient had regained full range of motion and strength compared to the unaffected limb and apprehension and relocation tests for instability were negative. This case illustrates successful management of a first-time, traumatic, anterior shoulder dislocation using immobilization in external rotation combined with an intensive rehabilitation program.

Traumatic anterior shoulder dislocation: a case study of nonoperative management in a mixed martial arts athlete

PubMed Central

Sims, Kevin; Spina, Andreo

2009-01-01

Objective: To present an evidence-informed approach to the nonoperative management of a first-time, traumatic anterior shoulder dislocation. Clinical Features: A 30-year-old mixed martial arts athlete, with no prior shoulder injuries, presented one day following a first-time, traumatic anterior shoulder dislocation. An eight-week, individualized, intensive, nonoperative rehabilitation program was immediately begun upon presentation. Intervention and Outcome: Management consisted of immobilization of the shoulder in external rotation and a progressive rehabilitation program aimed at restoring range of motion, strength of the dynamic stabilizers, and proprioception of the shoulder. Eight weeks post-dislocation the patient had regained full range of motion and strength compared to the unaffected limb and apprehension and relocation tests for instability were negative. Conclusion: This case illustrates successful management of a first-time, traumatic, anterior shoulder dislocation using immobilization in external rotation combined with an intensive rehabilitation program. PMID:20037691

Systemic Lupus Erythematosus Presenting as Refractory Thrombotic Thrombocytopenic Purpura: A Diagnostic and Management Challenge. A Case Report and Concise Review of the Literature.

PubMed

Abu-Hishmeh, Mohammad; Sattar, Alamgir; Zarlasht, Fnu; Ramadan, Mohamed; Abdel-Rahman, Aisha; Hinson, Shante; Hwang, Caroline

2016-10-25

BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is one of the thrombotic microangiopathic (TMA) syndromes, caused by severely reduced activity of the vWF-cleaving protease ADAMTS13. Systemic lupus erythematosus (SLE), on the other hand, is an autoimmune disease that affects various organs in the body, including the hematopoietic system. SLE can present with TMA, and differentiating between SLE and TTP in those cases can be very challenging, particularly in patients with no prior history of SLE. Furthermore, an association between these 2 diseases has been described in the literature, with most of the TTP cases occurring after the diagnosis of SLE. In rare cases, TTP may precede the diagnosis of SLE or occur concurrently. CASE REPORT We present a case of a previously healthy 34-year-old female who presented with dizziness and flu-like symptoms and was found to have thrombocytopenia, hemolytic anemia, and schistocytes in the peripheral smear. She was subsequently diagnosed with TTP and started on plasmapheresis and high-dose steroids, but without a sustained response. A diagnosis of refractory TTP was made, and she was transferred to our facility for further management. Initially, the patient was started on rituximab, but her condition continued to deteriorate, with worsening thrombocytopenia. Later, she also fulfilled the Systemic Lupus International Collaborating Clinics (SLICC) criteria for diagnosis of SLE. Treatment of TTP in SLE patients is generally similar to that in the general population, but in refractory cases there are few reports in the literature that show the efficacy of cyclophosphamide. We started our patient on cyclophosphamide and noticed a sustained improvement in the platelet count in the following weeks. CONCLUSIONS Thrombotic thrombocytopenic purpura is a life-threatening hematological emergency which must be diagnosed and treated in a timely manner. Refractory cases of TTP have been described in the literature, but without clear evidence-based guidelines for its management, and is solely based on expert opinion and previous case reports. Further studies are needed to establish guidelines for its management. We present this case to highlight the role that cyclophosphamide might carry in those cases and to be a foundation for these future studies.

Who Wants To Be an IPM Super Sleuth? Integrated Pest Management Educational Activities & Resources for Kids of All Ages.

ERIC Educational Resources Information Center

Walejko, Gina K.; Colon, Joseph L.

This guide presents games and activities on integrated pest management (IPM) for home targeting grades 1-7. The activities and games use a problem-solving approach based on pest knowledge to develop an understanding of pest management. Three cases are presented: (1) "Inspection is the Key to IPM Success" includes two…

Improving healthcare services using web based platform for management of medical case studies.

PubMed

Ogescu, Cristina; Plaisanu, Claudiu; Udrescu, Florian; Dumitru, Silviu

2008-01-01

The paper presents a web based platform for management of medical cases, support for healthcare specialists in taking the best clinical decision. Research has been oriented mostly on multimedia data management, classification algorithms for querying, retrieving and processing different medical data types (text and images). The medical case studies can be accessed by healthcare specialists and by students as anonymous case studies providing trust and confidentiality in Internet virtual environment. The MIDAS platform develops an intelligent framework to manage sets of medical data (text, static or dynamic images), in order to optimize the diagnosis and the decision process, which will reduce the medical errors and will increase the quality of medical act. MIDAS is an integrated project working on medical information retrieval from heterogeneous, distributed medical multimedia database.

An unusual pathogen in ambulatory care: two cases of Scedosporium soft tissue infections presenting as "unresponsive cellulitis".

PubMed

Misselbrook, Gary Peter; Lillie, Patrick; Thomas, Claire P

2016-01-01

Soft tissue infections with Scedosporium spp. are an uncommon but serious and emerging cause of infection in immunocompromised patients. Acute Medical Units (AMUs) in the UK are increasingly managing patients with cellulitis in an outpatient setting, therefore acute physicians should be aware of some of the more uncommon causes of soft tissue infection, particularly in patients not responding to initial antibiotic therapy. We present two cases of Scedosporium presenting to the AMU as cellulitis not responding to initial antibiotic therapy and outline the assessment and management of this important condition.

Dangerous space emphysema after dental treatment

PubMed Central

Hagr, Abdulrahman

2010-01-01

We report the case of an elderly female patient who presented with dangerous space emphysema occurring after a dental procedure. This case presented a diagnostic and management dilemma because of the development of an unusual complication of dental disease. In our review of the medical literature, we were unable to find any cases with similar manifestations and clinical courses. PMID:20835314

American Guild of Musical Artists: A Case for System Development, Data Modeling, and Analytics

ERIC Educational Resources Information Center

Harris, Ranida; Wedel, Thomas

2017-01-01

This article presents a case scenario that may be used in system analysis and design, database management, and business analytics classes. The case document includes realistic, detailed information on the operations at the American Guild of Musical Artists (AGMA). Examples of assignments for each class and suggested reading are presented. In each…

Strategies for Managing a Multigenerational Workforce

ERIC Educational Resources Information Center

Iden, Ronald

2016-01-01

The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to…

28 CFR 541.23 - Protection cases.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Protection cases. 541.23 Section 541.23 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE... present documentary evidence, to request witnesses, to be present throughout the hearing, and advance...

Esthesioneuroblastoma (Olfactory Neuroblastoma) with Ectopic ACTH Syndrome: A Multidisciplinary Case Presentation from the Joan Karnell Cancer Center of Pennsylvania Hospital

PubMed Central

Zheng, Sarah; Nagamine, Michiko; Newman, Jason; Benito, Maria

2010-01-01

The case of a patient with recurrent esthesioneuroblastoma complicated by ectopic adrenocorticotropic hormone production is presented, including the workup and management of this uncommon complication of an uncommon disease. PMID:20053760

Complex Adaptive Systems as Metaphors for Organizational Management

ERIC Educational Resources Information Center

Palmberg, Klara

2009-01-01

Purpose: The purpose of this paper is to explore the concept of complex adaptive systems (CAS) from the perspective of managing organizations, to describe and explore the management principles in a case study of an organization with unconventional ways of management and to present a tentative model for managing organizations as CAS--system…

Foam bezoar: resection of perforated terminal ileum in a 17-year-old with sickle β+ thalassemia and pica.

PubMed

Altepeter, Tara; Annes, John; Meller, Janet

2011-07-01

Children and adolescents with sickle cell disease demonstrate an increased incidence of pica. Pica involving polyurethane foam has been previously reported, but effective management of such cases remains unclear. We present the case of a 17-year-old African American adolescent girl with sickle β+ thalassemia who presented with a long history of foam rubber pica resulting in intestinal obstruction. Conservative management was unsuccessful, and the patient ultimately required operative intervention. We advocate for a low threshold for early operation in cases of foam rubber bezoar. Copyright © 2011 Elsevier Inc. All rights reserved.

Tonsillitis with acute myeloid leukemia: a case series for caution.

PubMed

Thakur, Jagdeep S; Mohindroo, N K; Sharma, D R; Mohindroo, Shobha; Thakur, Anamika

2013-01-01

Worldwide, tonsillitis is very common. The most common etiology is cross-infection with bacteria and viruses. These cases are managed with antibiotics and anti-inflammatory drugs without any further investigation because the diagnosis is based on simple clinical examination. Usually, leukemia presents with bleeding, weight loss, lymphadenopathy, fever, and frequent infection. Tonsillitis is a rare first presentation of leukemia. We present 3 cases in which the diagnosis of leukemia was made on routine examination, and in 1 case diagnosis was suspected during tonsillectomy.

Complete duplication of collecting system in a horseshoe kidney presenting with recurrent urinary tract infections: report of an exceedingly rare congenital anomaly and review of literature.

PubMed

Mirzazadeh, Majid; Richards, Kyle A

2011-01-01

We report the fifth case in the English literature of a horseshoe kidney with a complete ureteral duplication. Our case is unique in that the previous four cases occurred in the presence of a ureterocele, whereas our patient lacked this anomaly. Further, our patient was managed conservatively, whereas the previous four patients were managed with surgery.

Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery.

PubMed

Ahiskalioglu, Elif Oral; Ahiskalioglu, Ali; Firinci, Binali; Dostbil, Aysenur; Aksoy, Mehmet

2015-01-01

Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Single-specialty management and reconstruction of necrotizing fasciitis of the upper extremities: clinical and economic benefits from a case series.

PubMed

Mattison, Gennaya; Leis, Amber R; Gupta, Subhas C

2014-05-01

Patients with necrotizing fasciitis are managed with multiple prompt, radical surgical debridements and critical care support. Debridement and reconstruction are often provided by different surgical teams. Anecdotally, single-specialty management seemed to be a more efficient management strategy. This study aimed to investigate and compare the outcomes of management by plastic surgery versus multiple disciplines through a retrospective economic and clinical analysis of patients with necrotizing fasciitis treated over 8 years. We also present 3 index cases for which our service functioned as the primary management team. Necrotizing fasciitis cases evaluated and treated by our department, covering both Level I and Level II Trauma Centers, were reviewed for total charges, length of hospital stay, length of intensive care unit (ICU) stay, and number of procedures. The admission Acute Physiology and Chronic Health Evaluation II score was calculated for each patient. Three comparative index cases of upper extremity necrotizing fasciitis managed primarily by the plastic surgery team are presented in greater detail. Patients managed primarily by the plastic surgery service had equivalent Acute Physiology and Chronic Health Evaluation II scores to patients managed by multiple services for their necrotizing fasciitis, with the average score higher for patients managed by plastic surgery alone. In a case-matched series of upper extremity necrotizing fasciitis, the patients admitted directly to plastic surgery had shorter average lengths of hospital and ICU stays as well as decreased total number of procedures, resulting in decreased average total hospital charges. There were no amputations among the cases treated primarily by the plastic surgery. The patients also required smaller areas of reconstruction with skin grafting despite large initial areas of debridement compared to those whose reconstructive teams differed from the team performing the debridement. Improved economic and clinical outcomes-as indicated by the reduced lengths of overall and ICU stay, the reduced number of procedures, none of the cases requiring amputation, and the reduced need for skin grafting-may be attainable when the surgeon eventually performing the reconstruction is involved early in management. We propose that, in the interest of improving patient care, a closer collaboration should be established between the reconstructive and primary managing teams.

Airway Management of Near-Complete Tracheal Transection by Through-the-Wound Intubation: A Case Report.

PubMed

Jean, Yuel-Kai; Potnuru, Paul; Diez, Christian

2018-06-11

We present an approach to airway management in a patient with machete injuries culminating in near-complete cricotracheal transection, in addition to a gunshot wound to the neck. Initial airway was established by direct intubation through the cricotracheal wound. Once the airway was secured, a bronchoscopy-guided orotracheal intubation was performed with simultaneous retraction of the cricotracheal airway to optimize the surgical field. This case offers insight into a rarely performed approach to airway management. Furthermore, our case report demonstrates that, in select airway injuries, performing through-the-wound intubation engenders a multitude of benefits.

Diagnosis and Management of Transplanted Kidney Extrarenal Pseudoaneurysms: A Series of Four Cases and a Review of the Literature

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fananapazir, Ghaneh, E-mail: fananapazir@ucdavis.edu; Hannsun, Gemmy; Wright, Luke A.

Extrarenal pseudoaneurysms of transplanted kidneys are very rare but can have devastating consequences. In the past, these extrarenal pseudoaneurysms have often led to graft loss as well as significant morbidity and mortality. The role of advanced diagnostic imaging studies and of modern radiologic interventional management has not been studied. In this case series, we present four cases of extrarenal pseudoaneurysms of transplanted kidneys, describe the clinical scenarios and imaging that led to the angiographic diagnosis, and discuss the various endovascular and surgical approaches to management.

Virilized external genitalia in young girls: clinical characteristics and management challenges in a low-resource setting.

PubMed

Ekenze, S O; Adiri, C O; Igwilo, I O; Onumaegbu, O O

2014-02-01

Virilization of the external genitalia in young girls (VEG) manifests mostly as ambiguity of the genitalia and elicits concerns and uncertainties especially in settings with poor awareness. This study evaluates the profile and challenges of VEG in southeast Nigeria. We analyzed 23 children with VEG managed in 2 referral centers in southeast Nigeria from June 2005 to January 2013. They presented at median age of 13.3 months (interquartile range [IQR] 3 months-3 years). The cases included 3 (13%) of Prader type 1, 6 (26%) of type 2, 11 (48%) of type 3, and 3 (13%) of type 4. Five of the Prader type 3 and all 3 cases of Prader type 4 were reared as male prior to presentation. Following evaluation, all the cases were assigned female gender at a mean age of 2.7 years (range 2 months-10.5 years). Appropriate feminizing genitoplasty was undertaken in all the cases and after a follow-up period of 3 months to 5 years (mean 2 years), 2 patients developed vaginal stenosis, and 3 cases had surgical wound infection. Poor awareness, delayed presentation, inadequate facilities, and lack of trained manpower were the challenges in the management of the cases. VEG in our setting is associated with delayed management. Focused health education and public awareness programs, and improved healthcare funding may improve outcome and minimize the need for gender reassignment. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

[New professional field in France: Analysis of the training needs of case managers].

PubMed

Somme, Dominique; Corvol, Aline; Couturier, Yves; Pimouguet, Clément; Moreau, Olivier; Perivier, Samuel; Balard, Frédéric; de Stampa, Matthieu

2015-01-01

Case management is a relatively new career field in France. It was first introduced on an experimental basis in 2007-2008, and was then developedfollowing the National Alzheimer Plan and finally enshrined in legislation in 2012. This careerfield is based on a set of tasks widely described internationally: identifying the right level of intervention, standardized multidimensional assessment, planning all aid (care and social services), implementation of the plan, monitoring and reassessment and periodic reassessment of all needs in a continuous and long-term process. The specific, systematic and dedicated nature of these tasks to these tasks makes training essential. Regulations also stipulate that the professional must acquire additional training by a dedicated inter-university degree. This requirement is a French specificity The authors present the history of case management and training in France and analyze the various international training frameworks identified by an Internet search. Moreover, based on the opinions expressed by case managers at different times of the scientific assessment and a review ofseveral studies conducted by inter-university case management program students, this article highlights the specific training needs of case managers and how the proposed training can meet these needs.

The Business of Internationalisation: Emerging Issues for the Entrepreneurial University. AIR 1999 Annual Forum Paper.

ERIC Educational Resources Information Center

Poole, David; Pratt, Graham

This paper analyzes various strategic management models for international programs from an Australian perspective. It presents the results of a qualitative case study of one Australian university faculty of business in the context of the relevance of chaos and complexity theories to strategic management. The case study is organized around the…

A giant cystic pheochromocytoma mimicking liver abscess an unusual presentation - a case report.

PubMed

Sarveswaran, Venugopal; Kumar, Surees; Kumar, Amit; Vamseedharan, Muthukumar

2015-01-01

Giant cystic pheochromocytoma is a rare neuroendocrine tumor. The possibility of cystic pheochromocytoma should be considered for any peri-adrenal mass even in absence of characteristic symptoms and negative biochemical analysis. The key in the management of a case of cystic pheochromocytoma is the preoperative suspicion and the intraoperative crisis management.

The Impact of Arbitration Intervention Services on Psychosocial Functioning: A Follow-Up Study

ERIC Educational Resources Information Center

Dembo, Richard; Wareham, Jennifer; Poythress, Norman G.; Cook, Brittany; Schmeidler, James

2006-01-01

We report the impact of case management services on drug use and self-reported delinquency for youths involved in a clinical trial of the Juvenile Arbitration program. The project evaluated an innovative intervention service providing 16 weeks of intensive case management services to youths and their families. The present study examines interview…

The Role of Multi-Institutional Partnerships in Supply Chain Management Course Design and Improvement

ERIC Educational Resources Information Center

Long, Suzanna; Moos, J. Chris; Radic, Anne Bartel

2012-01-01

The authors examined the skills achieved through a multicultural, virtual student project environment among 3 supply chain management courses. The partnership included 2 universities in the United States and 1 in France and created virtual teams of students across university lines and is presented as a case study. The case includes detailed…

Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.

PubMed

Sasnett, Bonita; Harris, Susie T; White, Shelly

Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

Two similar cases of elderly women with moderate abdominal pain and pneumoperitoneum of unknown origin: a surgeon's successful conservative management.

PubMed

Vinzens, Fabrizio; Zumstein, Valentin; Bieg, Christian; Ackermann, Christoph

2016-05-26

Patients presenting with abdominal pain and pneumoperitoneum in radiological examination usually require emergency explorative laparoscopy or laparotomy. Pneumoperitoneum mostly associates with gastrointestinal perforation. There are very few cases where surgery can be avoided. We present 2 cases of pneumoperitoneum with unknown origin and successful conservative treatment. Both patients were elderly women presenting to our emergency unit, with moderate abdominal pain. There was neither medical intervention nor trauma in their medical history. Physical examination revealed mild abdominal tenderness, but no clinical sign of peritonitis. Cardiopulmonary examination remained unremarkable. Blood studies showed only slight abnormalities, in particular, inflammation parameters were not significantly increased. Finally, obtained CTs showed free abdominal gas of unknown origin in both cases. We performed conservative management with nil per os, nasogastric tube, total parenteral nutrition and prophylactic antibiotics. After 2 weeks, both were discharged home. 2016 BMJ Publishing Group Ltd.

Knowledge Management.

ERIC Educational Resources Information Center

1999

The first of the four papers in this symposium, "Knowledge Management and Knowledge Dissemination" (Wim J. Nijhof), presents two case studies exploring the strategies companies use in sharing and disseminating knowledge and expertise among employees. "A Theory of Knowledge Management" (Richard J. Torraco), develops a conceptual…

Outcome of single-trajectory rigid endoscopic third ventriculostomy and biopsy in the management algorithm of pineal region tumors: a case series and review of the literature.

PubMed

Abbassy, Mahmoud; Aref, Khaled; Farhoud, Ahmed; Hekal, Anwar

2018-05-28

Tumors within the pineal region represent 1.5 to 8.5% of the pediatric brain tumors and 1.2% of all brain tumors. A management algorithm has been proposed in several publications. The algorithm includes endoscopic third ventriculostomy (ETV) and biopsy in cases presenting with hydrocephalus. In this series, we are presenting the efficacy of a single-trajectory approach for both ETV and biopsy. Eleven cases were admitted to Alexandria main university hospital from 2013 to 2016 presenting with pineal region tumors and hydrocephalus. Mean age at diagnosis was 11 years (1-27 years). All cases had ETV and biopsy using rigid ventriculoscope through a single trajectory from a burr hole planned on preoperative imaging. Follow-up period was 7-48 months. All 11 cases presented with hydrocephalus and increased intracranial pressure manifestations. Histopathological diagnosis was successful in 9 out of 11 cases (81.8%). Three cases were germ-cell tumors, two cases were pineoblastomas, two cases were pilocytic astrocytomas, and two cases were grade 2 tectal gliomas. Five of the ETV cases (45.5%) failed and required VPS later on. Other complications of ETV included one case of intraventricular hemorrhage and a case with tumor disseminated to the basal cisterns. In our series, we were able to achieve ETV and biopsy through a single trajectory and a rigid endoscope with results comparable to other studies in the literature.

Aspects and Intensity of Pediatric Palliative Case Management Provided by a Hospital-Based Case Management Team: A Comparative Study Between Children With Malignant and Nonmalignant Disease

PubMed Central

Colenbrander, Derk A.; Bosman, Diederik K.; Grootenhuis, Martha A.; Kars, Marijke C.; Schouten-van Meeteren, Antoinette YN

2017-01-01

Objectives: Anticipating case management is considered crucial in pediatric palliative care. In 2012, our children’s university hospital initiated a specialized pediatric palliative care team (PPCT) to deliver inbound and outbound case management for children with life-shortening disease. The aim of this report is to gain insight in the first 9 months of this PPCT. Methods: Aspects of care during the first 9 months of the PPCT are presented, and comparison is made between patients with malignant disease (MD) and nonmalignant disease (NMD) in a retrospective study design. Insight in the aspects of care of all patients with a life-shortening disease was retrieved from web-based files and the hour registrations from the PPCT. Results: Forty-three children were supported by the PPCT during the first 9 months: 22 with MD with a median of 50 (1-267) days and 29 minutes (4-615) of case management per patient per day and 21 patients with NMD with a median of 79.5 (5-211) days and 16 minutes of case management per day (6-64). Our data show significantly more interprofessional contacts for patients with MD and more in-hospital contacts for patients with NMD. The median number of admission days per patient was 11 (0-22) for MD (44% for anticancer therapy) and 44 (0-303) for NMD (36% for infectious diseases). Significance of Results: This overview of aspects of pediatric palliative case management shows shorter but more intensive case management for MD in comparison with NMD. This insight in palliative case management guides the design of a PPCT. PMID:28273758

A prototype case-based reasoning human assistant for space crew assessment and mission management

NASA Technical Reports Server (NTRS)

Owen, Robert B.; Holland, Albert W.; Wood, Joanna

1993-01-01

We present a prototype human assistant system for space crew assessment and mission management. Our system is based on case episodes from American and Russian space missions and analog environments such as polar stations and undersea habitats. The general domain of small groups in isolated and confined environments represents a near ideal application area for case-based reasoning (CBR) - there are few reliable rules to follow, and most domain knowledge is in the form of cases. We define the problem domain and outline a unique knowledge representation system driven by conflict and communication triggers. The prototype system is able to represent, index, and retrieve case studies of human performance. We index by social, behavioral, and environmental factors. We present the problem domain, our current implementation, our research approach for an operational system, and prototype performance and results.

Clinicopathological profile and management of 161 cases of actinic cheilitis.

PubMed

Lopes, Maria Luiza Diniz de Sousa; Silva Júnior, Francisco Leonardo da; Lima, Kenio Costa; Oliveira, Patrícia Teixeira de; Silveira, Éricka Janine Dantas da

2015-01-01

Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun. To evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading. Demographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system. There was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803). This study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies.

Idiopathic granulomatous mastitis: a mimicking disease in a pregnant woman: a case report

PubMed Central

2013-01-01

Background Idiopathic granulomatous mastitis is a rare, benign, inflammatory chronic condition of unclear etiology. This case is reported because it illustrates how idiopathic granulomatous mastitis can mimic other diseases, making it difficult to associate the presenting symptoms and the correct diagnosis; This disease is a challenge for clinicians to diagnose, manage and avoid iatrogenic complications, and requires consultation with experts in several specialties. Case presentation The patient was 30 years old, South-American, eleven weeks pregnant, and with an apparent infectious mastitis. She presented with progressive worsening of her breast symptoms and multiple negative laboratory tests. She suffered different side effects from several prescribed treatments and endured a prolonged recovery. The article emphasizes the need for ruling out common pathologies to arrive at the correct diagnosis such as bacterial and fungal infections; granulomatous conditions like tuberculosis and sarcoidosis; and inflammatory breast carcinoma. It also describes frequently used pharmacological and supplementary forms of treatment for patients with this condition. Conclusion Idiopathic granulomatous mastitis is a rare unusual condition of unknown etiology. Pathological confirmation is required for its diagnosis and optimal management is still unclear. The presentation and management of this case is intended to advance its awareness to physicians from different specialties. PMID:23497626

Collaboration between Supported Employment and Human Resource Services: Strategies for Success

ERIC Educational Resources Information Center

Post, Michal; Campbell, Camille; Heinz, Tom; Kotsonas, Lori; Montgomery, Joyce; Storey, Keith

2010-01-01

The article presents the benefits of successful collaboration between supported employment agencies and human resource managers when working together to secure employment for individuals with disabilities. Two case studies are presented: one involving a successful collaboration with county human resource managers in negotiating a change in the…

Short Hospitalization after Early Intervention in Managing Grade III Pancreatic Injuries in Children: A Possible New Trend

PubMed Central

Al-Jazaeri, Ayman H.

2011-01-01

The presence of ductal disruption in pancreatic trauma is a major indicator of severity leading to higher morbidities and prolonged hospital stay. However, the adoption of early interventional approach in selected cases of documented grade III pancreatic trauma could result in shorter hospitalization and early recovery. We are describing our approach of early presentation-tailored interventions in managing two consecutive children diagnosed with grade III pancreatic injuries, which constitute the two main ends of the presentations’ spectrum. For the early presenter a spleen preserving distal pancreatectomy was performed, while for the late presenter with large symptomatic pseudocyst endoscopic drainage was attempted. Both early and late presenting children had quick and uneventful recoveries leading to 5 and 6 days of hospitalization, respectively. Both cases continued to be asymptomatic at 4 and 12 months post procedure. In the pseudocyst case, the gastro-cystostomy stents were removed after 10 weeks, and 2.5 months later a completely healed pancreas was demonstrated by magnetic resonance cholangio-pancreatography. Unlike other abdominal solid organ injuries in children, adopting early presentation-tailored intervention can be associated with quicker recovery and short hospitalization for grade III pancreatic injuries. While the series is still small, achieving such remarkable outcomes in two consecutive cases is possible and could set a new trend in managing these injuries in children. PMID:21912067

New arrows in the quiver for targeting care management: high-risk versus high-opportunity case identification.

PubMed

Bernstein, Richard H

2007-01-01

"Care management" purposefully obscures the distinctions between disease and case management and stresses their common features: action in the present to prevent adverse future outcomes and costs. It includes identifying a high-need population by referrals, screening, or data analysis, assessing those likely to benefit from interventions, intervening, evaluating the intervention, and adjusting interventions when needed. High-risk individuals can be identified using at least 9 techniques, from referrals and questionnaires to retrospective claims analysis and predictive models. Other than referrals, software based on the risk-adjustment methodology that we have adapted can incorporate all these methodologies. Because the risk adjustment employs extensive case mix and severity adjustment, it provides care managers with 3 innovative ways to identify not only high-risk individuals but also high-opportunity cases.

Complete Duplication of Collecting System in a Horseshoe Kidney Presenting with Recurrent Urinary Tract Infections: Report of an Exceedingly Rare Congenital Anomaly and Review of Literature

PubMed Central

Mirzazadeh, Majid; Richards, Kyle A.

2011-01-01

We report the fifth case in the English literature of a horseshoe kidney with a complete ureteral duplication. Our case is unique in that the previous four cases occurred in the presence of a ureterocele, whereas our patient lacked this anomaly. Further, our patient was managed conservatively, whereas the previous four patients were managed with surgery. PMID:22224073

Two case reports of orofacial paraesthesia demonstrating the role of the general dental practitioner in identifying patients with intracranial tumours.

PubMed

Barber, Andrew J; Lawson, David D A; Field, E Anne

2009-04-01

The following case reports describe the clinical features, diagnosis and management of two patients who presented to their general dental practitioner with a complaint of orofacial paraesthesia. After appropriate investigations, both patients were diagnosed as having benign intracranial tumours and were managed by a neurosurgeon. These cases illustrate the important role the general dental practitioner has in the early recognition of potentially life-threatening conditions.

How to Take HRMS Process Management to the Next Level with Workflow Business Event System

NASA Technical Reports Server (NTRS)

Rajeshuni, Sarala; Yagubian, Aram; Kunamaneni, Krishna

2006-01-01

Oracle Workflow with the Business Event System offers a complete process management solution for enterprises to manage business processes cost-effectively. Using Workflow event messaging, event subscriptions, AQ Servlet and advanced queuing technologies, this presentation will demonstrate the step-by-step design and implementation of system solutions in order to integrate two dissimilar systems and establish communication remotely. As a case study, the presentation walks you through the process of propagating organization name changes in other applications that originated from the HRMS module without changing applications code. The solution can be applied to your particular business cases for streamlining or modifying business processes across Oracle and non-Oracle applications.

A Case of Lionfish Envenomation Presenting to an Inland Emergency Department.

PubMed

Schult, Rachel F; Acquisto, Nicole M; Stair, Crystal K; Wiegand, Timothy J

2017-01-01

Lionfish envenomation can cause erythema, edema, necrosis, and severe pain at the exposed site. Treatment often includes supportive wound care, pain management, and hot water immersion. We report a case of lionfish exposure presenting to an inland emergency department treated successfully with these measures.

[A reflective case report applied to pain management in a complex care situation].

PubMed

Kinsperger, Laura; Mayrhofer, Stefanie Maria; Pichler, Birgit; Qin, Hong; Rheinfrank, Iris; Schrems, Berta

2015-10-01

This case report deals with the unsatisfying pain management of a 44 year old patient with cardiac arrest and subsequent cardiopulmonary resuscitation. The patient has (1) a reduced consciousness, (2) is isolated due to an infection with multi-resistant germs, (3) has a tracheotomy and (4) contractures of the muscles in fingers and hands. During nursing care he shows facial expressions and body postures that indicate pain which is insufficiently addressed. The case was processed according to the model of reflexive case report by Johns (1995) and interpreted by theoretical expertise and the change of the perspective. Therefore the following questions were answered: Which factors made the nurse who brought the case to the case deliberation feeling dissatisfied with the pain management? Insufficient pain management due to a lack of knowledge, no assessment of the state of consciousness, pain and isolation probably led to unnecessary burden of the patient, next of kin and nurses. Training, systematic pain management and multi-disciplinary case conferences might facilitate dealing with comparable complex situations of caring in the future. The present case report shows that pain can only be treated successfully if pain-triggering factors are recognized, systematically assessed and treated. An adequate external assessment of the pain situation is especially important when dealing with patients who suffer from disorders of consciousness. In complex cases, in which multiple factors influence the pain situation, interdisciplinary case conferences may help to improve the quality of pain management.

A Rare Case of Gestational Gigantomastia with Hypercalcemia: The Challenges of Management and Follow up

PubMed Central

Moazzami, Bahram; Chaichian, Shahla; Farahvash, Mohammad Reza; Taheri, Saeedeh; Ahmadi, Seyed Ali; Mokhtari, Majid; Sheibani, Kourosh

2016-01-01

Background: Gigantomastia is a breast disorder marked by exaggerated rapid growth of the breasts, generally bilaterally. Since this disorder is very rare and has been reported only in sparse case reports its etiology has yet to be fully established. Treatment is aimed at improving the clinical and psychological symptoms and reducing the treatment side effects; however, the best therapeutic option varies from case to case. Case Presentation: The present report described a case of gestational gigantomastia in a 30-year-old woman, gravida 2, parity 1, 17 week pregnant admitted to Pars Hospital, Tehran, Iran, on May 2014. The patient was admitted to hospital at week 17 of pregnancy, although her breasts initially had begun to enlarge from the first trimester. The patient developed hypercalcemia in her 32nd week of pregnancy. The present report followed this patient from diagnosis until the completion of treatment. Conclusion: Although gestational gigantomastia is a rare condition, its timely prognosis and careful examination of some conditions like hyperprolactinemia and hypercalcemia is essential in successful management of this condition. PMID:27921004

Short- and Long-Term Management of an Acute Pustular Psoriasis Flare: A Case Report.

PubMed

Georgakopoulos, Jorge R; Ighani, Arvin; Yeung, Jensen

Generalised pustular psoriasis (GPP) and acrodermatitis continua of Hallopeau (ACH) are chronic, relapsing variants of pustular psoriasis proven to be remarkably challenging to treat. Due to their uncommon presentation, there are few described cases in literature and scarce evidence for management. Further information is needed to help dermatologists formulate treatment plans for patients presenting with such diseases. We report the case of a 68-year-old man with a 3-year history of psoriasis presenting to our clinic with a severe breakout of GPP and associated ACH. The patient underwent treatment with cyclosporine A (200 mg PO twice daily) for a period of 2 weeks. This provided dramatic improvement in disease symptoms, with clearance of pustules, remarkable reduction of ACH lesions, and absence of pain. The patient was transitioned to infliximab (5 mg/kg intravenous) and apremilast (30 mg PO twice daily), displaying minimal GPP relapse and well-controlled onychodystrophy for several months. This case supports the use of cyclosporine as a first-line agent in providing immediate symptomatic relief for pustular psoriasis flares. Transitioning to infliximab and apremilast combination therapy offers a unique treatment regime for long-term GPP and ACH management.

Uterine rupture disguised by urinary retention following a second trimester induced abortion: a case report.

PubMed

Jiang, Qiaoying; Yang, Liwei; Ashley, Charles; Medlin, Erin E; Kushner, David M; Zheng, Yanmei

2015-01-22

Uterine rupture classically presents with severe abdominal pain, loss of fetal station, vaginal bleeding, and shock. We present a case of uterine rupture presenting as significant urinary retention that occurred following a second trimester abortion induced with mifepristone and misoprostol. Uterine rupture was discovered unexpectedly on diagnostic laparoscopy. The uterine rupture was contained by dense adhesions between the omentum and bladder with the previous uterine cesarean hysterotomy scar. This case highlights the difficulties in diagnosis of abnormal placentation and an unusual presentation of uterine rupture. This case was managed successfully laparoscopically.

When symptoms don't fit: a case series of conversion disorder in the pediatric otolaryngology practice.

PubMed

Caulley, Lisa; Kohlert, Scott; Gandy, Hazen; Olds, Janet; Bromwich, Matthew

2018-05-29

Conversion disorder refers to functional bodily impairments that can be precipitated by high stress situations including trauma and surgery. Symptoms of conversion disorder may mimic or complicate otolaryngology diseases in the pediatric population. In this report, the authors describe 3 cases of conversion disorder that presented to a pediatric otolaryngology-head and neck surgery practice. This report highlights a unique population of patients who have not previously been investigated. The clinical presentation and management of these cases are discussed in detail. Non-organic otolaryngology symptoms of conversion disorder in the pediatric population are reviewed. In addition, we discuss the challenges faced by clinicians in appropriately identifying and treating these patients and present an approach to management of their care. In this report, the authors highlight the importance of considering psychogenic illnesses in patients with atypical clinical presentations of otolaryngology disorders.

Corneal ulcer due to a rare coelomycetes fungus Chaetomium strumarium: Case report and global review of Chaetomium keratomycosis.

PubMed

Reddy, Mamatha; Venugopal, Ramya; Prakash, Peralam Yegneswaran; Kamath, Yogish Subraya

2017-09-01

We present a rare case of corneal ulcer caused by a species of a coelomycetes fungus, Chaetomium strumarium. This fungal genus is a rare causative agent of keratomycosis, with only a handful of cases reported. The clinical presentation, investigative techniques, and preliminary management of our patient are reported. The cases reported in global literature are also summarized in a tabular form in the discussion.

Perioperative management of massive fat embolism syndrome presenting as refractory status epilepticus

PubMed Central

Watson, William; Louro, Jack; Dudaryk, Roman

2018-01-01

Fat embolism syndrome (FES) most commonly can occur after trauma in patients with long bone fractures. While the majority of FES cases present as a mild decrease in mental status, some may manifest as seizure activity. We describe a case of a young patient with traumatic fractures who developed FES leading to refractory status epilepticus and simultaneously required damage controlled orthopedic surgery. The role of imaging modalities including magnetic resonance imaging, transcranial Doppler, and transesophageal echocardiography in diagnosis is discussed, and a multidisciplinary approach to successful perioperative management is described.

Executive Programs for Brazilian Mid-Career Public Managers: Pitfalls and Challenges

ERIC Educational Resources Information Center

Pacheco, Regina Silvia; Franzese, Cibele

2017-01-01

This paper discusses the challenges of professional education for mid-career public managers at graduate level, pointing out pitfalls to avoid and obstacles to face. Analyzing the Brazilian case, the goal is to raise issues that may also be present in other cases. The main argument developed here is that the puzzle faced by graduate programs on…

Munchausen syndrome: Playing sick or sick player

PubMed Central

Prakash, Jyoti; Das, R. C.; Srivastava, K.; Patra, P.; Khan, S. A.; Shashikumar, R.

2014-01-01

Munchausen syndrome is rare factitious disorder which entails frequent hospitalization, pathological lying and intentional production of symptoms for sick role. Management requires collateral history taking, sound clinical approach, exclusion of organicity and addressing psychological issues. A case which presented with unusual symptoms of similar dimension is discussed here. The case brings out finer nuances in evaluation and management of this entity. PMID:25535450

Integrating Learning, Leadership, and Crisis in Management Education: Lessons from Army Officers in Iraq and Afghanistan

ERIC Educational Resources Information Center

Kayes, D. Christopher; Allen, Nate; Self, Nate

2013-01-01

This article presents a model and case study used to teach crisis leadership as a management education topic. The materials emerge from studies of U.S. Army leaders (company commanders and platoon leaders) working in Iraq and Afghanistan. The authors explain how examples and cases from military combat provide tools to teach about crisis…

Treatment of a coronary artery aneurysm by use of a covered stent graft – a case report

PubMed Central

Gundoğdu, Fuat; Arslan, Sakir; Buyukkaya, Eyup; Senocak, Huseyin

2007-01-01

Coronary artery aneurysm is a rare finding at coronary angiography. Most coronary aneurysms remain asymptomatic. There is no consensus on its management; some advocate aggressive approach while others advocate conservative management. A case of coronary artery aneurysm successfully treated by implantation of a polytetrafluoroethylene-covered coronary stent is presented. PMID:22477247

Delayed presentation of anorectal malformation for definitive surgery.

PubMed

Sharma, Shilpa; Gupta, Devendra K

2012-08-01

To retrospectively study the outcome of patients with anorectal malformations (ARM) presenting late for definitive procedure. Patients with ARM presenting beyond 5 months of age managed from January 2008 to March 2012 were studied for clinical outcome. Ages at presentation varied from 5 months to 14 years, seven patients were older than 5 years of age. Of the 36 cases, 5 patients (3 boys and 2 girls) had presented with colostomy done elsewhere. Four patients had high anomalies. Of the 33 girls, 14 had rectovestibular fistula and 9 had anovestibular fistula. Bowel preparation with peglec was used in patients without colostomy. Preoperative retention enemas, laxatives and Hegar dilators were used for 3-11 days before surgery. On table irrigation was required in four. Patients without a covering colostomy were kept nil per oral for 5 days following surgery in prone/lateral position. Two patients had mild post-op wound infection, and were managed with local care. Delayed presentation of ARM especially in girls is quite common in developing countries. With proper perioperative care, these cases may be managed successfully with a single stage procedure in most cases. The mature tissue growth with age allows proper tissue dissection and good repair of the perineal body in girls.

Floor-of-Mouth Hematoma Following Dental Implant Placement: Literature Review and Case Presentation.

PubMed

Law, Catherine; Alam, Peyman; Borumandi, Farzad

2017-11-01

The authors provide a structured review of reported cases of floor-of-mouth hematoma during or after dental implantation and frequent causes and management and present a related case. An online search of the medical literature was conducted from 1990 through 2016. The following search terms were used: floor of mouth hematoma, sublingual hematoma, dental implant hematoma, implant in mandible, and complication of dental implant. Abstracts were screened for relevance to the aims of the review. Relevant reports in the English language were included and referenced. The articles were reviewed for patient demographics, implant location, coagulopathy, pre- or postoperative imaging, airway management, treatment of the hematoma, and management of the offending implant. The literature search identified 25 reported cases. Hemorrhage was caused by perforation of the lingual cortex in 84% of cases (n = 21). Airway obstruction resulted in emergency intubation or tracheostomy in 68% of patients (n = 17). Most cases (n = 18; 72%) required surgical management in the hospital setting. Management of the offending implant was reported inconsistently. Of 17 reported cases, 5 implants had to be removed, 9 remained in situ, and in 3 cases implant placement was abandoned. Only 1 case involved preoperative 3-dimensional (3D) imaging before implant insertion. The authors report on an additional case with a serious floor-of-mouth hematoma that required immediate surgical evacuation and hemostasis. Serious complications, such as floor-of-mouth hematoma after dental implant insertion, can occur, which could be life-threatening. Preoperative 3D imaging helps to visualize the individual mandibular shape, which could decrease the incidence of serious complications. If injury to vessels of the floor of the mouth cannot be confidently excluded, then further assessment and treatment are recommended before the patient is discharged. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

A Health Systems Approach to Integrated Community Case Management of Childhood Illness: Methods and Tools

PubMed Central

McGorman, Laura; Marsh, David R.; Guenther, Tanya; Gilroy, Kate; Barat, Lawrence M.; Hammamy, Diaa; Wansi, Emmanuel; Peterson, Stefan; Hamer, Davidson H.; George, Asha

2012-01-01

Integrated community case management (iCCM) of childhood illness is an increasingly popular strategy to expand life-saving health services to underserved communities. However, community health approaches vary widely across countries and do not always distribute resources evenly across local health systems. We present a harmonized framework, developed through interagency consultation and review, which supports the design of CCM by using a systems approach. To verify that the framework produces results, we also suggest a list of complementary indicators, including nine global metrics, and a menu of 39 country-specific measures. When used by program managers and evaluators, we propose that the framework and indicators can facilitate the design, implementation, and evaluation of community case management. PMID:23136280

Lessons Learned from a Decade of Sudden Oak Death in California: Evaluating Local Management

NASA Astrophysics Data System (ADS)

Alexander, Janice; Lee, Christopher A.

2010-09-01

Sudden Oak Death has been impacting California’s coastal forests for more than a decade. In that time, and in the absence of a centrally organized and coordinated set of mandatory management actions for this disease in California’s wildlands and open spaces, many local communities have initiated their own management programs. We present five case studies to explore how local-level management has attempted to control this disease. From these case studies, we glean three lessons: connections count, scale matters, and building capacity is crucial. These lessons may help management, research, and education planning for future pest and disease outbreaks.

Lessons Learned from a Decade of Sudden Oak Death in California: Evaluating Local Management

PubMed Central

Alexander, Janice

2010-01-01

Sudden Oak Death has been impacting California’s coastal forests for more than a decade. In that time, and in the absence of a centrally organized and coordinated set of mandatory management actions for this disease in California’s wildlands and open spaces, many local communities have initiated their own management programs. We present five case studies to explore how local-level management has attempted to control this disease. From these case studies, we glean three lessons: connections count, scale matters, and building capacity is crucial. These lessons may help management, research, and education planning for future pest and disease outbreaks. PMID:20559634

Sickle cell disease and HIV: a case highlighting management challenges for children in a resource-limited setting.

PubMed

Odera, Esther Brenda; Kwobah, Charles; Stone, Geren; Some, Faraj; Vreeman, Rachel Christine

2014-01-01

Sickle cell disease (SCD) is a genetic disorder resulting from a mutation in the hemoglobin (Hb) gene. Sickle cell disease results in chronic anemia and a variety of acute and chronic complications that can lead to early mortality. A child with both SCD and HIV presents a management challenge, particularly in a resource-limited setting. In this case report, we describe the case of an 18-month-old Kenyan girl with SCD and HIV who developed a severe hypersensitivity reaction to first-line antiretroviral therapy (ART). Selecting an appropriate drug substitute for a child with SCD and HIV presents a management dilemma when the available options have problematic side effect profiles or are inaccessible or inappropriate according to national guidelines. The challenges in choosing an appropriate ART regimen for a child with SCD and HIV highlight the lack of data and scarcity of treatment options for pediatric patients.

Technical Elements, Demonstration Projects, and Fiscal Models in Medicaid Managed Care for People with Developmental Disabilities.

ERIC Educational Resources Information Center

Kastner, Theodore A.; Walsh, Kevin K.; Criscione, Teri

1997-01-01

Presents a general model of the structure and functioning of managed care and describes elements (provider networks, fiscal elements, risk estimation, case-mix, management information systems, practice parameters, and quality improvement) critical to people with developmental disabilities. Managed care demonstration projects and a hypothetical…

A Process-Based Knowledge Management System for Schools: A Case Study in Taiwan

ERIC Educational Resources Information Center

Lee, Chi-Lung; Lu, Hsi-Peng; Yang, Chyan; Hou, Huei-Tse

2010-01-01

Knowledge management systems, or KMSs, have been widely adopted in business organizations, yet little research exists on the actual integration of the knowledge management model and the application of KMSs in secondary schools. In the present study, the common difficulties and limitations regarding the implementation of knowledge management into…

Filter membrane-based automated therapeutic plasma exchange: a report of two cases from Nigeria.

PubMed

Arogundade, Fatiu A; Sanusi, Abubakr A; Akinbodewa, Akinwunmi A; Hassan, Muzamil O; Omotosho, Bolanle O; Balogun, Rasheed A; Akinsola, Adewale

2013-02-01

These case reports demonstrated the diagnostic dilemma encountered in patients with systemic lupus erythematosus and thrombotic thrombocytopenic purpura particularly in settings with limited diagnostic facilities and laboratory support. The similarities in the diagnostic criteria for both conditions make clear distinction as well as management decisions difficult. We present the difficulties encountered with both the diagnosis and the management of these two patients that were managed in our facility. Copyright © 2013 Wiley Periodicals, Inc.

Successful use of balloon tamponade in the management of postpartum hemorrhage in a case of bicornuate uterus.

PubMed

Khan, Erum Saleem; Basharat, Ayesha

2018-01-01

Worldwide 50%-70% of all cases of maternal morbidity have been attributed to postpartum hemorrhage. This report discusses a case of bicornuate uterus in a term pregnancy. The delivery was by cesarean section, which was followed by massive postpartum hemorrhage, managed successfully with balloon tamponade. This is the second reported case of successful management of post partum hemorrhage in a bicornuate uterus with balloon tamponade. A 22-year-old primigravida at 39 weeks of gestational age presented with vaginal leaking of clear fluid. Cesarean section was done due to meconium stained liquor in early labor; with an incidental finding of bicornuate uterus followed by massive postpartum hemorrhage managed successfully with balloon tamponade. The use of uterine balloon tamponade as an effective method to control postpartum hemorrhage has been studied extensively, but use in cases of hemorrhage associated with uterine malformations has not been reported much in literature. Use of uterine balloon tamponade in case of uterine malformations has been highlighted in our case as an effective non-surgical method to control hemorrhage.

Teaching Communication with Ethics-Based Cases.

ERIC Educational Resources Information Center

Stevens, Betsy

1996-01-01

Argues the importance of presenting ethics and communication as twin concepts in the management communication class. Presents two cases useful in the classroom that address two contemporary issues (harassment in the workplace and the consumption of alcohol by pregnant women) that have implications for business professionals and allow students to…

A Case of Lionfish Envenomation Presenting to an Inland Emergency Department

PubMed Central

Stair, Crystal K.; Wiegand, Timothy J.

2017-01-01

Lionfish envenomation can cause erythema, edema, necrosis, and severe pain at the exposed site. Treatment often includes supportive wound care, pain management, and hot water immersion. We report a case of lionfish exposure presenting to an inland emergency department treated successfully with these measures. PMID:28884031

The Technology Principal: To Be or Not to Be?

ERIC Educational Resources Information Center

Anthony, Anika Ball; Patravanich, Supawaree

2014-01-01

This case provides principal licensure candidates a strategic perspective on leading and managing educational technology initiatives. It presents issues related to vision setting, planning, implementation, organizational structure, and decision making. The case narrative is presented from the perspective of a principal, but it can also be used to…

Imaging pediatric magnet ingestion with surgical-pathological correlation.

PubMed

Otjen, Jeffrey P; Rohrmann, Charles A; Iyer, Ramesh S

2013-07-01

Foreign body ingestion is a common problem in the pediatric population and a frequent cause for emergency room visits. Magnets are common household objects that when ingested can bring about severe, possibly fatal gastrointestinal complications. Radiography is an integral component of the management of these children. Pediatric and emergency radiologists alike must be aware of imaging manifestations of magnet ingestion, as their identification drives decision-making for consulting surgeons and gastroenterologists. Radiology can thus substantially augment the clinical history and physical exam, facilitating appropriate management. This manuscript sequentially presents cases of magnet ingestion featuring imaging findings coupled with surgical and pathological correlation. Each case is presented to highlight ways in which the radiologist can make impactful contributions to diagnosis and management. Clinical overview with pitfalls of magnet ingestion imaging and an imaging decision tree will also be presented.

Care for the case manager: balancing your wheel of life.

PubMed

Crowell, D M

1998-01-01

The case manager's role in our complex health care system is demanding and draining without some self-reflective attention. The Wheel of Life is a key tool for individuals to assess how well they are leading a fully balanced life. The eight aspects of a balanced life--values, self-care, work, relationships, leisure, relaxation, exercise, and centering--are explained and discussed. A self-reflective activity is presented that encourages readers to assess their current life balance. This focused clarification of personal and professional life will facilitate a more fully balanced life with rewards for case managers as individuals, and for their family, clients, and the health care organization.

Use of piezosurgery device in management of oral surgery complications: clincal case and clinical experience report.

PubMed

Sammartino, G; Riccitiello, F; Trosino, O; Marenzi, G; Cioffi, A; Mortellaro, C

2012-05-01

The root displacement into the maxillary sinus could be a complication of oral surgery in the upper jaw. In these cases, the root removal is needed in order to avoid the occurrence of sinus pathologies. Piezosurgery techniques could assure a safer management of such complications, because of the clear surgical visibility and the selective ability of cut. The aim of this article is to present a case of oral surgery complication (root displacement in the right maxillary sinus), in which piezosurgery technique helped for a correct and safe clinical management, allowing to reduce the soft tissue damage.

First branchial cleft anomalies: presentation, variability and safe surgical management.

PubMed

Magdy, Emad A; Ashram, Yasmine A

2013-05-01

First branchial cleft (FBC) anomalies are uncommon. The aim of this retrospective clinical study is to describe our experience in dealing with these sporadically reported lesions. Eighteen cases presenting with various FBC anomalies managed surgically during an 8-year period at a tertiary referral medical institution were included. Ten were males (56 %) and eight females (44 %) with age range 3-18 years. Anomaly was right-sided in 12 cases (67 %). None were bilateral. Nine patients (50 %) had prior abscess incision and drainage procedures ranging from 1 to 9 times. Two also had previous unsuccessful surgical excisions. Clinical presentations included discharging tract openings in external auditory canal/conchal bowl (n = 9), periauricular (n = 6), or upper neck (n = 4); cystic postauricular, parotid or upper neck swellings (n = 5); and eczematous scars (n = 9). Three distinct anatomical types were encountered: sinuses (n = 7), fistulas (n = 6), and cysts (n = 5). Complete surgical excision required superficial parotidectomy in 11 patients (61 %). Anomaly was deep to facial nerve (FN) in three cases (17 %), in-between its branches in two (11 %) and superficial (but sometimes adherent to the nerve) in remaining cases (72 %). Continuous intraoperative electrophysiological FN monitoring was used in all cases. Two cases had postoperative temporary lower FN paresis that recovered within 2 months. No further anomaly manifestation was observed after 49.8 months' mean postoperative follow-up (range 10-107 months). This study has shown that awareness of different presentations and readiness to identify and protect FN during surgery is essential for successful management of FBC anomalies. Intraoperative electrophysiological FN monitoring can help in that respect.

Mining level of control in medical organizations.

PubMed

Çalimli, Olgu; Türkeli, Serkan; Eken, Emir Gökberk; Gönen, Halil Emre

2014-01-01

In literature of strategic management, there are three layers of control defined in organizational structures. These layers are strategic, tactical and operational, in which resides senior, medium level and low level managers respectively. In strategic level, institutional strategies are determined according to senior managers' perceived state of organization. In tactical level, this strategy is processed into methods and activities of a business management plan. Operational level embodies actions and functions to sustain specified business management plan. An acknowledged lead organization in Turkish medical area is examined using case study and data mining method in the scope of this paper. The level of decisions regarded in managerial purposes evaluated through chosen organization's business intelligence event logs report. Hence specification of management level importance of medical organizations is made. Case study, data mining and descriptive statistical method of taken case's reports present that positions of "Chief Executive Officer", "Outpatient Center Manager", "General Manager", monitored and analyzed functions of operational level management more frequently than strategic and tactical level. Absence of strategic management decision level research in medical area distinguishes this paper and consequently substantiates its significant contribution.

[Rare side effects in management of hyperthyroidism. Case report].

PubMed

Sohár, Gábor; Kovács, Mónika; Györkös, Andrea; Gasztonyi, Beáta

2016-05-29

The authors present the case history of a patient suffering from hyperthyroidism. The diagnostic procedures revealed the presence of propylthiouracyl induced vasculitis with renal involvement, that recovered completely after the withdrawal of propylthiouracyl and corticosteroid treatment. Thereafter, the patient was treated with thiamasol, that caused agranulocytosis with fever. After transient litium carbonate therapy a succesful thyreoidectomy was performed. Cumulative serious side effects of antithyroid drugs are rare. This case highlights some of the challenges and complications encountered in the management of hyperthyroidism.

Two case reports of unexpected tracheal agenesis in the neonate: 3 C's beyond algorithms for difficult airway management.

PubMed

Grass, Beate; Simma, Leopold; Reinehr, Michael; Zimmermann, Urs; Gysin, Claudine; Henze, Georg; Cannizzaro, Vincenzo

2017-02-08

Handling neonates with postnatal respiratory failure due to congenital airway malformations implies knowledge about emergency management of unexpected difficult airway. In these stressful situations both technical and communication skills of the caretakers are essential. Two cases with prenatally unknown tracheal agenesis are reported. In the presented cases, airway malformation and subsequent difficulties upon endotracheal intubation were not adequately communicated between caretakers. We discuss the aspects of culture, communication, and capnography.

Integrating Six Sigma Concepts in an MBA Quality Management Class

ERIC Educational Resources Information Center

Weinstein, Larry B.; Petrick, Joseph; Castellano, Joseph; Vokurka, Robert J.

2008-01-01

Instructors face enormous challenges in presenting effective instruction on concepts and tools of quality management. Most textbooks focus on presenting individual concepts or tools and fail to address complex issues confronted in real-world problem-solving situations. The supplementary use of cases does not help students to understand the dynamic…

[Management experience of acute renal failure induced by unilateral ureteral calculi obstruction].

PubMed

Tan, Fu-qing; Shen, Bo-hua; Xie, Li-ping; Meng, Hong-zhou; Fang, Dan-bo; Wang, Chao-jun

2013-05-28

To explore the causes and treatment options of acute renal failure induced by unilateral ureteral calculi obstruction. The clinical data of 12 cases of acute renal failure induced by unilateral ureteral calculi obstruction between August 2008 and July 2012 were reviewed retrospectively. There were 5 males and 7 females with an average age of 65.7 years. Their clinical data and treatment options were retrospectively analyzed and summarized. Seven cases showed right side ureteral calculus with hydronephrosis while another 5 presented left side ureteral calculus with hydronephrosis. Serum creatinine was higher than 310 µmol/L in 12 cases. Anuria appeared in 4 cases for 1-7 days while oliguria in 8 cases for 2-10 days. High fever was present in 11 cases, the highest of whom was 40 °C. White blood cell count increased in 10 cases (>10×10(9)/L) and decreased in 2 cases (<4 × 10(9)/L). The therapeutic options included insertion of double J stent for internal drainage (n = 1), percutaneous nephrostomy for external drainage (n = 10) and open operation (n = 1). Traditional treatments were performed to manage ureteral calculus in the above 11 cases with drainage. All cases had improved renal function after comprehensive treatment of anti-infection, antishock, rinsing stones and relieving obstruction. All 12 cases were treated successfully. Unilateral ureteral calculus may impair contralateral renal function and cause acute renal failure due to the absorption of toxin at obstructive side. The keys of management are eliminating toxin and relieving obstruction.

Excluded segmental duct bile leakage: the case for bilio-enteric anastomosis.

PubMed

Patrono, Damiano; Tandoi, Francesco; Romagnoli, Renato; Salizzoni, Mauro

2014-06-01

Excluded segmental duct bile leak is the rarest type of post-hepatectomy bile leak and presents unique diagnostic and management features. Classical management strategies invariably entail a significant loss of functioning hepatic parenchyma. The aim of this study is to report a new liver-sparing technique to handle excluded segmental duct bile leakage. Two cases of excluded segmental duct bile leak occurring after major hepatic resection were managed by a Roux-en-Y hepatico-jejunostomy on the excluded segmental duct, avoiding the sacrifice of the liver parenchyma origin of the fistula. In both cases, classical management strategies would have led to the functional loss of roughly 50 % of the liver remnant. Diagnostic and management implications are thoroughly discussed. Both cases had an uneventful postoperative course. The timing of repair was associated with a different outcome: the patient who underwent surgical repair in the acute phase developed no long-term complications, whereas the patient who underwent delayed repair developed a late stenosis requiring percutaneous dilatation. Roux-en-Y hepatico-jejunostomy on the excluded bile duct is a valuable technique in selected cases of excluded segmental duct bile leakage.

Management of Foramen Magnum Meningioma During Pregnancy: Literature Review and Case Report.

PubMed

Casabella, Amanda M; Urakov, Timur M; Basil, Gregory; Morcos, Jacques J

2017-01-01

Foramen magnum meningiomas are very rare and challenging lesions. Their presentation in women during pregnancy tremendously complicates the course of gestation. Conservative management is always the first option, but in cases of a deteriorating clinical picture, there are currently no clear guidelines on best management. A woman presents in the 30th week of pregnancy with pain and progressive numbness in right posterior aspect of neck and right arm. Foramen magnum meningioma was diagnosed and successful surgical resection was performed with intraoperative fetal hearth monitoring and three fourths prone position of the patient. We believe a three fourths prone position of a pregnant patient is safe and adequate for the far-lateral exposure of craniocervical lesions. Rapid growing of tumor can be precipitated by steroids management during pregnancy. Published by Elsevier Inc.

A case-based reasoning tool for breast cancer knowledge management with data mining concepts and techniques

NASA Astrophysics Data System (ADS)

Demigha, Souâd.

2016-03-01

The paper presents a Case-Based Reasoning Tool for Breast Cancer Knowledge Management to improve breast cancer screening. To develop this tool, we combine both concepts and techniques of Case-Based Reasoning (CBR) and Data Mining (DM). Physicians and radiologists ground their diagnosis on their expertise (past experience) based on clinical cases. Case-Based Reasoning is the process of solving new problems based on the solutions of similar past problems and structured as cases. CBR is suitable for medical use. On the other hand, existing traditional hospital information systems (HIS), Radiological Information Systems (RIS) and Picture Archiving Information Systems (PACS) don't allow managing efficiently medical information because of its complexity and heterogeneity. Data Mining is the process of mining information from a data set and transform it into an understandable structure for further use. Combining CBR to Data Mining techniques will facilitate diagnosis and decision-making of medical experts.

Qualitative and Quantitative Pedigree Analysis: Graph Theory, Computer Software, and Case Studies.

ERIC Educational Resources Information Center

Jungck, John R.; Soderberg, Patti

1995-01-01

Presents a series of elementary mathematical tools for re-representing pedigrees, pedigree generators, pedigree-driven database management systems, and case studies for exploring genetic relationships. (MKR)

Case Report: A Case of Severe Cerebral Malaria Managed with Therapeutic Hypothermia and Other Modalities for Brain Edema.

PubMed

Gad, AbdAllah; Ali, Sajjad; Zahoor, Talal; Azarov, Nick

2018-04-01

Malarial infections are uncommon in the United States and almost all reported cases stem from recent travelers coming from endemic countries. Cerebral malaria (CM) is a severe form of the disease usually affecting children and individuals with limited immunity. Despite proper management, mortality from CM can reach up to 25%, especially when it is associated with brain edema. Inefficient management of the edema may result in brain herniation and death. Uniform guidelines for management of CM-associated brain edema are lacking. In this report, we present a case of CM with associated severe brain edema that was successfully managed using a unique combination of therapeutic hypothermia, hypertonic saline, mannitol, and hyperventilation along with the antimalarial drugs quinidine and doxycycline. Our use of hypothermia was based on its proven benefit for improving neurological outcomes in post-cardiac arrest patients and previous in vitro research, suggesting its potential inhibitory role on malaria growth.

Corneal ulcer due to a rare coelomycetes fungus Chaetomium strumarium: Case report and global review of Chaetomium keratomycosis

PubMed Central

Reddy, Mamatha; Venugopal, Ramya; Prakash, Peralam Yegneswaran; Kamath, Yogish Subraya

2017-01-01

We present a rare case of corneal ulcer caused by a species of a coelomycetes fungus, Chaetomium strumarium. This fungal genus is a rare causative agent of keratomycosis, with only a handful of cases reported. The clinical presentation, investigative techniques, and preliminary management of our patient are reported. The cases reported in global literature are also summarized in a tabular form in the discussion. PMID:28905835

Fractured Penis: Not So Rare!

PubMed

Tamhankar, Ashwin S; Pawar, Prakash W; Sawant, Ajit S; Kasat, Gaurav V; Savaliya, Abhishek; Mundhe, Shankar; Patil, Sunil; Narwade, Sayalee

2017-01-01

Penile fracture is a relatively common phenomenon. The main problem associated with this condition is the lack of patients' awareness on the urgency of the situation. This study reports the different modes of presentations and treatment results. We reviewed 21 cases of penile fracture over 5 years. Parameters were mode of injury, age group, time interval before presentation, management, site of injury, urethral involvement, results, complications and erectile function at follow-up. The mean age of patients was 34 years, the mean time interval until presentation was 26 h. Cases involving the right corpus cavernosum comprised 57.14% and 42.85% were cases involving the left corpus cavernosum. Two patients had full circumferential urethral tear. Two patients developed wound infections and 2 patients developed mild penile curvature (<30°). These 4 patients had all presented late for treatment (>40 h). Urologists need to consider penile fracture a urological emergency and atypical presentations need to be considered when deciding on management. © 2017 S. Karger AG, Basel.

Cochlear implantation in children with Jervell and Lange-Nielsen syndrome - a cautionary tale.

PubMed

Broomfield, Stephen J; Bruce, Iain A; Henderson, Lise; Ramsden, Richard T; Green, Kevin M J

2012-08-01

Jervell and Lange-Nielsen (JLN) syndrome is a rare cause of congenital profound hearing loss associated with a prolonged QT interval on the electrocardiogram. Children presenting for cochlear implantation with this condition may be asymptomatic but are at risk of sudden death. SCREENING AND SUBSEQUENT: careful management is therefore required to ensure a successful outcome. We present our experience of cochlear implantation in children with JLN syndrome, including two who died unexpectedly, and suggest a protocol for management of such cases. Clinical presentation Four cases of cochlear implantation in JLN syndrome are described. None had any previous cardiological family history. Two were diagnosed pre-operatively but, despite appropriate management under a cardiologist, died from cardiac arrest; the first in the perioperative period following reimplantation for infection, and the second unrelated to his cochlear implant surgery. The other two patients were diagnosed only subsequent to their implantation and continue to use their implants successfully. These cases highlight the variation in presentation of JLN syndrome, and the spectrum of disease severity that exists. Our protocol stresses the importance of careful assessment and counselling of parents by an experienced implant team.

The epidemiology and clinical features of melioidosis in Far North Queensland: Implications for patient management.

PubMed

Stewart, James D; Smith, Simon; Binotto, Enzo; McBride, William J; Currie, Bart J; Hanson, Josh

2017-03-01

The epidemiology, clinical presentation and management of melioidosis vary around the world. It is essential to define the disease's local features to optimise its management. Between 1998 and 2016 there were 197 cases of culture confirmed melioidosis in Far North Queensland; 154 (78%) presented in the December-April wet season. 145 (74%) patients were bacteraemic, 58 (29%) were admitted to the Intensive Care Unit and 27 (14%) died; nine (33%) of these deaths occurred within 48 hours of presentation. Pneumonia was the most frequent clinical finding, present in 101 (61%) of the 166 with available imaging. A recognised risk factor for melioidosis (diabetes, hazardous alcohol use, chronic renal disease, chronic lung disease, immunosuppression or malignancy) was present in 148 (91%) of 162 patients with complete comorbidity data. Despite representing only 9% of the region's population, Aboriginal and Torres Strait Island (ATSI) people comprised 59% of the cases. ATSI patients were younger than non-ATSI patients (median (interquartile range): 46 (38-56) years versus 59 (43-69) years (p<0.001) and had a higher case-fatality rate (22/117 (19%) versus 5/80 (6.3%) (p = 0.01)). In the 155 patients surviving the initial intensive intravenous phase of treatment, eleven (7.1%) had disease recurrence, despite the fact that nine (82%) of these patients had received prolonged intravenous therapy. Recurrence was usually due to inadequate source control or poor adherence to oral eradication therapy. The case fatality rate declined from 12/44 (27%) in the first five years of the study to 7/76 (9%) in the last five (p = 0.009), reflecting national improvements in sepsis management. Melioidosis in Far North Queensland is a seasonal, opportunistic infection of patients with specific comorbidities. The ATSI population bear the greatest burden of disease. Although the case-fatality rate is declining, deaths frequently occur early after hospitalisation, reinforcing the importance of prompt, targeted therapy in high-risk patients.

Plasmapheresis for Management of Antiphospholipid Syndrome in the Neurosurgical Patient.

PubMed

Arias, Eric J; Bruck, Brent; Vellimana, Ananth K; Eby, Charles; Reynolds, Matthew R; Blinder, Morey A; Zipfel, Gregory J

2018-05-24

Antiphospholipid syndrome (APS) is an autoimmune disorder associated with a hypercoagulable state and increased risk of intraoperative and postoperative thrombosis. Few neurosurgical studies have examined the management of these patients, though the standard of care in most other disciplines involves the use of anticoagulation therapy. However, this is associated with risks such as hemorrhage, thrombosis due to warfarin withdrawal, and is not compatible with operative intervention. We report the cases of 2 antiphospholipid positive patients who were on anticoagulant therapy and underwent surgical bypasses and received perioperative management with plasmapheresis. The first was a 44-yr-old woman who presented with worsening vision, recurring headaches, and a known left internal carotid artery aneurysm that was unsuccessfully treated twice via extracranial to intracranial (ECIC) bypass at another institution. Preoperative tests at our institution revealed elevated beta 2 glycoprotein 1 IgA autoantibodies. The second case was a 24-yr-old woman with previously diagnosed APS, who presented for surgical evaluation of moyamoya disease after sustaining recurrent left hemispheric strokes. Both cases were managed with perioperative plasmapheresis to avoid the need for anticoagulation during the perioperative period, and both underwent successful ECIC bypass procedures without perioperative ischemic or hemorrhagic complications. Management of neurosurgical patients with APS can be a precarious proposition. We describe the successful use of plasmapheresis and antiplatelet therapy to better manage patients undergoing neurosurgical procedures, specifically ECIC bypass, and feel this approach can be considered in future cases.

Diagnosis and Surgical Management of Nonsyndromic Nine Supernumerary Teeth and Leong's Tubercle

PubMed Central

Cruz, Christiane V.; Soares, Andrea L.; Braga, David N.; Costa, Marcelo C.

2016-01-01

Nonsyndromic multiple supernumerary teeth (ST) and Leong's tubercle are a condition with a very low prevalence and a multidisciplinary approach is required to restore function and aesthetics. So, this case report aimed at presenting a rare case of nonsyndromic nine supernumerary teeth and Leong's tubercle in a pediatric patient, without any evident familial history, showing its diagnosis and surgical management. PMID:27066278

Spontaneous Adrenal Hemorrhage in Pregnancy: A Case Series.

PubMed

Gupta, Ankita; Minhas, Ruby; Quant, Hayley S

2017-01-01

Background . Abdominal pain during pregnancy has a broad differential diagnosis which includes spontaneous adrenal hemorrhage (SAH). There is scant literature available on optimal mode of delivery in stable patients. Cases . Patient 1 was a 35-year-old nullipara who presented at 36 weeks of gestation with left flank pain. Patient 2 was a 27-year-old multipara at 38 weeks who presented with left upper quadrant pain. Diagnosis of SAH was made by CT scan and both were managed with pain control, serial hemoglobin assessments, and abdominal exams resulting in uncomplicated vaginal deliveries. Conclusion . SAH, although rare, is an important consideration when evaluating abdominal and flank pain in pregnancy. Management options vary from conservative management to surgical intervention depending on the stability of the patient.

Spontaneous Adrenal Hemorrhage in Pregnancy: A Case Series

PubMed Central

Minhas, Ruby; Quant, Hayley S.

2017-01-01

Background. Abdominal pain during pregnancy has a broad differential diagnosis which includes spontaneous adrenal hemorrhage (SAH). There is scant literature available on optimal mode of delivery in stable patients. Cases. Patient 1 was a 35-year-old nullipara who presented at 36 weeks of gestation with left flank pain. Patient 2 was a 27-year-old multipara at 38 weeks who presented with left upper quadrant pain. Diagnosis of SAH was made by CT scan and both were managed with pain control, serial hemoglobin assessments, and abdominal exams resulting in uncomplicated vaginal deliveries. Conclusion. SAH, although rare, is an important consideration when evaluating abdominal and flank pain in pregnancy. Management options vary from conservative management to surgical intervention depending on the stability of the patient. PMID:28421152

Management of difficult airway in intratracheal tumor surgery

PubMed Central

Goyal, Amit; Tyagi, Isha; Tewari, Prabhat; Agarwal, Surendra K; Syal, Rajan

2005-01-01

Background Tracheal malignancies are usual victim of delay in diagnosis by virtue of their symptoms resembling asthma. Sometimes delayed diagnosis may lead to almost total airway obstruction. For difficult airways, not leaving any possibility of manipulation into neck region or endoscopic intervention, femorofemoral cardiopulmonary bypass can be a promising approach. Case Presentation We are presenting a case of tracheal adenoid cystic carcinoma (cylindroma) occupying about 90% of the tracheal lumen. It was successfully managed by surgical excision of mass by sternotomy and tracheotomy under femorofemoral cardiopulmonary bypass (CPB). Conclusion Any patient with recurrent respiratory symptoms should be evaluated by radiological and endoscopic means earlier to avoid delay in diagnosis of such conditions. Femorofemoral cardiopulmonary bypass is a relatively safe way of managing certain airway obstructions. PMID:15941480

A radiological chronicle of the presentation and management of a long gap oesophageal atresia.

PubMed

Charlesworth, Paul; Mahomed, Anies

2009-01-01

Long gap oesophageal atresia is a clinically and technically challenging condition to manage. Documentation of the gap between the upper and lower pouches is critical to deciding the timing and feasibility of a primary anastamosis. Integral to this process is the role of radiology. We present a case of long gap oesophageal atresia accompanied by chronological radiography demonstrating its' staged management and highlighting some common complications.

THE POTENTIAL FOR PHARMACISTS TO MANAGE CHILDREN ATTENDING EMERGENCY DEPARTMENTS.

PubMed

Terry, David; Petridis, Konstantinos; Aiello, Matt; Sinclair, Anthony; Huynh, Chi; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Hughes, Elizabeth

2016-09-01

There have been concerns about maintaining appropriate clinical staff levels in Emergency Departments in England.1 The aim of this study was to determine if Emergency Department attendees aged from 0-16 years could be managed by community pharmacists or hospital independent prescriber pharmacists with or without further advanced clinical practice training. A prospective, 48 site, cross-sectional, observational study of patients attending Emergency Departments (ED) in England, UK was conducted. Pharmacists at each site collected up to 400 admissions and paediatric patients were included in the data collection. The pharmacist independent prescribers (one for each site) were asked to identify patient attendance at their Emergency Department, record anonymised details of the cases-age, weight, presenting complaint, clinical grouping (e.g. medicine, orthopaedics), and categorise each presentation into one of four possible categories: CP, Community Pharmacist, cases which could be managed by a community pharmacist outside an ED setting; IP-cases that could be managed at ED by a hospital pharmacist with independent prescriber status; IPT, Independent Prescriber Pharmacist with additional training-cases which could be managed at ED by a hospital pharmacist independent prescriber with additional clinical training; and MT, Medical Team only-cases that were unsuitable for the pharmacist to manage. An Impact Index was calculated for the two most frequent clinical groupings using the formula: Impact index=percentage of the total workload of the clinical grouping multiplied by the percentage ability of pharmacists to manage that clinical group. 1623 out of 18,229 (9%) attendees, from 45 of the 48 sites, were children aged from 0 to 16 years of age (median 8 yrs, range 0-16), 749 were female and 874 were male. Of the 1623 admissions, 9% of the cases were judged to be suitable for clinical management by a community pharmacist (CP), 4% suitable for a hospital pharmacist independent prescriber (IP), 32% suitable for a hospital independent pharmacist prescriber with additional training (IPT); and the remaining 55% were only suitable for the Medical Team (MT). The most frequent clinical groups and impact index for the attendees were General Medicine=10.78 and orthopaedics=10.60. Paediatric patients attending Emergency Departments were judged by pharmacists to be suitable for management outside a hospital setting in approximately 1 in 11 cases, and by hospital independent prescriber pharmacists in 4 in 10 cases. With further training, it was found that the total proportion of cases that could be managed by a pharmacist was 45%. The greatest impact for pharmacist management occurs in general medicine and orthopaedics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Nail gun injuries to the head with minimal neurological consequences: a case series.

PubMed

Makoshi, Ziyad; AlKherayf, Fahad; Da Silva, Vasco; Lesiuk, Howard

2016-03-16

An estimated 3700 individuals are seen annually in US emergency departments for nail gun-related injuries. Approximately 45 cases have been reported in the literature concerning nail gun injuries penetrating the cranium. These cases pose a challenge for the neurosurgeon because of the uniqueness of each case, the dynamics of high pressure nail gun injuries, and the surgical planning to remove the foreign body without further vascular injury or uncontrolled intracranial hemorrhage. Here we present four cases of penetrating nail gun injuries with variable presentations. Case 1 is of a 33-year-old white man who sustained 10 nail gunshot injuries to his head. Case 2 is of a 51-year-old white man who sustained bi-temporal nail gun injuries to his head. Cases 3 and 4 are of two white men aged 22 years and 49 years with a single nail gun injury to the head. In the context of these individual cases and a review of similar cases in the literature we present surgical approaches and considerations in the management of nail gun injuries to the cranium. Case 1 presented with cranial nerve deficits, Case 2 required intubation for low Glasgow Coma Scale, while Cases 3 and 4 were neurologically intact on presentation. Three patients underwent angiography for assessment of vascular injury and all patients underwent surgical removal of foreign objects using a vice-grip. No neurological deficits were found in these patients on follow-up. Nail gun injuries can present with variable clinical status; mortality and morbidity is low for surgically managed isolated nail gun-related injuries to the head. The current case series describes the surgical use of a vice-grip for a good grip of the nail head and controlled extraction, and these patients appear to have a good postoperative prognosis with minimal neurological deficits postoperatively and on follow-up.

Asperger's syndrome: a case report

PubMed Central

Goodman, Carol M.

1987-01-01

A case report is presented of an 11-year-old boy who has been diagnosed as having Asperger's syndrome. There follows a review of the clinical features, course, prognosis and management of this condition. PMID:2453672

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, multiple myeloma and skin changes) with cranial vault plasmocytoma and the role of surgery in its management: a case report.

PubMed

Plata Bello, Julio; Garcia-Marin, Victor

2013-10-18

POEMS syndrome (an acronym of polyneuropathy, organomegaly, endocrinopathy, multiple myeloma and skin changes) is a paraneoplastic disorder related to an underlying plasma cell dyscrasia. The development of such a syndrome is rare and its association with calvarial plasmocytoma is even less common, with only two previous reported cases. We describe, in detail, an unusual presentation of cranial plasmocytoma associated with POEMS syndrome and briefly discuss the possible role of surgery in the management of this disease. We present the case of a 45-year-old Caucasian man who was admitted to our department presenting with progressive weakness in his lower limbs, enlarged lymph nodes and a large mass on the scalp with intense bone erosion. POEMS criteria were present and pathological studies confirmed a Castleman's variant plasmocytoma. Clinical status improved noticeably after the excision of the plasmocytoma and the treatment was completed with radiotherapy and steroid pulse therapy. Cranial vault plasmocytoma and its association with POEMS syndrome are rare conditions with few previously reported cases. Although the role of surgery is not clearly defined in POEMS syndrome guidelines, the fact that there seems to be a better prognosis and clinical outcome when surgery is used as a part of the management in POEMS syndrome with cranial vault plasmocytoma is worth discussing.

STS-114: Engine Cut-Off Sensors Are a No-Go: Teaching Notes for NASA Case Study

NASA Technical Reports Server (NTRS)

Ransom, Khadijah S.; Johnson, Grace K.

2013-01-01

This case study format is intended to simulate the experience of facing the same difficult challenges and making the same critical decisions as managers, engineers, and scientists in the Space Shuttle Program. It has been designed for use in the classroom setting to help students develop skills related to decision-making. Students will read about the engine cut-off sensor anomaly which created challenges during the STS-114 mission and have the opportunity to make decisions as lead NASA engineers and Mission Management Team members. Included within this document are three case study presentation options - class discussion, group activity, and open-ended research. Please read the full case prior to in-class presentation to allow ample time for students' analysis and reflection, as well as to prepare additional questions. activities or exercises, material selection, etc. Depending upon the setting of your presentation and the number of participants, please choose at least one presentation format beforehand and plan accordingly. You may expect the following learning objectives by using the proposed formats. Learning Objectives: To enable students to experience the responsibilities of NASA management, engineers, and analysis; to discover possible procedures for investigating system anomalies; to become familiar with the liquid hydrogen low level engine cut-off sensor, including its function, connecting components, and location within the Space Shuttle; and to encourage critical analysis and stimulating discussion of Space Shuttle mission challenges.

A complicated case of amyand's hernia involving a perforated appendix and its management using minimally invasive laparoscopic surgery: A case report.

PubMed

Al-Ramli, Wisam; Khodear, Yahya; Aremu, Muyiwa; El-Sayed, Abdel Basset

2016-01-01

Amyand's hernia is a rare condition of inguinal hernia in which the appendix is incarcerated within the hernia sac through the internal ring. Complications include acute appendicitis and perforated appendicitis, which are rare in incidence, accounting for about 0.1% of cases. 1 These complications prove a diagnostic challenge due to their vague clinical presentation and atypical laboratory and radiological findings. Until recently, open appendectomy was the mainstay of treatment. Laparoscopic surgery offers a less invasive approach to confirming a diagnosis and serving as a therapeutic tool in equivocal cases. We report a case of a previously healthy 20-year-old male presenting with atypical signs and symptoms, as well as blood investigation results, and radiological findings of a perforated appendix within an Amyand's hernia. The patient was successfully managed using a minimally invasive laparoscopic appendectomy approach. Until recently, open appendectomy was considered the mainstay in the management of complicated Amyand's hernia. Laparoscopic surgery provides a new avenue for dealing with diagnostic uncertainty with advantages including faster recovery time, reduced hospital stay, and better quality of life. This case report highlights the concealing effects of an Amyand's hernia on a perforated appendix, the considerations required when an equivocal diagnosis present and the safe use of the minimally invasive laparoscopic surgery in the treatment of this rare condition. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Assessment and Management of Professionalism Issues in Pathology Residency Training: Results From Surveys and a Workshop by the Graduate Medical Education Committee of the College of American Pathologists.

PubMed

Domen, Ronald E; Talbert, Michael L; Johnson, Kristen; Post, Miriam D; Brissette, Mark D; Conran, Richard Michael; Hoffman, Robert D; McCloskey, Cindy B; Raciti, Patricia M; Roberts, Cory Anthony; Rojiani, Amyn M; Tucker, J Allan; Powell, Suzanne Zein-Eldin

2015-01-01

Professionalism issues are common in residency training and can be very difficult to recognize and manage. Almost one-third of the milestones for pathology recently instituted by the Accreditation Council for Graduate Medical Education encompass aspects of professionalism. Program directors are often unsure of how and when to remediate residents for unprofessional behavior. We used a case-based educational approach in a workshop setting to assist program directors in the management of unprofessional behavior in residents. Eight case scenarios highlighting various aspects of unprofessional behavior by pathology residents were developed and presented in an open workshop forum at the annual pathology program director's meeting. Prior to the workshop, 2 surveys were conducted: (1) to collect data on program directors' experience with identifying, assessing, and managing unprofessional behavior in their residents and (2) to get feedback from workshop registrants on how they would manage each of the 8 case scenarios. A wide range of unprofessional behaviors have been observed by pathology program directors. Although there is occasionally general agreement on how to manage specific behaviors, there remains wide variation in how to manage many of the presented unprofessional behaviors. Remediation for unprofessional behavior in pathology residents remains a difficult and challenging process. Additional education and research in this area are warranted.

Giant midesophageal diverticulum presenting as food impaction: case report and review of the literature.

PubMed

Hadi, Usamah; Rameh, Charbel

2007-01-01

A giant midesophageal diverticulum is a medical rarity that is usually asymptomatic, and discovered incidentally. We report a case of a giant midesophageal diverticulum that revealed itself secondary to food impaction. A literature review on epidemiology, etiology, clinical presentation, investigations, and management of giant midesophageal diverticula will be highlighted.

A case report on management of synergistic gangrene following an incisional abdominal hernia repair in an immunocompromised obese patient

PubMed Central

Merali, N.; Almeida, R.A.R.; Hussain, A.

2015-01-01

Introduction We present a case on conservative management of salvaging the mesh in an immunocompromised morbidly obese patient, who developed a synergistic gangrene infection following a primary open mesh repair of an incisional hernia. Presentation of case Our patient presented with a surgical wound infection, comorbidities were Chronic Lymphoblastic Leukemia (CLL), Body Mass Index (BMI) of 50, hypertension and diet controlled type-2 diabetes. In surgery, wide necrotic wound debridement, early and repetitive wound drainages with the use of a large pore polypropylene mesh and a detailed surgical follow up was required. High dose intravenous broad-spectrum antibiotic treatment and Negative Pressure Wound Therapy (NPWT) was administrated in combination with adopting a multidisciplinary approach was key to our success. Discussion Stoppa Re et al. complied a series of 360 ventral hernia mesh repairs reporting an infection rate of 12% that were managed conservatively. However, our selective case is unique within current literature, being the first to illustrate mesh salvage in a morbid obese patient with CLL. Recent modifications in mesh morphology, such as lower density, wide pores, and lighter weight has led to considerable improvements regarding infection avoidance. Conclusion This case has demonstrated how a planned multidisciplinary action can produce prosperous results in a severely obese immunocompromised patient with an SSI, following an incisional hernia repair. PMID:26322822

Osseous associated cervical spondylomyelopathy at the C2-C3 articular facet joint in 11 dogs.

PubMed

Cooper, C; Gutierrez-Quintana, R; Penderis, J; Gonçalves, R

2015-11-21

In dogs, vertebral canal stenosis at C2-C3 due to articular facet joint degeneration is only sporadically identified. The authors' aims were to review the clinical presentation, MRI characteristics, treatment and outcome of dogs presenting with this condition. Eleven cases were eligible for inclusion. Neurological examination revealed tetraparesis and proprioceptive ataxia in all 4 limbs in 3/11, proprioceptive tetra-ataxia only in 4/11, pelvic limb proprioceptive ataxia in 2/11 and no gait abnormalities in 2/11 dogs. Cervical hyperaesthesia was present in 7/11 dogs. MRI revealed bilateral articular facet joint degeneration in 10/11 cases and unilateral degeneration in one. Surgery was performed in six cases and medical management elected in five. Long-term follow-up information was available for 11 animals. Four of the surgical cases are alive and have no neurological deficits, one was euthanased for an unrelated condition and one lost to follow-up. Of the cases managed medically, three are alive showing no neurological deficits, one is alive still displaying neurological deficits and one euthanased for an unrelated condition whilst still ataxic. This study shows that both medical and surgical management can result in good outcomes in dogs with vertebral canal stenosis resulting from articular facet joint degeneration at the level of C2-C3. British Veterinary Association.

Varied Presentation of Congenital Segmental Dilatation of the Intestine in Neonates: Report of Three Cases

PubMed Central

Rai, Binod Kumar; Mirza, Bilal; Hashim, Imran; Saleem, Muhammad

2016-01-01

Congenital segmental dilatation (CSD) of the intestine is a rare developmental anomaly characterized by sharply demarcated dilatation of a gastrointestinal segment and may present with intestinal obstruction. We report three cases of CSD of the intestine in neonates with varied presentation. First patient was mistaken as pneumoperitoneum on abdominal radiograph, which led to initial abdominal drain placement. The 2nd patient was a case of anorectal malformation associated with congenital pouch colon (CPC) and CSD of ileum; and the third case presented as neonatal intestinal obstruction and found to have CSD of ileum. All the patients were successfully managed in our department. PMID:27896163

Management of hyperfunctioning single thyroid nodules in the era of minimally invasive thyroid surgery.

PubMed

Tan, Charles; Sidhu, Stan; Sywak, Mark; Delbridge, Leigh

2009-05-01

Both surgical excision and radioiodine ablation are effective modalities in the management of hyperfunctioning thyroid nodules. Minimally invasive thyroid surgery (MITS) using the lateral mini-incision approach has previously been demonstrated to be a safe and effective technique for thyroid lobectomy. As such MITS may offer advantages as a surgical approach to hyperfunctioning thyroid nodules without the need for a long cervical incision or extensive dissection associated with formal open hemithyroidectomy. The aim of the present study was to assess the safety and efficacy of MITS for the treatment of hyperfunctioning thyroid nodules. This is a retrospective case study. Data were obtained from the University of Sydney Endocrine Surgical Unit Database from 2002 to 2007. There were 86 cases of hyperfunctioning thyroid nodules surgically removed during the study period, of which 10 (12%) were managed using the MITS approach. The ipsilateral recurrent laryngeal nerve was identified and preserved in all cases with no incidence of temporary or permanent nerve palsy. The external branch of the superior laryngeal nerve was visualized and preserved in eight cases (80%). There were no cases of postoperative bleeding. There was one clinically significant follicular thyroid carcinoma in the series (10%). In nine of 10 cases (90%) normalization of thyroid function followed surgery. MITS is a safe and effective procedure, achieving the benefits of a minimally invasive procedure with minimal morbidity. As such it now presents an attractive alternative to radioiodine ablation for the management of small hyperfunctioning thyroid nodules.

Pedagogical Approaches to Develop Critical Thinking and Crisis Leadership

ERIC Educational Resources Information Center

Powley, Edward H.; Taylor, Scott N.

2014-01-01

Management schools must be prepared to aid leaders and managers to succeed in uncertain environments. We offer two approaches, each designed for critical thinking skill development, to teach graduate management students about leading in and through potential disruption to organizational life. First, we present a personalized case method that…

Cracked tooth syndrome: A report of three cases.

PubMed

Sadasiva, Kadandale; Ramalingam, Sathishmuthukumar; Rajaram, Krishnaraj; Meiyappan, Alagappan

2015-08-01

Cracked tooth syndrome (CTS), the term was coined by Cameron in 1964, which refers to an incomplete fracture of a vital posterior tooth extending to the dentin and occasionally into the pulp. CTS has always been a nightmare to the patient because of its unpredictable symptoms and a diagnostic dilemma for the dental practitioner due to its variable, bizarre clinical presentation. The treatment planning and management of CTS has also given problems and challenges the dentist as there is no specific treatment option. The management of CTS varies from one case to another or from one tooth to another in the same individual based on the severity of the symptoms and depth of tooth structure involved. After all, the prognosis of such tooth is still questionable and requires continuous evaluation. This article aims at presenting a series three cases of CTS with an overview on the clinical presentation, diagnosis and the different treatment options that varies from one case to another.

Cracked tooth syndrome: A report of three cases

PubMed Central

Sadasiva, Kadandale; Ramalingam, Sathishmuthukumar; Rajaram, Krishnaraj; Meiyappan, Alagappan

2015-01-01

Cracked tooth syndrome (CTS), the term was coined by Cameron in 1964, which refers to an incomplete fracture of a vital posterior tooth extending to the dentin and occasionally into the pulp. CTS has always been a nightmare to the patient because of its unpredictable symptoms and a diagnostic dilemma for the dental practitioner due to its variable, bizarre clinical presentation. The treatment planning and management of CTS has also given problems and challenges the dentist as there is no specific treatment option. The management of CTS varies from one case to another or from one tooth to another in the same individual based on the severity of the symptoms and depth of tooth structure involved. After all, the prognosis of such tooth is still questionable and requires continuous evaluation. This article aims at presenting a series three cases of CTS with an overview on the clinical presentation, diagnosis and the different treatment options that varies from one case to another. PMID:26538947

Malignant sigmoidoduodenal fistula

PubMed Central

Shapey, I.M.; Mahmood, K.; Solkar, M.H.

2014-01-01

INTRODUCTION Duodenocolic fistula is a rare complication of malignant colonic disease especially when involving and originating from the sigmoid colon. We aim to discuss the unusual clinical presentation of this case as well as the investigation and management of duodenocolic fistulas. PRESENTATION OF CASE A 91 year old lady presented as an emergency to a general surgical service at a District General Hospital with diarrhoea, vomiting and weight loss. Computed Tomography (CT) reported a large ovarian cyst elevating the sigmoid colon into immediate proximity of the duodenum. Adenocarcinoma was confirmed on histology obtained by colonoscopy. A classic apple core lesion with fistulating tract from the sigmoid colon to the duodenum was synchronously demonstrated on barium enema. DISCUSSION Sigmoido-duodenal fistulae represent a complex manifestation of gastrointestinal pathologies. CONCLUSION Management options must be considered in the context of patient wishes, their co-morbidities, and predicted post-operative outcome. In most cases this is likely to represent a non-operative approach, however surgical resection may benefit selected cases on occasion. PMID:25460456

Clinicopathological profile and management of 161 cases of actinic cheilitis*

PubMed Central

Lopes, Maria Luiza Diniz de Sousa; da Silva Júnior, Francisco Leonardo; Lima, Kenio Costa; de Oliveira, Patrícia Teixeira; da Silveira, Éricka Janine Dantas

2015-01-01

BACKGROUND Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun. OBJECTIVES To evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading. METHODS Demographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system. RESULTS There was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803). CONCLUSION This study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies. PMID:26375219

ACHP | News | Mrs. Laura Bush Presents "Preserve America History Teacher

Science.gov Websites

cases. However, regulatory and statutory changes since then have significantly altered case management practices. The Section 106 review process has evolved to focus ACHP participation on high-profile cases . Involvement in these cases can also lead the ACHP to pursue broad changes to Federal agency programs or

Aspergillus spinal epidural abscess: case presentation and review of the literature.

PubMed

Shweikeh, Faris; Zyck, Stephanie; Sweiss, Fadi; Sangtani, Ajleeta; Shweikeh, Mohammed; Issa, Husam; Steinmetz, Michael P; Markarian, Georges Z

2018-01-01

In this review, we present a case of Aspergillus spinal epidural abscess (ASEA) and review the literature. To provide further insight on a rare condition. A description of a patient with ASEA in a 58-year-old woman that was successfully treated with conservative management is presented. Following case presentation, a literature search (MedLine and PubMed) and assessment of epidemiology, presentation, diagnosis, treatments, and outcomes is performed. Review of the literature finds 26 reported cases. The infection occurs in males with a higher frequency (66.7%). The thoracic and lumbar regions are more likely afflicted (96.1%). Common symptoms are backache, neurological deficits, and fever. Most frequent comorbidities were malignancy, diabetes mellitus, and immunodeficiency. Complications were numerous and often catastrophic. Treatment entailed a combination of antibiotics and surgery. Overall, ASEA patients did poorly: death in majority (52%), minimal recovery in 22%, and others did attain full recovery (26%). Generally, this infection has high morbidity and mortality. Early identification is important to a successful outcome. Appropriate management with antifungals is central and proves to be effective as seen in the reported case though surgical intervention is usually a necessity as the literature suggests. From an epidemiological and public health perspective, particularly with recent outbreaks, understanding the treatment of this rare CNS infection becomes even more imperative.

Management of uncommon disorders in pregnancy: Von Hippel-Lindau disease, Gitelman syndrome, and Nutcracker syndrome.

PubMed

Merhi, Basma; Miller, Margaret; Lanis, Aviya; Katz, Brittany; Hsu, Tiffany; Tong, Iris

2017-09-01

Uncommon renal disorders in pregnancy can be challenging to manage given limited evidence in the literature to guide management. We present a series of three uncommon renal disorders in pregnancy: Von Hippel-Lindau disease, Gitelman syndrome, and Nutcracker syndrome. Previously published case reports with differing outcomes offer some guidance to the management of these disorders in pregnancy. In this case series, we address the management of these syndromes during pregnancy and discuss the maternal and fetal outcomes. All three of our patients had good maternal and fetal outcomes, which will contribute to current data on maternal and fetal outcomes in these rare diseases, which is limited.

Acute pancreatitis: current perspectives on diagnosis and management

PubMed Central

Shah, Adarsh P; Mourad, Moustafa M; Bramhall, Simon R

2018-01-01

The last two decades have seen the emergence of significant evidence that has altered certain aspects of the management of acute pancreatitis. While most cases of acute pancreatitis are mild, the challenge remains in managing the severe cases and the complications associated with acute pancreatitis. Gallstones are still the most common cause with epidemiological trends indicating a rising incidence. The surgical management of acute gallstone pancreatitis has evolved. In this article, we revisit and review the methods in diagnosing acute pancreatitis. We present the evidence for the supportive management of the condition, and then discuss the management of acute gallstone pancreatitis. Based on the evidence, our local institutional pathways, and clinical experience, we have produced an outline to guide clinicians in the management of acute gallstone pancreatitis. PMID:29563826

Cervical necrotizing fasciitis of nonodontogenic origin: case report and review of literature.

PubMed

Suárez, Aldo; Vicente, Mario; Tomás, Jose A; Floría, Luis M; Delhom, José; Baquero, Mari C

2014-11-01

Cervical necrotizing fasciitis (CNF) is a potentially fatal infection characterized by generalized necrosis of the cervical fascia that progresses rapidly. The incidence of this entity corresponds to 2.6% of all infections of the head and neck. The most frequent primary origin is dental infection, although other causes exist that should be evaluated.Delay in the diagnosis of this entity may lead to rapid progression and fatal outcome. Patients often present immunosuppression or systemic diseases that predispose them to this pathology. Cervical necrotizing fasciitis is associated with mortality rates of 7% to 20% depending on the extension of the cervical lesion. The highest rates correspond to cases that progress to mediastinitis or septic shock, which are the main and most frequent complications. Early detection and adequate emergency treatment are critical in the management of these patients and may reduce morbimortality and improve survival. The emergency services should be prepared to manage such cases efficiently, through a multidisciplinary treatment by coordinating emergency surgery with critical support and clinical stabilization of patients.We present a case of CNF of non odontogenic origin managed in our hospital.

Epidemiological review of scorpion stings in Qatar. The need for regional management guidelines in emergency departments.

PubMed

Alkahlout, Baha H; Abid, Muhammad M; Kasim, Mohammad M; Haneef, Shumaila M

2015-07-01

To review the epidemiology of scorpion sting in Qatar, to explore both the clinical significance, and the role of the emergency department (ED) in the management of such cases. In this retrospective study, we reviewed the records of all scorpion sting cases presented to the ED of Hamad General Hospital, Doha, Qatar between October 2010 and May 2013. A total of 111 cases of scorpion stings were reviewed, 81 (72.9%) were males and 30 (27.1%) were females, with a mean age of 38 years. Localized pain was the most frequent presenting complaint (89 [80.2%]), whereas localized redness (44 [39.6%]) and swelling (38 [34.2%]) were the most common clinical signs. Abroug's classification was used, and all cases  were found to be class I. All patients received symptomatic treatment and were sent home. Scorpion sting problem in Qatar has a low clinical significance. Data from such studies should be utilized to create more specific (local) management guidelines, which should be more efficient with more rational utilization of ED resources.

De Garengeot's hernia: our experience of three cases and literature review

PubMed Central

Akbari, Khalid; Wood, Claire; Hammad, Ahmed; Middleton, Simon

2014-01-01

Groin hernia is a common surgical presentation and nearly half of the femoral hernias present acutely with strangulation. The hernia sac usually contains omentum or small bowel. Rarely, the appendix can herniate into the femoral canal. De Garengeot's hernia is the term used to describe the presence of appendicitis in the femoral hernia. Hernia explorations are performed by surgical trainees and encountering a De Garengeot's hernia can be challenging to manage. We report our experience of three cases of this rare entity and a literature review to improve our understanding for optimum management. PMID:25080546

Chemical pleurodesis using mistletoe extracts via spray catheter during medical thoracoscopy for management of malignant pleural effusion.

PubMed

Eom, Jung Seop; Kim, Tae Hwa; Lee, Geewon; Ahn, Hyo Yeong; Mok, Jeong Ha; Lee, Min Ki

2017-05-01

We present three cases of successful chemical pleurodesis with a liquid solution of mistletoe extract using a spray catheter during medical thoracoscopy. The medical thoracoscopy was performed in all presented cases to remove pleural effusion and conduct chemical pleurodesis to manage symptomatic malignant pleural effusion. A spray catheter was used to instil the mistletoe extract evenly into the pleural cavity, and there were no pleurodesis-related complications. Respiratory symptoms caused by pleural effusion improved after pleurodesis, and successful pleurodesis was maintained for more than 3 months after medical thoracoscopy in all three patients.

An unusual case of priapism.

PubMed Central

Jam, M.; Datta, N. S.; Askari, A.

1993-01-01

A case of sickle cell disease with 63 documented episodes of priapism that were managed medically is presented. The case is very unusual because of the fact that despite so many episodes of priapism, he did not lose sexual potency. On the contrary, over a period of time, his penis hypertrophied. To the best of our knowledge, this is the first such case with so many episodes of priapism reported in the English literature. We present a hypothesis for such unusual occurrence. PMID:8366540

[Primary carcinoma of the thyroid growing in thyroglossal duct cyst: presentation of two cases].

PubMed

Godlewska, Paulina; Bruszewska, Elzbieta; Kozłowicz-Gudzińska, Izabella; Prokurat, Andrzej I; Chrupek, Małgorzata; Zegadło-Mylik, Maria A; Kluge, Przemysław

2007-01-01

Thyroglossal duct remnants (TGDR), most often cysts, are the most common type of developmental abnormalities of the thyroid gland. In about 1 to 2% of TGDR neoplastic transformation occurs. Papillary carcinoma of the thyroid may be encountered in over 90% of such cases. Two cases of primary papillary carcinoma of the thyroid in TGDR in young girls are presented. The diagnostic and therapeutic problems are shared, and up-to-date management guidelines in similar cases are discussed.

Congenital telangiectatic atrophic patch on a healthy child.

PubMed

Teresa Garcia-Romero, Maria; Ching, Joyce C Y; Ho, Nhung

2014-01-01

Rapidly involuting congenital hemangiomas (RICHs) are rare vascular tumors that have a proliferative phase in utero, present fully grown at birth, and have a fast involution phase after birth. Even rarer cases have completed involution in utero and present at birth as an atrophic plaque with redundant skin. We present one case of a RICH that underwent involution in utero and revise the diagnostic and management implications.

Development and pilot of Case Manager: a virtual-patient experience for veterinary students.

PubMed

Byron, Julie K; Johnson, Susan E; Allen, L Clare V; Brilmyer, Cheryl; Griffiths, Robert P

2014-01-01

There is an increasing demand in veterinary education to engage students, teach and reinforce clinical reasoning, and provide access anytime/anywhere to quality learning opportunities. In addition, accrediting bodies are asking for more concrete documentation of essential clinical-skills outcomes. Unfortunately, during the clinical year in a referral hospital setting, students are at the mercy of chance regarding the types of cases they will encounter and the opportunities they will have to participate. Patient- and case-simulation technology is becoming more popular as a way to achieve these objectives in human and veterinary medical education. Many of the current options available to the veterinary medical education community to develop virtual-patient cases are too time-consuming, cost prohibitive, or difficult for the instructor or learner to use. In response, we developed a learning tool, Case Manager, which is low-cost and user-friendly. Case Manager was designed to meet the demands of veterinary education by providing students with an opportunity to cultivate clinical reasoning skills and allowing for real-time student feedback. We launched a pilot test with 37 senior veterinary medical students as part of their Small Animal Internal Medicine clinical rotation. Students reported that Case Manager increased their engagement with the material, improved diagnostic and problem-solving skills, and broadened their exposure to a variety of cases. In addition, students felt that Case Manager was superior to a more traditional, less interactive case presentation format.

Analysis and Perspective from the Complex Aerospace Systems Exchange (CASE) 2013

NASA Technical Reports Server (NTRS)

Jones, Kennie H.; Parker, Peter A.; Detweiler, Kurt N.; McGowan, Anna-Maria R.; Dress, David A.; Kimmel, William M.

2014-01-01

NASA Langley Research Center embedded four rapporteurs at the Complex Aerospace Systems Exchange (CASE) held in August 2013 with the objective to capture the essence of the conference presentations and discussions. CASE was established to provide a discussion forum among chief engineers, program managers, and systems engineers on challenges in the engineering of complex aerospace systems. The meeting consists of invited presentations and panels from industry, academia, and government followed by discussions among attendees. This report presents the major and reoccurring themes captured throughout the meeting and provides analysis and insights to further the CASE mission.

Spontaneous Massive Adrenal Hemorrhage: A Management Dilemma

PubMed Central

Agarwal, Anshuman

2015-01-01

Abstract Adrenal hemorrhage (AH) is a rare but life-threatening condition. Small focal hemorrhage may present subclinically, but massive hemorrhage may lead to rapid cardiovascular collapse and ultimately death if not diagnosed appropriately and treated quickly. Most cases reported in the literature have been treated conservatively. In an event of increasing hemorrhage during conservative management, it may be tricky to intervene surgically because of the hematoma around the gland. Here we describe a case where we managed a large spontaneous AH by a combination of angioembolization and laparoscopic adrenalectomy. PMID:27579389

Emergency ultrasound-guided percutaneous embolization of post-traumatic bleeding hepatic artery pseudoaneurysms.

PubMed

Vyas, Sameer; Ahuja, Chirag Kamal; Yadav, Thakur Deen; Khandelwal, Niranjan

2012-09-01

Hepatic artery pseudoaneurysm (HAP) is an uncommon but serious complication of blunt trauma abdomen which can be managed by non-surgical interventional methods. We describe the case of a young boy with blunt trauma abdomen having a large hepatic laceration associated with two pseudoaneurysms of the hepatic artery branches. Both these HAPs were successfully managed by percutaneous injection of cyanoacrylate glue under sonographic guidance. A major surgery was thus averted. A brief review of the etiology, diagnosis and management of HAP including the present case is discussed.

Revolutionizing Child Welfare with Outcomes Management

PubMed Central

Toche-Manley, Linda L.; Dietzen, Laura; Nankin, Jesse; Beigel, Astrid

2013-01-01

Outcomes management technology holds great promise for improving the quality of services provided to youth in the child welfare system. Advantages include better detection of behavioral health and trauma-related issues, early indicators of case progress or risk of failure and program- and system-level learning. Yet organizational barriers to implementation persist. Attention is spent in this paper on addressing these barriers so the use of outcomes management technology becomes a common practice. A model for predicting resiliency is presented, along with case examples demonstrating its potential use for treatment planning and monitoring progress. PMID:23460130

Liquefied petroleum gas cold burn sustained while refueling a car.

PubMed

Scarr, Bronwyn; Mitra, Biswadev; Maini, Amit; Cleland, Heather

2010-02-01

There have been few cases of cold burn related to the exposure of liquid petroleum gas (LPG). We present the case of a young woman exposed to LPG while refueling her car who sustained partial thickness burns to the dorsum of her hand. Contact with LPG leaking from a pressurized system causes tissue damage because of cold injury. Immediate management of LPG is extrapolated from the management of frostbite. The increasing use of LPG mandates an awareness of prevention strategies and management principles in the setting of adverse events.

Modified Esthetic Splint Design for Management of Multiple Traumatic Injuries in Children: A Case Report

PubMed Central

Garla, Bharath Kumar; Deshmukh, Seema; Murthy, Prashanth Sadashiva; Satish, G

2015-01-01

Traumatic injuries to the dento-alveolar structures are emergencies that compromise the quality of life of the patients. In addition to symptomatic management, definitive functional restoration and suitable rehabilitation becomes a major treatment objective in such cases. The dynamics of the traumatic forces may cause multiple injuries of different grades to the oral and para-oral structures, which makes comprehensive management a greater challenge to the dentist. The present case report elaborates a modified esthetic splint designed to treat multiple dental injuries in children, which can promote healing, restore optimal functionality along with esthetic rehabilitation to psychologically benefit the child during the time of recovery. PMID:26435631

Challenges in managing a mother with a dual diagnosis of peripartum cardiomyopathy and paranoid schizophrenia - a case report.

PubMed

Weerasundera, Rajiv; Yogaratnam, Jegan

2013-01-01

Psychotic illness has a low incidence in the puerperal period. Peripartum cardiomyopathy as a complication of pregnancy is also rare. We report a case where the above two conditions occurred simultaneously in a patient and posed significant difficulties in the clinical management. She was diagnosed as having paranoid schizophrenia and peripartum cardiomyopathy. Many of the antipsychotics were contraindicated, and electroconvulsive therapy could not be administered due to the added risks involved with regard to anesthesia. She was therefore managed with clonazepam and olanzapine. This case highlights the challenges in a patient with a psychiatric illness presenting with comorbid physical illness. Copyright © 2013 Elsevier Inc. All rights reserved.

Orthodontic management by functional activator treatment: a case report.

PubMed

Aprile, Giuseppe; Ortu, Eleonora; Cattaneo, Ruggero; Pietropaoli, Davide; Giannoni, Mario; Monaco, Annalisa

2017-12-02

Managing orthodontic treatment is often very difficult for the orthodontist. Many devices are used during the orthopedic phase of orthodontic treatment, always with different functions. We describe a case of orthodontic management treated with the Equilibrator O.S.A. device (equilibrator designed by Ovidi, Santi, and Aprile for Eptamed SRL; Cesena, Italy; www.eptamed.com ). A healthy 10-year-old white boy presented with a skeletal class II, division 1 malocclusion, molar class II, exhibiting an overjet of 7 mm prior to treatment. For treatment, we only used the Equilibrator O.S.A. device. We successfully treated an orthopedic/orthodontic case with a particular device that we describe here.

Femoral vein injury managed by in situ saphenous vein bypass : a case report.

PubMed

Coppin, Th; Kuhnle, M

2014-01-01

Injured veins of the lower limbs may cause massive haemorrhage requiring early control. Operative management of injured veins remains a controversial topic and reconstruction or ligation depends on venous and adjacent tissue damage. Nevertheless, venous reconstruction seems to reduce the complications of venous ligation. The case of a 33 year old women with a venous wound to the right groin is presented. Surgical management consisted of controlling the bleeding and venous revascularisation with an in situ saphenous vein bypass to substitute the injured femoral vein. The patient had an uneventful postoperative period without any complications. The case demonstrates this method of vascular venous repair is the preferable one. Copyright© Acta Chirurgica Belgica.

Phenibut (β-Phenyl-γ-aminobutyric Acid) Dependence and Management of Withdrawal: Emerging Nootropics of Abuse.

PubMed

Ahuja, Tania; Mgbako, Ofole; Katzman, Caroline; Grossman, Allison

2018-01-01

This case report describes the development of withdrawal from phenibut, a gamma-aminobutyric acid-receptor type B agonist. Although phenibut is not an FDA-approved medication, it is available through online retailers as a nootropic supplement. There are reports of dependence in patients that misuse phenibut. We report a case in which a patient experienced withdrawal symptoms from phenibut and was successfully treated with a baclofen taper. This case report highlights the development of phenibut use disorder with coingestion of alcohol and potential management for phenibut withdrawal. We believe clinicians must be aware of how phenibut dependence may present and how to manage the withdrawal syndrome.

An open-source job management framework for parameter-space exploration: OACIS

NASA Astrophysics Data System (ADS)

Murase, Y.; Uchitane, T.; Ito, N.

2017-11-01

We present an open-source software framework for parameter-space exporation, named OACIS, which is useful to manage vast amount of simulation jobs and results in a systematic way. Recent development of high-performance computers enabled us to explore parameter spaces comprehensively, however, in such cases, manual management of the workflow is practically impossible. OACIS is developed aiming at reducing the cost of these repetitive tasks when conducting simulations by automating job submissions and data management. In this article, an overview of OACIS as well as a getting started guide are presented.

Traumatic brain injury with a machete penetrating the dura and brain: Case report from southeast Mexico.

PubMed

Del Castillo-Calcáneo, Juan D; Bravo-Angel, Ulises; Mendez-Olan, Raúl; Rodriguez-Valencia, Francisco; Valdés-García, Javier; García-González, Ulises; Broc-Haro, Guy G

2016-01-01

Traumatic Brain Injury (TBI) is a major cause of death and disability in our society, we present the first case report of non-missile penetrating (NMP) cranial trauma with a machete in Mexico, and our objective by presenting this case is to prove the usefulness of recently proposed algorithms in the treatment of NMP PRESENTATION OF CASE: We present the case of a 47 year old woman who received a machete hit to the right side of her head during an assault., she arrived fully conscious to the emergency department (ED), computed tomography was performed and based on the findings of this study and in accordance to recently proposed algorithms for managing NMP cranial trauma a craniotomy was performed, at follow-up the patient presented wtih minor neurological disability in the form of left hemiparesis. Non-missile penetrating (NMP) lesions are defined as having an impact velocity of less than 100m/s, causing injury by laceration and maceration, An algorithm for treating NMP cranial trauma has been recently published in the Journal World Neurosurgery by De Holanda et al., in this case we followed the algorithm in order to provide best care available for our patient with good results. The use of current algorithms for managing NMP cranial trauma has proved to be very useful when applied on this particular case. GCS on admission is an important prognostic factor in NMP cranial trauma. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Clean Cities case study : Barwood Cab Fleet study summary

DOT National Transportation Integrated Search

1999-05-21

Barwood Cab Fleet Study Summary is the second in a new series called 'Alternative Fuel Information Case Studies', designed to present real-world experiences with alternative fuels to fleet managers and other industry stakeholders.

Promoting and Disseminating Good Practice in the Planning and Management of Educational Facilities: Capital Investment Strategic Planning - A Case Study, Gold Coast Institute of TAFE, Queensland, Australia.

ERIC Educational Resources Information Center

Crump, Kelvin

This paper presents a case study of the process of capital investment strategic planning at the Gold Coast Institute of Technical and Further Education (TAFE), Queensland, Australia. Capital investment strategic planning is a means of contributing to success by providing strategies to ensure that assets are managed efficiently, effectively, and…

[Esophageal perforation and mediastinitis caused by fishbone ingestion: report of 3 cases].

PubMed

Vásquez, Julio C; Montesinos, Efraín; Castillo, Luis; Rojas, Luis; Peralta, Julio

2006-01-01

We present 3 consecutive cases of fishbone perforation of the esophagus that resulted in acute mediastinitis. All patients were successfully managed with drainage and debridement of the mediastinum and pleural cavity. However, temporary exclusion with external ligation of the esophagus was also performed in one patient, with spontaneous recanalization two weeks later. We discuss the possible role of this surgical maneuver in the management of esophageal perforation.

Isolated posterior high ankle sprain: a report of three cases.

PubMed

Botchu, Rajesh; Allen, Patricia; Rennie, Winston J

2013-12-01

High ankle sprains are difficult to diagnose and account for 10% of all ankle sprains. A high index of suspicion is essential for diagnosis. High ankle sprains are managed symptomatically, with prolonged rehabilitation. The posterior inferior tibiofibular ligament is the strongest syndesmotic ligament; isolated injury of it is rare. We present 3 cases of isolated posterior high ankle sprain and discuss the relevant anatomy, mechanism of injury, and management.

Integrating Patient-Controlled Analgesia Using Implanted Intrathecal Pumps for Postoperative Pain Management: A Case Report.

PubMed

Peniche, Alec; Poree, Lawrence; Schumacher, Mark; Yu, Xiaobing

2018-06-01

Intrathecal patient-controlled analgesia (IT-PCA) through implanted intrathecal infusion pumps has been increasingly utilized for severe cancer and chronic noncancer pain management. However, its application for acute postoperative pain management has not been reported to date. We present a case of a patient with an implanted intrathecal pump for chronic nonmalignant back pain who underwent an extensive spinal fusion surgery. The IT-PCA functionality of her intrathecal pump was successfully integrated into her postoperative multimodal pain regimen. Hence, IT-PCA can be safely incorporated into acute postoperative pain management with vigilant monitoring and close multidisciplinary collaboration.

Undisplaced Intraoperative Fracture Presenting as Early Dislocation with Tapered Wedge Stems in Total Hip Arthroplasty - Case Series and Review of Literature

PubMed Central

Reddy, A V Gurava; Eachempati, Krishna Kiran; Mugalur, Aakash; Suchinder, A; Rao, V B N Prasad; Kamurukuru, Nalanda

2017-01-01

Introduction: Periprosthetic fractures and dislocation in the early post-operative period can be disastrous both for the surgeon and the patient. However, undisplaced periprosthetic fractures presenting with dislocation is uncommon. We describe successful management of two cases (one bilateral dislocation and one unilateral dislocation) of undisplaced iatrogenic fractures in total hip arthroplasty (THA) presenting as early dislocation. Case Report: Case 1 was a 45-year-old female with osteoarthritis of hip secondary to developmental dysplasia of the hip with bilateral early nontraumatic dislocation with bilateral identical periprosthetic fracture. It was managed by revision to long stem and encirclage wiring. Case 2 presented with early dislocation in the 2nd week post THA. We found an intertrochanteric fracture intra-operatively with unstable implant. Acetabular component and femoral component revision were done with reconstruction of the greater trochanter. Discussion: These fractures could be occult iatrogenic fractures characteristic of taper wedge stems which presented as early nontraumatic dislocation in the post-operative period. The prosthesis subsidence, loss of muscle tension and change of version might be the factors leading to dislocation. Conclusion: Unrecognized incomplete intraoperative fracture can occur with tapered wedge uncemented stems which can present as a dislocation in the immediate post-operative period. This will require early revision of the femoral component. PMID:29051875

Robotic partial nephrectomy for duplex kidney with ectopic ureter draining in the vagina in an adult patient with urinary incontinence.

PubMed

Mahmood, Humza; Hadjipavlou, Marios; Das, Raj; Anderson, Chris

2017-02-06

A duplex kidney system with an ectopic ureter draining into the vagina is a congenital malformation that typically presents as refractory urinary incontinence. Diagnosis is often difficult to establish and delayed due to a low incidence. We present the case of a patient aged 26 years with a life-long history of persistent urinary incontinence. Initial presentation was at childhood; however, the diagnosis went undetermined for 22 years. CT urography revealed a duplex kidney with an atrophic upper pole associated with an ectopic ureter that drained into the vaginal vault. This is the first description of such a case being managed successfully via a robot-assisted partial nephrectomy approach. Ectopic ureteral duplication should be considered in the differential diagnosis for young women with refractory urinary incontinence. Robotic partial nephrectomy is a safe and effective technique to manage such cases. 2017 BMJ Publishing Group Ltd.

Complicated rheumatic mitral stenosis presenting in an elderly patient and the challenges in its management.

PubMed

Ganeshpure, Swapnil; Vaidya, Gaurang Nandkishor; Gattani, Vipul

2012-12-05

A 76 -year-old lady with a recent diagnosis of rheumatic heart disease (RHD), and a history of repeated lower respiratory tract infections, came with symptoms of gastritis unrelated to the primary disease but further diagnostic study in the hospital revealed poorly controlled atrial fibrillation, grossly dilated left atrium with two large left atrial thrombi and mitral valve area<1 cm(2). It was decided that the best approach in our patient would be mitral valve replacement with mechanical prosthesis. Despite the usual trend of using bioprosthesis in the elderly, our decision was influenced by the fact that the patient would need chronic anticoagulation for atrial fibrillation in any case. The purpose of our case presentation is to illustrate a late-presenting case of RHD with unusual associations and the challenges to choose the best possible management.

Effectiveness of assertive case management on repeat self-harm in patients admitted for suicide attempt: Findings from ACTION-J study.

PubMed

Furuno, Taku; Nakagawa, Makiko; Hino, Kosuke; Yamada, Tomoki; Kawashima, Yoshitaka; Matsuoka, Yutaka; Shirakawa, Osamu; Ishizuka, Naoki; Yonemoto, Naohiro; Kawanishi, Chiaki; Hirayasu, Yoshio

2018-01-01

Self-harm is an important risk factor for subsequent suicide and repetition of self-harm, and a common cause of emergency department presentations. However, there still remains limited evidence on intervention in emergency department settings for individuals who self-harm. This multicentre, randomised controlled trial was conducted at 17 general hospitals in Japan. In total, 914 adult patients admitted to emergency departments for a suicide attempt and had a DSM-IV-TR axis I disorder were randomly assigned to two groups, to receive either assertive case management (intervention) or enhanced usual care (control). Assertive case management was introduced by the case manager during emergency department admissions for suicide attempts, and continued after discharge. Interventions were provided until the end of the study period (for at least 18 months and up to 5 years). The number of overall self-harm episodes per person-year was significantly lower in the intervention group (adjusted incidence risk ratio (IRR) 0.88, 95%CI 0.80-0.96, p=0.0031). Subgroup analysis showed a greater reduction of overall self-harm episodes among patients with no previous suicide attempt at baseline (adjusted IRR 0.73, 95% CI 0.53-0.98, p=0.037). Patients younger than 20 years and patients who self-harmed but were not admitted to an emergency department were excluded. The present study showed that assertive case management following emergency admission for a suicide attempt reduced the incident rate of repeat overall self-harm. Copyright © 2017 Elsevier B.V. All rights reserved.

Crusted scabies in remote Australia, a new way forward: lessons and outcomes from the East Arnhem Scabies Control Program.

PubMed

Lokuge, Buddhi; Kopczynski, Alex; Woltmann, Angela; Alvoen, Faye; Connors, Christine; Guyula, Terrence; Mulholland, Eddie; Cran, Samantha; Foster, Tim; Lokuge, Kamalini; Burke, Tanya; Prince, Sam

2014-06-16

Crusted scabies is a highly infectious, debilitating and disfiguring disease, and remote Aboriginal communities of northern Australia have the highest reported rates of the condition in the world. We draw on monitoring data of the East Arnhem Scabies Control Program to discuss outcomes and lessons learnt through managing the condition in remote communities. Using active case finding, we identified seven patients with crusted scabies in three communities and found most had not presented to health services despite active disease. We compared presentations and hospitalisations for a cumulative total of 99 months during a novel preventive program with 99 months immediately before the program for the seven cases and seven sentinel household contacts. Our preventive long-term case management approach was associated with a significant 44% reduction in episodes of recurrent crusted scabies (from 36 to 20; P = 0.025) in the seven cases, and a non-significant 80% reduction in days spent in hospital (from 173 to 35; P = 0.09). It was also associated with a significant 75% reduction in scabies-related presentations (from 28 to 7; P = 0.017) for the seven sentinel household contacts. We recommend active surveillance and wider adoption of this preventive case management approach, with ongoing evaluation to refine protocols and improve efficiency. Contacts of children presenting with recurrent scabies should be examined to exclude crusted scabies. In households where crusted scabies is present, a diagnosis of parental neglect due to recurrent scabies and weight loss in children should be made with extreme caution. Improved coordination of care by health services, and research and development of new therapies including immunotherapies for crusted scabies, must be a priority.

A case of coexistence of TSH/GH-secreting pituitary tumor and papillary thyroid carcinoma: Challenges in pathogenesis and management.

PubMed

Kiatpanabhikul, Phatharaporn; Shuangshoti, Shanop; Chantra, Kraisri; Navicharern, Patpong; Kingpetch, Kanaungnit; Houngngam, Natnicha; Snabboon, Thiti

2017-07-01

Co-existence of thyrotropin/growth hormone-secreting pituitary adenoma with differentiated thyroid carcinoma is exceedingly rare, with less than 15 cases having been reported. Its clinical presentation and treatment strategy are challenging. We report a case of pituitary macroadenoma, with clinical syndromes of acromegaly and hyperthyroidism, and a thyroid nodule, with cytologically confirmed to be a papillary thyroid carcinoma. Clinical implications, focusing on the strategy for proper management, and possible pathogenesis were discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Facial nerve palsy: analysis of cases reported in children in a suburban hospital in Nigeria.

PubMed

Folayan, M O; Arobieke, R I; Eziyi, E; Oyetola, E O; Elusiyan, J

2014-01-01

The study describes the epidemiology, treatment, and treatment outcomes of the 10 cases of facial nerve palsy seen in children managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 10 year period. It also compares findings with report from developed countries. This was a retrospective cohort review of pediatric cases of facial nerve palsy encountered in all the clinics run by specialists in the above named hospital. A diagnosis of facial palsy was based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Information retrieved from the case note included sex, age, number of days with lesion prior to presentation in the clinic, diagnosis, treatment, treatment outcome, and referral clinic. Only 10 cases of facial nerve palsy were diagnosed in the institution during the study period. Prevalence of facial nerve palsy in this hospital was 0.01%. The lesion more commonly affected males and the right side of the face. All cases were associated with infections: Mainly mumps (70% of cases). Case management include the use of steroids and eye pads for cases that presented within 7 days; and steroids, eye pad, and physical therapy for cases that presented later. All cases of facial nerve palsy associated with mumps and malaria infection fully recovered. The two cases of facial nerve palsy associated with otitis media only partially recovered. Facial nerve palsy in pediatric patients is more commonly associated with mumps in the study environment. Successes are recorded with steroid therapy.

Anaesthesia in the Guillian-Barré syndrome. A case report and recommendations.

PubMed

Perel, A; Reches, A; Davidson, J T

1977-03-01

A large proportion of patients with the Guillain Barré syndrome show signs of involvement of the autonomic nervous system beside the better known motor and sensory features of this disease. These patients present a substantial anaesthetic risk because of autonomic dysfunction. We present here an illustrative case in which the administration of a low subarachnoid block resulted in cardiac arrest and offer suggestions for the anaesthetic management of such cases.

Lyme Disease: Emergency Department Considerations.

PubMed

Applegren, Nathan D; Kraus, Chadd K

2017-06-01

Lyme disease (LD) is the most common vector-borne illness in North America. Reported cases of LD have increased from approximately 10,000 cases annually in 1991 to >25,000 cases in 2014. Greater recognition, enhanced surveillance, and public education have contributed to the increased prevalence, as have geographic expansion and the number of infected ticks. Cases are reported primarily in the Northeastern United States, Wisconsin, and Minnesota, with children having the highest incidence of LD among all age groups. The increased incidence and prevalence of LD in the United States makes it increasingly more common for patients to present to the emergency department (ED) for tick bites and LD-related chief complaints, such as the characteristic erythema migrans skin manifestation. We sought to review the etiology of LD, describe its clinical presentations and sequela, and provide a practical classification and approach to ED management of patients with LD-related presentations. In this review, ED considerations for LD are presented and clinical presentations and management of the disease at different stages is discussed. Delayed sequelae that have significant morbidity, including Lyme carditis and Lyme neuroborreliosis, are discussed. Diagnostic tests and management are described in detail. The increasing prevalence and growing geographic reach of Lyme disease makes it critically important for emergency physicians to consider the diagnosis in patients presenting with symptoms suggestive of LD and to initiate appropriate treatment to minimize the potential of delayed sequelae. Special consideration should be made for the epidemiology of LD and a high clinical suspicion should be present for patients in endemic areas or with known exposures to ticks. Emergency physicians can play a critical role in the recognition, diagnosis, and treatment of LD. Copyright © 2017 Elsevier Inc. All rights reserved.

Bilateral juvenile nasopharyngeal angiofibroma: report of a case.

PubMed

Wu, Edward C; Chark, Davin W; Bhandarkar, Naveen D

2014-07-01

Juvenile nasopharyngeal angiofibroma (JNA) is the most common benign neoplasm of the nasopharynx. Almost always unilateral on diagnosis, JNAs are locally invasive and may extend across the midline, giving a false bilateral appearance; as such, true bilateral JNA is exceedingly rare. We present a recent case of true bilateral JNA. Single case report of a patient with bilateral JNA, including clinical presentation, diagnosis, and management. The patient presented with unilateral nasal obstruction and recurrent epistaxis. Computed tomography and magnetic resonance imaging demonstrated bilateral, noncontiguous masses. Angiography revealed independent vascular supplies from each respective side with no bilateral supply noted. The patient underwent preoperative embolization followed by endoscopic surgical removal of the larger mass; no complications were noted. Follow-up at 2 years demonstrated no recurrence or growth. The vast majority of JNAs are unilateral, though invasive growth to the contralateral side may appear "bilateral" in presentation. Proper identification of true bilateral JNA is helpful in guiding management, wherein excision of both tumors may not be necessary. © 2014 ARS-AAOA, LLC.

Pregnancy and childbirth in a patient with multiple sclerosis: A case report of successful management.

PubMed

Wang, Chun-Kai; Lin, Chi-Kang; Wang, Tun-Jun; Wang, Chen-Yu; Hsu, Po-Chao; Su, Her-Young

2018-06-01

Multiple sclerosis (MS) preferentially affects females of reproductive age, making reproduction an important issue for women with MS. An increased incidence of poor labor progress often results in assisted vaginal delivery or a cesarean section. However, with good pre-pregnancy counseling and management, women with MS can conceive and give birth safely. Here, we present a case of pregnancy with MS, which was carried to term uneventfully and ended with unassisted vaginal delivery. A 36-year-old woman was treated for MS for three years before she conceived. Because of her mild clinical presentation, medication was discontinued when her pregnancy was confirmed. Counseling was completed, and she had a smooth pregnancy course and gave birth vaginally at 38 weeks and two days. Based on this case report, women with mild clinical presentation of MS before pregnancy can conceive and carry successfully to term with no or improved disease presentation. Copyright © 2018. Published by Elsevier B.V.

Enrollment Management Issue Analysis: Operating in a Post-Katrina Higher Education Environment

ERIC Educational Resources Information Center

Jones, Jacqueline; Das, Nabakrishna; Huggins, Desiree'; McNeely, Stanton, III

2008-01-01

A definition and brief history of enrollment management are presented. The challenges represented by Hurricane Katrina for enrollment management at one community technical college and a private 4-year college are identified along with three cases that illuminate the challenges. The need for rapid response planning is articulated. (Contains 1…

Managing In-House Development of a Campus-Wide Information System

ERIC Educational Resources Information Center

Shurville, Simon; Williams, John

2005-01-01

Purpose: To show how a combination of hard and soft project and change management methodologies guided successful in-house development of a campus-wide information system. Design/methodology/approach: A case study of the methodologies and management structures that guided the development is presented. Findings: Applying a combination of the…

Psychotropic Medication Management in a Residential Group Care Program

ERIC Educational Resources Information Center

Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.

2010-01-01

This article presents a psychotropic medication management approach that is used within a residential care program. The approach is used to assess medications at youths' times of entry and to facilitate decision making during care. Data from a typical case study have indicated that by making medication management decisions slowly, systematically,…

The Life Cycle of Academic Management Fads. ASHE Annual Meeting Paper.

ERIC Educational Resources Information Center

Birnbaum, Robert

This study reviewed the literature to trace the evolution and life cycles of seven management techniques related to higher education. The seven case studies involved analysis of a selected sample of periodical, monograph, and technical literature from 1960 to the present. The literature base on each management technique was reviewed in reference…

Developmental Visual Dysfunction: Models for Assessment and Management.

ERIC Educational Resources Information Center

Erhardt, Rhoda Priest

This book describes transdisciplinary management of multiply disabled children with vision problems and presents four theoretical models of visual assessment and three illustrative case studies in a sequence appropriate to the learning process. The first three models are intended to lead to assessment and management of the child and the last to…

Management of refractory anti-phospholipid syndrome.

PubMed

Scoble, Tina; Wijetilleka, Sonali; Khamashta, Munther A

2011-09-01

Anti-phospholipid syndrome (APS) is an autoimmune prothrombotic disorder characterised by the predisposition to venous and/or arterial thrombosis and obstetric morbidity. Management of APS centres on attenuating the procoagulant state whilst balancing the risks of anticoagulant therapy. Cases of recurrent thromboses and obstetric complications occur despite optimum therapy. Alternative therapies for refractory cases are subject to disparity among clinicians due to the current lack of clinical evidence present. This review aims to address the current management strategies for refractory thrombotic and obstetric cases and future therapeutic interventions. The role and current clinical evidence of using long term low molecular weight heparin (LMWH) as an alternative to warfarin therapy for refractory thromboses is evaluated. Potential alternatives for thromboses including statins, hydroxychloroquine, Rituximab are reviewed as well as the additional avenues to target in the future as the pathogenic mechanisms of APS are unveiled. The optimal management for refractory obstetric APS cases is subject to controversy. This review focuses and assesses the current evidence for the uses of low dose prednisolone, intravenous immunoglobulin and hydroxycholoroquine in obstetric cases. The treatment modalities for the management of refractory APS require further clinical evidence. Copyright © 2011 Elsevier B.V. All rights reserved.

Early excision and grafting, an alternative approach to the surgical management of large body surface area levamisole-adulterated cocaine induced skin necrosis.

PubMed

Miner, Jason; Gruber, Paul; Perry, Travis L

2015-05-01

Levamisole-adulterated cocaine as a cause of retiform purpura progressing to full-thickness skin necrosis was first documented in 2003 and currently comprises over 200 reported cases. Whereas, its presentation, pathophysiology, and diagnostic workup have been reasonably well-defined, only one publication has significantly detailed its surgical management. For this reason there exists a relative absence of data in comparison to its reported incidence to suggest a preferred treatment strategy. In the case mentioned, treatment emphasized delayed surgical intervention while awaiting lesion demarcation and the monitoring of autoantibodies. At our institution we offer an alternative approach and present the case of a 34 year old female who presented with 49% TBSA, levamisole-induced skin necrosis managed with early surgical excision and skin grafting. The patient presented three days following cocaine exposure with painful, purpura involving the ears, nose, buttocks, and bilateral lower extremities which quickly progressed to areas of full-thickness necrosis. Lab analysis demonstrated elevated p-ANCA and c-ANCA, as well as leukopenia, decreased C4 complement, and urinalysis positive for levamisole, corroborating the diagnosis. Contrasting the most thoroughly documented case in which the patient underwent first surgical excision on hospital day 36 and underwent 18 total excisions, our patient underwent first excision on hospital day 10 and received only one primary excision prior to definitive autografting. To our knowledge, this is the largest surface area surgically treated that did not result in surgical amputation or autoamputation of limbs or appendages, respectively. We contend that early excision and grafting provides optimal surgical management of this syndrome while avoiding the morbidity seen with delayed intervention. Published by Elsevier Ltd.

Getting ready for petaflop capacities and beyond: a utility perspective

NASA Astrophysics Data System (ADS)

Hamelin, J. F.; Berthou, J. Y.

2008-07-01

Why should EDF, the leading producer and marketer of electricity in Europe, start adding teraflops to its terawatt-hours and become involved in high-performance computing (HPC)? In this paper we answer this question through examples of major opportunities that HPC brings to our business today and, we hope well into the future of petaflop and exaflop computing. Five cases are presented dealing with nondestructive testing, nuclear fuel management, mechanical behavior of nuclear fuel assemblies, water management, and energy management. For each case we show the benefits brought by HPC, describe the current level of numerical simulation performance, and discuss the perspectives for future steps. We also present the general background that explains why EDF is moving to this technology and briefly comment on the development of user-oriented simulation platforms.

The Unexpected Ovarian Pregnancy at Laparoscopy: A Review of Management.

PubMed

Tabassum, Meher; Atmuri, Kiran

2017-01-01

Ovarian ectopic pregnancies are a rare occurrence; however the incidence is on the rise. Preoperative diagnosis remains difficult due to nonspecific clinical symptoms and USS findings. Most patients undergo diagnostic laparoscopy with subsequent surgical management. We present the case of a 32-year-old female who presented with vaginal bleeding and an unsited pregnancy, with a BhCG of 24693. Formal USS described unruptured right tubal ectopic with ovarian pregnancy being diagnosed at laparoscopy. A wedge resection was conducted to preserve ovarian function. Postoperative recovery was uneventful and BhCG levels returned to zero (nonpregnant) in an outpatient setting. Although laparoscopy remains the gold standard of diagnosis and treatment, in this case report we discuss benefits of early diagnosis for fertility conserving management, including nonsurgical options.

Management of penoscrotal extramammary Paget disease: case series and review of the literature

PubMed Central

Moretto, P.; Nair, V.J.; Hallani, S. El; Malone, S.; Belanger, E.; Morash, C.; Canil, C.M.

2013-01-01

Extramammary Paget disease (empd) is a rare, slow-growing neoplasm, considered to be an adenocarcinoma of the apocrine glands. In men, the penoscrotal region is the most commonly affected area. The disease can present as carcinoma in situ or as invasive disease that can subsequently metastasize to lymph nodes and distant sites. Because of the rarity of empd, the medical literature available to guide management of the disease is limited, particularly in patients with metastases. In addition, metastatic disease may pose a diagnostic challenge, because invasive cancer of the genitourinary or gastrointestinal tract can occur in association with empd. In the present case series, we describe our experience in treating penoscrotal empd with multimodality therapy, and we review the existing literature concerning its diagnosis and management. PMID:23904770

Triple confusion: An interesting case of proteinuria in pregnancy.

PubMed

Guru, Pramod K; Ramaeker, Devon M; Jeybalan, Arundhathi; Shah, Nirav A; Bastacky, Sheldon; Liang, Kelly V

2016-01-01

Pregnancy-related renal diseases are unique and need special attention, both for diagnosis and management. The major confounding factors for diagnosis are the physiological multiorgan changes that occur throughout the gestational period. Proper diagnosis of the renal disease is also important, given the impact of varied management options both on the maternal and fetal health. A young middle-aged female with a long-standing history of diabetes presented to the hospital with worsening proteinuria in her second trimester of pregnancy. Clinical history, examinations, and laboratory analysis did not give any clues for diagnosis of a specific disease entity. This led us to take the risk of renal biopsy for a tissue diagnosis. The odds of renal biopsy favored the management decision in her case, thereby avoiding the confusions prior to biopsy. The pathological diagnosis is a surprise though not a unique entity on its own (minimal change disease in pregnancy). The case illustrates the disparity of clinical presentations and the pathology in patients, and the importance of renal biopsy in pregnant patients in particular.

A rare case of failed healing in previously burned skin after a secondary burns.

PubMed

Goldie, Stephen J; Parsons, Shaun; Menezes, Hana; Ives, Andrew; Cleland, Heather

2017-01-01

Patients presenting with large surface area burns are common in our practice; however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported. We report on an unusual case of a patient sustaining a secondary large burn to areas previously injured by a burn from a different mechanism. We discuss the potential implications when managing a case like this and suggest potential biological reasons why the skin may behave differently. Our patient was a 33-year-old man who presented with a 5% TBSA burn on skin scarred by a previous 40% total body surface area (TBSA) burn and skin grafts. Initially assessed as superficial partial thickness in depth, the wounds were treated conservatively with dressings; however, they failed to heal and became infected requiring surgical management. Burns sustained in areas of previous burn scars and grafts may behave differently to normal patterns of healing, requiring more aggressive management and surgical intervention at an early stage.

Management of ingested foreign bodies in childhood and review of the literature.

PubMed

Arana, A; Hauser, B; Hachimi-Idrissi, S; Vandenplas, Y

2001-08-01

The management of ingested foreign bodies in children is not standardised. During a 15-year period, we recorded 325 consecutive paediatric cases of accidental ingestion of foreign bodies or with symptoms suggesting oesophageal obstruction presented at the emergency department or the paediatric gastroenterology unit. The foreign bodies that had to be removed were, in decreasing order of frequency: coins, toy parts, jewels, batteries, sharp materials such as needles and pins, fish and chicken bones, and "large" amounts of food. Only 54% of the patients had transient symptoms at the moment of ingestion, such as retrosternal pain, cyanosis and dysphagia. A minority (28, 9%) of foreign bodies could be removed with a McGill forceps; 65 (20%) were removed with a magnet probe. Endoscopic removal was performed in 82 cases (25%). In the majority of cases (150, 46%) natural elimination occurred. The outcome of all patients was uneventful. Recommendations for management of children presenting with a history of suspected accidental ingestion of a foreign body for the community paediatrician are proposed.

Civilian blast-related burn injuries

PubMed Central

Patel, J.N.; Tan, A.; Dziewulski, P.

2016-01-01

Summary There is limited English literature describing the experience of a civilian hospital managing blast-related burn injuries. As the largest regional burn unit, we reviewed our cases with the aim of identifying means to improve current management. A 6-year retrospective analysis of all patients coded as sustaining blast-related burns was conducted through the unit’s burns database. Medical case notes were reviewed for information on burn demographics, management and outcomes. 42 patients were identified. Male to female ratio was 37:5. Age range was 12-84 years, (mean=33 years). Total body surface area (%TBSA) burn ranged from 0.25% to 60%, (median=1%). The most common burn injury was flame (31/42, 73.8%). Gas explosions were the most common mechanism of injury (19 cases; 45.2%). 7/42 cases (16.7%) had full ATLS management pre-transfer to the burns unit. The Injury Severity Score (ISS) ranged from 0-43 (median=2). 17/42 (40.4%) patients required admission. 37/36 (88.1%) patients were managed conservatively of which 1 patient later required surgery due to deeper burns. 5/42 (11.9%) patients required surgical management at presentation and these were noted to be burns with >15% TBSA requiring resuscitation. One case required emergency escharotomies and finger amputations. All patients survived their burn injuries. Blast-related burn injuries are generally uncommon in the civilian setting. Following proper assessment, most of these cases can be deemed as minor injuries and managed conservatively. Improvement in burns management education and training at local emergency departments would provide efficient patient care and avoid unnecessary referrals to a burns unit. PMID:27857651

Otic Langerhans' Cell Histiocytosis in an Adult: A Case Report and Review of the Literature

PubMed Central

Gungadeen, Anil; Kullar, Peter; Yates, Philip

2013-01-01

Objective. To present a case of otic Langerhans' cell histiocytosis in an adult. Also included the diagnosis and management of the condition and a review of the relevant literature. Case Report. We report a case of a 41-year-old man with a history of persistent unilateral ear discharge associated with an aural polyp. Radiological imaging showed bony lesions of the skull and a soft-tissue mass within the middle ear. Histological analysis of the polyp demonstrated Langerhans' cell histiocytosis. His otological symptoms were completely resolved with the systemic therapy. Conclusions. Otic Langerhans' cell histiocytosis can present in adults. Persistent ear symptoms along with evidence of soft-tissue masses within the ear and bony lesions of the skull or elsewhere should prompt the otolaryngologists to include Langerhans' cell histiocytosis in their differential diagnosis. Management should be with systemic therapy rather than local surgical treatment. PMID:23762704

A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries

PubMed Central

Zorlu, Sevgi; Cankaya, Abdulkadir Burak; Aktoren, Oya; Gencay, Koray

2015-01-01

The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case. PMID:26339511

Intravascular ultrasound and angiographic demonstration of left main stem thrombus-high-risk presentation in a young adult with anabolic steroid abuse.

PubMed

Garg, Pankaj; Davis, Gershan; Wilson, John Ian; Sivananthan, Mohan

2010-01-01

We present a case of acute myocardial infarction in a young adult with a history of anabolic steroid abuse. On diagnostic coronary angiography and intravascular ultrasound, he was found to have a distal left main stem thrombus extending into the proximal left anterior descending artery and a large intermediate vessel. As he was hemodynamically stable and pain-free, he was managed conservatively with triple antiplatelet therapy (aspirin, clopidogrel, and abciximab). This was also to avoid the risk of 'wiring the vessel,' especially if there was underlying dissection. Repeat angiography a few weeks later showed complete thrombus resolution. This is the first reported case of extensive left main stem thrombus in a young patient with anabolic steroid abuse. Management of such cases is not straightforward and our case highlights one approach to both diagnosis and treatment.

An ovary as unusual contents of an incarcerated umbilical hernia

PubMed Central

Ahmed, R; Kamat, S; Elkholy, K

2014-01-01

We present the unusual case of a woman presenting with an incarcerated umbilical hernia. Intraoperatively, the contents of the hernia were found to be an ovary. We outline the clinical presentation of our patient, investigations and management as well as a discussion on unusual contents of umbilical hernias. To our knowledge, this is the first case of a non-malignant ovary incarcerated in an umbilical hernia. PMID:25198958

An ovary as unusual contents of an incarcerated umbilical hernia.

PubMed

Ahmed, U; Ahmed, R; Kamat, S; Elkholy, K

2014-09-01

We present the unusual case of a woman presenting with an incarcerated umbilical hernia. Intraoperatively, the contents of the hernia were found to be an ovary. We outline the clinical presentation of our patient, investigations and management as well as a discussion on unusual contents of umbilical hernias. To our knowledge, this is the first case of a non-malignant ovary incarcerated in an umbilical hernia.

Adaptive management of rangeland systems

USGS Publications Warehouse

Allen, Craig R.; Angeler, David G.; Fontaine, Joseph J.; Garmestani, Ahjond S.; Hart, Noelle M.; Pope, Kevin L.; Twidwell, Dirac

2017-01-01

Adaptive management is an approach to natural resource management that uses structured learning to reduce uncertainties for the improvement of management over time. The origins of adaptive management are linked to ideas of resilience theory and complex systems. Rangeland management is particularly well suited for the application of adaptive management, having sufficient controllability and reducible uncertainties. Adaptive management applies the tools of structured decision making and requires monitoring, evaluation, and adjustment of management. Adaptive governance, involving sharing of power and knowledge among relevant stakeholders, is often required to address conflict situations. Natural resource laws and regulations can present a barrier to adaptive management when requirements for legal certainty are met with environmental uncertainty. However, adaptive management is possible, as illustrated by two cases presented in this chapter. Despite challenges and limitations, when applied appropriately adaptive management leads to improved management through structured learning, and rangeland management is an area in which adaptive management shows promise and should be further explored.

Case report: a branchial cleft anomaly presenting as an oropharyngeal mass.

PubMed

Mullin, David; Merz, Meredith

2011-12-01

Branchial anomalies are common cervical pathologic entities encountered in the field of otolaryngology and are typical in the pediatric and young adult populations. In most cases, these anomalies present as a cyst, sinus, or fistula in a rather stereotypical fashion. When a branchial anomaly deviates from the classic presentation, an improper diagnosis and inadequate management are more likely to occur, leading to an increased recurrence rate. We present a case of a 6-year-old girl with an incidental finding of a right posterior oropharyngeal wall mass, distinctly separate from the tonsillar fossa, which was found on pathologic analysis to be a branchial cleft anomaly. The theories regarding the pathogenesis of branchial anomalies are presented, along with other cases of atypical branchial anomalies.

An update on the causes, assessment and management of third division sensory trigeminal neuropathies.

PubMed

Carter, E; Yilmaz, Z; Devine, M; Renton, T

2016-06-24

Introduction Sensory neuropathies of the mandibular division of the trigeminal (V3) nerve can be debilitating, causing difficulty with daily function. It has a variety of causes, including iatrogenic injury, usually caused by third molar removal, local anaesthetic administration, implant placement or endodontic treatment. Non-iatrogenic causes include infection, primary or secondary neoplasia and various medical conditions.Objective To review the aetiology, evaluation and management of V3 neuropathy in a retrospective case-series of patients referred to a specialist nerve injury clinic over an eight-year period, particularly focusing on the non-iatrogenic causes of this presentation.Methods A retrospective analysis of the case notes of 372 patients referred to the specialist nerve injury clinic between 2006 and 2014 was carried out to establish the cause of the neuropathy and subsequent management or referral. The assessment protocol of trigeminal neuropathy used in the clinic is also outlined.Results Most patients (89.5%) presented with neuropathy due to iatrogenic injury. Of the non-iatrogenic causes (10.5%), malignancy accounted for a fifth of presentations, and infection almost two-fifths, demonstrating the importance of prompt identification of a cause and management by the clinician, or referral to the appropriate specialty. Other, more rare causes are also presented, including multiple sclerosis, sickle-cell anaemia and Paget's disease, highlighting the importance to the clinician of considering differential diagnoses.Conclusions This case series demonstrates the less frequent, but nevertheless important, non-iatrogenic causes which clinicians should consider when assessing patients with trigeminal neuropathy.

Informing the public health management of typhoid and paratyphoid: the Australian context.

PubMed

Young, Megan K; Slinko, Vicki; Smith, James; Carroll, Heidi; Bennett, Sonya; Appleton, Sally; McCall, Brad J

2015-12-01

To examine outcomes of public health management of notified enteric fever cases in South-East Queensland over the past five years. Notification records of typhoid and paratyphoid infection in South-East Queensland 2008-2012 (inclusive) were reviewed to determine likelihood of cases and contacts adhering to present or previous recommendations for faecal clearance/screening, duration of infectiousness of cases and extent of local transmission to contacts. Sixty-nine of 85 cases and 218 of 265 contacts submitted at least one faecal specimen. Cases were 2.7 (95%CI 1.2-6.0) and contacts were 4.4 (95%CI 3.0-6.4) times more likely to complete recommended faecal clearance/screening under previous compared to present guidelines (requiring more specimens). In ten cases with positive post-treatment specimens, last recorded infectiousness was 19 days to six months after notification. The documented rate of local transmission of infection was 18/1,000 contacts submitting at least one faecal specimen (95%CI 6-48/1,000). Local transmission risk of enteric fever in South-East Queensland is low, although small numbers of cases may have prolonged bacilli excretion post-treatment. More complex clearance/screening regimens are associated with decreased compliance. Pursuing extensive faecal clearance/screening regimens is unlikely to be effective in terms of public health management of enteric fever in South-East Queensland. We suggest a unified national approach focussing on cases/contacts at high risk of disease transmission. © 2015 Public Health Association of Australia.

Unusual Presentation of Melioidosis in a Case of Pseudoaneurysm of Descending Thoracic Aorta: Review of Two Case Reports

PubMed Central

Padmaja, Kanne; Lakshmi, Vemu; Sudhaharan, Sukanya; Venkata Surya Malladi, Subbalaxmi; Gopal, Palanki; Venkata Ravinuthala, Kumar

2015-01-01

Introduction: Melioidosis is a rapidly fatal infectious disease caused by Burkholderia pseudomallei, an agent of potential biothreat, endemic in several parts of India. Most melioidosis-induced infected aneurysms are located in the abdominal or thoracic aorta. Case Presentation: We reported two unusual cases of melioidosis resulting in pseudoaneurysm of the descending thoracic aorta. In both cases, blood cultures yielded B. pseudomallei. The first patient was managed with resection of aneurysm and reconstruction with Dacron graft followed by medical treatment and was discharged uneventfully. The second patient died within one week of admission before the infecting etiological agent was identified and aneurysmal repair was planned. Conclusions: A high clinical index of suspicion, especially in areas of endemicity is essential for timely management of intracavitary infected pseudoaneurysms caused by B. pseudomallei and use of rapid microbiological techniques, such as bact/alert 3D system, which enables rapid and early recovery of the etiological agent. PMID:26380820

Rupture of an ascending and descending thoracic aortic aneurysm causing tension hemothorax: a case report.

PubMed

Pizon, Anthony; Bissell, Brad J; Gilmore, Nathan

2012-10-01

A ruptured thoracic aortic aneurysm is a life-threatening condition and can lead to a tension hemothorax. To describe the presentation and management of a case of a tension hemothorax. An 84-year-old woman presented in respiratory distress and was found to have a tension hemothorax. The cause was the rupture of an ascending and descending thoracic aortic aneurysm. She was managed with intubation, mechanical ventilation, and chest tube placement with stabilization. Definitive operative repair was deferred due to the patient's comorbidities and wishes of the family. A tension hemothorax can result from an ascending and descending thoracic aneurysm, as this case describes. Emergent therapy is necessary as this is a life-threatening condition. Copyright © 2012 Elsevier Inc. All rights reserved.

Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report

PubMed Central

Mortimer, Alex; Stubbs, Euan; Cookson, Daniel; Dawson, Raymond; Fleet, Mustafa

2009-01-01

Vertebro-vertebral arteriovenous fistulae occur infrequently. We report on such a case with delayed presentation following penetrating neck injury. This was successfully treated via coil embolisation. A 40-year-old woman presented with a subjective tinnitus that was abolished by turning her head to the right. She had sustained penetrating neck trauma 6 months earlier. Doppler Ultrasound and magnetic resonance angiogram confirmed the presence of a vertebral arterio-venous fistula. Using a trans-femoral arterial approach, the left vertebral artery was embolised by deployment of multiple coils. The patient had no return of symptoms at 3 months follow up. Radiological diagnosis and endovascular management of this condition is discussed. PMID:22470664

Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report.

PubMed

Mortimer, Alex; Stubbs, Euan; Cookson, Daniel; Dawson, Raymond; Fleet, Mustafa

2009-01-01

Vertebro-vertebral arteriovenous fistulae occur infrequently. We report on such a case with delayed presentation following penetrating neck injury. This was successfully treated via coil embolisation. A 40-year-old woman presented with a subjective tinnitus that was abolished by turning her head to the right. She had sustained penetrating neck trauma 6 months earlier. Doppler Ultrasound and magnetic resonance angiogram confirmed the presence of a vertebral arterio-venous fistula. Using a trans-femoral arterial approach, the left vertebral artery was embolised by deployment of multiple coils. The patient had no return of symptoms at 3 months follow up. Radiological diagnosis and endovascular management of this condition is discussed.

Food Culture, Preferences and Ethics in Dysphagia Management.

PubMed

Kenny, Belinda

2015-11-01

Adults with dysphagia experience difficulties swallowing food and fluids with potentially harmful health and psychosocial consequences. Speech pathologists who manage patients with dysphagia are frequently required to address ethical issues when patients' food culture and/ or preferences are inconsistent with recommended diets. These issues incorporate complex links between food, identity and social participation. A composite case has been developed to reflect ethical issues identified by practising speech pathologists for the purposes of illustrating ethical concerns in dysphagia management. The case examines a speech pathologist's role in supporting patient autonomy when patients and carers express different goals and values. The case presents a 68-year-old man of Australian/Italian heritage with severe swallowing impairment and strong values attached to food preferences. The case is examined through application of the dysphagia algorithm, a tool for shared decision-making when patients refuse dietary modifications. Case analysis revealed the benefits and challenges of shared decision-making processes in dysphagia management. Four health professional skills and attributes were identified as synonymous with shared decision making: communication, imagination, courage and reflection. © 2015 John Wiley & Sons Ltd.

Necrotizing fasciitis as a complication of odontogenic infection: a review of management and case series.

PubMed

Bayetto, K; Cheng, A; Sambrook, P

2017-09-01

The aims of the present study were to establish the incidence of head and neck necrotizing fasciitis (NF) in the Adelaide Oral and Maxillofacial Surgery Unit; review the current literature regarding the management of head and neck NF; and determine the evidence for the role of hyperbaric oxygen therapy in the management of NF. A retrospective audit of all patients admitted to the Royal Adelaide Hospital Oral and Maxillofacial Surgery Unit 2006-2015 with severe odontogenic infections was carried out. Patient demographics were recorded and treatment details were collected and analysed. A total of 672 patients were admitted for management of severe odontogenic infections. Of these, three were identified as NF. One case was treated using hyperbaric oxygen as an adjunct to conventional surgical and medical management. Two cases were managed using aggressive surgical management alone. Two patients survived. The incidence of head and neck NF in South Australia is 48/100 000 infections per year. The first-line treatment of severe odontogenic infections remains conventional surgical and medical management; however, hyperbaric oxygen therapy may have an additional role in the management of NF and other rare severe infections in medically complex patients. © 2017 Australian Dental Association.

Facility Benchmarking Trends in Tertiary Education - An Australian Case Study.

ERIC Educational Resources Information Center

Fisher, Kenn

2001-01-01

Presents how Australia's facility managers are responding to the growing impact of tertiary education participation and the increase in educational facility usage. Topics cover strategic asset management and the benchmarking of education physical assets and postsecondary institutions. (GR)

Attaining Success for Beginning Special Education Teachers.

ERIC Educational Resources Information Center

McCabe, Marjorie; And Others

1993-01-01

Three case studies are presented that highlight problem scenarios relating to beginning special education intern teachers and explain how the teachers attained success. The cases focus on classroom management, adaptation of the core curriculum, and knowledge of instructional practices. (JDD)

Professionalism in Residency Training

PubMed Central

Gronowski, Ann M.; McGill, Mitchell R.

2016-01-01

Professionalism is one of the most important competencies for physicians but is also the most difficult to teach, assess, and manage. To better understand professionalism in pathology, we surveyed practicing pathologists and pathology residents and fellows in training. We identified 12 key desirable attributes of professionalism. In addition, 8 case scenarios highlighting unprofessional behavior were presented, and results between pathologists in practice and in training were compared. No significant differences between attending pathologists and residents were identified in how these cases should be managed. Our study demonstrated remarkable concordance between practicing pathologists and residents as to what constitutes professionalism and how to manage unprofessional behavior. Our case-based approach can be a useful technique to teach professionalism to both pathologists in practice and in training. PMID:28725778

Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion.

PubMed

Palta, Renee; Sahota, Amandeep; Bemarki, Ali; Salama, Paul; Simpson, Nicole; Laine, Loren

2009-03-01

Previous reports of foreign-body ingestions focused primarily on accidental ingestions. To describe the characteristics and management of foreign-body ingestions, with predominantly intentional ingestion, in a lower socioeconomic status population. A retrospective case series. An urban county hospital. Patients >/=17 years old, with foreign-body ingestions between 2000 and 2006. Characteristics of ingestion cases, endoscopic extraction, need for surgery, and complications. Among 262 cases, 92% were intentional, 85% involved psychiatric patients, and 84% occurred in patients with prior ingestions. The time from ingestion to presentation was >48 hours in 168 cases (64%). The overall success rate for endoscopic extraction was 90% (165/183 cases). Surgery was performed in 30 cases (11%) and was more common for objects beyond the pylorus versus objects above the pylorus (16/43 [37%] vs 10/151 [7%], respectively) and in cases with a greater delay from ingestion to presentation (25/168 [15%] if >48 hours vs 4/77 [5%] if 48 hours vs 14/165 [8%] if

Nasopharyngeal branchial cysts-diagnosis and management: a case series.

PubMed

Flis, Daniel W; Wein, Richard O

2013-02-01

Nasopharyngeal branchial cysts (NBCs) have been discussed in the literature in only a limited number of publications. Differing from Tornwaldt cysts, NBCs present laterally and arise from the fossa of Rosenmuller and may track superiorly within the bony confines of the Eustachian tube. Initially patients are asymptomatic but may present with aural fullness, unilateral conductive hearing loss, and serous otitis media as the cyst mass grows. Two of our three patients had the lesion incidentally identified at the time of assessment for another diagnosis. In this case series, imaging characteristics and response to treatment are reviewed. A literature search was performed to summarize the management options for this entity.

Bilateral ovarian fibrothecoma. An uncommon cause of a large pelvic mass

PubMed Central

Salemis, Nikolaos S.; Panagiotopoulos, Nikolaos; Papamichail, Vera; Kiriakopoulos, Konstantinos; Niakas, Evangelos

2010-01-01

Ovarian fibrothecomas are uncommon tumors of gonadal stromal cell origin. They account for 3–4% of all ovarian tumors and in 90% of the cases are unilateral. Here, we describe a rare case of a bilateral ovarian fibrothecoma in a postmenopausal woman who presented with a large pelvic mass and metrorrhagia. Diagnostic evaluation and surgical management are discussed along with a brief review of the literature. Although rare, ovarian fibrothecoma should be considered in patients presenting with a large pelvic mass and postmenopausal bleeding. Radical surgery is the preferred management strategy for postmenopausal women with bilateral ovarian fibrothecomas and is associated with a good prognosis. PMID:22096681

Bilateral ovarian fibrothecoma. An uncommon cause of a large pelvic mass.

PubMed

Salemis, Nikolaos S; Panagiotopoulos, Nikolaos; Papamichail, Vera; Kiriakopoulos, Konstantinos; Niakas, Evangelos

2011-01-01

Ovarian fibrothecomas are uncommon tumors of gonadal stromal cell origin. They account for 3-4% of all ovarian tumors and in 90% of the cases are unilateral. Here, we describe a rare case of a bilateral ovarian fibrothecoma in a postmenopausal woman who presented with a large pelvic mass and metrorrhagia. Diagnostic evaluation and surgical management are discussed along with a brief review of the literature. Although rare, ovarian fibrothecoma should be considered in patients presenting with a large pelvic mass and postmenopausal bleeding. Radical surgery is the preferred management strategy for postmenopausal women with bilateral ovarian fibrothecomas and is associated with a good prognosis.

Laser therapy in general dental practice

NASA Astrophysics Data System (ADS)

Darbar, Arun A.

2006-02-01

This is a clinical presentation on the use of laser therapy in a private dental practice using a 810nm diode. A wide range of conditions involving pain management, treatment and as an adjunct to procedures to enhance patient comfort and experience. This will include cases treated for TMD (Temporo mandibular dysfunction), apthous ulcers, angular chelitis, cold sores, gingival retraction, periodontal treatment and management of failing dental implants. The case presentation will include the protocols used and some long term reviews. The results have been very positive and will be shared to enable this form of treatment to be used more frequently and with confidence within dental practice.

Parenteral organophosphorus poisoning in a rural emergency department: a case report

PubMed Central

2013-01-01

Background Poisoning is a common presentation in the emergency department. Oral exposures to organophosphorus compounds are especially frequent in rural and agricultural regions of South Asia and throughout the developing world. Case presentation Here we report a case of deliberate self-harm with an organophosphorus pesticide via the relatively uncommon parenteral route. A young woman injected herself with chlorpyriphos. Although the cholinergic effects were mild, cellulitis and abscess development were noted as a result. Conclusion Resource limited agricultural countries like Nepal present health care workers with numerous challenges in poisoning management. This case represents a rare but potentially morbid method of agrochemical poison exposure. PMID:24321121

Neurosurgical rare disease: solitary plasmacytoma of the skull - case report and literature review.

PubMed

Rizea, Radu Eugen; Popescu, Mihai; Gheorghiţă, Karina Lidia; Popescu, George; Neamţu, Marius Cristian; Busuioc, Cristina Jana; Ciurea, Alexandru Vlad

2018-01-01

Solitary extranevraxial plasmacytoma (SEP), as a clinical entity without signs of systemic myelomatosis, is extremely rare; it is difficult to find literature on the issue of patient management and proper course of action in the presence of associated pathology. The authors present a rare case of plasmacytoma of the skull vault associated with severe cardiac pathology, which made surgery extremely difficult and possible only through temporization of the interventions, as presented. We discuss our findings and opportunities for treatment in this case, which seemed unapproachable at presentation, in connection with the associated cardiac pathology. The case was followed-up for eight years with no recurrences.

Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation

PubMed Central

Jit, Mark; Stagg, Helen R; Aldridge, Robert W; White, Peter J

2011-01-01

Objective To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis. Design Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis. Setting London, United Kingdom. Population Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London’s enhanced tuberculosis surveillance system. Main outcome measures Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service. Results The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10 000/QALY gained (about €7300-€11 000 or $10 000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18 000-£26 000/QALY gained; case management support team, £4100-£6800/QALY gained). Conclusions Both the screening and case management components of the Find and Treat service are likely to be cost effective in London. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance. PMID:22067473

Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation.

PubMed

Jit, Mark; Stagg, Helen R; Aldridge, Robert W; White, Peter J; Abubakar, Ibrahim

2011-09-14

To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis. Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis. London, United Kingdom. Population Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London's enhanced tuberculosis surveillance system. Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service. The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10,000/QALY gained (about €7300-€11,000 or $10,000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18,000-£26,000/QALY gained; case management support team, £4100-£6800/QALY gained). Both the screening and case management components of the Find and Treat service are likely to be cost effective in London. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance.

Krazy Glue® in the ear: A case report of child abuse.

PubMed

Sorichetti, Brendan D; Fandiño, Marcela; Kozak, Frederick K

2018-06-01

Krazy Glue ® or cyanoacrylate glue is an acrylic resin that polymerizes in less than a minute when in contact with moisture or water. We present a case of a one month old referred to our tertiary pediatric otolaryngology clinic from an outside emergency department with a history of application of cyanoacrylate glue in the external ear canals. This report presents the management of this case along with the medical and legal outcomes surrounding this case of child abuse. Copyright © 2018. Published by Elsevier B.V.

Real-world use of the risk-need-responsivity model and the level of service/case management inventory with community-supervised offenders.

PubMed

Dyck, Heather L; Campbell, Mary Ann; Wershler, Julie L

2018-06-01

The risk-need-responsivity model (RNR; Bonta & Andrews, 2017) has become a leading approach for effective offender case management, but field tests of this model are still required. The present study first assessed the predictive validity of the RNR-informed Level of Service/Case Management Inventory (LS/CMI; Andrews, Bonta, & Wormith, 2004) with a sample of Atlantic Canadian male and female community-supervised provincial offenders (N = 136). Next, the case management plans prepared from these LS/CMI results were analyzed for adherence to the principles of risk, need, and responsivity. As expected, the LS/CMI was a strong predictor of general recidivism for both males (area under the curve = .75, 95% confidence interval [.66, .85]), and especially females (area under the curve = .94, 95% confidence interval [.84, 1.00]), over an average 3.42-year follow-up period. The LS/CMI was predictive of time to recidivism, with lower risk cases taking longer to reoffend than higher risk cases. Despite the robust predictive validity of the LS/CMI, case management plans developed by probation officers generally reflected poor adherence to the RNR principles. These findings highlight the need for better training on how to transfer risk appraisal information from valid risk tools to case plans to better meet the best-practice principles of risk, need, and responsivity for criminal behavior risk reduction. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Management of Mucosal Basal Cell Carcinoma of the Lip: An Update and Comprehensive Review of the Literature.

PubMed

Loh, Tiffany; Rubin, Ashley G; Brian Jiang, Shang I

2016-12-01

Basal cell carcinoma (BCC) is the most common malignancy in the United States. Most BCCs occur on cutaneous surfaces, but rare cases on the mucosal lip have also been documented. Because only a small number of mucosal BCC (mBCC) cases have been reported, data on their clinical characteristics and management are limited. To perform an updated literature review of the management of mBCCs on the lip. A comprehensive literature review was conducted through a search of the PubMed database with the key phrases "mucosal basal cell carcinoma," "basal cell carcinoma mucosa," and "basal cell carcinoma lip mucosa." Forty-eight cases of mBCCs have been reported, and 35 had sufficient data for analysis. The average age at presentation was 66.8 years, and 57% (n = 20) had a history of skin cancer. Most cases were treated with surgical excision or Mohs micrographic surgery (MMS), with only 1 recurrence in the literature. Furthermore, the authors present 8 additional cases of mBCCs successfully treated with MMS. Mucosal basal cell carcinomas are rare, and skin cancer history may be a risk factor. Because the lip is a cosmetically and functionally important area, MMS may be the preferred treatment method for mBCCs in this location.

Management of starvation in a Role 1 setting.

PubMed

Jeffery, S M T; Freshwater, D A

2012-01-01

Historical reports from war and natural disasters first identified the dangers of reintroducing food after a period of starvation or malnutrition. The development of advanced nutritional support for hospitalised patients gave rise to the concept of refeeding syndrome, further highlighting the problems and leading to the development of guidelines and protocols for managing malnutrition. In this paper we present a case of starvation in the maritime setting and review the pathophysiology of starvation and refeeding. We discuss the problems associated with managing acute starvation in a Role 1 setting without access to higher medical care, and present guidance for its management.

Guidelines for the management of human brucellosis in the State of Paraná, Brazil.

PubMed

Tuon, Felipe Francisco; Cerchiari, Natacha; Cequinel, Juliana Clélia; Droppa, Elizabeth El Hajjar; Moreira, Suzana Dal Ri; Costa, Tânia Portella; Navarro, Amanda de Paula Boni; Handar, Antonieta Milleo; Souza, Margely Nunes de

2017-01-01

Human brucellosis is a re-emerging disease with the potential for bioterrorism. The number of cases in Brazil has increased; however, the ideal management has not been established. These guidelines are intended for use by clinicians and other health-care workers providing medical care for patients with suspected brucellosis in the State of Paraná. We included a brief description of the epidemiology, clinical presentation, diagnosis, prevention of exposure, prevention of disease by chemoprophylaxis, treatment of disease, monitoring of adverse effects during treatment, management of treatment failure and relapse cases.

Early intervention reduces morbidity in extravasation injuries from 'lighter fuel' injection.

PubMed

Thaha, M A; McKinnell, T H; Graham, K E; Naasan, A N

2007-01-01

Injection of 'lighter fuel' with suicidal intent is rare. Extravasation of the chemical may rarely cause systemic toxicity, but usually it results in extensive soft tissue damage. Such injuries when managed by the traditional expectant policy are associated with considerable morbidity. Early aggressive surgical management using 'saline flush out' limits the tissue damage by stopping the natural progression of the chemical mediated injury and the subsequent inflammatory response, thereby allowing better skin preservation and functional outcome in these cases. We report a case of 'lighter fuel' subcutaneous extravasation injury managed by 'saline flush out' technique soon after presentation.

Investment feasibility tracking: the importance of measuring and tracking the success level of the project during commercialization phase

NASA Astrophysics Data System (ADS)

Saputra, Y. A.; Setyaningtyas, V. E. D.; Latiffianti, E.; Wijaya, S. H.; Ladamay, O. S. A.

2018-04-01

Measuring project success level is a challenging activity. This area of works has attracted many researchers to look deeper into the method of measurement, success factor identification, risk management, and many others relevant topics. However, the project management scope is limited until the project handover stage. After a project handover, the control of a project management changes from Project Management Team to the project owner/commercialization team. From an investor’s point of view, the success of a project delivery needs to be followed by the success of commercialization phase. This paper aims to present an approach on how we track and measure the progress and success level of a project investment in the commercialization phase. This is an interesting topic which probably often being forgotten in many practical case. Our proposed concept modify Freeman and Beale concept by estimating the variance between the Planned Net Present Value / Annual Worth (as it is in the Feasibility Study Document) and the Actual Net Present Value / Annual Worth (until the point time of evaluation). The gap will lead us to the next analysis and give us some important information, especially exposing whether our project investment performs better than the planning or underperformed. Some corrective actions can be suggested based on the provided information. Practical cases to exercise the concept is also provided and discussed; one case in a property sector in the middle of commercialization phase, and another case in a Power Plant investment approaching the end of commercialization phase.

Idiopathic Subareolar Breast Abscess in a Male Patient

PubMed Central

Ranga, Upasana; Veeraiyan, Saveetha

2015-01-01

We present a case of left breast abscess in a young male patient who presented with acute onset swelling left breast. Imaging studies helped in accurate diagnosis and the case was managed by subareolar incision and drainage. Subareolar breast abscess is an uncommon entity in male and should be kept as a differential diagnosis for male breast swellings. PMID:25738061

An adult ureterocele complicated by a large stone: A case report.

PubMed

Atta, Omar N; Alhawari, Hussein H; Murshidi, Muayyad M; Tarawneh, Emad; Murshidi, Mujalli M

2018-01-01

Ureterocele is a cystic dilatation of the lower part of the ureter. It is a congenital anomaly that is associated with other anomalies such as a duplicated system, and other diseases. It poses a great challenge owing to its numerous types and clinical presentations. Its incidence is 1 in every 4000 individuals. One of its presentations in the adult population is the presence of a stone, usually a solitary stone, inside the ureterocele. We are reporting a case of an adult ureterocele complicated by a large calculus; managed endoscopically with transurethral deroofing of the ureterocele followed by cystolitholapaxy. A literature review was also conducted. The pathogenesis of ureteroceles is not well understood, however many proposed mechanisms exist with the incomplete dissolution of chwalla membrane being the most accepted one. The type of ureterocele and age at presentation will help guide the appropriate investigation and management, nevertheless certain goals of treatment should apply to all cases. Adult ureterocele is usually clinically silent but it may co-exist with other conditions such as a ureteral calculus and in these conditions it can be managed endoscopically. Ureteroceles complicated by stones can be effectively managed with endoscopic resection or incision of the ureterocele coupled with stone removal, however long term follow up is required to monitor for hydronephrosis and iatrogenic vesicoureteric reflux. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Hyperammonemic Encephalopathy Associated With Fibrolamellar Hepatocellular Carcinoma: Case Report, Literature Review, and Proposed Treatment Algorithm.

PubMed

Chapuy, Claudia I; Sahai, Inderneel; Sharma, Rohit; Zhu, Andrew X; Kozyreva, Olga N

2016-04-01

We report a case of a 31-year-old man with metastatic fibrolamellar hepatocellular carcinoma (FLHCC) treated with gemcitabine and oxaliplatin complicated by hyperammonemic encephalopathy biochemically consistent with acquired ornithine transcarbamylase deficiency. Awareness of FLHCC-associated hyperammonemic encephalopathy and a pathophysiology-based management approach can optimize patient outcome and prevent serious complications. A discussion of the management, literature review, and proposed treatment algorithm of this rare metabolic complication are presented. Pathophysiology-guided management of cancer-associated hyperammonemic encephalopathy can improve patient outcome and prevent life-threatening complications. Community and academic oncologists should be aware of this serious metabolic complication of cancer and be familiar with its management. ©AlphaMed Press.

Depression is More Than Just Sadness: A Case of Excessive Anger and Its Management in Depression

PubMed Central

Sahu, Anamika; Gupta, Preeti; Chatterjee, Biswadip

2014-01-01

People with depressive illness often have symptoms of overt or suppressed anger. Those with anger traits face exaggerated problem during symptomatic period of depression. Pharmacological management helps in control of depressive and anxiety symptoms, but rarely address anger symptoms. Non-pharmacological management like cognitive-behavioral therapy (CBT) is effective in depression as well as in anger management, but is not used frequently in anger associated or exacerbated by depression. We present the case of a 27-year-old male suffering from moderate depressive episode with associated anger outburst. He underwent CBT, which resulted in a significant decrease in anger symptoms as well as in severity of depression. PMID:24701016

Depression is More Than Just Sadness: A Case of Excessive Anger and Its Management in Depression.

PubMed

Sahu, Anamika; Gupta, Preeti; Chatterjee, Biswadip

2014-01-01

People with depressive illness often have symptoms of overt or suppressed anger. Those with anger traits face exaggerated problem during symptomatic period of depression. Pharmacological management helps in control of depressive and anxiety symptoms, but rarely address anger symptoms. Non-pharmacological management like cognitive-behavioral therapy (CBT) is effective in depression as well as in anger management, but is not used frequently in anger associated or exacerbated by depression. We present the case of a 27-year-old male suffering from moderate depressive episode with associated anger outburst. He underwent CBT, which resulted in a significant decrease in anger symptoms as well as in severity of depression.

Towards Customer-Driven Management in Hospitality Education: A Case Study of the Higher Hotel Institute, Cyprus.

ERIC Educational Resources Information Center

Varnavas, Andreas P.; Soteriou, Andreas C.

2002-01-01

Presents and discusses the approach used by the Higher Hotel Institute in Cyprus to incorporate total quality management through establishment of a customer-driven management culture in its hospitality education program. Discusses how it collects and uses service-quality related data from future employers, staff, and students in pursuing this…

Evaluating the Facilities Planning, Design, and Construction Department: The Capital Programs Management Audit.

ERIC Educational Resources Information Center

Kaiser, Harvey H.; Kirkwood, Dennis M.

2000-01-01

Presents a diagnostic model for assessing the state of an institution's capital programs management (CPM) by delineating "work processes" which comprise that function. What capital programs management is, its resources, and its phases and work processes are described, followed by case studies of the CPM Process Model as an assessment tool. (GR)

The Influence of Corporate Leadership and Management Practices on a Public School District

ERIC Educational Resources Information Center

Napier, Randall Paul, Jr.

2012-01-01

The purpose of this case study is to understand how management and leadership ideas that were present in Toyota Motor Manufacturing Kentucky influenced management and leadership practices adopted by Scott County Public Schools during 2002-2011. Data for the study were collected during the summer of 2011, using individual and focus group interviews…

Analysis of Risks in a Learning Management System: A Case Study in the Spanish National University of Distance Education (UNED)

ERIC Educational Resources Information Center

Vázquez-Cano, Esteban; Sevillano García, Ma. Luisa

2015-01-01

This article presents a research that examines the university students' risk perception when using a Learning Management System called "aLF" and implemented by the Spanish National University of Distance Education (UNED) for the development of its university distance studies. The development of comprehensive Learning Management Systems…

Career Management in Transition: HRD Themes from the Estonian Civil Service

ERIC Educational Resources Information Center

Rees, Christopher J.; Jarvalt, Jane; Metcalfe, Beverley

2005-01-01

Purpose: To explore, through a case study, some of the key career-related HRD issues that senior managers are currently facing in the Estonian civil service. Design/methodology/approach: Presents primary empirical research into career management in the Estonian civil service since 1991, that is, in the post-Soviet era. The research involved…

[Rib cage ostheosynthesis. Literature review and case reports].

PubMed

Jiménez-Quijano, Andrés; Varón-Cotés, Juan Carlos; García-Herreros-Hellal, Luis Gerardo; Espinosa-Moya, Beatriz; Rivero-Rapalino, Oscar; Salazar-Marulanda, Michelle

2015-01-01

Fractures of the chest wall include sternum and rib fractures. Traditionally they are managed conservatively due to the anatomy of the rib cage that allows most of them to remain stable and to form a callus that unites the fractured segments. In spite of this management, some patients present with chronic pain or instability of the wall which makes them require some type of fixation. The present article performs a literature review based on 4 cases. The first case was a 61 year-old man with blunt chest trauma, with a great deformity of the chest wall associated with subcutaneous emphysema, and pneumothorax. The second case was a 51 year-old man with blunt chest trauma, initially managed at another institution, who despite treatment, had persistent pain and dyspnoea. The third case was a 30 year-old man that suffered a motor vehicle accident, with resulting pain and crepitation of the rib cage and with diagnostic images showing multiple rib fractures. The last case is a 62 year-old man that fell down the stairs, with blunt chest trauma with high intensity pain, dyspnoea and basal ipsilateral hypoventilation. Rib fracture fixation offers a good alternative in selected patients to decrease associated morbidity, leading to a patient's fast return to his or her working life. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Clinical profile and containment of the Ebola virus disease outbreak in two large West African cities, Nigeria, July-September 2014.

PubMed

Ohuabunwo, Chima; Ameh, Celestine; Oduyebo, Oyin; Ahumibe, Anthony; Mutiu, Bamidele; Olayinka, Adebola; Gbadamosi, Wasiu; Garcia, Erika; Nanclares, Carolina; Famiyesin, Wale; Mohammed, Abdulaziz; Nguku, Patrick; Koko, Richard I; Obasanya, Joshua; Adebayo, Durojaye; Gbadegesin, Yemi; Idigbe, Oni; Oguntimehin, Olukayode; Nyanti, Sara; Nzuki, Charles; Abdus-Salam, Ismail; Adeyemi, Joseph; Onyekwere, Nnanna; Musa, Emmanuel; Brett-Major, David; Shuaib, Faisal; Nasidi, Abdulsalami

2016-12-01

The Ebola virus disease (EVD) outbreak in Nigeria began when an infected diplomat from Liberia arrived in Lagos, the most populous city in Africa, with subsequent transmission to another large city. First-, second-, and third-generation contacts were traced, monitored, and classified. Symptomatic contacts were managed at Ebola treatment centers as suspected, probable, and confirmed EVD cases using standard operating procedures adapted from the World Health Organization EVD guidelines. Reverse transcription PCR tests confirmed EVD. Socio-demographic, clinical, hospitalization, and outcome data of the July-September 2014 Nigeria EVD cohort were analyzed. The median age of the 20 EVD cases was 33 years (interquartile range 26-62 years). More females (55%), health workers (65%), and persons <40 years old (60%) were infected than males, non-health workers, and persons aged ≥40 years. No EVD case management worker contracted the disease. Presenting symptoms were fever (85%), fatigue (70%), and diarrhea (65%). Clinical syndromes were gastroenteritis (45%), hemorrhage (30%), and encephalopathy (15%). The case-fatality rate was 40% and there was one mental health complication. The average duration from symptom onset to presentation was 3±2 days among survivors and 5±2 days for non-survivors. The mean duration from symptom onset to discharge was 15±5 days for survivors and 11±2 days for non-survivors. Mortality was higher in the older age group, males, and those presenting late. The EVD outbreak in Nigeria was characterized by the severe febrile gastroenteritis syndrome typical of the West African outbreak, better outcomes, rapid containment, and no infection among EVD care-providers. Early case detection, an effective incident management system, and prompt case management with on-site mobilization and training of local professionals were key to the outcome. Copyright © 2016. Published by Elsevier Ltd.

Audit of deaths less than a week after admission through an emergency department: how accurate was the ED diagnosis and were any deaths preventable?

PubMed

Nafsi, Tabassum; Russell, Rob; Reid, Cilla M; Rizvi, Syed M M

2007-10-01

To review the causes of death in patients admitted via the emergency department (ED) who died within 7 days of admission and to identify any ways in which ED care could have been better. The study also aims to compare the diagnosis made in the ED and the mortality diagnosis. A retrospective study; subjects were all patients who attended the ED over 4 months and died within 7 days of admission. The paramedics' notes, ED case cards, inpatient medical notes and details of postmortem findings were examined to identify the time and date of arrival in the ED, presenting complaint, provisional diagnosis made by the ED, treatment plan devised by the ED, diagnosis made in wards, and the cause of death as issued on death certificates or from postmortem findings. Summary sheets of cases where the care provided by the emergency department could have been improved were reviewed, errors were identified and deaths were classified as preventable or unpreventable. Database revealed 3521 admissions via the ED over 4 months, of which 95 cases (2.69%) died within 7 days of admission. 78 patients (82.1% of cases) were appropriately diagnosed and managed whereas 17 (17.87% of cases) were identified with deficiencies in either the diagnosis or the management provided in the ED. We reviewed the quality of care provided in the ED for these cases and rated deaths according to our preventability criteria: 5 (5.26%) deaths were unpreventable despite the deficiency in care provided in the ED; 3 (3.15%) deaths were definitely preventable; 3 (3.15%) were probably preventable; and 6 (6.31%) were possibly preventable deaths. The ED is playing a good role in the management of critically ill patients, with appropriate diagnosis and management in 82% of cases. Training of junior doctors is required to prevent occurrence of errors and thus preventable deaths, but all deaths are not preventable. New guidelines for sepsis management and management of undifferentiated clinical presentations are being introduced and we intend to audit the implications of new guidelines.

Treatment of Penetrating Nonmissile Traumatic Brain Injury. Case Series and Review of the Literature.

PubMed

Zyck, Stephanie; Toshkezi, Gentian; Krishnamurthy, Satish; Carter, David A; Siddiqui, Adnan; Hazama, Ali; Jayarao, Mayur; Chin, Lawrence

2016-07-01

Penetrating traumatic brain injuries (TBIs), with the exception of gunshot wounds, are relatively rare occurrences and affect all ages. Clinical presentation varies depending on the mechanism of the injury. Prompt surgical treatment is often indicated and is influenced by patient clinical examination, anatomic trajectory, and the penetrating object's size, shape, and velocity. We present 3 cases of penetrating TBI. Their similarities and differences affecting operative and medical management are compared. We relate our experience with management of penetrating intracranial foreign bodies in general and discuss the relevant literature. Our first case was a 12-year-old male who presented with a self-inflicted transfacial transcranial injury by a crossbow. The arrow passed through the left sphenoid and cavernous sinus and exited through the parietal calvarium. Our second case was a 37-year-old man with a transoral intracranial stab wound by a knife. In our third case, we present a 46-year-old male who accidentally fired a nail gun into his right ear. The nail traversed the posterior wall of the external auditory canal into the posterior fossa, ending in the cerebellar vermis. Each case was treated with craniotomy and foreign body removal. All resulted in good outcomes after surgical treatment. Surgery in penetrating TBI is the treatment of choice. Our cases demonstrate how certain principles applied to individual patient scenarios may optimize clinical results. Severity of the injury and operative approach are among the most important considerations to achieve the best patient outcomes. Published by Elsevier Inc.

School Planning and Management Buyer's Guide 2000.

ERIC Educational Resources Information Center

School Planning and Management, 1999

1999-01-01

Presents product information and a suppliers' directory for school purchasing managers for the year 2000, including a detailed product showcase and case histories and a section on descriptions of free brochures, pamphlets, and guides from key suppliers. An advertiser index concludes the issue. (GR)

Left paraduodenal hernia: case report and review of the literature

PubMed Central

Falk, Gavin A; Yurcisin, Basil J; Sell, Harry S

2010-01-01

Paraduodenal hernias are congenital internal hernias that usually present with non-specific symptoms, and are therefore rarely diagnosed preoperatively. Left-sided paraduodenal hernias are three times more likely to occur than right-sided ones. Both hernias present similarly, but have a differing embryological basis. Here, the case of a 76-year-old woman with a left paraduodenal hernia presenting with small bowel obstruction is presented, and a brief discussion of the literature on its diagnosis and management given. PMID:22797200

Bilateral Vocal Cord Palsy with Arnold Chiari Malformation: A Rare Case Series

PubMed Central

Arora, Nikhil; Meher, Ravi; Bhargava, Eishaan K.

2016-01-01

Stridor in paediatric age group is not an uncommon presentation to the ENT emergency. The range of differential diagnosis is vast. The presentation may vary from noisy breathing to severe respiratory distress and apnea. Early and meticulous diagnosis is crucial for the management as the condition may be life threatening. We report a rare case series of 3 infants with Arnold Chiari Malformation who presented to the hospital with stridor and were diagnosed with bilateral vocal cord palsy. These 3 infants had similar underlying neurological condition with hydrocephalus and raised intracranial pressure. Chiari malformation is the one of the most common congenital central nervous system anomaly associated with bilateral vocal cord paralysis. However, the presentation is rare. This article, thus, emphasizes the significance of early diagnosis and immediate management of this condition. PMID:27790480

Clinical Decision Making in the Management of Patients With Cervicogenic Dizziness: A Case Series.

PubMed

Jung, Francis C; Mathew, Sherin; Littmann, Andrew E; MacDonald, Cameron W

2017-11-01

Study Design Case series. Background Although growing recognition of cervicogenic dizziness (CGD) is emerging, there is still no gold standard for the diagnosis of CGD. The purpose of this case series is to describe the clinical decision making utilized in the management of 7 patients presenting with CGD. Case Description Patients presenting with neck pain and accompanying subjective symptoms, including dizziness, unsteadiness, light-headedness, and visual disturbance, were selected. Clinical evidence of a temporal relationship between neck pain and dizziness, with or without sensorimotor disturbances, was assessed. Clinical decision making followed a 4-step process, informed by the current available best evidence. Outcome measures included the numeric rating scale for dizziness and neck pain, the Dizziness Handicap Inventory, Patient-Specific Functional Scale, and global rating of change. Outcomes Seven patients (mean age, 57 years; range, 31-86 years; 7 female) completed physical therapy management at an average of 13 sessions (range, 8-30 sessions) over a mean of 7 weeks. Clinically meaningful improvements were observed in the numeric rating scale for dizziness (mean difference, 5.7; 95% confidence interval [CI]: 4.0, 7.5), neck pain (mean difference, 5.4; 95% CI: 3.8, 7.1), and the Dizziness Handicap Inventory (mean difference, 32.6; 95% CI: 12.9, 52.2) at discontinuation. Patients also demonstrated overall satisfaction via the Patient-Specific Functional Scale (mean difference, 9) and global rating of change (mean, +6). Discussion This case series describes the physical therapist decision making, management, and outcomes in patients with CGD. Further investigation is warranted to develop a valid clinical decision-making guideline to inform management of patients with CGD. Level of Evidence Diagnosis, therapy, level 4. J Orthop Sports Phys Ther 2017;47(11):874-884. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7425.

Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data

PubMed Central

Wood, David Michael; Webster, Emma; Martinez, Daniel; Dargan, Paul Ivor; Jones, Alison Linda

2002-01-01

Introduction Strychnine poisoning is uncommon, and in most severe cases, the patient dies before reaching hospital. The management of strychnine poisoning is well documented, although there are few data on the kinetics of elimination of strychnine after overdose. Case report A 42-year-old man presented shortly after ingestion of an unknown quantity of strychnine powder. After a respiratory arrest, with intensive supportive management requiring admission to an intensive care unit, he survived. Eight serum samples were taken over the first 5 days and analysed subsequently for strychnine concentrations. Results The initial concentration at 1.5 hours after ingestion was 4.73 mg/l, falling to 0.38 mg/l at 74 hours postingestion. Serum concentrations followed a monoexponential elimination curve with a calculated elimination half-life of 12 hours. Discussion and conclusion Strychnine poisoning presents with classical features, and with early diagnosis and supportive management, the patient can survive. The initial serum concentration of 4.73 mg/l is the highest reported concentration in a patient who has survived. Previous reports of the elimination half-life have suggested it is between 10 and 16 hours, which conforms to the elimination data in our case. PMID:12398788

Endodontic management of an unusual maxillary first molar with a single buccal root.

PubMed

Nayak, Gurudutt; Dahiya, Surya; Singh, Inderpreet; Mohammad, Faiz Hasan

2014-05-01

The aim of this clinical article is to describe the unusual anatomy that was detected in a maxillary first molar during routine endodontic treatment. Variation in Root and Root canal morphology especially in multirooted teeth presents a constant challenge for a clinician in their detection and management. The literature is replete with cases that have extra canal or Root but cases with fused Root and fewer numbers of canals are sparse. This case report describes the endodontic management of one such unusual case of maxillary first molar presenting with a single fused buccal and a palatal Root. The confirmatory diagnosis of this morphologic aberration was done with the help of spiral computerized tomography, which revealed that the contralateral tooth also had a similar morphology. Dental practitioners should always be aware of the fact that abnormalities need not be in form of extra Roots or Root canals; anomalies can also be in form of fewer number of Roots or Root canals. A thorough knowledge of the complexities and variations of the Root canal system would help in avoiding some of the common iatrogenic access opening errors like perforations and excessive tooth removal caused during the search for the missing or extracanal.

Laparoscopic Management of a Proximal Jejunal Gallstone Ileus with Patulous Ampulla and Choledochal Cyst-a Report of Unusual Presentation and a Review.

PubMed

Narkhede, Rajvilas Anil; Bada, Vijaykumar C; Kona, Lakshmi Kumari

2017-02-01

Gallstone ileus is a diagnosis of rarity, and a proximal site of obstruction in a young patient is even rare. Of the three cases in our experience, we found two cases of gallstone ileus (GSI) with typical epidemiology and presentation, one had combination of multiple rare associations. We report such a case, suspected to have gallstone ileus on ultrasound and confirmed diagnosis on computed tomography. Presence of biliary-enteric fistula, old age, and obstructive features, as in typical cases, was a bigger asset for diagnosis, but it was difficult to entertain diagnosis of GSI in young girl in absence of a demonstrable biliary-enteric fistula, with uncommon association of choledochal cyst and sickle cell disease. A very surprising finding, dilated major papilla, could however explain the pathogenesis which has also been reported in the past. Although differential opinions regarding management exist, we decided to follow two-stage surgery as our institute protocol. A minimal access approach has been immensely helpful in accurate diagnosis, and expedative management with early recovery has been proven in the past studies which we agreed with our experience.

Late recurrent urothelial carcinoma in the Studer neobladder: conversion to continent reservoir

PubMed Central

Kotb, AF; Alkosiry, M; AbdElkawy, N; Atta, MA

2012-01-01

Bladder cancer represents a considerable issue in Egypt and the Middle East. Radical cystectomy and orthotopic neobladder represent the standard of care for managing cases with invasive bladder tumour. There are few cases reported in the literature considering the urothelial recurrence in the urethra, connected to neobladder. We are presenting a rare case of a young female patient, with an aggressive urothelial tumour, recurring 13-year post-radical cystectomy, and the Studer neobladder. Our case was managed by urethrectomy and conversion of the neobladder into continent reservoir, with good short-term oncological and functional outcomes. We can conclude that bladder cancer cases should be followed thoroughly throughout their life. Follow-up urethroscopy and cytology should be done for all cases of post-radical cystectomy, regardless of patients’ symptoms. Key message Late urothelial recurrence of post-radical cystectomy is possible and, in our case, happened 13 years following surgery. The Studer neobladder can be safely converted into continent reservoir, allowing good functional outcomes. Also, recurrence in the Studer neobladder can be safely managed, allowing good oncological outcomes, without the need for any ureteroileal interventions. PMID:22973413

Use of standardised patients to assess antibiotic dispensing for tuberculosis by pharmacies in urban India: a cross-sectional study.

PubMed

Satyanarayana, Srinath; Kwan, Ada; Daniels, Benjamin; Subbaraman, Ramnath; McDowell, Andrew; Bergkvist, Sofi; Das, Ranendra K; Das, Veena; Das, Jishnu; Pai, Madhukar

2016-11-01

India's total antibiotic use is the highest of any country. Patients often receive prescription-only drugs directly from pharmacies. Here we aimed to assess the medical advice and drug dispensing practices of pharmacies for standardised patients with presumed and confirmed tuberculosis in India. In this cross-sectional study in the three Indian cities Delhi, Mumbai, and Patna, we developed two standardised patient cases: first, a patient presenting with 2-3 weeks of pulmonary tuberculosis symptoms (Case 1); and second, a patient with microbiologically confirmed pulmonary tuberculosis (Case 2). Standardised patients were scheduled to present each case once to sampled pharmacies. We defined ideal management for both cases a priori as referral to a health-care provider without dispensing antibiotics or steroids or both. Between April 1, 2014, and Nov 29, 2015, we sampled 622 pharmacies in Delhi, Mumbai, and Patna. Standardised patients completed 1200 (96%) of 1244 interactions. We recorded ideal management (defined as referrals without the use of antibiotics or steroids) in 80 (13%) of 599 Case 1 interactions (95% CI 11-16) and 372 (62%) of 601 Case 2 interactions (95% CI 58-66). Antibiotic use was significantly lower in Case 2 interactions (98 [16%] of 601, 95% CI 13-19) than in Case 1 (221 [37%] of 599, 95% CI 33-41). First-line anti-tuberculosis drugs were not dispensed in any city. The differences in antibiotic or steroid use and number of medicines dispensed between Case 1 and Case 2 were almost entirely attributable to the difference in referral behaviour. Only some urban Indian pharmacies correctly managed patients with presumed tuberculosis, but most correctly managed a case of confirmed tuberculosis. No pharmacy dispensed anti-tuberculosis drugs for either case. Absence of a confirmed diagnosis is a key driver of antibiotic misuse and could inform antimicrobial stewardship interventions. Grand Challenges Canada, Bill & Melinda Gates Foundation, Knowledge for Change Program, and World Bank Development Research Group. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Structured review: evaluating the effectiveness of nurse case managers in improving health outcomes in three major chronic diseases.

PubMed

Sutherland, Debbie; Hayter, Mark

2009-11-01

This paper presents the findings of a review and appraisal of the evidence for the effectiveness of nurse case management in improving health outcomes for patients living either with Diabetes, Chronic Obstructive Pulmonary Disease or Coronary Heart Disease. Long term chronic health conditions provide some of the greatest challenges to western health care systems. In the UK, three of the most significant chronic conditions are Diabetes, Chronic Obstructive Pulmonary Disease and Coronary Heart Disease. Patients with these long term conditions are high users of health services who often receive unplanned, poorly co-ordinated, ad-hoc care in response to an exacerbation or crisis. To counter this, the nurse case manager is identified as a central aspect of improving care for these patients. However, the evidence for the effectiveness of nurse case management in improving health outcomes for the chronically ill is scarce. A structured review of the literature. The review was undertaken focussing on studies that evaluated nurse case management with one or all of the three major long term chronic conditions. A total of 108 papers were initially reviewed and filtered to leave 75 citations that were appraised. About 18 papers were finally included in the review and subject to thematic analysis based on the health outcomes evaluated in the studies. Significantly positive results were reported for nurse case management impact on five health outcomes; 'objective clinical measurements', 'quality of life and functionality', 'patient satisfaction', 'adherence to treatment' and 'self care and service use'. The evidence generated in this review suggests that nurse case managers have the potential to achieve improved health outcomes for patients with long term conditions. Further research is required to support role development and create a more targeted approach to the intervention.

Endovascular management of radiotherapy-induced injury to brachiocephalic artery using covered stents.

PubMed

Cenizo, Noelia Maria; Gonzalez-Fajardo, Jose A; Ibanez, Maria A; Gastambide, Victoria; Martin-Pedrosa, Miguel; Gutierrez, Vicente; Taylor, James; Vaquero, Carlos

2014-04-01

Actinic vascular lesions tend to be stenotic-occlusive lesions. In this article, we present 2 exceptional cases of pseudoaneurysms caused by radionecrosis of the supra-aortic trunks. Both patients were treated by a retrograde carotid approach and deployment of a self-expanding covered stent. Proper exclusion of the pseudoaneurysm was attained in both cases; the first patient remained asymptomatic 12 months later; the second patient died of mediastinitis. Compared with conventional surgery, endovascular management is a viable, less invasive alternative in select patients, especially in life-threatening cases. Copyright © 2014 Elsevier Inc. All rights reserved.

Mountain laurel toxicosis in a dog.

PubMed

Manhart, Ingrid O; DeClementi, Camille; Guenther, Christine L

2013-01-01

To describe a case of mountain laurel (Kalmia latifolia) toxicosis in a dog, including case management and successful outcome. A dog presented for vomiting, hematochezia, bradycardia, weakness, and ataxia, which did not improve with supportive treatment. Mountain laurel ingestion was identified as cause of clinical signs after gastrotomy was performed to remove stomach contents. Supportive treatment was continued and the dog made a full recovery. This report details a case of mountain laurel toxicosis in a dog, including management strategies and outcome, which has not been previously published in the veterinary literature. © Veterinary Emergency and Critical Care Society 2013.

Primary sporadic Burkitt lymphoma of the orbit, clinical characteristics, management, and outcomes: a case study.

PubMed

Bouali, Sofiene; Said, Imed Ben; Yedeas, Mohamed Dahmani; Abderrahmen, Khansa; Maatar, Nidhal; Boubaker, Adnen; Kallel, Jalel; Jemel, Hafedh

2016-03-01

Involvement of the orbit with Burkitt's lymphoma is a very rare presentation of extra-nodal lymphoma. We report a case of a 2-year-old female presented an unusual location of sporadic Burkitt's lymphoma arising in the orbital region. Diagnostic magnetic resonance imagining identified an oval-shaped mass on the lateral rectus of the right orbit that caused dislocation of eyeball, for which she underwent a biopsy from the periorbital swellings. The mass was histologically confirmed as Burkitt's lymphoma, and postoperative aggressive chemotherapy was initiated. We describe clinical diagnosis, histological aspects, radiological features, and current management of this rapidly growing malignant tumor. Because of the rapid progression of Burkitt lymphoma, and considering that it responds well to treatment, early recognition and appropriate management are important factors for survival and to preserve visual function.

Migraine with Aura or Sports-Related Concussion: Case Report, Pathophysiology, and Multidisciplinary Approach to Management.

PubMed

Ellis, Michael J; Cordingley, Dean; Girardin, Richard; Ritchie, Lesley; Johnston, Janine

The evaluation and management of athletes presenting with clinical features of migraine headache with aura in the setting of sports-related head trauma is challenging. We present a case report of a 15-yr-old boy with a history of migraine with visual aura that developed acute visual disturbance and headache after a head injury during an ice hockey game. The patient underwent comprehensive assessment at a multidisciplinary concussion program, including neuro-ophthalmological examination, neurocognitive testing, and graded aerobic treadmill testing. Clinical history and multidisciplinary assessment was consistent with the diagnosis of coexisting sports-related concussion and migraine with brainstem aura. The authors discuss the pearls and pitfalls of managing patients who develop migraine headache with visual aura after sports-related head injury and the value of a comprehensive multidisciplinary approach to this unique patient population.

Treatment of Refractory Filamentary Keratitis With Autologous Serum Tears.

PubMed

Read, Sarah P; Rodriguez, Marianeli; Dubovy, Sander; Karp, Carol L; Galor, Anat

2017-09-01

To report a case of filamentary keratitis (FK) successfully treated with autologous serum tears and to review the pathogenesis and management of FK. Case report including high-resolution anterior segment optical coherence tomography and filament histopathology. A 61-year-old Hispanic man presented with pain and photophobia of the right eye. He was found to have a corneal epithelial defect and a small peripheral infiltrate 4 months after Laser Assisted in situ Keratomileusis. After resolution of the epithelial defect, he developed FK. Over a 4-month period, conservative management with aggressive lubrication, lid hygiene, topical corticosteroids, topical cyclosporine, bandage contact lenses, and oral doxycycline failed to resolve the corneal filaments. Notably, treatment with 20% autologous serum tears, four times daily, led to a sustained resolution of the FK within 1 week. This case demonstrates the complexity of FK management and introduces autologous serum tears as a viable management option when conservative approaches to this condition fail.

Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

PubMed Central

Rusnak, James E.

1987-01-01

Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The hospital must insure the CMMS project provides a means to implement an integrated on-line hospital information data base for use by departments in operating under a DRG-based Prospective Payment System. This paper presents guidelines for use in selecting a Case Mix Mangement System to meet the hospital's financial and operations planning, budgeting, marketing, and other management needs, while considering the data base implications of the implementation.

Using the "Seven A's" assessment tool for developing competency in case management.

PubMed

Gallagher, Louise P; Truglio-Londrigan, Marie

2004-01-01

In the latter part of the 20th century, healthcare reform sparked a transition in the nursing curriculum from acute care to primary and secondary care. Faculty responded to this challenge by redesigning curricula in creative ways. The transitional curriculum introduced community clinical experiences designed to challenge students to practice in diverse, nontraditional sites and in more independent ways. Such practice requires the nurse to function as designer, coordinator, and manager of patient care in addition to the traditional provider role. Additionally, the transitional curricula emphasized the roles of communicator, educator, facilitator, listener, and advocate to a greater degree. For students to achieve competence in the above roles, the curriculum must include learning activities that allow them to practice as case managers in the community. This paper presents the "Seven A's" as a framework for students to gain an understanding of and engage in the role and process of case management in the community.

Chronic Mycobacterium infection of first dorsal web space after accidental Bacilli Calmette-Guérin injection in a health worker: case report.

PubMed

Vigler, Mordechai; Mulett, Hanan; Hausman, Michael R

2008-11-01

We present a case of inoculation of the first dorsal web space by a nurse practitioner who accidentally stuck herself while preparing Bacilli Calmette-Guérin vaccine for treatment of bladder tumor. We report the evolution and management of this resistant chronic Mycobacterium infection that ultimately required use of a vacuum wound management system followed by a microvascular free tissue transfer.

Using landscape limnology to classify freshwater ecosystems for multi-ecosystem management and conservation

USGS Publications Warehouse

Soranno, Patricia A.; Cheruvelil, Kendra Spence; Webster, Katherine E.; Bremigan, Mary T.; Wagner, Tyler; Stow, Craig A.

2010-01-01

Governmental entities are responsible for managing and conserving large numbers of lake, river, and wetland ecosystems that can be addressed only rarely on a case-by-case basis. We present a system for predictive classification modeling, grounded in the theoretical foundation of landscape limnology, that creates a tractable number of ecosystem classes to which management actions may be tailored. We demonstrate our system by applying two types of predictive classification modeling approaches to develop nutrient criteria for eutrophication management in 1998 north temperate lakes. Our predictive classification system promotes the effective management of multiple ecosystems across broad geographic scales by explicitly connecting management and conservation goals to the classification modeling approach, considering multiple spatial scales as drivers of ecosystem dynamics, and acknowledging the hierarchical structure of freshwater ecosystems. Such a system is critical for adaptive management of complex mosaics of freshwater ecosystems and for balancing competing needs for ecosystem services in a changing world.

Postoperative Cerebral Vasospasm Following Transsphenoidal Pituitary Adenoma Surgery.

PubMed

Eseonu, Chikezie I; ReFaey, Karim; Geocadin, Romergryko G; Quinones-Hinojosa, Alfredo

2016-08-01

Cerebral vasospasm following a transsphenoidal resection of a pituitary adenoma is a devastating occurrence that can lead to delayed cerebral ischemia and poor neurologic outcome if not diagnosed and treated in a timely manner. The etiology of this condition is not well understood but can lead to significant arterial vasospasm that causes severe ischemic insults. In this paper, we identify common presenting symptoms and essential management strategies to treat this harmful disease. A retrospective case report and literature review of presentation, treatment, and outcome of cerebral vasospasm following transsphenoidal surgery. We present 1 case and review 12 known cases in the literature on vasospasm following transsphenoidal surgery. Mean age was 48 (±13.8) years. There were 46.2% male patients. Factors associated with vasospasm, such as cerebral spinal fluid leaks following surgery, were seen in 38.5% of cases, and postoperative subarachnoid hemorrhage (SAH) was seen in 84.6% of cases. Hemiparesis was the presenting symptom of delayed cerebral ischemia in 61.5% of cases. For management, maintaining at least a euvolemic volume status was used in 76.9%, induced hypertension was used in 61.5%, and nimodipine was administered in 46.2% of cases. Patients returned to their neurologic baseline in 61.5% of cases, had new permanent deficits in 7.7% of cases, and died in 30.8% of cases. Cerebral vasospasm following transsphenoidal surgery is a dangerous disease that can lead to a high likelihood of mortality if not identified and treated. Early postoperative events, such as peritumoral subarachnoid hemorrhage and hemiparesis, may be factors associated with post-transsphenoidal surgery vasospasm. Effective treatment options used in patients that regained complete neurologic recovery were by inducing hypertension, maintaining euvolemia, and administering nimodipine. Copyright © 2016 Elsevier Inc. All rights reserved.

The many faces of intestinal tract gastric heterotopia; a series of four cases highlighting clinical and pathological heterogeneity.

PubMed

Nasir, Aqsa; Amateau, Stuart K; Khan, Sabina; Simpson, Ross W; Snover, Dale C; Amin, Khalid

2018-04-01

Gastric heterotopia of the intestinal tract can have a diverse clinicopathologic presentation, resulting in a diagnostic dilemma. We present a series of four cases, two male and two female patients with age range of 31-82 years, found in the duodenum, jejunum, and transverse colon. The most common and rather unusual clinical presentation was iron deficiency anemia, seen in three cases, while one patient presented with abdominal pain. Endoscopically, two cases were visualized as pedunculated polyps and two as sessile/plaque-like lesions. Polypectomy was performed in three patients, and one patient underwent biopsy followed by resection. Two cases showed oxyntic-type epithelium, and two cases exhibited pyloric-type gastric epithelium. Three patients were relieved of their presenting symptoms after therapeutic procedures with no evidence of recurrence noted on follow-up. Follow-up was not available on one patient. This case series highlights a diverse clinicopathologic spectrum of gastric heterotopia. Accurate diagnosis is essential for proper management. Copyright © 2018. Published by Elsevier Inc.

Conservative management of an elite ice hockey goaltender with femoroacetabular impingement (FAI): a case report.

PubMed

MacIntyre, Kyle; Gomes, Brendan; MacKenzie, Steven; D'Angelo, Kevin

2015-12-01

To detail the presentation of an elite male ice hockey goaltender with cam-type femoroacetabular impingement (FAI) and acetabular labral tears. This case will outline the prevalence, clinical presentation, imaging criteria, pathomechanics, and management of FAI, with specific emphasis on the ice hockey goaltender. A 22-year old retired ice hockey goaltender presented to a chiropractor after being diagnosed by an orthopaedic surgeon with MRI confirmed left longitudinal and chondral flap acetabular labral tears and cam-type femoroacetabular impingement (FAI). As the patient was not a candidate for surgical intervention, a multimodal conservative treatment approach including manual therapy, electroacupuncture and rehabilitation exercises were implemented. FAI is prevalent in ice hockey players, particularly with goaltenders. Both skating and position-dependent hip joint mechanics involved in ice hockey may exacerbate or contribute to acquired and congenital forms of symptomatic FAI. As such, practitioners managing this population must address sport-specific demands in manual therapy, rehabilitation and physical training, to improve functional outcomes and prevent future injury.

Oropharyngeal trauma mimicking a first branchial cleft anomaly.

PubMed

Larem, Aisha; Sheikh, Rashid; Al Qahtani, Abdulsalam; Khais, Frat; Ganesan, Shanmugam; Haidar, Hassan

2016-06-01

We present a unique and challenging case of a remnant foreign body that presented to us in a child disguised as a strongly suspected congenital branchial cleft anomaly. This case entailed oropharyngeal trauma, with a delayed presentation as a retroauricular cyst accompanied by otorrhea that mimicked the classic presentation of an infected first branchial cleft anomaly. During surgical excision of the presumed branchial anomaly, a large wooden stick was found in the tract. The diagnostic and therapeutic obstacles in the management of such cases are highlighted. In addition to exploring the existing literature, we retrospectively analyzed a plausible explanation of the findings of this case. Laryngoscope, 126:E224-E226, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

A Rare Cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception.

PubMed

Sertkaya, Mehmet; Emre, Arif; Pircanoglu, Eyüp Mehmet; Yazar, Fatih Mehmet; Tepe, Murat; Cengiz, Emrah; Isler, Ali; Vicdan, Halit

2016-01-01

Intussusception in adults is very rarely seen, and this cause acute abdomen. A computed tomography (CT) scan, clinical suspicion, history, and a physical examination are important for the diagnosis. We present two cases of colonic intussusceptions induced by lipoma. The cases had similar locations, diagnoses, and management. Both lipomas were located close to the cecum in the ascending colon, and a right segmental colon resection was performed in both cases. The follow-up of both cases was uneventful. Although benign lesions can cause colonic intussusception, the high incidence of malignancy in colonic lesions should always be considered. Therefore, oncologic surgical procedures should be applied. The definitive diagnosis can be made by histopathology. Sertkaya M, Emre A, Pircanoglu EM, Yazar FM, Tepe M, Cengiz E, Isler A, Vicdan H. A Rare cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception. Euroasian J Hepato-Gastroenterol 2016;6(2):179-182.

Recognition and treatment of Alzheimer's disease: a case-based review.

PubMed

Marseille, Dana M; Silverman, Daniel H S

2006-01-01

Early recognition and treatment initiation are pivotal in managing Alzheimer's disease (AD). Once a diagnosis of AD is made, a treatment plan is developed and should include treatment initiation with cholinesterase inhibitors (ChEIs) to improve cognition, management of comorbid conditions, and treat behavioral symptoms. Caregiver compliance is integral to AD treatment success. The purpose of this report is to present two real case studies of "suspected" AD or related dementia and stress the significance of early and accurate diagnosis in disease management. In case 1, a caregiver reports gradual but progressive loss of memory, and the patient himself complains of memory impairment. Neuroimaging analysis confirms "typical " AD. In case 2, initiation of ChEI therapy is followed by substantial clinical improvement in the face of a complex medical picture, and neuroimaging revealing more neurodegenerative changes than could be accounted for by "pure" AD.

Diagnosis and management of maxillary incisors affected by incisal wear: an interdisciplinary case report.

PubMed

Bernardo, Jussara Karina; Maia, Elaine A Vilela; Cardoso, Antônio Carlos; de Araújo Júnior, Edson Medeiros; Monteiro Júnior, Sylvio

2002-01-01

In the attempt to restore anterior teeth affected by erosion and bruxism, many clinicians have been frustrated with the constant restorative failures. Frequently, these failures are attributed to the restorative materials employed, especially in cases in which composite resins are used. However, some flaws of the restorations are related to the oversight of occlusal principles. The purpose of this article is to discuss the etiology, signs, and symptoms of incisal wear, with special attention to that caused by bruxism and chemical erosion. Relatively simple management techniques (e.g., occlusal adjustment, adhesive restorations) are proposed, and the diagnosis and management of a representative clinical case is presented. In some cases of bruxism and/or dental erosion, it is possible to acquire space to recuperate the esthetics and function of maxillary incisors affected by incisal wear through a conservative treatment associated with the control of the etiologic factors.

Report of a patient chewing fentanyl patches who was titrated onto methadone

PubMed Central

Dale, Eric; Ashby, Fleur; Seelam, Kalyan

2009-01-01

This case report discusses the clinical presentation and management of a patient presenting to substance misuse services reporting chewing fentanyl patches in addition to wearing them transdermally. The patient was successfully titrated onto methadone 30 mg. Only one previously reported case of an individual chewing fentanyl patches was found in the literature; no case reports were found where treatment involved titrating the patient onto methadone. The pharmacology and illicit use of fentanyl are also considered. PMID:22114625

A case of true tubal hydatidiform mole and literature review.

PubMed

Siozos, A; Sriemevan, A

2010-08-09

Tubal hydatidiform mole is an uncommon condition with about 40 confirmed cases in the accessible literature. The patient usually presents with symptoms and signs of a classical ectopic pregnancy and it is only after histological examination and DNA ploidy analysis of the conceptus that a hydatidiform mole is diagnosed. Management requires complete removal of the conceptus and follow-up needs to be arranged with an appropriate supraregional centre. The authors present a case of complete molar tubal pregnancy and a review of the literature.

Case management in oncology rehabilitation (CAMON): the effect of case management on the quality of life in patients with cancer after one year of ambulant rehabilitation. a study protocol for a randomized controlled clinical trial in oncology rehabilitation.

PubMed

Bachmann-Mettler, Irene; Steurer-Stey, Claudia; Senn, Oliver; Wang, Mathyas; Bardheci, Katarina; Rosemann, Thomas

2011-04-28

Cancer diseases and their therapies have negative effects on the quality of life. The aim of this study is to assess the effectiveness of case management in a sample of oncological outpatients with the intent of rehabilitation after cancer treatment. Case management wants to support the complex information needs of the patients in addition to the segmented structure of the health care system. Emphasis is put on support for self-management in order to enhance health - conscious behaviour, learning to deal with the burden of the illness and providing the opportunity for regular contacts with care providers. We present a study protocol to investigate the efficacy of a case management in patients following oncology rehabilitation after cancer treatment. The trial is a multicentre, two-arm randomised controlled study. Patients are randomised parallel in either 'usual care' plus case management or 'usual care' alone. Patients with all types of cancer can be included in the study, if they have completed the therapy with chemo- and/or radiotherapy/surgery with curative intention and are expected to have a survival time >1 year. To determine the health-related quality of life the general questionnaire FACT G is used. The direct correlation between self-management and perceived self-efficacy is measured with the Jerusalem & Schwarzer questionnaire. Patients satisfaction with the care received is measured using the Patient Assessment of Chronic Illness Care 5 As (PACIC-5A). Data are collected at the beginning of the trial and after 3, 6 and 12 months. The power analysis revealed a sample size of 102 patients. The recruitment of the centres began in 2009. The inclusion of patients began in May 2010. Case management has proved to be effective regarding quality of life of patients with chronic diseases. When it comes to oncology, case management is mainly used in cancer treatment, but it is not yet common in the rehabilitation of cancer patients. Case management in oncology rehabilitation is not well-established in Switzerland. A major challenge of the study will therefore probably be the recruitment of the patients due to the physicians' and patients' scarcely existing awareness of this issue. Trial registrationISRCTN41474586

The potential of disease management for neuromuscular hereditary disorders.

PubMed

Chouinard, Maud-Christine; Gagnon, Cynthia; Laberge, Luc; Tremblay, Carmen; Côté, Charlotte; Leclerc, Nadine; Mathieu, Jean

2009-01-01

Neuromuscular hereditary disorders require long-term multidisciplinary rehabilitation management. Although the need for coordinated healthcare management has long been recognized, most neuromuscular disorders are still lacking clinical guidelines about their long-term management and structured evaluation plan with associated services. One of the most prevalent adult-onset neuromuscular disorders, myotonic dystrophy type 1, generally presents several comorbidities and a variable clinical picture, making management a constant challenge. This article presents a healthcare follow-up plan and proposes a nursing case management within a disease management program as an innovative and promising approach. This disease management program and model consists of eight components including population identification processes, evidence-based practice guidelines, collaborative practice, patient self-management education, and process outcomes evaluation (Disease Management Association of America, 2004). It is believed to have the potential to significantly improve healthcare management for neuromuscular hereditary disorders and will prove useful to nurses delivering and organizing services for this population.

Risk-stratification, resource availability, and choice of surgical location for the management of parturients with abnormal placentation: a survey of United States-based obstetric anesthesiologists.

PubMed

Grant, T R; Ellinas, E H; Kula, A O; Muravyeva, M Y

2018-05-01

Parturients with abnormally adherent placentas present anesthetic challenges that include risk-stratification, management planning and resource utilization. The labor and delivery unit may be remote from the main operating room services. Division chiefs of North American obstetric anesthesiology services were surveyed about their practices and management of parturients with an abnormally adherent placenta. Eighty-four of 122 chiefs, representing 103 hospital sites, responded to the survey (response rate 69%). Sixty-one percent of respondents agreed that women with preoperative placental imaging that was "suspicious" of placenta accreta represented a lower risk category; all other suggested descriptions fell into a higher risk category. Seventy-nine percent of respondents indicated that lower risk cases were managed on the labor and delivery unit, while 71% indicated that higher risk cases would be managed in the main operating room. Institutions where all cases were managed on the labor and delivery unit had better access to human and technical resources, were less remote from their main operating areas, and promoted neuraxial rather than general anesthesia, even for parturients perceived to be at higher risk. Obstetric anesthesia leaders identified patients at lower clinical risk and those less likely to require greater resources. Additional resources were available in institutions where all abnormal placentation cases were managed on the labor and delivery unit. Practitioners should consider risk-stratification and resource availability when planning high-risk cases. Copyright © 2018 Elsevier Ltd. All rights reserved.

Non-operative management of abdominal gunshot injuries: Is it safe in all cases?

PubMed

İflazoğlu, Nidal; Üreyen, Orhan; Öner, Osman Zekai; Meral, Ulvi Mehmet; Yülüklü, Murat

2018-01-01

In line with advances in diagnostic methods and expectation of a decrease in the number of negative laparotomies, selective non-operative management of abdominal gunshot wounds has been increasingly used over the last three decades. We aim to detect the possibility of treatment without surgery and present our experience in selected cases referred from Syria to a hospital at the Turkish-Syrian border. Between February 2012 and June 2014, patients admitted with abdominal gunshot wounds were analyzed. Computed tomography was performed for all patients on admission. Patients who were hemodynamically stable and did not have symptoms of peritonitis at the time of presentation were included in the study. The primary outcome parameters were mortality and morbidity. Successful selective non-operative management (Group 1) and unsuccessful selective non-operative management (Group 2) groups were compared in terms of complications, blood transfusion, injury site, injury severity score (ISS), and hospital stay. Of 158 truncal injury patients, 18 were considered feasible for selective non-operative management. Of these, 14 (78%) patients were treated without surgery. Other Four patients were operated upon progressively increasing abdominal pain and tenderness during follow-up. On diagnostic exploration, all of these cases had intestinal perforations. No mortality was observed in selective non-operative management. There was no statistically significant difference between Group 1 and Group 2, in terms of length of hospital stay (96 and 127 h, respectively). Also, there was no difference between groups in terms of blood transfusion necessity, injury site, complication rate, and injury severity score (p>0.05). Decision making on patient selection for selective non-operative management is critical to ensure favorable outcomes. It is not possible to predict the success of selective non-operative management in advance. Cautious clinical examination and close monitoring of these patients is vital; however, emergency laparotomy should be performed in case of change in vital signs and positive symptoms concerning peritonitis.

A case report on bronchoalveolar carcinoma presenting as non-resolving consolidation.

PubMed

Shoib, Sheikh; Malik, Javid A; Arif, Tasleem; Bashir, Haamid

2012-08-01

Bronchoalveolar carcinoma presenting as non-resolving consolidation is an uncommon presentation. The typical presentation of bronchoalveolar carcinoma is asymptomatic (solitary nodule) and remains without symptoms even as disease disseminates. We report a case of bronchoalveolar carcinoma presenting as non-resolving consolidation in a young male with productive cough, exertional breathlessness and physical examination revealing the features of right lower consolidation on x-ray chest, with subsequent CT of the chest and bronchoscopic examination revealed bronchoalveolar carcinoma. Patient had a good score and was managed conservatively.

GEOGRAPHIC INFORMATION SYSTEMS IN ENVIRONMENTAL ENFORCEMENT

EPA Science Inventory

GIS has become a common tool in environmental management and enforcement. Only in the last few years, however, has the technology come into use directly by litigators working on environmental cases. This presentation explores how GIS is being used in law firms to manage and sup...

A case study : the Las Vegas Freeway and Arterial Management System : use of a systems manager contractor to procure ITS

DOT National Transportation Integrated Search

2000-03-01

Procurement of Intelligent Transportation System (ITS) projects using Federal-aid funds can present challenges that are not typically observed in traditional transportation projects. Many roadway improvement projects involve the two-step "Design-Bid-...

Dealing with sub-trochanteric fracture in a child with osteopetrosis : A case report.

PubMed

Behera, P; Khurana, A; Saibaba, B; Aggarwal, S

2016-12-01

Osteopetrosis is a rare hereditary condition which may have autosomal recessive or autosomal dominant inheritance. Patients tend to present most commonly with fractures but involvement of cranial nerves and hematopoetic system is not uncommon. Patients with infantile and intermediate type tend to present more often with problems other than orthopaedic problems. While diagnosis can be made on the basis of radiographs, management needs to be customized for every patient. Non operative and operative management both have their advantages and disadvantages. We are here reporting a case of sub-trochanteric fracture in an eight-year-old child which was managed successfully with a dynamic hip screw (DHS). Surgery could be performed successfully by taking precautions during reduction, drilling and screw placement. At the latest follow up, which was after one and half years of surgery, the fracture had united well and the child faced no limitations of activities. Thus, open reduction and fixation with DHS can be considered as an effective management modality for pediatric sub-trochanteric fractures in osteopetrosis.

Cutibacterium acnes Septic Arthritis of the Nonoperated Knee: A Case Report

PubMed Central

Okoroha, Kelechi R.; Gabbard, Michael D.; Fitts, Jamal; Banka, Trevor R.

2017-01-01

Cutibacterium (Propionibacterium) acnes , a gram-positive bacillus with low pathogenicity, is an uncommon but known cause of prosthetic joint infections, particularly related to shoulder surgery. C. acnes , however, is an extremely rare pathogen in the nonoperated knee joint. This report details an uncommon case of C. acnes septic knee arthritis after multiple intra-articular steroid injections in a 56-year-old male patient. After an indolent presentation and late diagnosis, the patient underwent surgical debridement with IV antibiotic management. This case illustrates that intra-articular corticosteroid injections for the management of osteoarthritis are not without risk. Literature supporting their use remains limited and clinicians should use proficient clinical judgment for appropriate patient selection for these injections. Vigilance following injections or aspirations of the knee should be maintained to identify the indolent clinical presentation of C. acnes septic arthritis. PMID:28825032

Beware Swan-Ganz complications. Perioperative management.

PubMed

Asteri, T; Tsagaropoulou, I; Vasiliadis, K; Fessatidis, I; Papavasi-Liou, E; Spyrou, P

2002-08-01

Since the introduction of the pulmonary artery catheter (PAC) in 1970 by Swan et al., various complications are recognized with the insertion and the use of Swan-Ganz catheter. We present two different cases with rare but life threatening complications which had been successfully managed. The first case is a carotid cannulation with an 8.5 Fr introducer sheath, in an attempt to insert a pulmonary catheter via the right internal jugular vein. Two weeks later, the patient was re-admitted to the hospital and when an arteriovenous fistulae (carotid artery-internal jugular vein) was diagnosed, he was treated surgically. The second case presents the rupture of the right atrium in the conjunction with the superior vena cava. This serious cardiac complication was developed during the floatation of the PAC and the lesion was repaired while the mitral valve replacement was in progress.

KERATOACANTHOMA OF THE INFERIOR LIP: REVIEW AND REPORT OF CASE WITH SPONTANEOUS REGRESSION

PubMed Central

Ramos, Lara Maria A.; Cardoso, Sérgio V.; Loyola, Adriano M.; Rocha, Marcus A.; Durighetto, Antônio Francisco

2009-01-01

Keratoacanthoma (KA) is a self-limited benign epithelial proliferative lesion that eventually presents with very similar clinical features to squamous cell carcinoma. Many KA appear in the vermilion border of the lips and therefore dental professionals must be familiar of the disease. This article reports the case of a 40-year-old female patient presenting with an exophytic ulcerative tumor in her lower lip that resolved after incisional biopsy. Photographic documentation of the case is presented and topics that are relevant to the clinical management of the disease are addressed. PMID:19466263

WMOST v2 Case Study: Monponsett Ponds

EPA Science Inventory

This webinar presents an overview of the preliminary results of a case study application of EPA's Watershed Management Optimization Support Tool v2 (WMOST) for stakeholders in the Monponsett Ponds Watershed Workgroup. Monponsett Ponds is a large water system consisting of two ba...

Risk Management and Performance in the Balkans Support Contract

DTIC Science & Technology

2005-01-01

Defense contracts-United States-Case studies . 2. United States. Army- Procurement-Case studies . 3. Bosnia and Hercegovina-History, Military-20ts...24 3.1. Assessment of GAO Cost Study .................................. 72 3.2. Comparison of Potential Sources of Nonperformance...accepting inappropriate risks, what can it do about it? Case studies of CSS contracts can provide some answers. In this report, we present a case study of

Concerns About Lung Cancer Among Prisoners.

PubMed

Renault, Luc; Perrot, Emmanuel; Pradat, Eric; Bartoli, Christophe; Greillier, Laurent; Remacle-Bonnet, Anne; Telmon, Norbert; Mazières, Julien; Molinier, Laurent; Couraud, Sébastien

2018-02-01

Few studies have looked at lung cancer in prisoners, despite this population is possibly at increased risk of malignancy. In a previous study, we found an early onset of lung cancer in prisoners. Thus, the present CARCAN study was aimed at assessing the epidemiological characteristics, management, prognosis, and incidence of lung cancer in prisoners compared to a sample of non-prisoner patients. We performed a multi-center observational case-control study. Cases were prisoners diagnosed with lung cancer from 2005 to 2013. Controls were non-prisoner lung cancer patients selected from hospital databases and randomly matched to cases (targeted case-control ratio: 1:3). Incidence rates in both groups were calculated using national statistics. Seventy-two cases and 170 controls met inclusion criteria. Cases were mainly men (99%). Mean age at diagnosis was 52.9 (± 11.0) in cases and 64.3 (± 10.1) in controls (p < 0.0001). More case patients were current smokers compared to control patients (83% vs 53%; p < 0.0001). We found no significant differences between the two groups as concerns histologic types, TNM stages at diagnosis, initially-employed treatments, times to management or survival. Incidence rates (2008-2012) in male prisoners were higher than those in the general population in all concerned age groups. There is a shift of lung cancer toward young people in prisons. However, the presentation, management, and prognosis of lung cancer are similar between prisoners and non-prisoners. These finding could justify a specific screening policy for the incarcerated populations.

Ruptured cervical arteriovenous fistulas presenting with subarachnoid hemorrhage and quadriplegia: an uncommon case.

PubMed

Liu, Chien-Liang; Su, Yung-Cheng; Chen, Chien-Chih; Chong, Chee-Fah; Wang, Tzong-Luen

2008-02-01

Nontraumatic subarachnoid hemorrhage is a neurologic emergency, and prompt treatment is necessary to avoid catastrophic result. We present a patient with subarachnoid hemorrhage caused by ruptured cervical intradural extramedullary arteriovenous fistulas, which rapidly progressed to quadriplegia. Because of the timely management, the patient had a good recovery. This is a rare but important case that emergency physicians should be aware of.

Juvenile primary extranasopharyngeal angiofibroma, presenting as cheek swelling

PubMed Central

Nandhini, J; Ramasamy, S; Kaul, Ronak Nazir; Austin, Ravi David

2018-01-01

Angiofibroma is a locally advancing immensely vascular tumor that essentially arises from the nasopharynx. The clinical characteristics of extranasopharyngeal angiofibroma (ENA) do not accord to that of nasopharyngeal angiofibroma and can present a diagnostic confront. We describe a case of primary juvenile ENA in a 19-year-old patient who presented with a rapidly enlarging mass of the cheek region. The case is unusual because of its anatomic location. The diagnostic and management particulars are sketched. PMID:29491611

Towards adaptive and integrated management paradigms to meet the challenges of water governance.

PubMed

Halbe, J; Pahl-Wostl, C; Sendzimir, J; Adamowski, J

2013-01-01

Integrated Water Resource Management (IWRM) aims at finding practical and sustainable solutions to water resource issues. Research and practice have shown that innovative methods and tools are not sufficient to implement IWRM - the concept needs to also be integrated in prevailing management paradigms and institutions. Water governance science addresses this human dimension by focusing on the analysis of regulatory processes that influence the behavior of actors in water management systems. This paper proposes a new methodology for the integrated analysis of water resources management and governance systems in order to elicit and analyze case-specific management paradigms. It builds on the Management and Transition Framework (MTF) that allows for the examination of structures and processes underlying water management and governance. The new methodology presented in this paper combines participatory modeling and analysis of the governance system by using the MTF to investigate case-specific management paradigms. The linking of participatory modeling and research on complex management and governance systems allows for the transfer of knowledge between scientific, policy, engineering and local communities. In this way, the proposed methodology facilitates assessment and implementation of transformation processes towards IWRM that require also the adoption of adaptive management principles. A case study on flood management in the Tisza River Basin in Hungary is provided to illustrate the application of the proposed methodology.

The Management of Student Affairs Programs in Community Colleges: Revamping Processes and Structures. Horizons Issues Monograph Series.

ERIC Educational Resources Information Center

Deegan, William L.

Based on a review of the management literature in the fields of business and education and on case studies, interviews, and discussions, this monograph identifies the prerequisites for the successful management of student affairs programs. Chapter 1 presents perspectives on the student affairs profession, summarizes the problems facing the field,…

Professional Identities of Middle Managers: A Case Study in the Faculty of Health and Social Care

ERIC Educational Resources Information Center

Thomas-Gregory, Annette

2014-01-01

This article presents and discusses the findings of a recent study on the professional identities of middle managers in a school of healthcare in a selected Chartered (pre-1992) UK university. Attention focuses on the career backgrounds of the middle managers, perception of identity and the interactional balance between the professional, academic…

Is It Ethical for Patents to Be Issued for the Computer Algorithms that Affect Course Management Systems for Distance Learning?

ERIC Educational Resources Information Center

Moreau, Nancy

2008-01-01

This article discusses the impact of patents for computer algorithms in course management systems. Referring to historical documents and court cases, the positive and negative aspects of software patents are presented. The key argument is the accessibility to algorithms comprising a course management software program such as Blackboard. The…

School Crisis Management: A Model of Dynamic Responsiveness to Crisis Life Cycle

ERIC Educational Resources Information Center

Liou, Yi-Hwa

2015-01-01

Purpose: This study aims to analyze a school's crisis management and explore emerging aspects of its response to a school crisis. Traditional linear modes of analysis often fail to address complex crisis situations. The present study applied a dynamic crisis life cycle model that draws on chaos and complexity theory to a crisis management case,…

Management Perception of Introducing Social Networking Sites as a Knowledge Management Tool in Higher Education: A Case Study

ERIC Educational Resources Information Center

Garcia, Elaine; Annansingh, Fenio; Elbeltagi, Ibrahim

2011-01-01

Purpose: The purpose of this paper is to present a study of the understanding and usage of social networking sites (SNS) as a knowledge management (KM) tool in knowledge-intensive enterprises. Design/methodology/approach: In terms of research approach, the study has taken an interpretitivist framework, using a higher education (HE) institution as…

Universidad de Chile: Self-Assessment and Its Effects on University's Management

ERIC Educational Resources Information Center

Busco, Carolina; Dooner, Cecilia; d'Alencon, Andrés

2018-01-01

This paper presents a brief approach to the results of a case study of a university within the Chilean higher education system, focusing on the effects of self-assessment on the university's management of undergraduate and postgraduate programs from 2011 to 2014. The research hypothesis is that the university's management, as a dependent variable,…

Case Management in the School Context. A Center Quick Training Aid.

ERIC Educational Resources Information Center

California Univ., Los Angeles. Center for Mental Health in Schools.

When a student is involved with more than one intervener, management of care is a concern. Management of care involves a variety of activity all of which is designed to ensure that student/family interests are well served. At the core is enhanced monitoring focused on the appropriateness of interventions. This quick training aid presents a brief…

Pure squamous cell carcinoma of the breast presenting as a pyogenic abscess: a case report.

PubMed

Nair, Vimoj J; Kaushal, Vivek; Atri, Rajeev

2007-08-01

The field of oncology is studded with fascinating case reports of rarities, and management of breast cancer by the oncologist has, at times, resulted in the surfacing of such instances of rarities. Pure squamous cell carcinoma (SCC) of the breast is such an example of a rare and generally aggressive malignancy constituting < 0.1% of invasive breast cancers. To the best of our knowledge, until 2006, only 5 patients of primary SCC of the breast, which presented clinically as breast abscess, have been reported in medical literature. We report the sixth worldwide case of pure primary SCC of the breast presenting as an abscess. In this report, we highlight the fact that a benign lesion like breast abscess can harbor such a rare malignancy. Clinicians should be aware of that fact, and adequate investigations should be done to rule out that possibility. Extensive literature review has been done to discuss the clinical and radiologic features as well as management of this rare lesion.

Anaesthetic management of a child with massive extracranial arteriovenous malformation

PubMed Central

Shamim, Faisal; Ullah, Hameed; Rehman, Azhar

2012-01-01

Vascular tumors affect the head and neck commonly but arteriovenous malformations are rare. Vascular malformations are often present at birth and grow with the patient, usually only becoming significant later in childhood. Embolization has been the mainstay of treatment in massive and complex arteriovenous malformations. We present a case of massive extracranial arteriovenous malformation in a 7-year-old boy causing significant workload on right heart and respiratory distress. The management of angioembolization under general anaesthesia and anaesthetic concerns are presented. PMID:22345959

Conflict: an imperative for success.

PubMed

Wenzel, F J

1986-04-01

Conflict in organizations of any type is inevitable. Medical institutions, particularly multispecialty clinics, are no exception. This paper presents an examination of the anatomy of conflict in group practice settings. Several case studies, including the "Hunterdon Experiment," are presented to illustrate the outcome of conflict situations where management was unable to direct its energy to productive ends. Recommendations are made for identifying, considering, and resolving conflicts in a proactive fashion. The conflict management role of the top management of the organization is described, with particular emphasis on the pivotal position of the Medical Director.

Endoscopic management of ingested foreign bodies and food impactions.

PubMed

Malick, K Jane

2013-01-01

Endoscopy plays a major role in the management of foreign bodies and food impactions. Because of their frequent occurrence and potential for complications, it is important for the gastroenterology nurse and associate to gain an understanding of the incidence, diagnosis, and management of patients who present with ingested foreign bodies or food impaction. This article summarizes the clinical approach to patient: assessment, preparation for endoscopic procedure, preparation of endoscopic accessories, and follow-up care. Finally, an interesting case presentation highlights key components of caring for patients requiring endoscopic intervention.

Neurosurgical management in children with bleeding diathesis: auditing neurological outcome.

PubMed

Zakaria, Zaitun; Kaliaperumal, Chandrasekaran; Crimmins, Darach; Caird, John

2018-01-01

OBJECTIVE The aim of this study was to assess the outcome of neurosurgical treatment in children with bleeding diathesis and also to evaluate the current management plan applied in the authors' service. METHODS The authors retrospectively analyzed all cases in which neurosurgical procedures were performed in pediatric patients presenting with intracranial hematoma due to an underlying bleeding tendency over a 5-year period at their institution. They evaluated the patients' neurological symptoms from the initial referral, hematological abnormalities, surgical treatment, neurological outcome, and scores on the Pediatric Glasgow Outcome Scale-Extended (GOS-E Peds) obtained 1 year after the last operation. RESULTS Five patients with a bleeding diathesis who underwent surgery for intracranial hematoma were identified; the diagnosis was hemophilia A in 3 cases, idiopathic thrombocytopenic purpura in 1 case, and severe aplastic anemia in 1 case. Intracerebral hematoma (ICH) (n = 4) and acute subdural hematoma (n = 1) were confirmed on radiological investigations. In 2 of the 4 patients with ICH, the diagnosis of bleeding diathesis was made for the first time on presentation. Four patients (all male) were younger than 2 years; the patient with severe aplastic anemia and spontaneous ICH was 15 years old and female. The duration of symptoms varied from 24 hours to 5 days. Neurological examination at 1 year's follow-up showed complete recovery (GOS-E Peds score of 1) in 3 cases and mild weakness (GOS-E Peds score of 2) in 2 cases. CONCLUSIONS Neurosurgical management of patients with bleeding diathesis should be carried out in a tertiary-care setting with multidisciplinary team management, including members with expertise in neuroimaging and hematology, in addition to neurosurgery. Early diagnosis and prompt treatment of a bleeding diathesis is crucial for full neurological recovery.

Diagnostic and management of spontaneous rectus sheath hematoma.

PubMed

Smithson, Alex; Ruiz, Jessica; Perello, Rafael; Valverde, Marta; Ramos, Javier; Garzo, Luïsa

2013-09-01

Spontaneous rectus sheath hematoma is an uncommon and often misdiagnosed cause of abdominal pain. The aim of this study is to describe our experience in their management. Retrospective analysis of the characteristics and outcomes of the spontaneous rectus sheath hematomas diagnosed over the last 12years was conducted. 24 patients were included (66% women; mean age: 74years; range: 54-87). All cases presented predisposing factors mainly anticoagulant therapy in 21 (87.5%) patients, hypertension in 19 (79.1%) and abdominal surgery in 12 (50%) cases. Eighteen (75%) referred triggering factors like coughing being the most common one, present in 17 (70.8%) patients. The main clinical findings were abdominal pain in 21 (87.5%) cases and the existence of an abdominal mass in 20 (83.3%). The diagnosis was confirmed by abdominal ultrasonography and/or computerized tomography in 23 (95.8%) patients. Nineteen cases (79.1%) responded to conservative management while 5 (20.8%) required interventional treatment, which consisted in an arteriography with selective embolization of the epigastric arteries in all cases. Four (80%) of the patients needing interventional treatment were receiving low molecular weight heparin. Nine (37.5%) patients developed hypovolemic shock and 1 (4%) died. Spontaneous rectus sheath hematomas should be considered in the differential diagnosis of abdominal pain, particularly in elderly women under anticoagulant therapy with onset of symptoms after a bout of cough. Most cases respond to conservative management, although those related to low molecular weight heparin might require interventional treatment; arteriography with selective embolization of the epigastric arteries is the first therapeutic option. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Anesthesia for a Rare Case of Uncorrected Pentalogy of Fallot Undergoing Craniotomy and Drainage of Brain Abscess.

PubMed

Marulasiddappa, Vinay; Raghavavendra, B S

2015-07-01

Children with uncorrected cyanotic congenital heart diseases can present for non cardiac surgeries. They pose several challenges to the Anaesthesiologist, especially when they are posted for emergency surgery, due to the complex haemodynamic changes secondary to the heart disease. Pentalogy of Fallot (POF) is a rare form of congenital heart disease characterized by the association of Tetralogy of Fallot (TOF) with an atrial septal defect (ASD). TOF is the leading cause of intracardiac right to left shunt and is the commonest type of cyanotic congenital heart disease to cause a brain abscess. Children with POF presenting with brain abscess pose several challenges to the anaesthesiologist due to the altered haemodynamics and warrant a meticulous anaesthetic plan. There are very few case reports of Anaesthesia management of a child with Pentalogy of Fallot (POF) presenting for non cardiac surgery. We report the anaesthetic management of a rare case of a 5-year-old child with uncorrected POF, who presented to our Superspeciality hospital with a brain abscess and underwent an emergency craniotomy with drainage of the brain abscess successfully.

Pseudoaneurysm of head and neck vessels has been frequently observed in road side bomb blast victims.

PubMed

Yousuf, Kamal Muhammad; Khan, Fahad Hanif

2016-06-01

Due to recent war situation in neighboring country we have witnessed large number of victims with post-traumatic false (pseudo) aneurysms of head and neck in roadside bomb blast victims in Pakistan. Thus through this observational retrospective study we aim to share our experience of managing these patients. 5 years patients' case records, from June 2008-June 2013, were reviewed from the hospital's records. 14 cases of roadside bomb blast victims, developing false aneurysms of major or minor vessels of head and neck, were studied. We excluded the post-traumatic pseudoaneurysms involving other sites and vessels of the body. We observed the mechanism, the duration of presentation, symptoms/signs, vessels involved, complications and the management done. All 14 cases presented with a localized pulsatile swelling with tenderness in the course of a known artery and with an overlying entry site wound from bomb blast sharp nails. Men were affected more as compared to women. All (14) cases had 2-12 weeks of duration between the injury and presentation. Temporal artery (4) was involved in most cases followed by common carotid artery (3). Open surgery was treatment of choice in 12 (85.7%) of cases; however 2 (14.3%) patients had endovascular intervention to correct the pathology. Post-operatively all patients recovered completely, without any major or minor complications. Surgical intervention remains the management of choice for post-traumatic false aneurysms of head and neck in Pakistan. Despite the benefits of endovascular procedures, improvements must be weighed against the added costs on the patients. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Abdominal shotgun trauma: A case report

PubMed Central

Toutouzas, Konstantinos G; Larentzakis, Andreas; Drimousis, Panagiotis; Riga, Maria; Theodorou, Dimitrios; Katsaragakis, Stylianos

2008-01-01

Introduction One of the most lethal mechanisms of injury is shotgun wound and particularly the abdominal one. Case presentation We report a case of a 45 years old male suffering abdominal shotgun trauma, who survived his injuries. Conclusion The management of the abdominal shotgun wounds is mainly dependent on clinical examination and clinical judgment, while requires advanced surgical skills. PMID:18625076

Massive Lower Gastrointestinal Bleed caused by Typhoid Ulcer: Conservative Management.

PubMed

Goel, Apoorv; Bansal, Roli

2017-01-01

Typhoid fever is caused by gram-negative organism Salmonella typhi. The usual presentation is high-grade fever, but complications like gastrointestinal (GI) hemorrhage and perforation are also seen frequently. With the advent of antibiotics, these complications are rarely seen now. We present a case of a young female who was admitted with a diagnosis of typhoid fever presented with a massive GI bleed from ulcers in the terminal ileum and was managed conservatively without endotherapy and surgery. How to cite this article: Goel A, Bansal R. Massive Lower Gastrointestinal Bleed caused by Typhoid Ulcer: Conservative Management. Euroasian J Hepato-Gastroenterol 2017;7(2):176-177.

Spontaneous Resolution of Massive Spontaneous Tubercular Pneumothorax

PubMed Central

Kant, Surya; Saheer, S.; Hassan, G.; Parengal, Jabeed

2011-01-01

A 29-year-old female presented with complaints of fever and productive cough of three weeks duration. Pulmonary tuberculosis was diagnosed bacteriologically and she was prescribed antituberculosis drugs. During follow-up she developed massive pneumothorax, for which patient refused surgical management and was managed conservatively. After six months there was complete spontaneous resolution of pneumothorax. The unusual presentation and unexpected outcome prompted us to report this case. PMID:22937428

Atypical Presentations of Tularemia.

PubMed

Odegaard, Karah; Boersma, Beth; Keegan, James

2017-05-01

Francisella tularensis is a gram-negative coccobacillus that causes a condition commonly referred to as tularemia. There has been a dramatic increase in tularemia cases reported in South Dakota, many of which were challenging to diagnose due to atypical clinical manifestations. We describe an interesting case of pneumonic tularemia and summarize six similar cases, several of which presented with lung nodules suggestive of malignancy. According to the literature, this is only the third outbreak of pneumonic tularemia reported in the U.S. We believe it is important for clinicians to be aware of the increased incidence of tularemia in the area and to be vigilant in the diagnosis and management of these atypically presenting cases. Copyright© South Dakota State Medical Association.

Primitive Neuroectodermal Tumor Presenting with Diffuse Leptomeningeal Involvement in a 55-Year-Old Woman: A Case Report and Brief Summary of Current Diagnostic Tests and Treatment

PubMed Central

Kalidindi, Navya; Torres, Carlos H.; Michaud, Jean; Zwicker, Jocelyn Christine

2014-01-01

Primitive neuroectodermal tumors (PNETs) are typically present as masses in children and adolescents, but rarely in adults. Diagnoses, management strategies, and prognostication factors are not well established in adult cases of PNETs. We describe the case of a central nervous system PNET diagnosed in a 55-year-old woman presenting with a sudden onset of symptoms consisting of increased intracranial pressure and findings of diffuse leptomeningeal enhancement and a small medullary lesion seen on MRI. Amongst the small database of PNETs diagnosed in adults, our case report stands out as one of few cases describing a primarily leptomeningeal PNET diagnosed on biopsy. We also review the literature on PNETs presenting with diffuse leptomeningeal disease and the treatment of PNETs in the adult population. PMID:25202261

“Puestow modified procedure in the era of advanced endoscopic interventions for the management of chronic lithiasic pancreatitis. A two cases report”

PubMed Central

Fragulidis, Georgios P.; Vezakis, Αntonios; Dellaportas, Dionissios; Sotirova, Ira; Koutoulidis, Vassilis; Kontis, Elliseos; Polydorou, Andreas

2015-01-01

Introduction Pancreatic duct calculi in chronic pancreatitis (CP) patients are the main cause of intractable pain which is their main symptom. Decompression options of for the main pancreatic duct are both surgical and advanced endoscopic procedures. Presentation of cases A 64-year-old male with known CP due to alcohol consumption and a 36-year-old female with known idiopathic CP and pancreatic duct calculi were managed recently in our hospital where endoscopic procedures were unsuccessful. A surgical therapy was considered and a longitudinal pancreaticojejunostomy (modified Puestow procedure) in both patients was performed with excellent results. Discussion Over the last 30 years, endoscopic procedures are developed to manage pancreatic duct strictures and calculi of the main pancreatic duct in CP patients. In both of our cases endoscopic therapy was first attempted but failed to extract the pancreatic duct stones, due to their size and speculations. Modified Puestow procedure was performed for both and it was successful for long term pain relief. Conclusion Despite advancement in endoscopic interventions and less invasive therapies for the management of chronic lithiasic pancreatitis we consider that classic surgical management can be appropriate in certain cases. PMID:26318135

TelePain: Primary Care Chronic Pain Management through Weekly Didactic and Case-based Telementoring.

PubMed

Flynn, Diane M; Eaton, Linda H; McQuinn, Honor; Alden, Ashley; Meins, Alexa R; Rue, Tessa; Tauben, David J; Doorenbos, Ardith Z

2017-12-01

Chronic pain is a significant problem among military personnel and a priority of the military health system. The U.S. Army Surgeon General's Pain Management Task Force recommends using telehealth capabilities to enhance pain management. This article describes the development and evaluation of a telehealth intervention (TelePain) designed to improve access to pain specialist consultation in the military health system. The study uses a wait-list controlled clinical trial to test: 1) effectiveness of the intervention, and 2) interviews to assess barriers and facilitators of the intervention implementation. The intervention involves a didactic presentation based on the Joint Pain Education Curriculum followed by patient case presentations and multi-disciplinary discussion via videoconference by clinicians working in the military health system. A panel of pain specialists representing pain medicine, internal medicine, anesthesiology, rehabilitation medicine, psychiatry, addiction medicine, health psychology, pharmacology, nursing, and complementary and integrative pain management provide pain management recommendations for each patient case. We use the Pain Assessment Screening Tool and Outcomes Registry (PASTOR) to measure patient outcomes, including pain, sleep, fatigue, anxiety, and depression. This article reports some of the challenges and lessons learned during early implementation of the TelePain intervention. Weekly telephone meetings among the multisite research team were instrumental in problem solving, identifying problem areas, and developing solutions. Solutions for recruitment challenges included additional outreach and networking to military health providers, both building on.

Perioperative Care for Pediatric Patients With Penetrating Brain Injury: A Review.

PubMed

Mikhael, Marco; Frost, Elizabeth; Cristancho, Maria

2017-05-19

Traumatic brain injury (TBI) continues to be the leading cause of death and acquired disability in young children and adolescents, due to blunt or penetrating trauma, the latter being less common but more lethal. Penetrating brain injury (PBI) has not been studied extensively, mainly reported as case reports or case series, due to the assumption that both types of brain injury have common pathophysiology and consequently common management. However, recommendations and guidelines for the management of PBI differ from those of blunt TBI in regards to neuroimaging, intracranial pressure (ICP) monitoring, and surgical management including those pertaining to vascular injury. PBI was one of the exclusion criteria in the second edition of guidelines for the acute medical management of severe TBI in infants, children, and adolescents that was published in 2012 (it is referred to as "pediatric guidelines" in this review). Many reviews of TBI do not differentiate between the mechanisms of injury. We present an overview of PBI, its presenting features, epidemiology, and causes as well as an analysis of case series and the conclusions that may be drawn from those and other studies. More clinical trials specific to penetrating head injuries in children, focusing mainly on pathophysiology and management, are needed. The term PBI is specific to penetrating injury only, whereas TBI, a more inclusive term, describes mainly, but not only, blunt injury.

Health impact assessment in multinationals: A case study of the Royal Dutch/Shell Group

DOE Office of Scientific and Technical Information (OSTI.GOV)

Birley, Martin

2005-10-15

Health impact assessment is part of the risk management process of multinational corporations/companies. Sexually transmitted infections, including HIV/AIDS, and the 'paradox of plenty' are used as examples of the challenges they face. The 'business case' for impact assessment is explained. The policies, procedures, standards, and activities used by Shell to manage such risks are described. An approach to capacity building and competency development is presented that applies to both company staff and external contractors.

Saline Infusion and Amiloride in the Management of Lithium Toxicity

PubMed Central

Czerniewski, Ian W D; Short, Jacquline A; McConnell, A A

1990-01-01

This paper describes the case of a 74 year old patient who became lithium toxic after 15 years of lithium therapy. We discuss the clinical presentation of the case and some of the possible causes of the sudden development of his toxicity. Although haemodialysis is the treatment of choice for severe lithium toxicity it is not always available. In this paper we propose that the combination of saline diuresis and Amiloride may provide a suitable alternative in the management of lithium toxicity. PMID:2093357

Endoscopic management of sinonasal hemangiopericytoma.

PubMed

Tessema, Belachew; Eloy, Jean Anderson; Folbe, Adam J; Anstead, Amy S; Mirani, Neena M; Jourdy, Deya N; Joudy, Deya N; Ruiz, Jose W; Casiano, Roy R

2012-03-01

Sinonasal hemangiopericytomas (SNHPCs) are rare perivascular tumors with low-grade malignant potential. Traditionally, these tumors have been treated with open approaches such as lateral rhinotomy, Caldwell-Luc, or transfacial approaches. Increased experience with endoscopic management of benign and malignant sinonasal tumors has led to a shift in management of SNHPC. The authors present their experience in the largest series of patients with SNHPC managed endoscopically. Case series at a tertiary care medical center. A retrospective chart review of all patients undergoing endoscopic management of SNHPC at the University of Miami between 1999 and 2008 was conducted. All endoscopic resections were performed with curative intent. Twelve patients with the diagnosis of SNHPC were treated endoscopically. Mean age was 62.5 years (range, 51-83 years). There were 6 men and 6 women. The mean follow-up was 41 months (range, 15-91 months). Seven (58.3%) presented with nasal obstruction, whereas 4 (41.6%) had epistaxis as their initial presenting symptom. Preoperative angiography or embolization was not performed in any case. Mean estimated blood loss was 630 mL (range, 100-1500 mL). Six patients underwent endonasal endoscopic anterior skull base resection; 4 had complete endoscopic resection all with negative margins. None underwent postoperative adjuvant treatment. No recurrence or metastatic disease was observed in this patient population. Endoscopic management of SNHPC is a feasible approach and did not compromise outcomes in this experience. In this series, familiarity with advance endoscopic sinus surgery was necessary to manage these patients. Postoperative adjuvant therapy was not necessary in this cohort.

Meckel’s diverticulum: new solutions for an old problem?

PubMed Central

Chauhan, Abhishek; Suggett, Nigel; Guest, Peter; Goh, Jason

2016-01-01

Meckel's diverticulum (MD) is the most commonly encountered true diverticulum in the small bowel. Although overall a rare cause of gastrointestinal bleeding, it remains an important differential in a child/young adult presenting with lower gastrointestinal bleeding. We present two MD cases, one associated with brisk bleeding resulting in haemodynamic instability and the other in insidious blood loss causing symptoms of chronic iron deficiency. These cases illustrate the heterogeneous nature of the clinical picture associated with Meckel's diverticulae, a condition most gastroenterological and surgical units will encounter. We subsequently discuss the diagnostic and management dilemma Meckel's diverticulae pose and appraise the latest evidence and management strategies in this regard. PMID:28839845

[A new case of a rare anomaly of the biliary tract].

PubMed

Orea-Martínez, J G; Bretón-Márquez, J H; Contreras-Vera, R A; Anestesiólogo Práctica Privada, M

2011-01-01

We present a 36 year-old female with jaundice, who underwent surgical exploration with the diagnosis of probable biliary fasciolosis vs. Mirizzi´s syndrome. At surgery we found a short common duct leading to the body of gallbladder followed by a long cystic duct draining into the duodenum. Patient underwent hepaticojejunostomy with a Roux Y. The suspicious images of fasciola corresponded to inflammatory nodes in the hepatic hilium. A literature review was conducted and we found very few cases with this rare anomaly, some of them were managed with preservation of a portion of the gallbladder. We discuss the possible implications of this treatment and present an alternative management.

Management of colorectal cancer in three South Thames District Health Authorities.

PubMed

Pollock, A M; Vickers, N

1997-05-01

This study describes the management of colorectal cancer, diagnosed in 1988, of residents in three South Thames Districts. Of the 328 cases identified as having being diagnosed in 1988, case notes were retrieved on 263 (80%) including 62 registered by death certificate only. There were 159 cases (61%) of colon cancer and 104 cases (39%) of rectal cancer. Of these, 172 cases (68%) were admitted electively and 90 (32%) as emergencies. Patients subsequently diagnosed with colon cancer had a relative risk of being admitted through emergency (relative to rectal cancer patients) of 1.39 (95% C.I.: 1.16, 1.67). Elective admissions varied significantly by district of residence (P < 0.0001) ranging from 36-65% for colon cancers and from 63-92% for rectal cancers across the three districts. Dukes' stage was recorded in only 143 (54%) sets of case notes, with significant variation by district of residence in the proportion of elective patients for whom a Dukes' stage was indicated (P < 0.01). Two-hundred and thirty-six (90%) cases received treatment. Of the treated cases, 233 patients received surgery with 29 cases of colon cancer (18%) and 32 cases of rectal cancer (31%) receiving adjuvant therapy. The proportions of anterior resection, AP resection and colostomies given, varied by district. Patients presenting for elective surgery were more likely to be treated by a consultant than patients presenting on emergency: the relative risks were 2.58 (95% C.I.: 1.74, 3.82) for colon cancer patients and 4.93 (95% C.I.: 2.20, 11.06) for rectal cancer patients. In 44 (26%) colon cancer cases and 21 (22%) rectal cancer cases it was explicitly stated that the tumour had not been fully resected. For colon tumours the five year relative survival rates were 35% (95% C.I.: 21%, 50%), 52% (95% C.I.: 34%, 70%), and 14% (95% C.I.: -2%, 30%) in districts A, B and C respectively. The corresponding figures for rectal tumours were 45% (95% C.I.: 27%, 64%), 62% (95% C.I.: 41%, 83%) and 24% (95% C.I.: -1%, 50%). There were wide variations in the representation, management of and survival from colorectal cancers across the three districts. Differences were significant at the level of district of residence, mode of presentation and surgical grade. More assiduous recording of Dukes' stage is imperative if consensus is to be achieved on effective management. Further work is also warranted on district differences in diagnostic and referral protocols.

Arrested Hydrocephalus in Childhood: Case Series and Review of the Literature.

PubMed

Hurni, Yannick; Poretti, Andrea; Schneider, Jacques; Guzman, Raphael; Ramelli, Gian Paolo

2018-06-22

 Hydrocephalus can be progressive or spontaneously arrested. In arrested hydrocephalus, the balance between production and absorption of the cerebrospinal fluid is restored. Patients are mostly asymptomatic, and no surgical treatment is necessary for them.  We performed a two-center consecutive case series study, aimed at investigating the safety of nonsurgical management of hydrocephalus in selected pediatric patients. We retrospectively selected all consecutive patients, suspected to suffer from arrested hydrocephalus and referred to our two institutions between January 2011 and December 2013. Data on clinical and radiological follow-up were collected until June 2017.  Five children diagnosed with arrested hydrocephalus were included in the study. All patients presented macrocephaly as the main presenting sign. Associated mild-to-moderate stable motor disorders were assessed in four out of five cases. Typical symptoms and signs associated with acute raised intracranial pressure were absent in all patients. Magnetic resonance imaging studies showed ventriculomegaly in all patients. A diagnosis of arrested hydrocephalus was made in all five cases based on stable clinical and radiological findings during the initial observation. Conservative management based on active surveillance was, therefore, proposed. During the follow-up period, we observed stable or improved conditions in four out of five patients, while the remaining patient presented progressive hydrocephalus.  Making a distinction between arrested and progressive hydrocephalus is fundamental, because of the opposed appropriate management. Any newly discovered case of hydrocephalus, not characterized by clear signs of progressive hydrocephalus, should benefit from active surveillance before any definitive decision is taken. Georg Thieme Verlag KG Stuttgart · New York.

Use of endoscopy in diagnosis and management of patients with dysphagia in an African setting.

PubMed

Mudawi, H M Y; Mahmoud, A O A; El Tahir, M A; Suliman, S H; Ibrahim, S Z

2010-04-01

The objectives of this study were to define the utility of esophagogastroduodenoscopy in the diagnosis and management of patients presenting with dysphagia and to determine the relative incidence of the various causes of dysphagia in Sudan. This is a prospective, cross-sectional, descriptive, hospital-based study carried out at the endoscopy unit of Soba University Hospital, Khartoum, Sudan. All patients complaining of dysphagia underwent upper gastrointestinal endoscopy with therapeutic intervention when necessary. A total of 114 patients were enrolled in the study, with a mean age of 47 years SD +/- 19 and a male to female ratio of 1 : 1.04. A benign condition was diagnosed in 56% of the cases; this included esophageal strictures in 21% of the cases and achalasia in 14%. Malignant causes were mainly due to esophageal cancer (40.4%) and cancer of the stomach cardia (3.5%). Therapeutic intervention was attempted in 83% of the cases. Risk factors predictive of a malignant etiology were age over 40 years (P < 0.000), dysphagia lasting between 1 month and 1 year (P < 0.000), and weight loss (P < 0.000). A barium study was performed in 35 cases (31%) prior to endoscopic examination and proved to be inaccurate in three cases (8.6%). Upper gastrointestinal endoscopy in our African setting is an accurate and useful investigation in the diagnosis and management of patients presenting with dysphagia. Patients over the age of 40 years presenting with dysphagia and weight loss are more likely to have a neoplastic disease and should be referred for urgent endoscopy.

Clinical Management of Two Root Resorption Cases in Endodontic Practice

PubMed Central

2016-01-01

Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment. PMID:27648314

A practical approach to acute hemiparesis in children.

PubMed

Bhate, Sanjay; Ganesan, Vijeya

2015-08-01

Acute hemiparesis in children is a common clinical syndrome presenting to a variety of care settings. The recognition and the differential diagnosis is challenging, particularly in young children. Arterial ischaemic stroke (AIS) is the primary diagnosis to be considered as this requires emergency investigations and management; however, there are several conditions collectively described as 'stroke mimics' that need consideration. Accurate diagnosis is essential for appropriate management. Clinical data combined with neuroimaging are important for accurate diagnosis and management. This review and the accompanying illustrative case vignettes suggest a practical approach to differential diagnosis and management of children presenting with acute hemiparesis. © 2015 Mac Keith Press.

FDDI information management system for centralizing interactive, computerized multimedia clinical experiences in pediatric rheumatology/Immunology.

PubMed

Rouhani, R; Cronenberger, H; Stein, L; Hannum, W; Reed, A M; Wilhelm, C; Hsiao, H

1995-01-01

This paper describes the design, authoring, and development of interactive, computerized, multimedia clinical simulations in pediatric rheumatology/immunology and related musculoskeletal diseases, the development and implementation of a high speed information management system for their centralized storage and distribution, and analytical methods for evaluating the total system's educational impact on medical students and pediatric residents. An FDDI fiber optic network with client/server/host architecture is the core. The server houses digitized audio, still-image video clips and text files. A host station houses the DB2/2 database containing case-associated labels and information. Cases can be accessed from any workstation via a customized interface in AVA/2 written specifically for this application. OS/2 Presentation Manager controls, written in C, are incorporated into the interface. This interface allows SQL searches and retrievals of cases and case materials. In addition to providing user-directed clinical experiences, this centralized information management system provides designated faculty with the ability to add audio notes and visual pointers to image files. Users may browse through case materials, mark selected ones and download them for utilization in lectures or for editing and converting into 35mm slides.

Role of Ketamine and Methadone as Adjunctive Therapy in Complex Pain Management: A Case Report and Literature Review

PubMed Central

Faisal, Wasek; Jacques, Judith

2017-01-01

Assessment and management of complex cancer pain always remains a major challenge for any palliative care team, given its heterogeneity of underlying pathophysiology and limitations of any pharmacotherapy. Here, we present a case of complex pain management in a young patient with a life-limiting illness, highlighting the issues of organic and nonorganic contributors of pain and provide some insight into the role of ketamine and methadone as adjunctive therapy to opioid analgesics. A brief literature review is also done to provide the context of use of these adjunctive drugs in this setting. PMID:28216871

Methadone Management of Withdrawal Associated With Loperamide-related Opioid Use Disorder.

PubMed

Leo, Raphael J; Ghazi, Muhammad A; Jaziri, Kelly S

: Loperamide hydrochloride is an over-the-counter anti-diarrheal agent, acting via mu-opioid receptor agonist effects in the intestinal myenteric plexus. Although preclinical investigations suggested that abuse liability associated with loperamide use is low, there are increasing numbers of cases reported to the US Food and Drug Administration, of abuse, dependence, and withdrawal associated with loperamide use. A case of a patient with opioid use disorder, that is, in the form of protracted loperamide excess use, requiring management of withdrawal with methadone is presented. Management of withdrawal from abrupt loperamide discontinuation has not been discussed in the literature. Long-term treatment issues are also described.

Management of mandibular body fractures in pediatric patients: a case report with review of literature.

PubMed

John, Baby; John, Reena R; Stalin, A; Elango, Indumathi

2010-10-01

Mandibular fractures are relatively less frequent in children when compared to adults, which may be due to the child's protected anatomic features and infrequent exposure of children to alcohol related traffic accidents. Treatment principles of mandibular fractures differ from that of adults due to concerns regarding mandibular growth and development of dentition. A case of a 4.5-year-old boy with fractured body of mandible managed by closed reduction using open occlusal acrylic splint and circum mandibular wiring is presented. This article also provides a review of literature regarding the management of mandibular body fracture in young children.

Management of mandibular body fractures in pediatric patients: A case report with review of literature

PubMed Central

John, Baby; John, Reena R.; Stalin, A.; Elango, Indumathi

2010-01-01

Mandibular fractures are relatively less frequent in children when compared to adults, which may be due to the child's protected anatomic features and infrequent exposure of children to alcohol related traffic accidents. Treatment principles of mandibular fractures differ from that of adults due to concerns regarding mandibular growth and development of dentition. A case of a 4.5-year-old boy with fractured body of mandible managed by closed reduction using open occlusal acrylic splint and circum mandibular wiring is presented. This article also provides a review of literature regarding the management of mandibular body fracture in young children. PMID:22114443

Management of pediatric mandibular fracture using orthodontic vacuum-formed thermoplastic splint: A case report and review of literature.

PubMed

Sanu, O O; Ayodele, Aos; Akeredolu, M O

2017-05-01

Fractures of the mandible are relatively less frequent in children when compared to adults. The anatomic features of children are protected. Children have a higher adaptation to maxillofacial fractures compared to adults. Treatment principles of mandibular fractures in children differ from that of adults due to concerns regarding mandibular growth and the developing dentition. A case of a 6-year-old boy with fractured mandibular symphysis managed by closed reduction using a vacuum formed thermoplastic splint and circummandibular wiring is presented. This article also provides a review of the literature regarding the management of mandibular fracture in young children.

Intra-operative post-induction hyperthermia, possibly malignant hyperthermia: Anesthetic implications, challenges and management

PubMed Central

Gulabani, Michell; Gurha, Pavan; Ahmad, Sabih; Dass, Prashant

2014-01-01

Malignant Hyperthermia is a pharmacogenetic disorder. Classical manifestations comprise of tachycardia, increase in expired carbon dioxide levels, muscle rigidity, hyperthermia (>38.8°C) and unexpected acidosis. Here we report a case of 16-year-old female patient, ASA-I with chronic rhino-sinusitis and slight strabismus of the left eye posted for functional endoscopic sinus surgery, developing a rise in ETCO2 and temperature immediately following anesthesia induction. She was aggressively managed to an uneventful recovery. We present a case of intra-operative post-induction hyperthermia possibly MH, its anesthetic implications, challenges encountered and its management. PMID:25425784

Gastro-oesophageal reflux associated with duodenum inversum: two case reports and a review of the literature.

PubMed

Patel, Dhiren; Agarwal, Roshani; Powell, William; Al-Ansari, Namir

2017-08-01

Gastro-oesophageal reflux disease (GORD) is a very common paediatric disorder and the majority of patients are treated successfully by primary care physicians. Two infants aged 2 months with GORD which did not respond to conventional medical management are reported; they were diagnosed with duodenum inversum. The first infant failed medical management and required Nissen's fundoplication to control his symptoms. The second infant improved on maximizing medical management without the need for a surgical procedure. These two cases highlight the need for further work-up in patients who do not respond to conventional GORD therapy and/or present with atypical clinical symptoms.

Hirayama disease.

PubMed

Kieser, David C; Cox, P J; Kieser, S C J

2018-06-01

Hirayama disease is an initially progressive disease caused by cervical neck flexion compressing the anterior horns of the lower cervical spinal cord. It is primarily seen in young males of Indian or Asian descent. With increasing dispersion of these populations this condition is increasingly being encountered internationally. This grand round reviews this rare but increasingly recognized condition. We present a classic case of a young Indian male with progressive hand and forearm weakness. We discuss the typical clinical presentation, appropriate investigations and management of this condition. Our patient presented with oblique amyotrophy and underwent a diagnostic flexion MRI scan which revealed anterior translation of the posterior dura with compression of the anterior horns of the lower cervical cord. He has been successfully treated in a cervical collar. This case illustrates the typical presentation, diagnostic investigations and treatment of Hirayama syndrome. It is hoped that this review will alert clinicians of this condition and optimize the management of affected individuals.

Clinical problem solving: monster on the hook--case problems in neurosurgery.

PubMed

Muh, Carrie R; Boulis, Nicholas M; Chandler, William F; Barkan, Ariel L; Mosunjac, Marina B; Oyesiku, Nelson M

2011-03-01

Nonfunctioning and functioning pituitary tumors can present in numerous ways. They may be difficult to diagnose correctly and, even with proper treatment, may lead to complications. We present the case of a patient who presented with a large, invasive sellar mass and underwent both medical and surgical treatment for this lesion. The patient's course did not progress as was expected from his initial workup. The patient's history, physical examination, laboratory values, pathologic specimens, and radiologic findings are discussed. His management before, during, and after medical therapy and surgery is reviewed by pituitary experts from 2 different institutions. Aspects of diagnosis and management of sellar lesions are presented and reviewed in the literature. Neurosurgeons frequently treat patients with sellar lesions and should remember that despite modern laboratory, pathologic, and radiologic techniques, the diagnosis and treatment of these lesions is not always clear.

Ampullary Mixed Adenoneuroendocrine Carcinoma: Surprise Histology, Familiar Management.

PubMed

Mahansaria, Shyam Sunder; Agrawal, Nikhil; Arora, Asit; Bihari, Chhagan; Appukuttan, Murali; Chattopadhyay, Tushar Kanti

2017-10-01

Mixed adenoneuroendocrine carcinoma (MANEC) has recently been defined by the World Health Organization in 2010. These are rare tumors and MANECs of ampullary region are even rarer. Only 19 cases have been reported in literature. We present 3 cases; the largest series, second case of amphicrine tumor and first case associated with chronic pancreatitis. Retrospective review of 3 patients who were diagnosed to have ampullary MANEC. All 3 patients were diagnosed preoperatively as neuroendocrine carcinoma and underwent margin negative pancreaticoduodenectomy. The histopathology revealed MANECs of small cell, mixed type in 2 patients and large cell, amphicrine type in 1 patient. The neuroendocrine component was grade 3 in all, the tumor was T3 in 2 and T2 in 1 and all had nodal metastases. Two patients received adjuvant chemotherapy and 2 of them had recurrence at 13 and 16 months. The median survival was 15 months. Ampullary MANECs are rare tumors. They are diagnosed on histopathologic examination of the resected specimen. Clinical presentation, management, and prognosis is similar to ampullary adenocarcinoma in literature.

Overall comparative analysis of management and outcomes of cardiac cases reported on board merchant ships.

PubMed

Apostolatos, Charalampos; Andria, Vivian; Licari, Julie

Telemedical assistance has always been the cornerstone of medical care on board. Significant technological progress has provided improved scientific tools and equipment for high-quality communication and prompt management of either minor incidents or major emergencies on board. Med Solutions International is a medical management company, offering services exclusively to the maritime industry. Registered vessels contact the medical team and healthcare professionals provide immediate guidelines for onboard management as well as necessary action thereafter, i.e. examination ashore or urgent medical evacuation. Since cardiac conditions or diseases are potentially the most dangerous when traveling at sea, it is of major importance to analyse and evaluate the overall management and outcomes of cases reporting symptoms of possible heart disease so as to improve telemedical assistance services in future. The study included cases reporting cardiac symptoms from 5 major shipping companies during the year 2016. Data was collected from telecommunication, emails and seafarers' final medical reports. A descriptive analysis of overall management and outcomes was performed. The study showed that the number of confirmed cardiovascular cases on board was very low. Among 551 total cases and 44 cases with reported cardiac symptoms there was only one heart attack, one pulmonary oedema and one suspected myocarditis. In the majority of cases, chest pain was musculoskeletal or due to respiratory infection. Symptoms resulting from issues such as stress or anxiety often present as potential cardiac conditions. Stress may also amplify the severity of symptoms. Language barriers between the seafarer, the master and the doctor often make communication very difficult. According to our findings there are grounds to intensify the prevention process through more efficient pre-employment medical examinations and improve management on board through more intensive training. Communication problems often complicate medical management on board. Effective communication and knowledge of patient's medical history and risk profile is very important to reviewing physician. Effective diagnosis depends on accurate and objective description of symptoms and clinical condition.

Transtympanic Facial Nerve Paralysis: A Review of the Literature

PubMed Central

Schaefer, Nathan; O’Donohue, Peter; French, Heath; Griffin, Aaron; Gochee, Peter

2015-01-01

Summary: Facial nerve paralysis because of penetrating trauma through the external auditory canal is extremely rare, with a paucity of published literature. The objective of this study is to review the literature on transtympanic facial nerve paralysis and increase physician awareness of this uncommon injury through discussion of its clinical presentation, management and prognosis. We also aim to improve patient outcomes in those that have sustained this type of injury by suggesting an optimal management plan. In this case report, we present the case of a 46-year-old white woman who sustained a unilateral facial nerve paresis because of a garfish penetrating her tympanic membrane and causing direct damage to the tympanic portion of her facial nerve. On follow-up after 12 months, her facial nerve function has largely returned to normal. Transtympanic facial nerve paralysis is a rare injury but can have a favorable prognosis if managed effectively. PMID:26090278

Emergency Response and Long Term Planning: Two sides of the Coin for Managing Water Resources

NASA Astrophysics Data System (ADS)

Metchis, K.; Beller-Simms, N.

2014-12-01

As projected by the US National Climate Assessment and the IPCC, extreme climate and weather events are occurring more frequently and with more intensity across the nation. Communities - and the water resource managers that serve them - are facing difficult choices to increase emergency preparedness, recover from costly impacts, and increase long term resilience. The presentation is based on a recent set of case studies about what happened in six communities that experienced one or more extreme events, focusing on water resource management. Two of the case studies will be presented, revealing that building climate resilience is not just about long term planning - it is also about taking the steps to be prepared for - and to be able to recover from - emergency events. The results of this study have implications for educating local officials on ways to think about resilience to balance both long-term and short-term preparedness.

Surgical management of vulvovaginal agglutination due to lichen planus.

PubMed

Fairchild, Pamela S; Haefner, Hope K

2016-02-01

Lichen planus is a rare dermatological disorder that is often associated with painful and disfiguring vulvovaginal effects. At the University of Michigan Center for Vulvar Diseases, we see many women with vulvovaginal lichen planus each year, with marked scarring and vulvovaginal agglutination that precludes vaginal intercourse and causes difficulty with urination. Through our experience, we developed a protocol for the operative management and postoperative care for severe vulvovaginal agglutination. Our objective is to share this protocol with a wider audience so that providers who see patients with these devastating effects of lichen planus can benefit from our experience to better serve this patient population. The figure represents a case of erosive lichen planus with early vaginal agglutination. The video reviews the pathophysiology and presentation of lichen planus. We then present a case of scarring and agglutination in a young woman, including our surgical management and postoperative care recommendations. Copyright © 2016 Elsevier Inc. All rights reserved.

Early orthodontic management of Crouzon Syndrome: a case report.

PubMed

Hlongwa, P

2009-03-01

Crouzon Syndrome is an autosomal dominant disorder with complete penetrance and variable expressivity. Described by a French neurosurgeon in 1912, it is a rare genetic disorder. Crouzon syndrome is caused by mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. The disease is characterized by premature synostosis of coronal and sagittal sutures which begins in the first year of life. Once the sutures become closed, growth potential to those sutures is restricted. However, multiple sutural synostoses frequently extend to premature fusion of skull base causing midfacial hypoplasia, shallow orbit, maxillary hypoplasia and occasional upper airway obstruction.The case of a 7-year-old South African black boy with Crouzon Syndrome is presented. He presented with characteristic triad of cranial deformity, maxillary hypoplasia and exophthalmos. The clinical, cephalometric features and initial orthodontic management of this patient are discussed as part of multidisciplinary management.

Pneumatosis intestinalis: a case report and approach to management.

PubMed

Donovan, Sean; Cernigliaro, Joseph; Dawson, Nancy

2011-01-01

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

Pneumatosis Intestinalis: A Case Report and Approach to Management

PubMed Central

Donovan, Sean; Cernigliaro, Joseph; Dawson, Nancy

2011-01-01

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios. PMID:21331331

Leiomyoma of Urinary Bladder Presenting with Febrile Urinary Tract Infection: A Case Report.

PubMed

Haddad, Ra'ed Ghassan; Murshidi, Mujalli Mhailan; Abu Shahin, Nisreen; Murshidi, Muayyad Mujalli

2016-01-01

Leiomyomas of urinary bladder constitute only about 0.43% of all bladder tumors. Only about 250 cases were reported in English literature. This is the first reported case of bladder leiomyoma to present with febrile urinary tract infection. We report a case of a 37- year old male who presented with febrile urinary tract infection. Imaging showed a bladder lesion. This lesion was managed by transurethral resection. Pathologic diagnosis was bladder leiomyoma. Although bladder leiomyomas are benign, they can cause serious sequelae, including serious urinary tract infections as the case we present here shows. This is why it is important to early diagnose and treat this condition. This case highlights the importance of early introduction of imaging in patients presenting with severe urinary tract infections. Failure to diagnose this lesion as the underlying cause of infection may have easily led to recurrence of similar severe life-threatening infections. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Infection Associated Secondary Hemophagocytic Lymphohistiocytosis in Sepsis Syndromes - A Tip of an Iceberg.

PubMed

Agarwal, Arun; Agarwal, Aakanksha

2016-10-01

Hemophagocytic lymphohistiocytosis (HLH) is a rare, underdiagnosed, fatal and devastating hyperinflammatory syndrome that has gained increasing recognition over the past decade. Patients with HLH present with clinical and laboratory evidence of uncontrolled inflammation. Delay in diagnosis and management inevitably leads to a rapidly progressive and fatal course. In this case series, we present 7 cases of secondary HLH (sHLH) in adults with their presentation, course, and outcomes. We retrospectively looked at the 7 cases of secondary HLH who were diagnosed and managed in our institute between January 2013 and august 2015. Medical records were retrieved from medical records department and data analyzed and tabulated. The median age at diagnosis was 35 years (age range 26-72 years). Diagnosis was based on HLH 2004 diagnostic criteria. We report profile of 7 adult patients with sHLH. All patients had a short history of illness (<2 weeks) and presented uniformly with prolonged fever, bi or trilineage cytopenia and multiorgan dysfunction syndrome (MODS) at admission or developed MODS during the course of their illness. None of them had prediagnosed HLH. All patients fulfilled 5 to 6 of 8 criteria as per HLH 2014 diagnostic criteria. The median length of hospital stay was 12 days (range 7-50 days) and the median time to diagnosis was 5 days (range 3 to 21 days). Mortality was 57%. HLH is a rare and under-diagnosed clinical syndrome and is rapidly fatal if not diagnosed and managed timely. The cases reported in literature probably represent a tip of an iceberg of large number of undiagnosed cases mostly labeled as sepsis with MODS in critical care units. sHLH should be suspected in any patient who present with persistent and prolonged fever, transaminitis, cytopenia, and high serum Ferritin or dramatically rising serial serum Ferritin. Early diagnosis and prompt aggressive treatment are vital for patients' survival and favorable outcome.

Infection Associated Secondary Hemophagocytic Lymphohistiocytosis in Sepsis Syndromes - A Tip of an Iceberg.

PubMed

Agarwal, Arun; Agarwal, Aakanksha

2017-10-01

Hemophagocytic lymphohistiocytosis (HLH) is a rare, underdiagnosed, fatal and devastating hyperinflammatory syndrome that has gained increasing recognition over the past decade. Patients with HLH present with clinical and laboratory evidence of uncontrolled inflammation. Delay in diagnosis and management inevitably leads to a rapidly progressive and fatal course. In this case series, we present 7 cases of secondary HLH (sHLH) in adults with their presentation, course, and outcomes. We retrospectively looked at the 7 cases of secondary HLH who were diagnosed and managed in our institute between January 2013 and august 2015. Medical records were retrieved from medical records department and data analyzed and tabulated. The median age at diagnosis was 35 years (age range 26-72 years). Diagnosis was based on HLH 2004 diagnostic criteria. We report profile of 7 adult patients with sHLH. All patients had a short history of illness (<2 weeks) and presented uniformly with prolonged fever, bi or trilineage cytopenia and multiorgan dysfunction syndrome (MODS) at admission or developed MODS during the course of their illness. None of them had prediagnosed HLH. All patients fulfilled 5 to 6 of 8 criteria as per HLH 2014 diagnostic criteria. The median length of hospital stay was 12 days (range 7-50 days) and the median time to diagnosis was 5 days (range 3 to 21 days). Mortality was 57%. HLH is a rare and under-diagnosed clinical syndrome and is rapidly fatal if not diagnosed and managed timely. The cases reported in literature probably represent a tip of an iceberg of large number of undiagnosed cases mostly labeled as sepsis with MODS in critical care units. sHLH should be suspected in any patient who present with persistent and prolonged fever, transaminitis, cytopenia, and high serum Ferritin or dramatically rising serial serum Ferritin. Early diagnosis and prompt aggressive treatment are vital for patients' survival and favorable outcome.

Microneurosurgical management of temporal lobe epilepsy by amygdalohippocampectomy (AH) plus standard anterior temporal lobectomy (ATL): a report of our initial five cases in Bangladesh

PubMed Central

Chowdhury, F H; Haque, M R; Islam, M S; Sarker, MH; Kawsar, KA; Sarker, AC

2010-01-01

Patient presenting as a case of Temporal Lobe Epilepsy (TLE) are usually resistant to antiepileptic drugs and surgery is the treatment of choice. This type of epilepsy may be due to Mesial Temporal Sclerosis (MTS), tumors [i.e. low grade glioma, Arterio-Venous Malformation (AVM) etc], trauma, infection (Tuberculosis) etc. Here we report five cases of surgically treated TLE that were due to a MTS, MTS with arachnoid cyst, low grade ganglioglioma, high grade ganglioglioma and a tuberculoma in the department of neurosurgery, Dhaka Medical College Hospital and Islami Bank Central Hospital, Dhaka, Bangladesh from August 2009 to February 2010. In all cases the only presenting symptoms was complex partial seizures (psychomotor epilepsy) for which all underwent scalp EEG (Electro Encephalogram) and MRI (Magnetic Resonance Imaging) of Brain. All patients were managed by amygdalohippocampectomy plus standard anterior lobectomy. One patient with high grade ganglioglioma recurred within two months of operation and expired within five months. The rest of the cases are seizure and disease free till the last follow up. PMID:22028754

Anesthetic management of spontaneous cervical epidural hematoma during pregnancy: a case report.

PubMed

Samali, Mehdi; Elkoundi, Abdelghafour; Tahri, Achraf; Bensghir, Mustapha; Haimeur, Charki

2017-06-26

Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. The potential for difficult airway management with the patient under general anesthesia is one of the major concerns that needs to be addressed to prevent further cord compression. Anesthetic management should also include measures to maintain the mean arterial pressure to improve spinal cord perfusion. Furthermore, spine surgery in pregnant patients needs special consideration in terms of positioning and in the postoperative period. We present a case of a 35-year-old white woman at 21 weeks of gestation with a spontaneous cervical epidural hematoma. Fiberoptic bronchoscope-guided nasal intubation was a safe option to ensure a higher rate of successful endotracheal intubation while minimizing the risk of aggravating the injury. Her care posed other multiples challenges that required a multidisciplinary team approach. The case of our patient serves as a reminder of this rare condition and its implications regarding anesthesia.

Challenges in the diagnosis and management of sleeping sickness in Tanzania: a case report.

PubMed

Sindato, C; Kibona, S N; Nkya, G M; Mbilu, T J N K; Manga, C; Kaboya, J S; Rawille, F

2008-07-01

In Tanzania sleeping sickness presents a serious threat to human health with a country-wide average of 400 cases reported annually. Both wild and domestic animals have been found to play a significant role in the epidemiology of sleeping sickness. Serengeti National Park in northern Tanzania, has experienced a number of sleeping sickness epidemics since 1922. The epidemics were associated with abundant game animals in the areas and Glossina swynnertoni was incriminated as the main vector. However since 2001 there has been no case of sleeping sickness reported from the park. This case report highlights on the possibility of resurgence and challenges in the diagnosis and management of sleeping sickness in Serengeti. A 38 years old Tanzanian man working in the Serengeti National Park who had experienced various tsetse bites was presented with a febrile condition and history of unsuccessful case management at different health facilities. Blood and cerebrospinal fluid (CSF) samples were examined for the presence oftrypanosomes using wet film, Field's stain and concentration techniques. Typanosoma brucei rhodesiense were detected in both the blood and CSF samples. The patient was treated successfully with melarsoprol. The results of this case study highlight the possibility of resurgence of sleeping sickness in the park hence calls for the need to create more awareness among the community and clinicians. There is need for early reporting to health facility and strengthening the diagnostic capacity of healthcare facilities in and around national parks endemic for sleeping sickness.

Alternative Endpoints and Approaches Selected for the Remediation of Contaminated Groundwater at Complex Sites

NASA Astrophysics Data System (ADS)

Deeb, R. A.; Hawley, E.

2011-12-01

This presentation will focus on findings, statistics, and case studies from a recently-completed report for the Department of Defense's Environmental Security Technology Certification Program (ESTCP) (Project ER-0832) on alternative endpoints and alternative remedial strategies for groundwater remediation under a variety of Federal and state cleanup programs, including technical impracticability (TI) and other Applicable or Relevant and Appropriate Requirement (ARAR) waivers, state and local designations such as groundwater management zones, Alternate Concentration Limits (ACLs), use of monitored natural attenuation (MNA) over long timeframes, and more. The primary objective of the project was to provide environmental managers and regulators with tools, metrics, and information needed to evaluate alternative endpoints for groundwater remediation at complex sites. A statistical analysis of Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) sites receiving TI waivers will be presented as well as case studies of other types of alternative endpoints and alternative remedial strategies to illustrate the variety of approaches used at complex sites and the technical analyses used to predict and document cost, timeframe, and potential remedial effectiveness. Case studies provide examples of the flexible, site-specific, application of alternative endpoints and alternative remedial strategies that have been used in the past to manage and remediate groundwater contamination at complex sites. For example, at least 13 states consider some designation for groundwater containment in their corrective action policies, such as groundwater management zones, containment zones, and groundwater classification exemption areas. These designations typically indicate that groundwater contamination is present above permissible levels. Soil and groundwater within these zones are managed to protect human health and the environment. Lesson learned for the analyses conducted and the case studies evaluated allow for a more careful consideration of alternative, beneficial, and cost-effective cleanup objectives and metrics that can be achieved over the short-term (while eventually meeting long-term cleanup objectives or demonstrating the applicability of alternative endpoints), thus improving the site cleanup process at complex sites where appropriate.

Occipital peripheral nerve stimulation in the management of chronic intractable occipital neuralgia in a patient with neurofibromatosis type 1: a case report

PubMed Central

2011-01-01

Introduction Occipital peripheral nerve stimulation is an interventional pain management therapy that provides beneficial results in the treatment of refractory chronic occipital neuralgia. Herein we present a first-of-its-kind case study of a patient with neurofibromatosis type 1 and bilateral occipital neuralgia treated with occipital peripheral nerve stimulation. Case presentation A 42-year-old Caucasian woman presented with bilateral occipital neuralgia refractory to various conventional treatments, and she was referred for possible treatment with occipital peripheral nerve stimulation. She was found to be a suitable candidate for the procedure, and she underwent implantation of two octapolar stimulating leads and a rechargeable, programmable, implantable generator. The intensity, severity, and frequency of her symptoms resolved by more than 80%, but an infection developed at the implantation site two months after the procedure that required explantation and reimplantation of new stimulating leads three months later. To date she continues to experience symptom resolution of more than 60%. Conclusion These results demonstrate the significance of peripheral nerve stimulation in the management of refractory occipital neuralgias in patients with neurofibromatosis type 1 and the possible role of neurofibromata in the development of occipital neuralgia in these patients. PMID:21569290

Reengineering outcomes management: an integrated approach to managing data, systems, and processes.

PubMed

Neuman, K; Malloch, K; Ruetten, V

1999-01-01

The integration of outcomes management into organizational reengineering projects is often overlooked or marginalized in proportion to the entire project. Incorporation of an integrated outcomes management program strengthens the overall quality of reengineering projects and enhances their sustainability. This article presents a case study in which data, systems, and processes were reengineered to form an effective Outcomes Management program as a component of the organization's overall project. The authors describe eight steps to develop and monitor an integrated outcomes management program. An example of an integrated report format is included.

Introduction to Command, Control and Communications (C3) Through Comparative Case Analysis

DTIC Science & Technology

1990-03-01

enhancing the process of learning from experience. Case study allows the student to apply concepts , theories, and techniques to an actual incident within...part of the thesis describes selected principles and concepts of 33 related to cormruication management, interoperability, command structure and...The solutions to the cases require applying the principles and concepts presented in the first rart. The four cases are: (1) the Iran hostage rescue

The John Kay Williams gold medal of the Royal Colleges of England and Glasgow 2011.

PubMed

Levisianos, Ioannis

2013-03-01

This paper describes the orthodontic treatment of two cases presented at the bi-collegiate examination of the Royal Colleges of Surgeons of England and Glasgow as part of the Membership in Orthodontics examination. The first case details the management of an 11-year-old Caucasian female patient with a Class II Division 2 malocclusion who was treated with a combination of extra-oral anchorage and fixed appliances. The second case details the management of a 14-year-old Indian male with a Class II Division 1 malocclusion who was treated with a combination of functional and fixed appliance therapy.

Undiagnosed light chain systemic amyloidosis: does it matter to anesthesiologists? -a case report-

PubMed Central

Kim, Gwan Ho; Lee, Woo Kyung; Na, Se Hee

2013-01-01

Light chain systemic amyloidosis is rare but may accompany laryngeal or pulmonary involvement, which may increase the risk in airway management. We present a case of a patient planned for resection of cervical epidural mass. The patient had face and neck ecchymoses and purpuras with an unknown cause. Mask ventilation and intubation were successful, but the operation was cancelled to evaluate bleeding from facial skin lesions. A diagnosis of light chain systemic amyloidosis prompted evaluation of involvement of other organs and treatment. This case shows the importance of preoperative evaluation and careful airway management in patients with systemic amyloidosis. PMID:24363850

Trans-arterial Onyx Embolization of a Functional Thoracic Paraganglioma

PubMed Central

Chacón-Quesada, Tatiana; Maud, Alberto; Ramos-Duran, Luis; Torabi, Alireza; Fitzgerald, Tamara; Akle, Nassim; Cruz Flores, Salvador; Trier, Todd

2015-01-01

Paragangliomas are rare tumors of the endocrine system. They are highly vascular and in some cases hormonally active, making their management challenging. Although there is strong evidence of the safety and effectiveness of preoperative embolization in the management of spinal tumors, only five cases have been reported in the setting of thoracic paragangliomas. We present the case of a 19-year-old man with a large, primary, functional, malignant paraganglioma of the thoracic spine causing a vertebral fracture and spinal cord compression. To our knowledge this is the first report of preoperative trans-arterial balloon augmented Onyx embolization of a thoracic paraganglioma. PMID:25763296

Dental, dermatological and radiographic findings in a case of Gorlin-Goltz Syndrome: report and review.

PubMed

Nilesh, Kumar; Tewary, Shivsagar; Zope, Sameer; Patel, Jinesh; Vande, Aaditee

2017-01-01

Gorlin-Goltz syndrome (GGS) is a rare autosomal dominant disorder. The disease shows multiple organ involvement with variable clinical presentation. Thus a multidisciplinary approach is required for its prompt clinical diagnosis and management of this condition. This paper highlights a case of GGS presenting in a young male patient with cranial, facial, dermatological, dental and skeletal involvement. The diagnosis of the syndrome was based on its clinical presentation, radiological features and histopathological findings. A review of the diagnostic criteria is also presented.

Dental, dermatological and radiographic findings in a case of Gorlin-Goltz Syndrome: report and review

PubMed Central

Nilesh, Kumar; Tewary, Shivsagar; Zope, Sameer; Patel, Jinesh; Vande, Aaditee

2017-01-01

Gorlin-Goltz syndrome (GGS) is a rare autosomal dominant disorder. The disease shows multiple organ involvement with variable clinical presentation. Thus a multidisciplinary approach is required for its prompt clinical diagnosis and management of this condition. This paper highlights a case of GGS presenting in a young male patient with cranial, facial, dermatological, dental and skeletal involvement. The diagnosis of the syndrome was based on its clinical presentation, radiological features and histopathological findings. A review of the diagnostic criteria is also presented. PMID:28819517

Cougar attacks on humans: a case report.

PubMed

McKee, Denise

2003-01-01

Cougar attacks on humans are increasing. Presented is a case report of a nonfatal 2-year-old male cougar attack on an 8-year-old girl in British Columbia. Discussions of wound management, rabies postexposure prophylaxis (RPEP), and the possible psychologic ramifications of such an attack are presented. Also reviewed are recommendations on actions that may be helpful in preventing an attack following a sudden encounter with a cougar. Humans must learn to coexist with cougars, which present a small but real threat to people.

Branchial Cleft Cyst.

PubMed

Nahata, Vaishali

2016-01-01

Branchial cleft cyst, sinuses, and fistulae are among the most commonly encountered congenital anomalies in pediatric otolaryngic practice. They can present difficulty in diagnosis and surgical management. Here, I report a case of 14-year-old boy who presented with asymptomatic, congenital swelling located just below the jawline in the lateral part of the neck. The lesion was excised surgically. Histopathology showed the cyst lined by squamous as well as columnar ciliated epithelium, which was a characteristic finding of branchial cleft cyst. The aim of presenting this case is its rarity.

Resettlement: A Cultural and Psychological Crisis.

ERIC Educational Resources Information Center

Hulewat, Phyllis

1996-01-01

The stages of resettlement and need to integrate past cultural experience into their new life are similar for all immigrants. Describes stages of resettlement and basic elements needed to manage the resettlement process. Three specific groups of clients are identified, and case management methods are presented for dealing with issues raised by…

Using Knowledge Management to Revise Software-Testing Processes

ERIC Educational Resources Information Center

Nogeste, Kersti; Walker, Derek H. T.

2006-01-01

Purpose: This paper aims to use a knowledge management (KM) approach to effectively revise a utility retailer's software testing process. This paper presents a case study of how the utility organisation's customer services IT production support group improved their test planning skills through applying the American Productivity and Quality Center…

Meniere's Disease in Childhood: Implications for Management in the School Environment.

ERIC Educational Resources Information Center

Hance, Susan E.

1990-01-01

The symptoms of Meniere's disease, including tinnitus, fluctuating hearing loss, and vertigo, present specific problems in the school setting. The paper reviews the literature on Meniere's Disease in childhood, focusing on incidence, symptoms, diagnosis, etiology, treatment, and implications for management in the school environment. A case study…

A Guide to the Identification of Training Needs.

ERIC Educational Resources Information Center

Boydell, T. H.

This comprehensive analysis of training needs, which is illustrated with case studies and factual examples, is directed towards training management, but its concepts are expressed in terms valuable to all management. The first chapter answers the question, "What are training needs?" The following chapters discuss present and future training needs,…

Online Project Based Learning in Innovation Management.

ERIC Educational Resources Information Center

O'Sullivan, David

2003-01-01

An innovation management course has three strands with face-to-face and online components: (1) seminars with online course notes and slides; (2) assignments (group online case studies, tutorials, in-class presentations); and (3) assessment (online, oral, in-class, written). Students are able to benchmark their work online and teachers use the…

The management of self-inflicted oral trauma secondary to encephalitis: a clinical report.

PubMed

Finger, S T; Duperon, D F

1991-01-01

Encephalitis is a neurological condition that can present with self-inflicted oral trauma from fever-induced dyskinesia as one of its complications. Three cases of encephalitis are described in this report. The management of this trauma, through the use of soft plastic mouth-guards, is discussed.

American Electrical: Managing an Environmental Crisis.

ERIC Educational Resources Information Center

O'Rourke, James S., IV

1998-01-01

Presents a case study for use in business communication classes to help students understand and learn both the context and the strategies for communication with business and management. Deals with an electrical company that finds itself with an environmental crisis on its hands. Includes five assignments as well as five samples. (SR)

Managing Serious Teacher Misbehaviour

ERIC Educational Resources Information Center

Page, Damien

2014-01-01

This article presents findings from a study of five head teachers who were responsible for the management of serious teacher misbehaviour (TMB) in England. In cases that included the downloading of extreme pornography on a school laptop and a sexual relationship with a pupil, the multiple impacts of TMB were potentially devastating to the…

The successful use of simple tube duodenostomy in large duodenal perforations from varied etiologies

PubMed Central

Kutlu, Onur C.; Garcia, Steven; Dissanaike, Sharmila

2012-01-01

INTRODUCTION Tube decompression of the duodenum is an old but underutilized technique known to decrease morbidity and mortality in patients with difficult to manage duodenal injuries. Broad arrays of techniques have been described in the literature and are reviewed, but most are complex procedures not appropriate for the management of an unstable patient. PRESENTATION OF CASE In this paper we describe the technique of tube duodenostomy and the successful application in three cases of large defects (>3 cm) which two of these cases had failed previous repair attempts. The defects were caused by very different etiologies, including blunt trauma, peptic ulcer disease and erosion from cancer. All were finally managed by application of tube duodenostomy with success. DISCUSSION Patients with “difficult to manage duodenum” usually present with hemodynamic instability with hostile abdomen. Complex procedures in an unstable patient are associated with adverse outcomes. In patients with significant comorbidities and instability the damage control principle of trauma surgery is gaining popularity. Tube duodenostomy technique described in this paper fits in well with that principle. CONCLUSION Application of tube duodenostomy instead of a complex procedure in an unstable patient provides an opportunity to stabilize the patient, converting an impending catastrophe to a future scheduled surgery. PMID:23357008

The management of work-related asthma guidelines: a broader perspective.

PubMed

Baur, Xaver; Aasen, Tor Brøvig; Burge, P Sherwood; Heederik, Dick; Henneberger, Paul K; Maestrelli, Piero; Schlünssen, Vivi; Vandenplas, Olivier; Wilken, Dennis

2012-06-01

The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5-25% of all adult asthma cases and is responsible for a significant socioeconomic burden. Several hundred occupational agents, mainly allergens but also irritants and substances with unknown pathological mechanisms, have been identified as causing work-related asthma. The essential message of these guidelines is that the management of work-related asthma can be considerably optimised based on the present knowledge of causes, risk factors, pathomechanisms, and realistic and effective interventions. To reach this goal we urgently require greatly intensified primary preventive measures and improved case management. There is now a substantial body of evidence supporting the implementation of comprehensive medical surveillance programmes for workers at risk. Those workers who fail surveillance programmes need to be referred to a clinician who can confirm or exclude an occupational cause. Once work-related asthma is confirmed, a revised risk assessment in the workplace is needed to prevent further cases. These new guidelines confirm and extend already existing statements and recommendations. We hope that these guidelines will initiate the much-needed research that is required to fill the gaps in our knowledge and to initiate substantial improvements in preventative measures.

Erosion and intrusion of silicone rubber scleral buckle. Presentation and management.

PubMed

Nguyen, Q D; Lashkari, K; Hirose, T; Pruett, R C; McMeel, J W; Schepens, C L

2001-01-01

To describe the clinical presentation and management of erosion and intrusion of silicone rubber implants that are used in scleral buckling procedures for the treatment of retinal detachment. The authors identified four patients from their practices during the last 20 years (1978-1998) who had erosion or intrusion of silicone rubber scleral buckles that were used to manage retinal detachment. Approximately 4400 scleral buckling procedures were performed during this period. A retrospective review of the medical records of all patients was performed. Factors that influenced management decisions concerning the intruding buckle are emphasized. All four patients had myopia. The interval between placement of the scleral buckle and development of intrusion ranged from 1 to 20 years. The buckles were intrascleral in three cases and episcleral in one. Recurrent detachment and vitreous hemorrhage were indications for surgical intervention in three cases. After the surgical removal of buckling elements, visual acuity stabilized in all patients and the retina remained attached in all cases. Erosion and intrusion of scleral buckle are rare complications of scleral buckling procedures. The intruding buckle may be left intact unless there is significant threat to the integrity of ocular structures, recurrent detachment, or hemorrhage. Manipulation of the encircling band or buckle does not necessarily alter the visual acuity or the status of the retina.

Robotic assisted laparoscopic repair of a symptomatic ureterosciatic hernia.

PubMed

Regelman, Mikhail; Raman, Jay D

2016-04-01

Ureterosciatic hernias (USH) are a rare entity and to date there have been limited case reports detailing their presentation, diagnosis, and management. Until recently, repair of ureterosciatic hernias has been performed via open, endoscopic, or purely laparoscopic approaches. We present the second known published case of a robotic approach to the USH repair with detailed outline of the surgical technique accompanied by video recording from the operative procedure.

Vulvar trichoblastoma: case report and literature review.

PubMed

Pina, Annick; Sauthier, Philippe; Rahimi, Kurosh

2015-01-01

Trichoblastomas are rare and benign tumors that arise from rudimentary hair follicles. Presentation varies from superficial plaques to papular or nodular lesions. Trichoblastomas usually arise on the head or neck. A few cases of other vulvar trichoblastic tumors such as trichofibromas and trichoepitheliomas have been reported to this day, but no such report of vulvar trichoblastoma exists. We report the case of a 61-year-old woman who presented with a vulvar trichoblastoma. The woman presented with a lump of the labium majus. She was managed surgically, first by wide excision of the mass followed by a second surgery consisting of a partial vulvectomy. Because surgical margins were positive and there is a potential for malignant transformation, a third surgery was performed. The margins came back negative. A literature review on trichoblastomas was performed, including its potential for malignant transformation, management, and immunohistochemistry to differentiate it from basal cell carcinoma. Trichoblastomas are benign tumors that have a potential for malignant transformation. These tumors can present aggressive characteristics. Differential diagnosis from basal cell carcinoma can be difficult but is facilitated using immunohistochemistry. This is the first case of vulvar trichoblastoma reported in the literature. Although it is a benign tumor, excision with negative margins is recommended because it can be difficult to distinguish from basal cell carcinoma and it has a potential for malignant transformation.

[Unstable thorax fixation with bioabsorbable plates and screws. Presentation of some cases].

PubMed

Nolasco-de la Rosa, Ana Lilia; Mosiñoz-Montes, Roberto; Matehuala-García, Jesús; Román-Guzmán, Edgardo; Quero-Sandoval, Fidel; Reyes-Miranda, Alma Lorena

2015-01-01

Flail chest is managed with mechanical ventilation or inhalation therapy, and analgesia. Mechanical ventilations carry risks by themselves and disengage with the external fixators so they must be operated to improve lung ventilatory mechanics and cleaning. Little has been published on the use of bioabsorbable material and its evolution in the setting of flail chest. A material that did had to be retired, that presented the malleability of titanium and its inflammatory reaction was minimal and could be handled in both adults and children was investigated. Here is shown a descriptive study of patients with flail chest under rib fixation with plates and bioabsorbable screws. 18 cases are presented, aged 33-74 years, three with bilateral flail chest; fixation was performed between days 1-21 of the accident. In cases that showed no fractures pelvic limbs, gait next day restarted fi ng in all cases improved mechanical ventilation, pain decreased, none has so far presented reaction material. Flail chest has a high (16.3%) mortality when no management provides the pathophysiology of the condition (pain, poor mechanical ventilation, alveolar edema-pulmonary contusion). The use of bioabsorbable material has no side effects attributable to material which is another option for rib fixation. Copyright © 2015. Published by Masson Doyma México S.A.

What healthcare students do with what they don't know: the socializing power of 'uncertainty' in the case presentation.

PubMed

Spafford, Marlee M; Schryer, Catherine F; Lingard, Lorelei; Hrynchak, Patricia K

2006-01-01

Healthcare students learn to manage clinical uncertainty amid the tensions that emerge between clinical omniscience and the 'truth for now' realities of the knowledge explosion in healthcare. The case presentation provides a portal to viewing the practitioner's ability to manage uncertainty. We examined the communicative features of uncertainty in 31 novice optometry case presentations and considered how these features contributed to the development of professional identity in optometry students. We also reflected on how these features compared with our earlier study of medical students' case presentations. Optometry students, like their counterparts in medicine, displayed a novice rhetoric of uncertainty that focused on personal deficits in knowledge. While optometry and medical students shared aspects of this rhetoric (seeking guidance and deflecting criticism), optometry students displayed instances of owning limits while medical students displayed instances of proving competence. We found that the nature of this novice rhetoric was shaped by professional identity (a tendency to assume an attitude of moral authority or defer to a higher authority) and the clinical setting (inpatient versus outpatient settings). More explicit discussions regarding uncertainty may help the novice unlock the code of contextual forces that cue the savvy member of the community to sanctioned discursive strategies.

Keratoconus presenting with bilateral simultaneous acute corneal hydrops.

PubMed

Bilgin, Burak; Unal, Betül; Unal, Mustafa; Doğan, Erkan; Cetinkaya, Aslı; Akyol, Mahmut; Yücel, Iclal; Akar, Yusuf; Apaydın, Cemil; Ilhan, Deniz

2013-04-01

To report a case of unknown keratoconus presenting with bilateral simultaneous acute corneal hydrops. Case report. A case of a 12-year-old male patient with Leber congenital amaurosis (LCA) presented with sudden whitening and lacrimation for 2 days in both eyes simultaneously. At the initial examination, there were bilateral acute corneal hydrops, enophthalmic eyes and roving nystagmus. Ultrasonography revealed clear crystalline lenses and attached retina. Initial management consisted of topical hypertonic solutions, steroids and artificial tears. Bilateral simultaneous acute corneal hydrops has not been reported before in the literature. It may be the presenting sign of keratoconus. Copyright © 2012 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Severe transfusion-related acute lung injury managed with extracorporeal membrane oxygenation (ECMO) in an obstetric patient.

PubMed

Lee, Allison J; Koyyalamudi, Pushpa L; Martinez-Ruiz, Ricardo

2008-11-01

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality in the United States. Management is usually supportive, including supplemental oxygen, intravenous fluids, and mechanical ventilation if necessary. Most patients recover within 72 hours. We present a nearly fatal case of TRALI in an obstetric patient, which was successfully managed with extracorporeal membrane oxygenation (ECMO).

Is estimated bullet trajectory a reliable predictor of severe injury? Case report of a thoraco-abdominal gunshot with a protracted trajectory managed nonoperatively

PubMed Central

2013-01-01

Background Operative management of all gunshot’s traumas carries a high rate of unwarranted interventions that are known to cause serious complications. Selective nonoperative management is thus being increasingly practiced which has reduced these avoidable interventions. Physical examination and computed tomography scans are most sensitive in assessing need of laparotomy. Assessment of internal injuries on the basis of an estimated bullet trajectory is often practiced but has seldom been studied. We report a case of conservative management of a thoraco abdominal gun shot patient where an estimated bullet trajectory was indicative of serious injuries. To the best of our knowledge this is the first report of a thoraco abdominal gunshot that, despite of a protracted trajectory, had no sequelae and was thus managed nonoperatively. Case presentation A 30 year old male patient having height of 180 cm and weight of 70 kg (Body Mass Index 21.6) presented with complaint of a penetrating injury at left side of upper torso. The patient had no symptoms or obvious bleeding and was vitally stable. On examination a 1 cm × 1 cm entry wound at the left 3rd intercostal space in the mid clavicular line was identified. The chest and abdomen were otherwise unremarkable on examination. The chest radiograph displayed clear lung fields. The abdominal radiographs displayed a bullet in the upper left quadrant of the abdomen lateral to the spine. The bullets estimated trajectory from 3rd intercostal space and its lodgment in the abdomen lateral to the spine indicated severe visceral injury. The computed tomography scan showed that the bullet was lodged postero-medially to the left kidney. All thoracic, intra peritoneal and retroperitoneal visceral structures were identified to be normal. The patient remained clinically and vitally stable, hence was managed nonoperatively being discharged after 48 h of observation. Conclusion From this case we conclude that decision for managing gun shot patients should be based on objective clinical and diagnostic findings. We recommend further investigation of the predictability of estimated trajectory for visceral injuries and consequent operative intervention as we found it to be misleading in this case. PMID:23414905

Macroergonomic analysis and design for improved safety and quality performance.

PubMed

Kleiner, B M

1999-01-01

Macroergonomics, which emerged historically after sociotechnical systems theory, quality management, and ergonomics, is presented as the basis for a needed integrative methodology. A macroergonomics methodology was presented in some detail to demonstrate how aspects of microergonomics, total quality management (TQM), and sociotechnical systems (STS) can be triangulated in a common approach. In the context of this methodology, quality and safety were presented as 2 of several important performance criteria. To demonstrate aspects of the methodology, 2 case studies were summarized with safety and quality performance results where available. The first case manipulated both personnel and technical factors to achieve a "safety culture" at a nuclear site. The concept of safety culture is defined in INSAG-4 (International Atomic Energy Agency, 1991). as "that assembly of characteristics and attitudes in organizations and individuals which establishes that, as an overriding priority, nuclear plant safety issues receive the attention warranted by their significance." The second case described a tire manufacturing intervention to improve quality (as defined by Sink and Tuttle, 1989) through joint consideration of technical and social factors. It was suggested that macroergonomics can yield greater performance than can be achieved through ergonomic intervention alone. Whereas case studies help to make the case, more rigorous formative and summative research is needed to refine and validate the proposed methodology respectively.

Global Lakes Sentinel Services: Monitoring Water Quality Trends in Deep, Clear Lakes to Detect Causes and Effects of Changes in Trophic Status

NASA Astrophysics Data System (ADS)

Poser, Kathrin; Peters, Steef; Hommersom, Annelies; Giardino, Claudia; Bresciani, Mariano; Cazzaniga, Ilaria; Schenk, Karin; Heege, Thomas; Philipson, Petra; Ruescas, Ana; Bottcher, Martin; Stelzer, Kerstin

2015-12-01

The GLaSS project develops a prototype infrastructure to ingest and process large amounts of Sentinel-2 and Sentinel-3 data for lakes and reservoirs. To demonstrate the value of satellite observations for the management of aquatic ecosystems, global case studies are performed addressing different types of lakes with their respective problems and management questions. One of these case studies is concentrating on deep clear lakes worldwide. The aim of this case study is to evaluate trends of chlorophyll-a concentrations (Chl-a) as a proxy of the trophic status based on the MERIS full resolution data archive. Some preliminary results of this case study are presented here.

Institutional Protocol to Manage Consanguinity Detected by Genetic Testing in Pregnancy in a Minor

PubMed Central

Chen, Laura P.; Beck, Anita E.; Tsuchiya, Karen D.; Chow, Penny M.; Mirzaa, Ghayda M.; Wiester, Rebecca T.

2015-01-01

Single-nucleotide polymorphism arrays and other types of genetic tests have the potential to detect first-degree consanguinity and uncover parental rape in cases of minor teenage pregnancy. We present 2 cases in which genetic testing identified parental rape of a minor teenager. In case 1, single-nucleotide polymorphism array in a patient with multiple developmental abnormalities demonstrated multiple long stretches of homozygosity, revealing parental rape of a teenage mother. In case 2, a vague maternal sexual assault history and diagnosis of Pompe disease by direct gene sequencing identified parental rape of a minor. Given the medical, legal, and ethical implications of such revelations, a protocol was developed at our institution to manage consanguinity identified via genetic testing. PMID:25687148

Update on the management of pineal cysts: Case series and a review of the literature.

PubMed

Berhouma, M; Ni, H; Delabar, V; Tahhan, N; Memou Salem, S; Mottolese, C; Vallee, B

2015-01-01

The natural history of pineal cysts still remains unclear. Incidental pineal cysts have become more common which raises the question of their management. Symptomatic pineal cysts may require a surgical solution but therapeutic indications have not yet been clearly established. From 1986 to 2012, 26 patients with pineal cysts were identified. Their medical records were retrospectively assessed focusing on the initial symptoms, imaging characteristics of the cyst, management strategy, operative technique and their complications, as well as the latest follow-up. A systematic review of the literature is also presented. Twenty-six patients with pineal cysts were identified. The mean age was 23.5 years ranging from 7 to 49 years. Symptoms included intracranial hypertension with obstructive hydrocephalus in 18 cases and oculomotor anomalies in 12 cases. Two adult cases presented with non-specific headaches and did not require surgery. Twenty patients were operated via a suboccipital transtentorial approach with total removal of the cyst in 70% of the cases, while the remaining 4 cases were treated with an intraventricular endoscopic marsupialization associating a third ventriculostomy. Four patients required a preoperative ventriculo-peritoneal shunt due to life-threatening obstructive hydrocephalus. Overall, peri-operative mortality was nil. In the two non-operated patients, the cyst remained stable and no recurrences were observed in all operated patients with a mean follow-up of 144 months. In the majority of incidental pineal cysts, a clinical and imaging follow-up is sufficient but occasionally not required especially in adults as very rare cases of increase in size have been reported. Copyright © 2014. Published by Elsevier Masson SAS.

Western U.S.-Canada crossborder case study : activity 2 : task D : conduct regional and local trucking case studies

DOT National Transportation Integrated Search

2012-08-01

This report presents the test plan for conducting the Technical Capability Analysis for the United States Department of Transportation (U.S. DOT) evaluation of the San Diego Integrated Corridor Management (ICM) Initiative Demonstration. The ICM proje...

Denny's: Communicating Amidst a Discrimination Case.

ERIC Educational Resources Information Center

Chin, Teresa; Naidu, Sharmila; Ringel, Jonathan; Snipes, Wayne; DeSilva, Jean; Bienvenu, Sherron Kenton

1998-01-01

Presents a case study for use in business communication classes to help students understand and learn both the context and the strategies for communication with business and management. Looks at communication strategies employed by Denny's during its crisis caused by charges of racial discrimination. Includes actual communications instrumental in…

[Prevention and principles of management in case of cardiac tamponade after catheterisation of the subclavian vein in parenteral nutrition].

PubMed

Głuszek, S; Kot, M; Matykiewicz, J

1999-01-01

The authors described different complications after the subclavian vein catheterisation, focusing on the cardiac tamponade. The authors presented the prevention and treatment principles respectively in case of the cardiac tamponade and reported experiences in this field.

Spontaneous resolution of postoperative lumbar pseudomeningoceles: A report of four cases.

PubMed

Solomon, Prince; Sekharappa, Vijay; Krishnan, Venkatesh; David, Kenny Samuel

2013-07-01

Pseudomeningocele is an extradural cerebrospinal fluid collection arising from a dural defect, that may be congenital, traumatic, or more commonly as a result of postoperative complication. Majority of the postoperative pseudomeningoceles occurring after lumbar spine surgeries are small and resolve spontaneously. However, large pseudomeningoceles are rare and spontaneous resolution of such pseudomeningoceles has not been described. We report four cases of postoperative large lumbar pseudomeningoceles that presented as asymptomatic soft fluctuant swelling over the back which resolved spontaneously. We also reviewed the related literatures and operative records of these patients to find the possible mechanism of occurrence, their management, prevention, and reasons for spontaneous resolution. We conclude that nonoperative management under close observation can be employed for asymptomatic postoperative large lumbar pseudomeningoceles. Surgical exploration and repair should be reserved for symptomatic cases presenting with clinical features of intracranial hypotension, worsening neurology, external fistula or infection, thereby avoiding morbidity and potential complications associated with surgical treatment.

Abscess inside craniopharyngioma: diagnostic and management implications.

PubMed

Bhaisora, Kamlesh Singh; Prasad, Surya Nandan; Das, Kuntal Kanti; Lal, Hira

2018-02-03

Abscess inside the pituitary fossa is very rare. Such abscess can be primary, occurring in an otherwise healthy pituitary gland, or secondary, developing inside a diseased gland (ie, harbouring craniopharyngioma, Rathke's cleft cyst, etc). Secondary pituitary abscess inside a craniopharyngioma remains an extremely rare occurrence. Our literature search revealed only six such cases reported so far. In this report, we present the seventh case of craniopharyngioma with abscess in a 38-year-old woman. We describe the uniqueness of the clinical presentation of our case, the radiological pointers to the possible diagnosis and the management issues in our patient. A review of literature is also included to provide a comprehensive picture of this rare condition to the readers. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

OUTER LOOP LANDFILL CASE STUDY

EPA Science Inventory

This presentation will describe the interim data reaulting from a CRADA between USEPA and Waste Management, Inc. at the outer Loop Landfill Bioreactor research project located in Louisville, KY. Recently updated data will be presented covering landfill solids, gas being collecte...

Post-traumatic cervical pneumorrhachis--a rare entity.

PubMed

Gill, Maneet; Sreenivas, Mukkamala; Beniwal, Rajveer Singh

2011-02-01

Pneumorrhachis(PR) is a rare phenomenon and post traumatic PR even more so. Presentation can vary from asymptomatic to significant neurological deficit and so the management has to be individualised. We present a case of post-traumatic cervical PR.

Congenital Shunts of the Portal Venous System: Case-series of Uncommon Shunts.

PubMed

Santos, Liliana; Nobre, Susana; Laezza, Nadia; Cunha, Catarina; Gonçalves, Isabel; Lopes, Maria F

Congenital shunts of the portal venous system are rare entities that can present in children with clinical heterogeneity. To evaluate the clinical course of children with uncommon shunts presenting to our institution and examine the available literature on this topic. Medical records of children with rare forms of congenital shunts were retrospectively reviewed for demographics, symptoms, management, and outcome between 2003 and 2016. Three female patients with congenital shunts, including a congenital mesenterico-portal Rex shunt (n = 1) and congenital portosystemic shunts (CPSS) (n = 2), were referred for surgical evaluation between ages 4 and 9. Median follow-up was 8 years (range, 6-13 years). One asymptomatic patient did not require treatment and remained disease-free during long-term follow-up. The other 2 patients with CPSS and unusual symptoms, including liver focal nodular hyperplasia (FNH) in infancy (n = 1) and bleeding from esophageal varices (n = 1), showed subsequent progression to liver nodules that were managed by endovascular shunt occlusion. One patient showed symptom resolution and the other showed stable lesions at last follow-up. Literature yielded descriptions of two cases of congenital mesenterico-portal Rex shunt, one case of coincident CPSS and FNH in infancy, but zero reports of bleeding from esophageal varices. This case series examines each distinct patient's presentation, discusses the diagnosis, management and outcome and compares findings while discussing literature on this topic. A high index of suspicion and familiarity with unusual forms and treatment options is required to allow timely diagnosis and appropriate treatment.

Let's Make a Movie: Investigating Pre-Service Teachers' Reflections on Using Video Recorded Role Playing Cases in Turkey

ERIC Educational Resources Information Center

Koc, Mustafa

2011-01-01

This study examined the potential consequences of using student-filmed video cases in the study of classroom management in teacher education. Pre-service teachers in groups were engaged in video-recorded role playing to simulate classroom memoirs. Each group shared their video cases and interpretations in a class presentation. Qualitative data…

MO-E-BRB-00: PANEL DISCUSSION: SBRT/SRS Case Studies - Lung

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

2016-06-15

In this interactive session, lung SBRT patient cases will be presented to highlight real-world considerations for ensuring safe and accurate treatment delivery. An expert panel of speakers will discuss challenges specific to lung SBRT including patient selection, patient immobilization techniques, 4D CT simulation and respiratory motion management, target delineation for treatment planning, online treatment alignment, and established prescription regimens and OAR dose limits. Practical examples of cases, including the patient flow thought the clinical process are presented and audience participation will be encouraged. This panel session is designed to provide case demonstration and review for lung SBRT in terms ofmore » (1) clinical appropriateness in patient selection, (2) strategies for simulation, including 4D and respiratory motion management, and (3) applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent, and (4) image guidance in treatment delivery. Learning Objectives: Understand the established requirements for patient selection in lung SBRT Become familiar with the various immobilization strategies for lung SBRT, including technology for respiratory motion management Understand the benefits and pitfalls of applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent determination for lung SBRT Understand established prescription regimes and OAR dose limits.« less

The "wins" of change: evaluating the impact of predicted changes on case management practice.

PubMed

Stanton, Marietta P; Barnett Lammon, Carol Ann

2008-01-01

A variety of strategies were employed to identify current and future trends that would impact the practice of case management. Historical review, consultation with case management experts, literature review, and environmental scanning by practicing case managers were strategies employed to determine the impact of current and future trends on case management. The trends identified in this article have implications for case managers in a variety of settings. Case managers participating in the environmental scanning process to evaluate the impact of the identified trends on their organization included representation from acute care, home care, behavioral health, workers' compensation, and private insurance settings. The top 7 trends identified by experts in the field of case management included pay for performance, recovery audit contractors, Medicare demonstration projects, transitions of care, informatics in healthcare and case management, metrics for case management, and the impact of an aging population in case management. Practicing case managers were asked to react to these trends in terms of likelihood of occurrence in their organization and impact of these trends on their case management practice. Case management will ultimately have a higher degree of accountability for its practice if metrics to evaluate and reimbursement for case management become a reality. A multitude of performance measures exist that will be monitored and be tied to reimbursement. To ensure that agencies are accomplishing these performance measures, case management will potentially have a growing importance. Case managers perceive that these trends have a predominantly positive impact on case management.

A case of hypertensive urgency.

PubMed

Baum, Laurence

2016-08-01

A 41-year-old male Nepalese soldier presented to the primary care medical centre with a 1-week history of fatigue and muscle aches following a trip to Nepal. His BP was 164/98 but was otherwise normal. Four days later he presented with new symptoms of sweating and palpitations and a BP of 200/127 whereupon he was admitted to hospital with the diagnosis of hypertensive crisis. Appropriate investigation and initial management were undertaken, and he was discharged after 12 h on antihypertensive treatment. This case highlights the risk of hypertensive crisis in both diagnosed and silent hypertensive disease, and the review highlights the presentations, initial investigation and different management of hypertensive crisis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Management of a traumatic hepatic artery pseudoaneurysm and arterioportal fistula with a combination of a stent graft and coil embolization using flow control with balloon remodeling.

PubMed

Flum, Andrew S; Geiger, James D; Gemmete, Joseph J; Williams, David M; Teitelbaum, Daniel H

2009-10-01

We describe a child who presented with a traumatic hepatic artery pseudoaneurysm and arterioportal fistula, which were subsequently managed with an endovascular stent graft and coil embolization using flow control with balloon remodeling. This case demonstrates a rarely seen condition in the pediatric population and a novel management strategy, which should be considered in the management of this complex injury.

Ecological Knowledge Among Communities, Managers and Scientists: Bridging Divergent Perspectives to Improve Forest Management Outcomes

NASA Astrophysics Data System (ADS)

Rist, Lucy; Shackleton, Charlie; Gadamus, Lily; Chapin, F. Stuart; Gowda, C. Made; Setty, Siddappa; Kannan, Ramesh; Shaanker, R. Uma

2016-04-01

Multiple actors are typically involved in forest management, namely communities, managers and researchers. In such cases, suboptimal management outcomes may, in addition to other factors, be symptomatic of a divergence in perspectives among these actors driven by fundamental differences in ecological knowledge. We examine the degree of congruence between the understandings of actors surrounding key issues of management concern in three case studies from tropical, subtropical and boreal forests. We identify commonly encountered points of divergence in ecological knowledge relating to key management processes and issues. We use these to formulate seven hypotheses about differences in the bodies of knowledge that frequently underlie communication and learning failures in forest management contexts where multiple actors are involved and outcomes are judged to be suboptimal. Finally, we present a set of propositions to acknowledge and narrow these differences. A more complete recognition of the full triangulation between all actors involved, and of the influence that fundamental differences in ecological knowledge can exert, may help lead to a more fruitful integration between local knowledge and practice, manager knowledge and practice, and contemporary science in forest management.