415 Improving Preoperative Computed Tomography Staging for Men with Suspected Testicular Cancer

Abstract Introduction Neo-adjuvant chemotherapy may be considered for suspected testicular malignancy if widespread life-threatening metastases are identified on computed tomography (CT) imaging. Staging preoperatively enables this and may prevent delays in ongoing oncological care. This project aimed to increase the proportion of staging scans performed preoperatively in the University Hospitals of Leicester NHS trust. Method All referrals between 01/01/2016 and 31/12/2018 to the urology multidisciplinary team for suspected testicular cancer were reviewed. Exclusion criteria were applied prior to collecting treatment pathway data for each patient. Based on initial audit findings, clinicians were advised to request staging CT scans at the first urology clinic appointment. Re-audit was between 01/01/2019 and 31/12/2019. Results Initial audit included 95 patients and re-audit included 23 patients. The proportion of preoperative scans increased from 28.4% to 82.6% following intervention. Median time from first ultrasound to CT was reduced from 44 days to 17 days without affecting median time to orchidectomy (27 to 23 days) or oncology appointment (61 days). Conclusions Requesting a staging CT scan as part of the first clinic assessment improved the proportion of preoperative scans without affecting time to surgery or oncology appointment.

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Computed Tomography Imaging in Simulated Ongoing Cardiopulmonary Resuscitation: No Need to Switch Off the Chest Compression Device during Image Acquisition

Diagnostics ◽

10.3390/diagnostics11061122 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1122

Author(s):

Jessica Graef ◽

Bernd A. Leidel ◽

Keno K. Bressem ◽

Janis L. Vahldiek ◽

Bernd Hamm ◽

...

Keyword(s):

Computed Tomography ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Image Acquisition ◽

Circulatory Arrest ◽

Motion Artifacts ◽

Current Standard ◽

Ct Protocol ◽

Life Threatening ◽

Reconstruction Time

Computed tomography (CT) represents the current standard for imaging of patients with acute life-threatening diseases. As some patients present with circulatory arrest, they require cardiopulmonary resuscitation. Automated chest compression devices are used to continue resuscitation during CT examinations, but tend to cause motion artifacts degrading diagnostic evaluation of the chest. The aim was to investigate and evaluate a CT protocol for motion-free imaging of thoracic structures during ongoing mechanical resuscitation. The standard CT trauma protocol and a CT protocol with ECG triggering using a simulated ECG were applied in an experimental setup to examine a compressible thorax phantom during resuscitation with two different compression devices. Twenty-eight phantom examinations were performed, 14 with AutoPulse® and 14 with corpuls cpr®. With each device, seven CT examinations were carried out with ECG triggering and seven without. Image quality improved significantly applying the ECG-triggered protocol (p < 0.001), which allowed almost artifact-free chest evaluation. With the investigated protocol, radiation exposure was 5.09% higher (15.51 mSv vs. 14.76 mSv), and average reconstruction time of CT scans increased from 45 to 76 s. Image acquisition using the proposed CT protocol prevents thoracic motion artifacts and facilitates diagnosis of acute life-threatening conditions during continuous automated chest compression.

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COVD-26. TELEPHONE CONSULTATIONS IN NEURO-ONCOLOGY DURING THE COVID-19 PANDEMIC: LEVELS OF PATIENT SATISFACTION AND COMPARISON WITH TRADITIONAL FACE-TO-FACE CONSULTATIONS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.107 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii26-ii26

Author(s):

Emma Toman ◽

Claire Goddard ◽

Frederick Berki ◽

William Garratt ◽

Teresa Scott ◽

...

Keyword(s):

Patient Satisfaction ◽

University Hospitals ◽

Health Crisis ◽

Patient Satisfaction Questionnaire ◽

Telephone Consultation ◽

Exact Test ◽

Face To Face ◽

Significant Difference ◽

The Face ◽

The University

Abstract INTRODUCTION Controversy exists as to whether telephone clinics are appropriate in neurosurgical-oncology. The COVID-19 pandemic forced neuro-oncology services worldwide to re-design and at the University Hospitals Birmingham UK, telephone clinics were quickly implemented in select patients to limit numbers of patients attending hospital. It was important to determine how these changes were perceived by patients. METHODS A 20-question patient satisfaction questionnaire was distributed to patients who attended neuro-oncology clinic in person (“face-to-face”), or via the telephone. Fisher’s exact test was used to determine significance, which was set at p< 0.05. RESULTS Eighty questionnaires were distributed between June 2020 and August 2020. Overall, 50% (n=40) of patients returned the questionnaire, 50% (n=23) of face-to-face and 50% (n=17) telephone patients. Of those who received telephone consultations, 88% (n=15) felt the consultation was convenient, 88% (n=15) were satisfied with their consultation and 18% (n=3) felt they would have preferred to have a face-to-face appointment. Of those who attended clinic in person, 96% (n=22) felt their consultation was convenient, 100% (n=23) were satisfied with their consultation and 13% (n=3) would have preferred a telephone consultation. Within the face-to-face clinic attendees, only 13% (n=3) were concerned regarding the COVID risk associated with attending hospital. There was no significant difference in patient convenience or satisfaction (p=0.565 and p=0.174 respectively) between face-to-face and telephone clinics. There was no significant difference in whether patients would’ve preferred the alternative method of consultation (p > 0.999). CONCLUSION Our study suggests that careful patient selection for neuro-oncology telephone clinic is not inferior to face-to-face clinic. Telephone clinic during COVID-19 pandemic proved to be convenient, safe and effective. This global health crisis has transformed telephone neuro-oncology consultations from an experimental innovation into established practice and should be continued beyond the pandemic in select cases.

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Diagnosing gastric volvulus in chest X-ray: report of three cases

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa229 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Narendra Pandit ◽

Abhijeet Kumar ◽

Tek Narayan Yadav ◽

Qamar Alam Irfan ◽

Sujan Gautam ◽

...

Keyword(s):

Computed Tomography ◽

Acute Abdomen ◽

Gastric Volvulus ◽

X Ray ◽

Pain Abdomen ◽

Life Threatening ◽

Chest X Ray ◽

High Index Of Suspicion ◽

Specific Symptoms ◽

Prompt Diagnosis

Abstract Gastric volvulus is a rare abnormal rotation of the stomach along its axis. It is a surgical emergency, hence requires prompt diagnosis and treatment to prevent life-threatening gangrenous changes. Hence, a high index of suspicion is required in any patients presenting with an acute abdomen in emergency. The entity can present acutely with pain abdomen and vomiting, or as chronic with non-specific symptoms. Chest X-ray findings to diagnose it may be overlooked in patients with acute abdomen. Here, we report three patients with gastric volvulus, where the diagnosis was based on the chest X-ray findings, confirmed with computed tomography, and managed successfully with surgery.

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Concussion Knowledge among Medical Students and Neurology/Neurosurgery Residents

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100013524 ◽

2012 ◽

Vol 39 (3) ◽

pp. 361-368 ◽

Cited By ~ 28

Author(s):

Miranda Boggild ◽

Charles H. Tator

Keyword(s):

Medical Students ◽

Chronic Traumatic Encephalopathy ◽

Sample Population ◽

Diagnosis And Management ◽

University Of Toronto ◽

Concussion Management ◽

Life Threatening ◽

Concussion History ◽

The University ◽

Impact Syndrome

Background and Objectives:Concussion is a prevalent brain injury in the community. While primary prevention strategies need to be enhanced, it is also important to diagnose and treat concussions expertly and expeditiously to prevent serious complications that may be life-threatening or long lasting. Therefore, physicians should be knowledgeable about the diagnosis and management of concussions. The present study assesses Ontario medical students’ and residents’ knowledge of concussion management.Methods:A survey to assess the knowledge and awareness of the diagnosis and treatment of concussions was developed and administered to graduating medical students (n= 222) and neurology and neurosurgery residents (n = 80) at the University of Toronto.Results:Residents answered correctly significantly more of the questions regarding the diagnosis and management of concussions than the medical students (mean = 5.8 vs 4.1, t= 4.48, p<0.01). Gender, participation in sports, and personal concussion history were not predictive of the number of questions answered correctly. Several knowledge gaps were identified in the sample population as a whole. Approximately half of the medical students and residents did not recognize chronic traumatic encephalopathy (n = 36) or the second impact syndrome (n = 44) as possible consequences of repetitive concussions. Twenty-four percent of the medical students (n = 18) did not think that “every concussed individual should see a physician” as part of management.Conclusions:A significant number of medical students and residents have incomplete knowledge about concussion diagnosis and management. This should be addressed by targeting this population during undergraduate medical education.

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Poster 240 Spinal ataxia from Ewing’s sarcoma: a case report Yusuf Z. Tatli III MD (New York Presbyterian The University Hospitals of Columbia and Cornell, New York, NY); Michael D. Stubblefield MD; Christian M. Custodio MD, [email protected]

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2004.07.307 ◽

2004 ◽

Vol 85 (9) ◽

pp. e49

Keyword(s):

New York ◽

Case Report ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

University Hospitals ◽

The University

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Die Hämolytischen Syndrome im Kindesalter

PEDIATRICS ◽

10.1542/peds.14.2.178a ◽

1954 ◽

Vol 14 (2) ◽

pp. 178-179

Keyword(s):

Mushroom Poisoning ◽

University Hospitals ◽

City Center ◽

Stationary Population ◽

Children's Hospital ◽

Children’S Hospital ◽

The University

The author of this excellent monograph has been for many years connected with the University Children's Hospital in Zürich, as a coworker of Fanconi who wrote the preface of this book. The University hospitals in Zürich are a traditional center of clinical hematologic research. Feer, Fanconi and Naegeli made important contributions dealing with the constitutional etiology of blood dyscrasias. The stationary population of Zürich facilitates study of hereditary traits such as spherocytosis, the international influx, e.g., experiences in Mediterranean anemia and the location as university and city center abundant material of mushroom poisoning and erythroblastosis.

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Association of Genital Mycoplasmas with Exudative Vaginitis in a 10 Year Old: A Case of Misdiagnosis

PEDIATRICS ◽

10.1542/peds.71.2.250 ◽

1983 ◽

Vol 71 (2) ◽

pp. 250-252

Author(s):

K. B. Waites ◽

M. B. Brown ◽

S. Stagno ◽

J. Schachter ◽

S. Greenberg ◽

...

Keyword(s):

Ureaplasma Urealyticum ◽

Bacterial Pathogen ◽

Mycoplasma Hominis ◽

University Of Alabama ◽

Large Numbers ◽

Lower Genital Tract ◽

History Of ◽

The University ◽

Urology Clinic ◽

Multiple Antibiotics

A 10-year-old girl with a 1-year history of lower genitourinary tract symptoms suggestive of bacterial infection but with numerous negative urine cultures was referred to the University of Alabama urology clinic after empirical treatment with multiple antibiotics failed to resolve her symptoms. An extensive urologic evaluation revealed no structural or physiologic abnormalities, but an exudative vaginitis was noted and large numbers of Ureaplasma urealyticum and Mycoplasma hominis were isolated from the lower genital tract. Cultures for Chlamydia, viruses, and routine bacterial pathogens were negative. After initiation of tetracycline therapy, symptoms resolved and subsequent cultures for mycoplasmas were negative. In addition, a seroconversion was noted for M hominis but not for U urealyticum. Chlamydia serology was negative. It was later learned that the patient had been sexually molested just prior to the onset of symptoms. This case illustrates the necessity of early consideration of a mycoplasmal etiology in the patient with persistent genitourinary symptoms and no obvious bacterial pathogen, or in the patient whose condition is refractory to routine antibiotic therapy.

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