scholarly journals Diagnosis of Tinnitus Due to Auditory Radiation Injury Following Whiplash Injury: A Case Study

Diagnostics ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 19 ◽  
Author(s):  
Sung Jun Lee ◽  
Chang Hoon Bae ◽  
Jeong Pyo Seo ◽  
Sung Ho Jang
Keyword(s):  
Whiplash Injury ◽  
Diffusion Tensor ◽  
Brain Mri ◽  
Pure Tone Audiometry ◽  
University Hospital ◽  
Hearing Status ◽  
Car Crash ◽  
Nose And Throat ◽  
Specific Abnormality

We report on a patient with tinnitus who showed injury of auditory radiation following whiplash injury, demonstrated by diffusion tensor tractography (DTT). A 48-year-old male patient suffered from a car crash resulting in flexion-hyperextension injury of his head after being hit from behind by a moving car while waiting at a signal while driving a car. Three days after the car crash, he began to feel tinnitus in both ears and his tinnitus became aggravated with the passage of time. No specific lesion was observed on a conventional brain MRI performed two weeks after the car crash. Although he visited several hospitals, the precise cause of his tinnitus was not detected. Two years after the car crash, he underwent evaluation for his tinnitus at the ear, nose and throat department of a university hospital. The pure tone audiometry was evaluated in a sound-proof room to screen his hearing status for the frequencies of 250–8000 Hz and no specific abnormality was detected. Although he was also tested for speech audiometry, there was also no specific abnormality. In order to assess his tinnitus, a tinnitogram was conducted to evaluate the frequency content and the loudness. His tinnitus was characterized at an intensity of 40 dB and a frequency of 4000 Hz. However, no abnormality was observed in either ear on physical examination. On DTT, the auditory radiation showed severe narrowing and tearing in both hemispheres. To summarize, neural injury of the auditory radiation was demonstrated in a patient with tinnitus following whiplash injury, using DTT.

scholarly journals Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: A Case Report

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 145 ◽  
Author(s):  
Jang ◽  
Kwon ◽  
Lee
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Memory Impairment ◽  
Whiplash Injury ◽  
Diffusion Tensor ◽  
Pain Syndrome ◽  
University Hospital ◽  
Central Pain ◽  
Spinothalamic Tract ◽  
Motor Weakness ◽  
The Right

Objectives: We report on a patient with whiplash injury who had central pain, due to injury of the spinothalamic tract (STT), but who was misdiagnosed as complex regional pain syndrome (CRPS). Case description: While a minivan in which a 43-year-old female was seated in the passenger seat was stopped for a signal, a truck collided with the minivan from behind, and the minivan then repeatedly collided with trucks in front and behind the minivan. Her head repeatedly struck the minivan seat resulting in whiplash injuries. After onset, she felt pain in both legs with mild motor weakness in all four extremities and memory impairment. Eight years after onset, she was diagnosed at a university hospital as CRPS type 1 with the clinical features of hyperalgesia and mild edema and motor weakness of both legs. She visited another university hospital nine years after onset and complained of pain in the right arm and both legs, constant tingling and burning pain along with allodynia and hyperalgesia. She also showed mild weakness in the four extremities, mild edema of both legs, and memory impairment. On diffusion tensor tractography (DTT), the left spinothalamic tract (STT) showed marked narrowing, and the right STT revealed mild narrowing and partial tearing. In addition, partial tears were observed in both corticospinal tracts and the right corticoreticulospinal tract. Discontinuations were observed in the left corticoreticulospinal tract and the left fornical crus. Conclusion: Injury of the STT was demonstrated on DTT in a patient with central pain following whiplash injury. Previously, the patient was misdiagnosed as CRPS.

scholarly journals Impaired consciousness due to injury of the ascending reticular activating system in a patient with bilateral pontine infarction: A case report

2020 ◽  
Vol 11 (1) ◽  
pp. 264-268
Author(s):  
Soyoung Kwak ◽  
Min Cheol Chang
Keyword(s):  
Diffusion Tensor ◽  
Brain Mri ◽  
Chronic Stable Angina ◽  
University Hospital ◽  
Verbal Response ◽  
Impaired Consciousness ◽  
Total Occlusion ◽  
Ascending Reticular Activating System ◽  
Pontine Infarction ◽  
Reticular Activating System

AbstractThe ascending reticular activating system (ARAS) is known to play an essential role in maintaining arousal and consciousness. In this report, we describe the case of a patient with impaired consciousness due to injury of the ARAS after bilateral pontine infarction. A 73-year-old female patient presented with anterior chest pain to the Emergency Department of our university hospital. She was diagnosed with chronic stable angina pectoris, three-vessel disease, and chronic total occlusion of the left anterior descending artery by coronary angiography and received conservative treatment. After five days, she showed deep drowsy mentality and brain MRI revealed bilateral paramedian pontine infarction. Four weeks after the pontine infarction, she showed severely impaired consciousness, with a Glasgow Coma Scale score of 7 (eye-opening: 2, best verbal response: 2, and best motor response: 3). Coma Recovery Scale-Revised score was 10 (auditory function: 2, visual function: 3, motor function: 2, verbal function: 2, communication: 0, and arousal: 1). Results of diffusion tensor tractography (DTT) for the ARAS showed decreased neural connectivity in the left lower dorsal ARAS, both lower ventral ARAS, and both upper ARAS. To the best of our knowledge, this is the first report of injury to the ARAS in bilateral pontine infarction diagnosed by DTT. We presume that our report would provide clinicians a better understanding of the mechanism of impaired consciousness in patients with pontine infarction.

Doctors’ functional leadership in psychiatric healthcare teams – a reversible leadership logic

2015 ◽  
Vol 21 (3/4) ◽  
pp. 159-180 ◽  
Author(s):  
Johan M. Berlin
Keyword(s):  
Leadership Style ◽  
University Hospital ◽  
Multidisciplinary Teams ◽  
Leadership And Management ◽  
Content Type ◽  
Team Members ◽  
Healthcare Teams ◽  
Medical Teams ◽  
Difficult Situations

Purpose – The purpose of this paper was to study how psychiatric doctors practise leadership in multidisciplinary healthcare teams. The paper seeks to answer the question: How do psychiatric doctors lead multidisciplinary teams during treatment conferences? Design/methodology/approach – Six psychiatric teams were studied at a university hospital. Each team was observed over a period of 18 months, and data were collected during four years (2008-2011). Data were collected through interviews with doctors (n = 19) and observations (n = 30) of doctors’ work in multidisciplinary psychiatric teams. Findings – Doctors in a multidisciplinary team use either self-imposed or involuntary leadership style. Oscillating between these two extremes was a strategy for handling the internal tensions of the team. Research limitations/implications – The study was a case study, performed during treatment conferences at psychiatric wards in a university hospital. This limitation means that there is cause for some caution in generalising the results. Practical implications – The results are useful for understanding leadership in multidisciplinary medical teams. By understanding the reversible logic of leadership, cooperation and knowledge sharing can be gained, which means that a situation of mere peaceful coexistence can be avoided. Understanding the importance of the informal contract makes it possible to switch leadership among team members. A reversible leadership with an informal contract makes the team less vulnerable. The team’s professionals can thus easily handle difficult situations and internal tensions, facilitating leadership and management of multidisciplinary teams. Originality/value – Doctors in multidisciplinary psychiatric teams use reversible leadership logic.

Abstract 14258: Modulation of Kynurenine Pathway to Prevent Brain Injury After Cardiac Arrest and Cardiopulmonary Resuscitation in Mice

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Aurora Magliocca ◽  
Carlo Perego ◽  
Francesca Motta ◽  
Giulia Merigo ◽  
Francesca M Fumagalli ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Diffusion Tensor ◽  
Neuroprotective Effect ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Kynurenine Pathway ◽  
Baseline Heart Rate ◽  
Brain White Matter ◽  
Fluoro Jade B

Introduction: Kynurenine pathway (KP) is emerging as one of the potential components affecting cardiac arrest (CA) outcomes. The aim of this study is to evaluate the effects of KP inhibition through genetic deletion of the rate-limiting enzyme of the KP, indoleamine-2,3-dyoxygenase (IDO) on survival and neurological outcome after CA. Methods and Results: Sixteen adult male wild-type (WT) and IDO-deleted (IDO -/- ) mice were subjected to 8 min untreated CA followed by resuscitation. At baseline heart rate and mean arterial pressure (MAP) did not differ among groups. At the time of return of spontaneous circulation, 30 and 60 min later, MAP was higher in the IDO -/- group compared to the WT one (p=0.0005). IDO -/- mice showed higher survival compared to WT at 7 days after CA (68.5% in IDO -/- vs 37.5% in WT; log rank p=0.036). Neurological function was higher in IDO -/- than in WT mice during the 7 days following CA (p=0.0124). IDO -/- mice also showed an improved locomotor function compared to WT mice (p=0.037). Brain magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) sequences showed a reduction in fractional anisotropy in the external capsule of the corpus callosum in WT mice compared to IDO -/- mice at 7 days after resuscitation (p=0.015). We then treated additional IDO -/- mice with L-kyn 15 min before CA, to revert the IDO -/- phenotype. Brain MRI with diffusion-weighted imaging (DWI) sequences and histological analysis were performed 24h after CA in WT, IDO -/- , and IDO -/- +L-Kyn mice. Brain MRI revealed restriction of water diffusivity 24h after CA in WT mice. IDO-deletion reduced water diffusion abnormalities while the beneficial effect was reverted in the L-kyn group (p=0.01). Degenerating neurons in the frontal cortex, represented as Fluoro-Jade B positive cells, were more numerous in WT compared to IDO -/- mice; L-kyn halted this IDO deletion-induced reduction in degenerating cells (p=0.05). Conclusion: KP inhibition improves survival and neurological outcome after CA. The neuroprotective effect of IDO-deletion was associated with preservation of brain white matter microintegrity and with reduction of cerebral cytotoxic edema. Reversal of these beneficial effects by L-kyn administration in IDO -/- mice further confirm the KP role in CA outcome.

scholarly journals Diagnostics of Human Body Cavities Using Diode Laser Gas Spectroscopy

2008 ◽  
Vol 2 (2) ◽  
Author(s):  
M. Cassel-Engquist ◽  
L. Persson ◽  
K. Svanberg ◽  
S. Svanberg
Keyword(s):  
Clinical Trial ◽  
Diode Laser ◽  
Medical Application ◽  
University Hospital ◽  
Scattering Media ◽  
Laser Absorption ◽  
Initial Clinical Trial ◽  
Frontal Sinuses ◽  
Diode Laser Absorption ◽  
Nose And Throat

We have developed a technique to measure gas non-intrusive in scattering media, such as human tissue. The technique was first demonstrated for test samples in 2001 by our group and utilizes diode laser absorption spectroscopy to monitor molecular oxygen and water vapor. The focus of medical application has been on sinuses, both maxillary and frontal sinuses and the potential of the technique has been shown on volunteers. A spin-off company named GasPorOx AB has been formed with the aim to develop a product used to improve the diagnosis of the sinus infections. A portable fiber-guided system has been developed and is used in an ongoing initial clinical trial in collaboration with the Ear, Nose and Throat Clinic, the Oncology and Diagnostic radiology clinics at the Lund University Hospital.

Engaging professionals with serious games: the Lean Healthcare Lab at Siena University Hospital

2017 ◽  
Vol 31 (3) ◽  
pp. 7-10 ◽  
Author(s):  
Federico Barnabè ◽  
Maria Cleofe Giorgino ◽  
Jacopo Guercini ◽  
Caterina Bianciardi ◽  
Vincenzo Mezzatesta
Keyword(s):  
Serious Games ◽  
Leadership Skills ◽  
University Hospital ◽  
Management Tools ◽  
Lean Thinking ◽  
Content Type ◽  
Lean Principles ◽  
Lean Healthcare ◽  
Firsthand Experience

Purpose This paper aims to stimulate interest in the potentials of serious games within organizations. Through the examination of a case study, emphasis is given to serious games designed for health care (HC) organizations that are adopting lean thinking principles and tools. Design/methodology/approach The paper discusses how serious games can be designed and implemented in practice by describing a case study based on a HC organization. The program, now in its second year, has been used extensively to train HC professionals. Findings The article is based on the authors’ firsthand experience with serious games and the outcome of several projects carried out in the HC setting under analysis. Serious games were found to be powerful training and management development tools as well as engaging environments for professionals. Specifically, The Lean Healthcare Lab supported professionals in their use and implementation of several Lean principles and techniques. Research limitations/implications The article suggests the opportunity to evaluate the effectiveness of serious games also to improve team performance and develop leadership skills. Practical implications Serious games have an enormous potential in sustaining processes of both individual and organizational learning, as well as facilitating improved teamwork. Moreover, serious games are very effective educational tools when compared to more conventional programs. Originality/value The approach described in this study can be used to design and implement serious games in any type of organization, in particular, those employing highly skilled professionals. Additionally, this article highlights how serious games can provide learners with a simulated close-to-reality environment where they are challenged to develop policies and use a variety of Lean and management tools.

Use of an optical surface scanner in assessment of outcome following rhinoplasty surgery

2008 ◽  
Vol 122 (9) ◽  
pp. 972-977 ◽  
Author(s):  
H Chau ◽  
R Dasgupta ◽  
V Sauret ◽  
G Kenyon
Keyword(s):  
Surgical Intervention ◽  
University Hospital ◽  
Facial Features ◽  
Optical Surface ◽  
Case Study Analysis ◽  
The Future ◽  
University College London ◽  
One Year ◽  
The Right

AbstractObjective:To demonstrate the use of an optical surface scanner, with associated software, in the assessment of rhinoplasty patients, and to discuss the possible clinical applications of this technology in the future.Design:Case study analysis of pre- and post-operative scans of a patient undergoing septorhinoplasty at Whipps Cross University Hospital, London, UK.Subject:A 21-year-old man undergoing septorhinoplasty underwent pre-operative optical surface scanning of his face. The scans were repeated at one week and one year post-operatively. Software developed at University College London was then used to analyse the scans.Results:The scans clearly showed that the man's dorsal hump had been well reduced and the nose straightened, with a resulting 1600 mm3 gain on the right side and a 1000 mm3 loss on the left side of the nose. Tip projection had also been achieved.Conclusion:This technique allowed objective quantification of facial features and analysis of change. It may well prove useful in the future in predicting change following surgical intervention.

scholarly journals Can post-mortem MRI be used as a proxy for in vivo? A case study

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Baayla D C Boon ◽  
Petra J W Pouwels ◽  
Laura E Jonkman ◽  
Matthijs J Keijzer ◽  
Paolo Preziosa ◽  
...  
Keyword(s):  
White Matter ◽  
Rating Scales ◽  
Brain Volume ◽  
Brain Mri ◽  
Post Mortem ◽  
Early Onset Alzheimer’S Disease ◽  
And Diffusion

Abstract Post-mortem in situ MRI has been used as an intermediate between brain histo(patho)logy and in vivo imaging. However, it is not known how comparable post-mortem in situ is to ante-mortem imaging. We report the unique situation of a patient with familial early-onset Alzheimer’s disease due to a PSEN1 mutation, who underwent ante-mortem brain MRI and post-mortem in situ imaging only 4 days apart. T1-weighted and diffusion MRI was performed at 3-Tesla at both time points. Visual atrophy rating scales, brain volume, cortical thickness and diffusion measures were derived from both scans and compared. Post-mortem visual atrophy scores decreased 0.5–1 point compared with ante-mortem, indicating an increase in brain volume. This was confirmed by quantitative analysis; showing a 27% decrease of ventricular and 7% increase of whole-brain volume. This increase was more pronounced in the cerebellum and supratentorial white matter than in grey matter. Furthermore, axial and radial diffusivity decreased up to 60% post-mortem whereas average fractional anisotropy of white matter increased approximately 10%. This unique case study shows that the process of dying affects several imaging markers. These changes need to be taken into account when interpreting post-mortem MRI to make inferences on the in vivo situation.

scholarly journals SPECIALIST SERVICE IN LIVER TRANSPLANT IN A UNIVERSITY HOSPITAL: A CASE STUDY

2017 ◽  
Vol 26 (2) ◽  
Author(s):  
Sílvia Ferrazzo ◽  
Mara Ambrosina de Oliveira Vargas ◽  
Diana Coelho Gomes ◽  
Francine Lima Gelbcke ◽  
Karina Silveira de Almeida Hammerschimidt ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Care Service ◽  
University Hospital ◽  
Structured Interviews ◽  
Specialist Service ◽  
Immunosuppressed Patients ◽  
Structures Of Care ◽  
The Impact

ABSTRACT Objective: was to describe the flow of a specialist service in the care of liver transplant in a university hospital. Method: a qualitative research in the form of a case study, performed in a transplant service in southern Brazil. Data collection occurred from November 2013 to February 2014 through the triangulation of data, document analysis, structured interviews with 11 professional and semi direct observations interviews. Data analysis was performed by analysis of thematic content. Results: describes the flow of service and revealed the involvement of a multidisciplinary team in a cohesive manner, with competence recognized by patients and other sectors of the institution and structural deficiencies in care service for immunosuppressed patients. Conclusion: it was found that there is a need for studies that address the structures of care in liver transplantation services and to evaluate the impact of the quality of the life expectancy and proper recovery of persons undergoing liver transplantation.

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