Treatment of physicians with epilepsy.
Journal - Neurology (United States )
BACKGROUND: Physicians with epilepsy (physician-patients) are an understudied, unique patient population due to the potential adverse outcomes that seizures or medication side effects might have on patients under their care, as well as their ability to modify treatments without consulting treating physicians. We examine the effect epilepsy has upon physician-patients as well as surveying epileptologists on their views and experiences in treating physician-patients. METHODS: We reviewed charts to assess the clinical course of all physician-patients treated and distributed a questionnaire to active physician-patients at our epilepsy center. We surveyed epileptologists throughout the United States on their experience and views on treating physician-patients. RESULTS: Seventy-three percent of responding physician-patients experienced seizures while in a medical setting, 55% while interacting with patients, and 18% during invasive procedures. Eighteen percent of physician-patients felt seizures impacted their work and 9% were on disability secondary to epilepsy. Among epileptologists surveyed, 35% would counsel and manage physician-patients differently than other patients and 26% favored establishing guidelines or regulations governing physician-patients. The majority of physician--patients and one-third of epileptologists felt that physician-patients were most analogous to professions that are currently regulated by the federal government. CONCLUSION: This study highlights the diverse ways that epilepsy can affect physician-patients and the challenges that arise in treating this unique patient population.
|ISSN : ||1526-632X|
|Mesh Heading : ||Activities of Daily Living Adult Aged Clinical Competence Cognition Disorders Disability Evaluation Disabled Persons Epilepsy Female Humans Licensure, Medical Male Middle Aged Occupational Health Physician-Patient Relations Physicians Questionnaires psychology legislation & jurisprudence standards psychology psychology statistics & numerical data complications psychology legislation & jurisprudence standards ethics psychology|
|Mesh Heading Relevant : ||etiology drug therapy statistics & numerical data|
Proximal intracranial internal carotid artery branches: prevalence and importance for balloon occlusion test.
Journal - Journal of neurosurgery (United States )
OBJECT: The aim of this study was to determine the prevalence of angiographically identifiable skull base arterial branches that potentially serve as collateral conduits during a balloon occlusion test (BOT) of the internal carotid artery (ICA). The authors posited that neurological deficits in patients who had previously tolerated the occlusion test may be attributable to an unrecognized collateral support through these channels (operant during proximal ICA BOT) when permanent ICA occlusion was performed more distally. METHODS: In 481 cases (962 ICAs), cerebral angiograms obtained during routine Wada testing were retrospectively reviewed. Two hundred sixty-one patients had at least one angiographically identifiable ICA branch; 109 patients had two or more branches. A meningohypophyseal branch of the cavernous ICA was identified on the right side in 108 patients and on the left in 122. A vidian artery originated from the petrous portion of the ICA on the right side in 58 patients and on the left in 85. The inferolateral trunk revealed itself as a branch of the cavernous ICA on the right side in 17 patients and on the left in 33. A caroticotympanic artery arose from a left cavernous ICA. A persistent trigeminal artery was situated on the right side in two patients and on the left in three. More than half of the patients had angiographically identifiable and perhaps hemodynamically significant skull base branches of the ICA, and approximately one quarter had more than one identifiable branch. CONCLUSIONS: The authors recommend that patients be screened during angiography studies performed prior to BOT in branches of the proximal intracranial ICA and that the site of BOT be moved distally if such branches are identified.
|ISSN : ||0022-3085|
|Mesh Heading : ||Adolescent Aged Aged, 80 and over Angiography, Digital Subtraction Balloon Occlusion Brain Brain Ischemia Carotid Artery, Internal Child Child, Preschool Collateral Circulation Female Humans Male Middle Aged Retrospective Studies methods radiography radiography radiography|
|Mesh Heading Relevant : ||methods blood supply physiopathology physiopathology therapy physiopathology|
Acute presentation of infected urachal cysts: case report and review of diagnosis and therapeutic interventions.
Journal - Pediatric emergency care (United States )
Urachal remnants, although relatively rare, masquerade as a large number of diverse disorders leading to a high rate of misdiagnosis. A typical case is reported in which a 10-year-old boy presented to the Emergency Department twice before being incorrectly diagnosed with a pelvic or lower abdominal periappendiceal abscess. Definitive diagnosis and treatment of an infected urachal cyst were made intraoperatively. A review and discussion of urachal remnants is presented, and a diagnostic algorithm and treatment plan is offered for this entity.
|ISSN : ||1535-1815|
|Mesh Heading : ||Abdominal Abscess Acute Disease Anti-Bacterial Agents Appendicitis Child Diagnosis, Differential Diagnostic Errors Escherichia coli Infections Humans Klebsiella Infections Klebsiella pneumoniae Male Tomography, X-Ray Computed Urachal Cyst radiography therapeutic use radiography diagnosis drug therapy diagnosis drug therapy microbiology surgery|
|Mesh Heading Relevant : ||diagnosis|