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Objectives: Rapid delivery of antibiotics is a cornerstone of sepsis therapy, although time targets for specific components of antibiotic delivery are unknown. We quantified time intervals comprising the task of antibiotic delivery and evaluated the association between interval delays and hospital mortality among patients treated in the emergency department for suspected sepsis.Design: Retrospective cohort.Setting: Twelve hospitals in Southeastern United States from 2014 to 2017.Patients: Twenty-four thousand ninety-three encounters among 20,026 adults with suspected sepsis in 12 emergency departments.Measurements and Main Results: We divided antibiotic administration into two intervals: time from emergency department triage to antibiotic order (recognition delay) and time from antibiotic order to infusion (administration delay). We used generalized linear mixed models to evaluate associations between these intervals and hospital mortality. Median time from emergency department triage to antibiotic administration was 3.4 hours (interquartile range, 2.0-6.0 hr), separated into a median recognition delay (time from emergency department triage to antibiotic order) of 2.7 hours(interquartile range, 1.5-4.7 hr) and median administration delay (time from antibiotic order to infusion) of 0.6 hours (0.3-1.2 hr). Adjusting for other risk factors, both recognition delay and administration delay were associated with mortality, but pairwise comparison with a no-delay reference group was not significant for up to 6 hours of recognition delay or up to 1.5 hours of administration delay.Conclusions: Both recognition delays and administration delays were associated with increased hospital mortality, but only for longer delays. These results suggest that both metrics may be important to measure and improve for patients with suspected sepsis but do not support targets less than 1 hour. [ABSTRACT FROM AUTHOR]

A 26-year-old woman presented for a routine contact lens evaluation but was found to have a subtle right sixth nerve paresis and adducting nystagmus of the left eye. She reported horizontal diplopia on far right gaze as well as subjective right-sided weakness and poor balance for 1 year. Brain and spinal MRI revealed multiple cystic lesions with variable enhancement throughout the posterior fossa and cervical spinal cord. These MRI findings were highly suspicious for an infectious central nervous system process, such as neurocysticercosis; however, primary or metastatic tumors were also important considerations. Tumor location and imaging characteristics were most helpful in differentiating among these etiologies. A brain biopsy ultimately established the diagnosis of a rosette- forming glioneuronal tumor. [ABSTRACT FROM AUTHOR]

OBJECTIVE To describe the epidemiology of anorectal melanoma in the United States. METHODS AND MATERIALS We obtained case and population data from the Surveillance, Epidemiology, and End Results 13 Registries Database (SEER 13) between 1992 and 2011 using rectal diagnostic codes C20.9 to 21.8 and ICD-O-3 melanoma codes 8720 to 8721 and 8742 to 8746. RESULTS There were 260 primary anorectal melanomas in SEER 13 from 1992 to 2011, occurring mostly in the rectum. The incidence of anorectal melanoma was higher among women than men with the highest rates occurring among white Hispanics ages 65 to 74 years. During this time period, the age-adjusted incidence rates rose significantly (p < .05) for both women and men with estimated annual percentage changes of 3.02% and 5.08%, respectively. Overall and melanoma-specific survival was poor irrespective of gender or ethnicity. CONCLUSION Anorectal melanoma in the United States is increasing in both men and women, with the highest rates in elderly Hispanic white women. Hispanic whites were more likely to develop anorectal melanoma than non-Hispanic whites, suggesting that this population may be targeted for screening interventions. These results warrant further investigation to better understand the gender, racial, ethnic, and geographic variations for anorectal melanomas. [ABSTRACT FROM AUTHOR]

2022; 50:, e87-e88, 2 Taylor SP, Anderson WE, Beam K. The association between antibiotic delay intervals and hospital mortality among patients treated in the emergency department for suspected sepsis. Finally, we agree with Inagawa et al ([1]) that the subgroup analysis in our article should not be used to guide treatment of septic shock and patients with suspected septic shock should receive antibiotics as quickly as possible. Restriction to ICU admissions and inclusion of hospital-acquired sepsis would both be expected to result in a cohort with higher mortality than ours, which only evaluated community-acquired sepsis and for whom only 16% had an ICU stay greater than or equal to 72 hours. [Extracted from the article]

Neuropsychological evaluations of preoperative epilepsy surgical candidates have been a routine portion of the multidisciplinary evaluation at most epilepsy centers for decades. Neuropsychology assessments have been explored as a means to predict and identify postoperative cognitive deficits after resections (chiefly temporal lobe), and in numerically quantifying those changes that do occur. In this manuscript, we describe the typical tools used, including tests of general intelligence, tests of language, tests of visuospatial cognition, and tests of verbal memory. Evidence for or against the use of the neuropsychological evaluation as a means to localize seizure onset, or as an adjunct for ictal focus lateralization is also included. [ABSTRACT FROM AUTHOR]

The article presents a comparison of the safety and efficacy of sirolimus-eluting stents (SES) with paclitaxel-eluting stents (PES) among patients with diabetes in a contemporary registry. Adverse events in patients undergoing percutaneous coronary intervention can be predicted by diabetes. A similarity at two years was found in the rates of death, myocardial infarction, stent thrombosis, and repeat vascularization in diabetic patients.

A case study of a 48-year-old right-handed man with history of declining memory and symptoms of Alzheimer's Disease (AD) is presented. Topics discussed include examinations showing mild global cerebral volume loss; diagnosis of bilateral encephalomalacia; and role of deep brain stimulation of the fornix to improve symptoms of AD.

This review outlines and compares current attempts at the treatment of psychiatric disorders through neurosurgical techniques. In particular, we have undertaken to compare the results of lesioning techniques with those of stimulation of the brain. The original lesioning techniques, and in particular the use of frontal lobotomy as used and developed at the end of the 19th century and early 20th century represent an interesting period of strong interplay between the neurosurgery and psychiatry and are described in the first section. With the advent of modern stereotaxy, more selective procedures were developed that were also guided by concurrent advances in the neurosciences and the early interpretations of the limbic circuitry. These selective procedures included the anterior cingulotomy, the anterior capsulotomy, the subcaudate tractotomy, and the general limbic leucotomy. A discussion of implementation of these procedures and their neurobiologic justification has also been included in the second section. Besides being the targets of procedures, which cause gross mechanical disruption, several of these brain regions have been used as radiosurgical targets, and are also being considered for electrical stimulation as a treatment modality. The next 3 sections of the review focus on the newer uses of deep brain stimulation for treating specifically major depressive disorder, obsessive-compulsive disorder, and Tourette syndrome. Several choices of targets are described for these diseases along with their proposed physiologic rationale. The sixth section subsequently compares the lesioning and stimulation techniques with a particular focus on their relative merits and complications. [ABSTRACT FROM AUTHOR]

Hodgkin's lymphoma (HL) has a unique and distinct history, epidemiology, treatment, and biology. A viral agent or infectious agent has long been considered as the etiologic agent and Epstein-Barr virus is the main candidate for the infectious agent causing HL; however, Epstein-Barr virus genome is found within the tumor in only about 20% to 40% of HL cases with a prior diagnosis of infectious mononucleosis. Recently, autoimmune and related conditions have drawn attention to a potential role for immune-related and inflammatory conditions in the etiology and pathogenesis of the malignancy. Evidence from multiply-affected families, a twin study, a case-control study, and population-based registry 'studies implicate genetic factors. Data from Eastern Asia and among Chinese immigrants in North America indicate increasing incidence trends for HL being associated with Westernization. These results emphasize an interaction between environmental and genetic risk factors in HL. [ABSTRACT FROM AUTHOR]

This monograph discusses the current treatment of spasticity via intrathecal baclofen (ITB) therapy. It describes the pathophysiology and the primary anatomic substrate of spasticity, and the current modern surgical and pharmacologic treatment options. Baclofen pumps are discussed in detail, including their implantation procedure, and basic modes of operation and design. Complications of ITB treatment are examined including infection, pump failure, and baclofen overdosing and withdrawal issues. Results from a recent cost-analysis study of ITB therapy are included, and promising future trends in the treatment of spasticity. [ABSTRACT FROM AUTHOR]

This descriptive study describes the frequency and severity of sleep-related breathing disorders in men who are hemodynamically stable who have an acute cardiovascular illness and are hospitalized in a critical care unit. Sixty-four males, aged 55-79 years, with an acute cardiovascular illness, stable hemodynamics, and no ongoing chest pain or history of sleep apnea were studied for 1 night in the critical care unit using polysomnography. Forty-seven percent of the sample had an apnea-hypopnea index ≥5, with events of both obstructive and central etiologies, including Cheyne-Stokes respiration. Oxygen desaturation to ≤90% occurred in 61% of the sample. There were no episodes of chest pain, ventricular tachycardia, or heart block associated with apneic or hypopneic events; however, dysrhythmias, including sinus bradycardia, supraventricular tachycardia, and premature ventricular beats, were associated with apneic and hypopneic events. Key words: cardiovasculur, respiration, sleep [ABSTRACT FROM AUTHOR]

Opioid receptors occur in locations of strategic importance within the central nervous system for modulation of pain. Is pain reduced by ongoing inhibition mediated by activation of these receptors? Experiments to date in which the opioid-receptor antagonist, naloxone, is administered during a painful event have yielded unclear results. Topically applied capsaicin can be used to induce tonic pain of moderate to severe intensity without tissue injury and is an ideal stimulus for studying acute pain modulation. We therefore conducted a placebo-controlled double-blind crossover study to investigate the effects of naloxone on capsaicin-induced pain (five men, four women, aged 29±5 years). Capsaicin (10%) was applied topically and subjects rated pain every 2 min. The subjects were told that any drug given to them could increase, decrease, or not change their pain sensation. Pain plateaued after 20 min. At 26 min subjects received either naloxone or placebo in double-blind fashion. At 56 min subjects received the alternative (placebo or naloxone). In a second session the order of presentation was reversed. The naloxone induced a significant increase in pain compared both to baseline (P<0.01) and placebo (P<0.01). The peak effect, reached at 12–20 min after naloxone delivery, was 59% greater than placebo. This experiment suggests that acute pain is actively suppressed by endogenous opioid-receptor activation. [Copyright &y& Elsevier]