RESUMEN
Castleman disease (CD) is a rare lymphoproliferative disorder that occurs in adults and rarely in the pediatric population. The disease is characterized by slowly enlarging masses that can form anywhere within the lymphatic system. It is an uncommon cause of a neck mass in both children and adults that presents insidiously and nonspecifically. A 21-year-old woman was referred to the otolaryngology service because of an asymptomatic neck mass found incidentally on computed tomographic imaging 15 months earlier. On repeat imaging, the lesion was characterized as a homogenously enhancing soft tissue mass and appeared stable in size compared with previous studies. Given the nondiagnostic radiologic features, tissue sampling was pursued, first using fine-needle aspiration and ultimately excisional biopsy. The excision revealed histopathology consistent with unicentric, hyaline-vascular CD. Excision is the gold standard for treatment of this variant of CD. The patient was referred to the hematology/oncology service but was subsequently lost to follow-up. This case illustrates a rare cause of a neck mass in a young adult and exemplifies the extremely broad differential in this setting. In addition, it highlights the importance of a systematic and thorough approach to diagnosing neck masses in children and adults.
Asunto(s)
Enfermedad de Castleman/diagnóstico , Cuello , Biopsia con Aguja , Enfermedad de Castleman/diagnóstico por imagen , Enfermedad de Castleman/patología , Enfermedad de Castleman/cirugía , Femenino , Humanos , Comunicación Interdisciplinaria , Cuello/diagnóstico por imagen , Cuello/patología , Cuello/cirugía , Grupo de Atención al Paciente , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the effect of TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) on operating room efficiency for the otolaryngology service at a tertiary care medical center. STUDY DESIGN: Retrospective database review. SETTING: Otolaryngology department at tertiary care medical center. SUBJECTS AND METHODS: To assess the impact of implementing an evidence-based patient safety initiative, TeamSTEPPS, on operating room efficiency in the otolaryngology department, the operative times, time lost to delayed starts, and turnover times during the year following the implementation of TeamSTEPPS were compared with the values from the prior year. RESULTS: The study compared 1322 cases and 644 turnovers in the year prior to TeamSTEPPS implementation with 1609 cases and 769 turnovers in the following year. There were no statistically significant decreases in operating room efficiency in the year after the TeamSTEPPS rollout. CONCLUSION: Operating room efficiency was preserved after the rollout of a rigorous evidence-based patient safety initiative that requires active participation from all operating room team members.
Asunto(s)
Eficiencia Organizacional , Quirófanos/normas , Otolaringología , Grupo de Atención al Paciente , Mejoramiento de la Calidad , Humanos , Estudios RetrospectivosRESUMEN
Paradoxical vocal fold movement is important to consider in the differential for dyspnea on exertion or shortness of breath. It is often confused with asthma and remains undiagnosed because of a paucity of pathognomonic examination and imaging findings. This case serves as a reminder of the specific clinical picture, diagnosis, and treatment of paradoxical vocal fold movement. It also highlights the broader importance of continuity of care and the clinician's ability to revisit the differential diagnosis if an initial workup is unrevealing or the patient is not responding to treatment.
Asunto(s)
Disnea/etiología , Logopedia/métodos , Disfunción de los Pliegues Vocales/complicaciones , Pliegues Vocales/fisiopatología , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/terapia , Estudios de Seguimiento , Humanos , Masculino , Nebulizadores y Vaporizadores , Disfunción de los Pliegues Vocales/fisiopatología , Disfunción de los Pliegues Vocales/terapia , Adulto JovenRESUMEN
OBJECTIVE: To assess the effect of a single aeroallergen on Internet search activity in 3 distinct geographic regions over time. STUDY DESIGN: A retrospective time series analysis. SETTING: Tertiary academic medical center. METHODS: Mountain Cedar pollen counts spanning the periods from 2011 to 2014 were collected for San Antonio, Dallas-Ft Worth, and Houston metro regions (Texas). Google search data for the corresponding period and regions were also obtained for the search terms pollen and mountain cedar. Data were analyzed through time series plots and autoregressive integrated moving average. RESULTS: Seasonal maximum pollen counts were greatest in San Antonio, ranging from 5413 to 9982 grains per cubic centimeter. In San Antonio, there was a strong, positive, and statistically significant effect of mountain cedar pollen count on search activity for both pollen (P = .001) and mountain cedar (P < .001) when evaluated by autoregressive integrated moving average. CONCLUSIONS: Environmental levels of a single allergen-mountain cedar pollen-show a geographic and temporal relationship between Internet searches and mountain cedar pollen, based on Google Trends. These data are useful to understand patients' perceptions of the health risk presented by mountain cedar pollen. In turn, this information affords practitioners the opportunity to offer targeted patient education in a geographically unique region, as well as adjust surveillance of related pathologies.