Pneumomediastinum Associated with Influenza A Infection

Figure 1.

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Poland Syndrome

Figure 1.

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Management of Sentinel-Node Metastasis in Melanoma

Potential benefits of completion lymph-node dissection in patients with metastases in their sentinel lymph node include more personalized prognostic information — and therefore more precise staging that, in turn, will influence decisions regarding adjuvant systemic therapy — and better regional…

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Favism and Glucose-6-Phosphate Dehydrogenase Deficiency

Pythagoras of Samos, a great mathematician rather than a physician, may have been first in stating emphatically, in the 5th century b.c. that fava beans could be dangerous and even lethal for humans. This gives him a place in nutrition science but not in nutrogenomics: it seems he did not realize…

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Going from A to Z

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 70-year-old man presented to the…

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Acute Pyelonephritis in Adults

Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. An otherwise…

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Improvement of Endovascular Stroke Treatment: A 24-Hour Neuroradiological On-Site Service Is Not Enough

Background and Purpose. With the advent of endovascular stroke treatment (EST) with mechanical thrombectomy, stroke treatment has also become more challenging. Purpose of this study was to investigate whether a fulltime neuroradiological on-site service and workflow optimization with a structured documentation of the interdisciplinary stroke workflow resulted in improved procedural times. Material and Methods. Procedural times of 322 consecutive patients, who received EST (1) before () and (2) after () establishing a 24-hour neuroradiological on-site service as well as (3) after implementation of a structured interdisciplinary workflow documentation ("Stroke Check") (), were analysed. Results. A fulltime neuroradiological on-site service resulted in a nonsignificant improvement of procedural times during out-of-hours admissions (). Working hours and out-of-hours procedural times improved significantly, if additional workflow optimization was realized (). Conclusions. A 24-hour interventional on-site service is a major prerequisite to adequately provide modern reperfusion therapies in patients with acute ischemic stroke. However, simple measures like standardized and focused documentation that affect the entire interdisciplinary pre- and intrahospital stroke rescue chain seem to be important.

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