Spontaneous Rupture of a Right Gonadal Artery Aneurysm: A Case Report

Gonadal artery aneurysm is a rare condition characterized by nonspecific presentation, typically manifesting as flank pain and formation of a retroperitoneal hematoma on imaging studies. Failure to recognize and treat this condition promptly can have serious consequences, as the presence of an aneurysm may lead to severe bleeding. Notably, most reported cases of gonadal artery aneurysms are not trauma-induced but rather spontaneous. In this case report, we describe the case of a previously healthy woman in her late 30s who presented to the emergency department with initial symptoms of flank pain and elevated white blood cell count. Subsequent imaging via computed tomography of the abdomen and pelvis revealed a significant hematoma surrounding the right kidney, indicative of a substantial hemorrhagic event. Angioembolization followed by endograft placement was performed on the patient, and she was expected to make a full recovery.

Acquired Hemophilia A After Multiple Transfusions Following Trauma

Acquired hemophilia A (AHA) is a coagulative disorder that is caused by the presence of inhibitors of factor VIII (FVIII). The presence of coagulation factor inhibitors can lead to severe episodes of bleeding in patients with no previous history of bleeding conditions. We present the clinical case of a man with severe bleeding two weeks after falling from a bicycle. The patient denied any previous history of bleeding disorders. The case clinically presented with a large retroperitoneal hematoma and continued to show signs of active bleeding even after multiple transfusions were administered. Coagulation studies showed an elevated inhibitor titer of 24.4 BU/mL (normal range is below 5 BU/mL) and a reduced FVIII activity level of 2% (normal range is between 50% to 150%), providing evidence of AHA. Hemostatic and immunosuppressive agents were then administered to the patient, whose condition improved in response to the treatments.

Laparoscopic Cholecystectomy in a Patient With Situs Inversus: A Case Report and Literature Review

Situs inversus (SI) is an autosomal recessive congenital abnormality in which there is a complete mirror reversal of visceral organs. In this article, we present the case of a 26-year-old male with a past medical history of suicidal ideations, gallstones, and SI who complained of left upper quadrant pain for two weeks. After admission for acute cholecystitis, he underwent a successful laparoscopic cholecystectomy without postoperative complications. Due to the anatomical deviation characteristic of SI, it can be challenging for surgeons to accurately diagnose and perform laparoscopic cholecystectomies. Careful consideration must be given when deciding to do a laparoscopic cholecystectomy, as the placement of not only the trocars and surgical instruments but also the position of the surgeon and assistants needs to be deliberated.

Use of patient navigation to improve diagnostic and treatment delays among patients with abnormal mammography results from a mobile unit

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Background: Screening mammography is frequently the initial step to breast cancer diagnosis. Upon detection of an abnormality on a mammogram, the patient must undergo follow-up procedures for diagnosis and treatment. The objective of this study was to examine the diagnostic and treatment delays after detection of an abnormality on a mammogram performed at a mobile unit.

Methods: During one-year beginning in February 2010, the mobile mammography unit of the University of Arkansas for Medical Sciences (UAMS) performed 1,547 mammograms in women who resided in counties that lacked a stationary mammography unit. Most of these counties are in rural areas with high poverty rates. The women were predominantly non-Hispanic white (62%) or African-American (36%) and 41% lacked health insurance. A patient navigator was available to assist patients through scheduling follow-up appointments, when needed. Diagnostic delay was defined as time from abnormal mammogram to biopsy that exceeded 60 days. Treatment delay was defined as time from abnormal mammogram to treatment initiation that exceeded 90 days.

Results: A total of 14 cancer cases were detected among the 1,547 women screened. The median age of these patients was 56 years of age and ranged from 46-79 years. The median time from screening mammography to biopsy was 31.5 days and ranged from 9-92 days, and diagnostic delay occurred in 2 (14%) patients. The median time from screening mammography to treatment was 78 days and ranged from 37-199 days, and treatment delay occurred in 5 (36%) patients. Three of these patients were managed outside the UAMS health care system, one patient required bilateral mastectomies and one patient refused the initial treatment recommendation.

Conclusions: Responsive health systems require vehicles to strengthen the continuum of breast care. With the use of a patient navigator, the proportion of patients with breast cancer who experienced diagnostic delays is comparable to that of other studies, but the proportion with treatment delays is higher than in other reports. Patient navigation provides a promising model to decrease diagnostic delays and improve access for the medically underserved.

Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy

BACKGROUND

Needle localization breast biopsy (NLBB) is presently the primary means of localizing non-palpable lesions. Disadvantages of NLBB include vasovagal episodes, patient discomfort, and miss rates. Because hematomas naturally fill the cavity after vacuum-assisted breast biopsies (VABB), we hypothesized that ultrasound (US) could be used to find and accurately excise the actual biopsy site of non-palpable breast lesions without a needle.

METHODS

This is a retrospective study from January 2000 to July 2005. Electronic chart review identified patients with non-palpable breast lesions detected by means of mammogram who then underwent lumpectomy via NLBB or the hematoma-directed ultrasound-guided technique (HUG). HUG involved localizing the hematoma with a 7.5-MHz US probe and using the "line of sight" technique straight down toward the chest wall. A block of tissue encompassing the hematoma was then excised.

RESULTS

Localization procedures were performed in 186 patients-63 (34%) via needle localization and 123 (66%) via HUG. The previous VABB site in 100% of patients was successfully excised using HUG, 65 of 123 (53%) were benign and 58 of 123 (47%) were malignant; margins were positive in 13 of these 58 (22%). NLBB was successful in 100% of patients, 44 of 63 (70%) were benign and 19 of 63 (30%) were malignant; margins were positive in 14 of these 19 (73%). Margin positivity was significantly higher for NLBB than HUG (P = 0.0001, Fisher Exact).

CONCLUSIONS

This study suggests that HUG is more accurate in localizing non-palpable lesions than NLBB. By eliminating the additional procedure needed for NLBB, HUG may also be more time- and cost efficient. HUG makes VABB not only a less invasive diagnostic procedure, but also a localization procedure.

Touch preparation of breast core needle specimens is a new method for same-day diagnosis

BACKGROUND

Touch preparation cytology (TPC) has proven to be a quick and accurate intraoperative diagnostic tool for excisional breast biopsy, margins and sentinel nodes. We hypothesized that TPC of core needle biopsy (CNB) specimens can provide a same-day diagnosis in the outpatient setting.

METHODS

Outpatients presenting with breast lesions underwent TPC of biopsy cores performed by biopsy gun or vacuum-assisted CNB. The TPC results were compared with the final diagnosis of CNB specimens.

RESULTS

In all, 199 CNB and TP were performed between August 1997 and October 2002. Twenty-nine percent of lesions were malignant. Touch preparation was deferred in 21% of cases. In the remaining 157 evaluable cases, TPC had an accuracy of 89% and a false negative rate of 26%. The sensitivity, specificity, positive predictive value and negative predictive value of TPC were 74%, 97%, 93%, and 86% respectively.

CONCLUSIONS

Touch preparation cytology on CNB can be performed simply in the outpatient setting. Collaboration between the surgeon and pathologist allows TP to be an accurate means of same-day pathological determination.

Population questions for Australian cities: reframing our narratives

"I focus on urban environments and on immigration as that segment of population growth often viewed as having certain effects on cities. The paper argues for a reframing of narratives linking population and urban environments, so that both immigrant-led population growth and the condition of urban environments in Australia can be understood as the product of the political and economic interpretations being made of the nation's internationalisation, which in turn has consequences for diversity amongst places and peoples."

Gender, age, and ethnicity in immigration for an Australian nation

An analysis of Australian immigration policy since the Second World War is presented. The emphasis is on the gender and age of preferred immigrants, rather than on their race or place of birth. "The author proposes that selection of immigrant settlers in Australia since World War 2 has been gendered as well as racialised, often combining particular sexisms with particular racisms and specifying the ways that ethnicity and gender should coexist in immigrants of different age groups. She notes implications for immigrants once in Australia (especially women) of the category under which they have entered the country. And she suggests that a new phase relating immigration to redefinition of the Australian nation, in which the temporary migration of skilled workers is preferred to their permanent migration, may be beginning; a phase whose modes of regulation and outcomes are as distinctively gendered as were those of their predecessors."

Quantitative trait loci for plant height in four maize populations and their associations with qualitative genetic loci

We report that plant height quantitative trait loci (QTLs) identified in a given small population are not consistent with QTLs identified in other small populations, and that most QTLs are in close proximity to mapped qualitative genetic loci. These observations provide evidence to support the hypothesis that qualitative genetic loci are the same loci that affect quantitative traits, and affirm that these modest experiments probably identify real QTLs.