Bowel Perforation in the Emergency Department Related to Bevacizumab Therapy and Recurrent Ovarian Cancer

Case Presentation

We describe the presentation to the emergency department of a patient with recurrent ovarian cancer treated with bevacizumab with the complication of bowel perforation.

Discussion

We review the frequency and outcomes of bevacizumab-related bowel perforation. We also report the patient’s imaging findings, including the radiologic presentation of free intraperitoneal air and portal venous gas, both indicative of bowel perforation and the need for emergent surgical evaluation. Our case also illustrates the potentially catastrophic side effects of bevacizumab and other targeted oncologic therapies of which emergecny physicians may not be aware.

Cauda equina syndrome in an ovarian malignant-mixed müllerian tumor with leptomeningeal spread

Leptomeningeal metastasis is extremely rare in patients with ovarian cancer, but should be considered in patients presenting with neurologic deficits such as cauda equine syndrome. Given its poor prognosis and lack of data currently on management, additional studies are needed to optimize treatment regimens and improve outcomes.

Career Interest and Psychomotor Aptitude Among Medical Students

OBJECTIVE

The primary objective is to assess psychomotor aptitude of medical students interested in pursuing a procedural career. Secondary objectives include exploring the relationship between actual and perceived aptitude, and identifying predictors of superior aptitude.

DESIGN

This is a cross-sectional, multisite study in which participants completed a paper survey, four visuospatial aptitude assessments, and a laparoscopic simulation modeled after the Fundamentals of Laparoscopic Surgery (FLS) peg transfer test (used as a proxy for psychomotor aptitude).

SETTING

Johns Hopkins University School of Medicine and Mayo Clinic School of Medicine.

PARTICIPANTS

All second-year medical students who had not yet initiated clinical rotations were eligible. Sixty-four students participated.

RESULTS

Students interested in a procedural career exhibited superior psychomotor aptitude (faster FLS task completion time), and a majority of these students correctly identified themselves as having above-average aptitude compared with peers. However, over one quarter of all students, regardless of career interest, incorrectly over- or under-rated their psychomotor aptitude. Upon completing their preclinical curriculum, a minority of students felt prepared to participate or assist in their surgical clinical rotations.

CONCLUSIONS

Prior to embarking on their clinical rotations, over one quarter of medical students lack awareness of their psychomotor aptitude and many do not feel prepared to participate in the next phase of their training. Early aptitude testing and introduction to laparoscopic training may assist in career selection, preparedness, and success.

Functional status, referral and cost of treatment for persons with traumatic head injury

This study was conducted to examine functional status, costs of treatment, and how function and costs are related to the referral process of persons with traumatic head injury (THI). The study attempted to answer questions such as: what portion of the THI population is not referred on for subsequent treatment? Is referral dependent upon level of function at time of discharge from acute care? What are the costs associated with different levels of treatment by different facilities? Information was gathered from medical record reviews. Data were gathered from 101 persons with traumatic head injury (PWTHI) using a survey form, a functional assessment inventory, and a performance status scale. Per subject cost statements were obtained from the treatment/service facilities. Results indicate that the factors in the referral process for further treatment and rehabilitation do not appear to be consistent. Acute care referral at discharge is dependent upon severity of residual dysfunction including other factors than THI, while referral at discharge from a rehabilitation centre is dependent upon less obvious factors; one of which may be age at time of injury. Acute care and rehabilitation centre per patient average costs are quite similar and significantly higher than average per client costs.

Perceived persistence of problems in post-head-injury rehabilitation

This study was an attempt to understand the relationship between provision of rehabilitation services and the perceived persistence of adjustment problems following services. Types of services provided by treatment facilities and patient ratings of presence of problems were identified. The results of the study strongly suggest that services provided by a single facility or a combination of facilities does little to reduce client-perceived persistence of adjustment problems. Severity of disability only accounts for small differences in identified problems. The relative constancy of post-treatment problems reflects the chronicity of disability. Results further suggest that post-acute care treatment by other facilities increases the number of perceived problems, especially following referral for vocational rehabilitation services.