A 33.5 cm Mucinous Ovarian Carcinoma and Associated Comorbidities in an 89-Year-Old Female.

Ovarian cancer is known to cause the highest mortality of gynecologic cancers. We present the case of an 89-year-old Caucasian female who presented to her surgeon with a large 33.5 cm abdominopelvic mass.

An Unusual Presentation of Neurosarcoidosis in a 64-Year-Old Man: A Case Report.

Sarcoidosis is a multisystem granulomatous disorder with an unknown etiology that typically involves the lungs, skin, and lymph nodes, with neurological involvement being relatively rare. We discuss a case of neurosarcoidosis in a 64-year-old man who initially presented with unexplained cognitive impairment, insomnia, hyponatremia, paresthesias, and weight loss and later developed uveitis, diplopia, and dysphagia. Ultimately, findings of hilar and mediastinal lymphadenopathy on chest computed tomography (CT) resulted in bronchoscopy, which led to the diagnosis.

Sezary Syndrome: A Case Report and Review of Current Therapeutics.

Sezary syndrome (SS) is a rare but aggressive type of cutaneous T-cell lymphoma (CTCL). Patients with SS have characteristic skin lesions (erythroderma) and a leukemic phase. The rash associated with CTCLs can often mimic common benign skin conditions such as psoriasis, atopic dermatitis, etc.

The Clinical Course of a Severe Case of Malignant Catatonia.

Catatonia is a psychomotor syndrome predominantly associated with mental illness disorders, most commonly bipolar disorder and schizophrenia. Catatonia is classified as malignant when, in addition to catatonic symptoms, dysautonomia is present. Autonomic abnormalities can include changes in temperature, labile blood pressure, and changes in heart and respiratory rates.

The Spontaneous Resolution of Trauma-Induced Uterine Arteriovenous Malformation.

This paper will describe the case of a woman who presented with a rare condition called uterine arteriovenous malformation (AVM). A uterine AVM represents a connection between veins and arteries in the uterus. Clinicians should always consider this condition for a woman of childbearing age who presents with unexplained vaginal bleeding.

Diaphragmatic Endometriosis Presenting as Recurrent Catamenial Pneumothorax: A Case Report.

Catamenial pneumothorax is one of the most common extra-pelvic presentations of endometriosis, with the gastrointestinal tract being the most common location. Catamenial pneumothorax is defined as spontaneous recurrent pneumothorax occurring in women of reproductive age in a temporal relationship with menses. Symptoms include dyspnea, sharp chest pain, and hypoxemia.

Basal Cell Carcinoma of Hand Presenting With Severe Sepsis.

Basal cell carcinoma (BCC) is one of the most common skin malignancies in the United States. It commonly presents in the neck and head as a papulo-nodular lesion that is slow-growing with rare metastasis. BCC has a high curative rate often with Mohs surgery or excision of the lesion.

Thoracic Aortic Rupture Post Cardiopulmonary Resuscitation in a Patient With Previous Thoracic Aneurysm Repair.

Aortic dissection is characterized by a tear or rupture in the intimal layer of the aorta causing blood to flow between the layers of the arterial wall, thus separating them. While cardiopulmonary resuscitation (CPR) is a life-saving intervention, it can unintentionally contribute to the development or worsening of aortic dissection. The forceful chest compressions involved in CPR can put significant pressure on the fragile aortic wall, potentially leading to a tear or rupture.

Clinicopathological significance of unraveling mitochondrial pathway alterations in non-small-cell lung cancer.

Early detection, accurate monitoring, and therapeutics are major problems in non-small-cell lung cancer (NSCLC) patients. We identified genomic copy number variation of a unique panel of 40 mitochondria-targeted genes in NSCLCs (GEOGSE #29365). Validation of mRNA expression of these molecules revealed an altered panel of 34 genes in lung adenocarcinomas (LUAD) and 36 genes in lung squamous cell carcinomas (LUSC).

Intraoperative Fluorescein Angiography Can Efficiently Identify Biomarkers and Guide Surgical Decision-Making.

Purpose: We sought to develop an efficient method for fluorescein angiography (FA) during digitally assisted vitreoretinal surgery (DAVS).

Methods: A 485-nm bandpass filter was placed into the filter holder of the accessory light sources of the Constellation Vision System with steel modified washers to produce an exciter source. A barrier filter was placed into the blank slot of a switchable laser filter with a 535-nm bandpass filter and another washer or created digitally with a specific color channel using NGENUITY software version 1.

Limited impact of a nudge comment in promoting de-escalation to first-generation cephalosporins in urinary tract infections.

In this study, we evaluated the impact of a microbiology nudge on de-escalation to first-generation cephalosporins in hospitalized patients with urinary tract infections secondary to , , and isolates with minimum inhibitory concentrations (MICs) ≤ 16 µg/mL. De-escalation to first generation-cephalosporins was uncommon at MICs = 4-16 µg/mL.

Percutaneous Coronary Intervention With Dual Antiplatelet Therapy in a Patient With Chronic Subdural Hematoma: Novel Approach.

Subdural hematoma is a type of brain bleed characterized by the accumulation of blood beneath the dura matter. It usually occurs as a sequela of a traumatic event or following the use of antiplatelets and/or anticoagulants. The clinical presentation may include symptoms like headache, confusion, ataxia, and hemiparesis.

A Rare Case of Myocarditis After the First Dose of Moderna Vaccine in a Patient With Two Previous COVID-19 Infections.

Myocarditis is the inflammation of the cardiac muscle caused by a variety of factors ranging from infections to autoimmune diseases. Most cases of vaccine-induced myocarditis occur after the second dose of vaccination; however, a few cases have been reported following the first dose of vaccination with or without previous coronavirus disease 2019 (COVID-19) infection. A case of myocarditis occurring about three weeks after the first dose of the Moderna vaccine has been reported in a patient with one previous COVID-19 infection.

Novel multifunctional robotically assisted bipolar instrument for simultaneous radiofrequency sealing and transection: preclinical and single-center experience.

Background: A novel robotic-assisted bipolar radiofrequency (RF) multifunctional vessel seal-and-transection instrument (SynchroSeal, Intuitive Surgical, Inc., Sunnyvale, CA) has been developed. The objective of the current paper is to describe the design of SynchroSeal based on bench studies, assess the safety of SynchroSeal in ex vivo and in vivo porcine studies, and provide early clinical context.

Reducing Opioid-Induced Constipation Post-Cardiac Surgery: An Improvement Project in a Pediatric Cardiac Intensive Care Unit.

Background: Pain management with opioids and underutilization of prophylaxis for constipation can prolong a patient's hospital length of stay and impede pain management efforts.

Problem: In pediatric postoperative cardiac patients, opioid therapy is a common approach to pain management but often places them at greater risk for constipation due to anatomy and age.

Methods: A retrospective review of 50 patients' medical records for baseline data was conducted, and a survey evaluated providers' current knowledge and practice.

Trauma Communications Center Coordinated Severity-Based Stroke Triage: Protocol of a Hybrid Type 1 Effectiveness-Implementation Study.

Mechanical thrombectomy (MT) can improve the outcomes of patients with large vessel occlusion (LVO), but a minority of patients with LVO are treated and there are disparities in timely access to MT. In part, this is because in most regions, including Alabama, the emergency medical service (EMS) transports all patients with suspected stroke, regardless of severity, to the nearest stroke center. Consequently, patients with LVO may experience delayed arrival at stroke centers with MT capability and worse outcomes.

Evaluation of the timing of MRSA PCR nasal screening: How long can a negative assay be used to rule out MRSA-positive respiratory cultures?

Purpose: Previous studies indicate that the polymerase chain reaction (PCR) nasal assay for methicillin-resistant Staphylococcus aureus (MRSA) has a consistently high (>95%) negative predictive value (NPV) in ruling out MRSA pneumonia; however, optimal timing of PCR assay specimen and respiratory culture collection is unclear.

Methods: A study including 736 patients from a community hospital system was conducted. Patients were included if they had undergone MRSA nasal screening with a PCR assay and had documented positive respiratory culture results.

Laparoscope-Assisted Guidance to the Pineal Region.

Tumors arising in the pineal region present a number of challenges when planning for effective removal. This report describes the successful resection of a falcotentorial meningioma occurring in a 56-year-old female using a supracerebellar infratentorial approach. In order to excise the pineal region mass, a unique combination of instrumentation was used, including a microscope, endoscope, and abdominal laparoscope.

What Isn't a Case-Control Study?

Background: Confusion exists among neurosurgeons when choosing and implementing an appropriate study design and statistical methods when conducting research. We noticed particular difficulty with mislabeled and inappropriate case-control studies in the neurosurgical literature.

Objective: To quantify and to rigorously review this issue for appropriateness in publication and to establish quality of the manuscripts using a rigorous technique.

What is a Case-Control Study?

Case-control (case-control, case-controlled) studies are beginning to appear more frequently in the neurosurgical literature. They can be more robust, if well designed, than the typical case series or even cohort study to determine or refine treatment algorithms. The purpose of this review is to define and explore the differences between case-control studies and other so-called nonexperimental, quasiexperimental, or observational studies in determining preferred treatments for neurosurgical patients.

Sufentanil sublingual tablet system for the management of postoperative pain following open abdominal surgery: a randomized, placebo-controlled study.

Background And Objectives: This study evaluates the efficacy and safety of a sufentanil sublingual tablet system (SSTS) for the management of postoperative pain following open abdominal surgery.

Methods: At 13 hospital sites in the United States, patients following surgery with pain intensity of greater than 4 on an 11-point numerical rating scale were randomized to receive SSTS dispensing a 15-μg sufentanil tablet sublingually with a 20-minute lockout or an identical system dispensing a placebo tablet sublingually. Pain intensity scores were recorded at baseline and for up to 72 hours after starting study drug.

Early experience treating tricuspid valve endocarditis with a novel extracellular matrix cylinder reconstruction.

Objective: The short-term outcomes were evaluated in patients treated for tricuspid valve endocarditis using a novel extracellular matrix (ECM) cylinder reconstruction technique.

Methods: Patients with clinically significant tricuspid regurgitation whose valves were not repairable by conventional techniques underwent valve replacement with a cylindrical construct sewn out of CorMatrix ECM (CorMatrix Cardiovascular, Roswell, Ga). The cylinders were sized to the native valve dimensions and attached distally to the papillary muscles using polypropylene sutures and ECM pledgets, and proximally to the annulus using a running suture.

Why some ignore public health disaster warnings.

This article was written as a course requirement in the Masters of Homeland Security Public Health Preparedness curriculum. The authors spell out the many reasons why people have ignored evacuation orders in the face of impending disasters, risking injury and death, and putting first responders and rescuers at greater risk. Public apathy, however does not relieve their leaders of the task of using mass notification and other methods to inform them of risks, employ effective persuasion methods, or responding to emergencies.

Oocyte number per live birth in IVF: were Steptoe and Edwards less wasteful?

As part of a learning exercise to assess the efficiency of oocyte utilization after controlled ovarian stimulation, we compared historical data from the publications of Steptoe and Edwards describing their early experiences in Oldham and at Bourn Hall with retrospective data from IVF and ICSI cycles carried out at Bourn Hall Clinic during the year 2000. For the purpose of analysing the more recent data, patients were subdivided into groups by age (< or = 37 years and > or = 38 years) and by oocyte yield (low, intermediate and high). In patients less than 38 years of age, live birth rates were equivalent in each group, irrespective of the number of oocytes retrieved.