Willifordsuhr4579

Key Words Malignant peripheral nerve sheath tumor, Cervix, Pulmonary metastasis, Hysterectomy, Chemotherapy.Peptic ulcer disease affects a large number of people around the world. Complications occur in 10-20% of patients and perforation develops in 2-14% of the cases. It can either be in the pyloric part of the stomach or in the first part of duodenum. Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) abuse and smoking are noted to be the most common risk factors in developing countries. Other risk factors are steroid abuse, post-surgery stress, burns and Zollinger-Ellison syndrome. Although small perforations can be treated conservatively but Graham patch repair is the treatment of choice. Double peptic ulcer perforation is a rare event with only a few cases reported worldwide. This patient presented with double peptic ulcer perforation in emergency due to post-surgery stress. She had cesarean section 10 days earlier with delayed recovery. Key Words Peptic ulcer disease, Perforation, Graham patch repair, Cesarean section.Uterine adenosarcoma is a rare tumor composed of benign epithelium in combination with malignant mesenchymal components. Misdiagnosis is common due to the lack of specific clinical manifestations and the rarity of such tumors in young age groups. The mean age at diagnosis is 58.6 years, and less then 10% of patients are younger than 40 years. Herein, we describe a case of a 19-year girl who presented with worsening menorrhagia. Her ultrasound revealed multiple heterogeneous masses in the uterine cavity. Intraoperatively, a small piece of grayish-white tumor tissue was sent for the frozen section, but the results did not confirm malignancy. She underwent hysteroscopy, laparoscopic hysterectomy, and bilateral salpingo-oophorectomy. Histopathologic examination finally confirmed uterine adenosarcoma. The patient had no evidence of residual tumor or recurrence during six months of follow-up. Key Words Uterus, Adenosarcoma, Mixed tumor.We share our experience of a two-way vacuum-assisted closure (VAC) technique that allows patients to heal when generalised peritonitis develops because of a recurrent duodenal leak. Two patients underwent omentoplasty for duodenal ulcer perforation and one patient underwent antrectomy, gastrojejunostomy, and tube duodenostomy. Two-way VAC was performed by taking an abdominal fluid culture and washing the abdomen with 6-12 litres of warm saline. Two-way VAC exchange pro-cedures were continued every 3 days and total parenteral nutrition was administered until cessation of the duodenal re-leak. The two-way VAC application was terminated when improvement in the re-leak was macroscopically detected. The subcutaneous layer was dissected from the anterior abdominal wall fascial layer, and the abdominal skin was closed without tension. The patients were subsequently discharged. Controlling the primary source is often difficult when treating duodenal re-leaks, and two-way VAC can localise the source of the peritonitis and remove toxic peritoneal material. Key Words Open abdomen, Vacuum-assisted closure, Severe peritonitis, Duodenal leak.Hyponatremia is regarded as the most common electrolyte imbalance among hospitalised patients. Most hyponatremic conditions present with various degrees of symptoms depending on the level of sodium. Herein, we present a case of hyponatremia in a 65-year male, which was being managed as a case of diabetic nephropathy. On admission, initial results showed a sodium level of 120 mmol/L. Subsequent electrolyte assay after a week on medications showed serum sodium of 103 mmol/L with no associated symptoms of hyponatremia, except nausea and an episode of vomiting. There was no associated focal neurological deficit in the patient. Glasgow coma scale was 15. A repeat electrolyte assay done 24 hours later showed a serum sodium level of 102 mmol/L. The simultaneous level of potassium was 2.6 mmol/L and 2.7 mmol/L, respectively. From this case, it is important to note that the level of hyponatremia does not necessarily have a direct relationship with the severity of symptoms of hyponatremia. Key Words Hyponatremia, Electrolytes, Diabetic nephropathy.Fishbone intake is a common clinical event; but serious complications resulting from the ingestion of fishbones, such as perforations in the stomach, diaphragm, and pericardium and heart lacerations, are rare. Here, we present a case of fishbone-induced pericardial hemorrhage that led to a misdiagnosis of acute myocardial infarction (AMI) since the emergency coronary angiogram showed normal coronaries. However, the patient's circulatory status was not good and an echocardiogram revealed pericardial effusion. A contrast-enhanced computed tomography (CT) of the chest and abdomen showed a foreign body in the upper abdomen. Therefore, an urgent exploratory thoracotomy was performed, and it was discovered that the pericardial hemorrhage was caused by the fishbone puncturing the pericardium and myocardium of the right ventricle. The fishbone was removed, damaged vessels were repaired, and the pericardium was closed with a drain. The patient was discharged in good clinical condition. In order to avoid unnecessary damage and suffering, the possibility of a foreign body in the esophagus or heart must be considered when patients have chest pain, and careful reporting of histories and corresponding examinations are necessary. Key Words Acute myocardial infarction, Fishbone, Pericardial effusion.Idiopathic premature ventricular contractions (PVCs) most often occur under or above the semi-lunar valves from the right ventricular outflow tract and less often from the left ventricular outflow tract. Radio-frequency ablation is mostly used for patients who develop left ventricular dysfunction or intolerable symptoms. Since most of the patients are in the young age group and ablation has a high success rate with recurrence being relatively low, it can be offered to those symptomatic patients who want a definitive cure. The use of 3-dimensional (3D) electroanatomic mapping systems helps locate the ablation site. We report a case of a young man with PVCs coming from a rare site of non-coronary cusp, which was ablated successfully by using a high-density mapping system. Key Words Catheter ablation, Left ventricular outflow tract, Non-coronary aortic cusp, Premature ventricular contractions.Coronary artery anomalies (CAA) are frequently asymptomatic clinical entities, associated with variable prognosis. Single coronary artery anomaly is a rare type of coronary anatomy anomaly with little data in the literature. Although prognostic data are not clear, it is thought that the course of anomalous artery is the most important determinant. Percutaneous revascularisation of concomitant atherosclerotic disease in anomalous coronary arteries may be technically challenging. In this report, we present a case of a single coronary artery undergoing percutaneous revascularisation with an alternative technique of advancing a guidewire into the anomalous left main coronary artery and then crossing the culprit lesion in the left anterior descending artery. This report highlights the importance of catheter stabilisation during percutaneous revascularisation with a simple yet very practical solution. Key Words Coronary angiography, Coronary vessel anomalies, Myocardial infarction, Percutaneous coronary intervention.Paratesticular liposarcoma (PLS) is a rare type of genitourinary malignancy in the spermatic cord presenting as scrotal swelling. In this case study, we report an 82-year male who presented with prolonged left scrotal swelling and pain that did not respond to analgesic treatment for one week. His ultrasound confirmed increased fluid content in the left scrotal compartment in the form of septated hydrocele, and hydrocelectomy was planned. During the operation, infected fluid was drained. The testicle and surrounding tissues were infected; hence, left orchiectomy was performed. The pathological examination revealed a dedifferentiated liposarcoma. To our knowledge, this is the first report of liposarcoma of the spermatic cord with hydrocele in the literature. Key Words Liposarcoma, Spermatic cord, Scrotal swelling, Hydrocele.

Clinical heterogeneity in major depressive disorder likely reflects the range of etiology and contributing factors in the disorder, such as genetic risk. Identification of more refined subgroups based on biomarkers such as white matter integrity and lipid-related metabolites could facilitate precision medicine in major depressive disorder.

A total of 148 participants (15 genetic high-risk participants, 57 patients with first-episode major depressive disorder and 76 healthy controls) underwent diffusion tensor imaging and plasma lipid profiling. Alterations in white matter integrity and lipid metabolites were identified in genetic high-risk participants and patients with first-episode major depressive disorder. Then, shared alterations between genetic high-risk and first-episode major depressive disorder were used to develop an imaging x metabolite diagnostic panel for genetically based major depressive disorder via factor analysis and logistic regression. A fivefold cross-validation test was performed to hite matter integrity in corpus callosum, superior longitudinal fasciculus and corona radiata, and unsaturated fatty acid profile may improve the identification of genetically based endophenotypes in major depressive disorder to advance precision medicine strategies.Complex coacervates are usually formed through electrostatic attraction between oppositely charged polyelectrolytes, with a few exceptions such as coacervates of like-charge proteins and polyelectrolytes, both in vivo and in vitro. Understanding of the preparation and mechanisms of these coacervates is limited. Here, a positively charged poly(ionic liquid), poly(1-vinyl-3-benzylimidazolium chloride) (PILben), is designed that bears benzene rings in repeating units. Fluidic coacervates are prepared by mixing the PILben aqueous solution with a like-charge poly(ionic liquid) named poly(dimethyl diallyl ammonium chloride) (PDDA). The effects of polymer concentration, temperature, and ionic strength in the PILben-PDDA coacervate are studied. Raman spectroscopy and 2D 1 H-13 C heteronuclear single quantum coherence (1 H-13 C HSQC) characterizations verify that the coacervate formation benefits from the cation-π interaction between PILben and PDDA. this website This work provides principles and understandings of designing coacervates derived from like-charge poly(ionic liquids) with high charge density.

To conduct a needs assessment for lay health workers and non-physician healthcare professionals [i.e., community health workers (CHW) and lung health professionals who spend more time face-to-face with tobacco-related disparity populations] to describe current gaps in tobacco cessation practices and knowledge.

A 46-item needs assessment survey was developed to understand knowledge, practices, and confidence about tobacco cessation among non-physician health professionals in a large, urban city in the U.S. Participants, recruited from local community-based organizations and email listservs, completed the online or paper survey, which included a 10-item investigator-initiated tobacco knowledge questionnaire.

About 61.5% of participants (N = 53) asked each client/patient about tobacco use at initial visit, 41.8% reported extreme likelihood of discussing tobacco during a visit, and 43.1% reported addressing tobacco use directly. Despite assisting with cessation, tobacco-related knowledge and confidence was low, with respondents scoring an average of 4.