A Case Report: Successful Management of an Aortic Saddle Embolism in a 28-Year-Old Female.

The obstruction of blood flow at the aortic bifurcation by an embolus defines aortic saddle embolism (ASE). This rare entity occurs preferentially in individuals with cardiovascular diseases such as the middle aged and the elderly. Conversely, its occurrence is sporadic in younger patients. As a result, the diagnosis of ASE is often overlooked or delayed in this age group; therefore, putting these patients at significant risk of neurologic impairment and potential limb loss. Following an extensive literature review, we have found only one reported case of ASE in a patient younger than 30 years. This patient died within 24 hours of admission and was diagnosed with ASE at autopsy. Here, we report for the first time, a case of a successful management of an ASE in a 28-year-old female who presented at our emergency room with acute weakness and numbness of the lower extremities. After vascular consult, the diagnosis of ASE was made and the patient was treated successfully. A week later, the patient was discharged home in stable condition without complications. The purpose of this report is to raise awareness about this potentially fatal condition and emphasize the importance of rapid assessment and treatment. The treatment options are heparin infusion, thrombolytic therapy, and embolectomy.

Comparative effectiveness in esophagogastric cancer.

Cancer of the esophagus and the gastroesophageal junction (GEJ) continues to have a dismal prognosis, with the incidence of esophageal cancer increasing in the United States. Although radical resection was initially the primary treatment for this disease process, systemic chemotherapy and radiation have been shown to play a role in prolonging survival in most patient populations. This chapter explores the evidence that guides treatment for esophageal and GEJ cancer today. Chemotherapy and radiation therapy were introduced as treatment modalities for esophageal and GEJ cancers when it became evident that surgical therapy alone provided poor long-term survival rates. A variety of treatment strategies have been explored including preoperative (neoadjuvant) and postoperative (adjuvant) chemotherapy, with and without radiation. The evidence suggests that neoadjuvant chemotherapy or chemoradiotherapy provides better outcomes compared to surgery alone for esophageal, GEJ, and gastric cancers. Studies indicate a trend towards improved survival when neoadjuvant chemoradiotherapy is compared to chemotherapy alone. When patients have undergone resection with node-positive disease without receiving neoadjuvant therapy, some form of adjuvant treatment is recommended. This chapter also explores the surgical management of esophageal, GEJ, and gastric cancers including the extent of the gastric lymph node dissection. It also includes a discussion about adherence to national guidelines in terms of gastric cancer treatment and esophageal and gastric lymph node examinations.

Successful laparoscopic management of ruptured tubal pregnancy with an ipsilateral ectopic pelvic kidney.

Objective. To report a case of successful laparoscopic management of a left ruptured tubal pregnancy in the setting of an ipsilateral ectopic pelvic kidney. Method. Case report was prepared at Wayne State University/Detroit Medical Center. The patient is a young woman gravida 2 para 0 in her twenties who presented with severe abdominal pain and vaginal bleeding. She had a plateaued beta HCG and ultrasonographic findings suggestive of ectopic left tubal pregnancy along with an ectopic ipsilateral pelvic kidney. The IRB approval is not needed, as this is a case report. The informed consent could not be obtained, as the patient was not reachable. Result. Multiple intraperitoneal adhesions, left ruptured ampullary ectopic pregnancy and left retroperitoneal pelvic mass consistent with ipsilateral ectopic pelvic kidney. Conclusion. Laparoscopic management of tubal pregnancy can be safely performed in the setting of an ipsilateral ectopic pelvic kidney.