Pelvic ultrasonography of the postpartum uterus in patients presenting to the emergency room with vaginal bleeding and pelvic pain.

Pelvic pain and vaginal bleeding are common symptoms in postpartum women presenting to the emergency room (ER). Pelvic ultrasonography plays a crucial role in evaluating symptomatic postpartum patients by allowing a rapid diagnosis and treatment initiation. The main goal of imaging is to distinguish between causes of pelvic pain and vaginal bleeding that may be managed conservatively and those requiring emergent intervention. This pictural essay focuses on the ultrasonographic features of common postpartum conditions for which patients may present to the ER with vaginal bleeding and pelvic pain, including retained products of conception, endometritis, uterine arteriovenous malformation, uterine artery pseudoaneurysm, ovarian vein thrombosis, bladder flap hematoma, and uterine dehiscence/rupture.

Ultrasonographic evaluation of patients with abnormal liver function tests in the emergency department.

Ultrasonography is often the initial modality used to evaluate patients found to have abnormal liver function tests (LFTs) in the emergency department. While an assessment for biliary ductal dilatation and obstruction remains one of the main questions to answer, radiologists should also be aware of the ultrasonographic appearance of other conditions that can cause abnormal LFTs. This may be crucial for the management and disposition of patients in the emergency department. This article reviews the ultrasonographic features of diseases that may cause abnormal LFTs.

Tales of Mentoring in Radiology: The Experience of Residents and Mentors at a Single Academic Program.

PURPOSE: To investigate the utility of mentoring groups in radiology residency. METHODS: Five assistant professors of Radiology and 20 radiology residents were divided into 5 groups. One resident from each academic year was randomly paired with a mentor group. Three 1-hour group mentoring sessions took place over the year. Upon completion of the project an anonymous Quality Improvement survey of 20 questions were sent out to participants to assess the utility of these mentoring sessions. RESULTS: Four mentors out of 5 responded. All 4 had prior neutral and positive experiences as mentees involving career advice and subspecialty choice. During this experience all mentors had a positive experience. The majority found it helpful to have residents of different levels in their group to allow for peer to peer mentoring and all thought the mentoring program should continue. The most common topics they covered during the sessions were career advice and specialty choice. Sixteen residents out of 20 responded. The majority had had a previous mentor experience which was mostly positive or very positive and predominantly career and/or research related. Almost all of them had a positive or very positive mentoring experience this year. The high majority found that having residents of different levels was beneficial. Topics that mentoring sessions helped mostly with were career advice, work life balance and study skills. All of the mentees thought the mentoring program should continue. CONCLUSIONS: Mentoring groups can be a valuable addition to residency training, especially in helping with career advice and work life balance.

A tour of the thymus: a review of thymic lesions with radiologic and pathologic correlation.

The thymus is routinely encountered on cross-sectional imaging studies of the chest. It has a variable appearance, undergoes dynamic changes during periods of stress, and demonstrates numerous different pathologic lesions. Understanding the imaging characteristics of these different lesions facilitates accurate radiographic diagnosis and can prevent unnecessary follow-up imaging and intervention. This article will review normal thymic anatomy and development, thymic hyperplasia and associated medical conditions, and the imaging and pathologic features of various benign and malignant thymic lesions.

Acute rejection of white adipose tissue allograft.

White adipose tissue (WAT) transplantation, although widely used in humans, has been done for cosmetic and reconstructive purposes only. Accumulating evidence indicates, however, that WAT is an important endocrine organ and, therefore, WAT transplantation may become valuable as a replacement therapy for a number of hereditary human diseases. Because the most readily available source for such transplantations would be allogeneic tissue, the mechanisms involved in the rejection of WAT allograft should be explored. We have established a model in which leptin-producing allogeneic WAT is transplanted into leptin-deficient ob/ob mice. Because ob/ob mice are obese, hyperphagic, and hypothermic, WAT allograft function is monitored as the reversal of this leptin-deficient phenotype. Here we report that allografted WAT is primarily nonfunctional. However, when WAT is transplanted into immunodeficient (Rag1-/-) ob/ob mice, or into ob/ob mice depleted of T cells by anti-CD3 antibody, a long-term graft survival is achieved as indicated by the reversal of hyperphagia, weight loss, and normalization of body temperature. The symptoms of leptin deficiency rapidly recur when normal spleen cells of the recipient type are injected, or when the antibody treatment is terminated. In contrast, selective depletion of either CD4+ or CD8+ cells alone does not prevent WAT allograft rejection. Similarly, WAT allografts that do not express MHC class I or class II molecules are rapidly rejected, suggesting that both CD4+ and CD8+ T cells may independently mediate WAT allograft rejection.

The eleven essentials of effective staff meetings, part 2: Getting it together in the name of customer service.

So there you have them: our first 5 Essentials: (1) Punctuality; (2) No Interruptions; (3) No Titles, No Privileges; (4) No Hanging Back, No Monopolizing; and (5) A Written Agenda. Meetings, even the best intentioned of them, need structure, and we are confident that if you adopt these rules, or some reasonable facsimile, you will see great improvement in both staff and patient relationships. In my next article, the remaining 6 Essentials will be discussed, including how we put the Essentials to effective use.

The match-mismatch model and panic patients' accuracy in predicting naturally occurring panic attacks.

The match-mismatch model of panic states that panic disorder patients tend to overestimate the probability of panic prior to engaging in a fear-provoking situation. Furthermore, patients are expected to become more accurate in predicting panic over subsequent occasions of exposure. We tested the model with naturally occurring panic attacks. Patients rated the probability of a panic attack in the morning, and these ratings were compared to the actual occurrence of panic that day. Ratings were collected daily in a baseline period before treatment, during treatment, and again for 2 weeks after treatment. The results confirmed that panic disorder patients tend to overpredict the likelihood of panic. However, patients did not become more accurate in their predictions over time. In fact, overprediction bias increased because expectancy of panic remained stable, in spite of the decline of the frequency of panic from pre- to post-test. Thus, over a short course of therapy panic patients tend to persist in overestimating the chance that panic may occur. At baseline, expectancy of panic and the tendency to overpredict were not associated with other aspects of the symptomatology. Neither expectancy nor overprediction bias was predictive of treatment outcome. Finally, improvement in treatment was not associated with a decreased expectancy of panic.