ABSTRACT
Sinoliths are mineral deposits that occur within the paranasal sinus due to long-standing obstruction and lack of drainage. It is a rare differential diagnosis for intrasinus lesions found on imaging. On computed tomography (CT) of the head, these calcifications are visualized as dense radiopaque bodies within the sinuses. Typically, patients with sinoliths are asymptomatic, but if complications of chronic obstruction and recurring sinusitis arise, endoscopic removal of the sinolith may be recommended. Here, we present a 95-year-old female found to have a sinolith in the sphenoid sinus on incidental imaging. This report discusses the etiology, pathophysiology, clinical presentation, radiologic findings, and management of sinoliths.
ABSTRACT
Appendiceal signet ring cell carcinoma is an exceedingly rare neoplasm which makes up only 4% of carcinomas of the appendix. It is a rare cause of abdominal pain which can mimic acute appendicitis. This case reports a 77-year-old female who presented to the emergency room with a complaint of right lower quadrant abdominal pain. After exploratory laparoscopy and histopathological studies, the patient was found to have peritoneal carcinomatosis and appendiceal signet ring cell carcinoma. This diagnosis unfortunately carries a relatively poor prognosis due to its aggressive nature. This study discusses the etiology, prevalence, clinical findings, and treatment of a rare cause of abdominal pain. This report sheds light on the importance of early detection and treatment of appendiceal signet ring cell carcinoma.
ABSTRACT
Encephaloceles and severe cardiac malformations are rare presentations in a newborn. The mechanism of these congenital abnormalities is relatively unknown, but it is hypothesized to be related to genetic, environmental, and maternal risk factors. This case report describes a newborn with an occipital encephalocele associated with severe right ventricular hypoplasia secondary to tricuspid and pulmonary atresia. The patient's maternal risk factors included obesity, type 2 diabetes mellitus, and everyday tobacco use during pregnancy. Education on preconception planning, management, and counseling is essential as a preventative measure in fetal development and is further emphasized in this case.
ABSTRACT
Spondyloarthropathy (SpA) is one of the most common causes of low back pain. It is caused by inflammatory arthritis in the spine, manifesting in various forms such as psoriatic arthritis (PsA), ankylosing spondylitis (AS), and sacroiliitis. A comprehensive systematic literature search was done to evaluate and compare MRI, CT, single-photon emission CT, PET, ultrasound (US) imaging, low-dose CT, and diffusion-weighted imaging (DWI) techniques in assessing SpAs. The search strategy was constructed by an analysis of key terms from relevant articles in MEDLINE ProQuest, Embase, and PubMed. The key terms used to search for these articles were "SpA," "sacroiliitis," "spondylitis," "psoriatic arthritis," "MRI," "CT scan," "x-ray," "magnetic resonance imaging," "computed tomography," "bone density," and "ultrasound." A total of 1,131 articles published in English between January 1, 2003, and October 15, 2023 were identified and screened for eligibility by members of the research team, which resulted in 69 total articles selected for the final review. US has played an important role in visualizing joint inflammation and enthesitis (inflammation of the enthesis), which are common features of PsA. Although MRI and CT are considered more reliable modalities for diagnosing active sacroiliitis, US imaging with Doppler flow can also be useful in conjunction with CT images to visualize abnormal blood flow in the sacroiliac joints, as well as other joints affected by inflammatory arthritis. MRI provides increased diagnostic confidence in the diagnosis of sacroiliitis in active AS patients when compared to CT. CT is more sensitive than plain radiographs. The PET activity score showed a good correlation in diagnosing inflammatory sacroiliitis but lacked in identifying structural lesions. CT has high diagnostic accuracy, but it exposes patients to a high radiation dose. MRI visualizes joint and tissue inflammation, bone, and bone marrow change and can identify peripheral inflammation in soft tissue and joints in patients diagnosed with PsA. MRI can also visualize bone marrow changes and subchondral edema, which can aid in the early diagnosis of ankylosing SpA and gauge disease severity. DWI and short-tau inversion recovery imaging are both MRI techniques used in detecting sacroiliitis. MRI and CT are shown to be reliable imaging modalities for the diagnosis of sacroiliitis; however, it was found that Doppler US played an accurate role in the diagnosis as well. MRI visualizes joints and tissue with the most precision, making it useful in evaluating patients with PsA, while PET CT is useful in the diagnosis of inflammatory sacroiliitis patients. There is limited literature available comparing the multiple modalities of imaging available for each SpA. The review's objective is to analyze imaging findings in patients diagnosed with sacroiliitis and SpAs. The findings in this literature review are valuable for properly assessing and diagnosing patients suffering from SpAs.
ABSTRACT
Loop electrosurgical excision procedure (LEEP) is a common procedure used to treat cervical dysplasia. It is performed by using an electrical current and loop wire to remove abnormal cervical tissue. Common complications include intraoperative and postoperative bleeding. A rare complication is delayed hemorrhage, presenting in 0.8-1.3% of women, which can require sutures, transfusions, or inpatient care. We present the case of a 41-year-old female presenting to the emergency department nine days after a LEEP procedure with heavy vaginal bleeding that resulted in delayed hemorrhage. Within hours of arrival, the patient passed several large clots and her hemoglobin dropped from 12.2 gm/mL to 6.9 gm/mL requiring emergency surgery and blood transfusion. The delayed hemorrhage was further exacerbated by this patient's concurrent clopidogrel use. It is pivotal to identify high-risk patients to help prevent potential procedural complications through the use of preoperative instructions and emerging intraoperative interventions. It is also imperative to provide adequate guidance to patients about the postoperative course and how to identify signs and symptoms of a life-threatening situation.
ABSTRACT
A source of support during birth could be the solution to negative outcomes for the mother and her baby. To improve the birthing experience and increase positive birthing outcomes, sources of support during pregnancy should be evaluated and understood. The goal of this review was to synthesize the existing literature on how doulas might improve birth outcomes. This scoping review also aimed to shed light on the positive impact emotional support during childbirth can have on the health and well-being of mother and child. PubMed and EBSCOhost were used to identify articles using the search words with Boolean operators "doulas" AND "labor support" AND "birth outcomes" AND "pregnancy" AND "effects during labor." The eligibility criteria for article selection included primary studies investigating how doulas contributed to birth outcomes. The studies in this review indicated that doula guidance in perinatal care was associated with positive delivery outcomes including reduced cesarean sections, premature deliveries, and length of labor. Moreover, the emotional support provided by doulas was seen to reduce anxiety and stress. Doula support, specifically in low-income women, was shown to improve breastfeeding success, with quicker lactogenesis and continued breastfeeding weeks after childbirth. Doulas can be a great resource for birthing mothers, and consideration should be given to using them more, as they may have a positive impact on the well-being of the mother and child. This study raised questions about the accessibility of doulas and how they may help mitigate health disparities among women from different socioeconomic levels.
