Early recognition of patients with axial spondyloarthritis-evaluation of referral strategies in primary care.

OBJECTIVE: Chronic inflammatory back pain (IBP) is frequently reported in axial SpA (axSpA) but also in the general population. We evaluated a recently proposed two-step referral system for early recognition of axSpA in primary care and compare it with other combinations of symptoms and SpA-related items. METHODS: Consecutive chronic back pain patients ≤45 years of age answered a questionnaire and were seen by a primary care physician who decided whether HLA-B27 needed to be determined. They were then referred to a rheumatologist who made the diagnosis. Generally sticking to the two-step system with HLA-B27 as an additional option, combinations with a sensitivity ≥90% and a likelihood ratio >4 were compared. RESULTS: A total of 326 patients were included, 46 of whom were diagnosed with axSpA (14.1%). The sensitivity of the strategy was 87%, the specificity was 56.8% and the positive and negative predictive values were 24.8% and 96.4%, respectively. A 'good response to NSAIDs', 'morning stiffness >30 min' and 'elevated C-reactive protein' performed best, with a sensitivity of 91%, specificity of 67%, positive predictive value of 31% and negative predictive value of 98%. On that basis, only three patients had to be seen by a rheumatologist to diagnose one. CONCLUSION: The earlier proposed referral system worked well but was outperformed by other combinations with high sensitivity and better specificity, which deserve to be prospectively studied.

A scientometric analysis of 20 years of research on breast reconstruction surgery: a guide for research design and journal selection.

BACKGROUND: Breast reconstruction refers to the rebuilding of a woman's breast using autologous tissue or prosthetic material to form a natural-looking breast. It is increasingly offered to women undergoing mastectomy for breast cancer. However, there is no systematic analysis available for the expanding area of research on breast reconstruction. METHODS: A bibliometric method was used to obtain a view of the scientific production about breast reconstruction by data extracted from the Institute for Scientific Information (ISI). Specific parameters were retrieved from the ISI. Articles about breast reconstruction were analyzed to obtain a view of the topic's structure, history, and document relationships using HistCite software. Trends in the most influential publications and authors were analyzed. RESULTS: The number of articles was constantly increasing. Most highly cited articles described the methods of flap construction in the surgery. Other highly cited articles discussed the psychological or emotional aspects of breast reconstruction, skin sparing mastectomy, and breast reconstruction in the irradiated breast. CONCLUSIONS: This was the first breast reconstruction scientometric analysis, representing the characteristics of papers and the trends of scientific production. A constant increase in the number of breast reconstruction papers and also the increasing number of citations shows that there is an increasing interest in this area of medical science. It seems that most of the research in this field is focused on the technical aspects of surgery.

Hemosuccus pancreaticus in a patient with celiac trunk aneurysm.

Celiac artery aneurysm associated with hemosuccus pancreaticus is extremely rare. We herein present a 67-year-old man with a large celiac artery aneurysm presenting with intermittent massive gastrointestinal bleeding due to connection of aneurysm with a blood-filled pancreatic duct who was successfully operated. To the best of our knowledge, this is the first report of a case of hemosuccus pancreaticus due to celiac artery trunk aneurysm.

Cervical internal carotid artery pseudoaneurysm following stab injury.

Carotid artery pseudoaneurysm is a rare complication of injury to the head and neck, which has been traditionally managed by an open surgical repair to avoid the occurrence of devastating cerebral strokes. Their treatment presents a challenge because of the risk of serious neurological events. This report presents a case of a stab penetrating injury to the left upper neck (Monson`s zone-III), which resulted in ipsilateral seventh and twelfth cranial nerve palsy and contra lateral hemiparesis, and false aneurysm of the internal carotid artery. After excision of the aneurysm, the internal carotid artery was ligated. The postoperative course was uneventful, and the patient remains free of symptoms.