Buske-Lowenstein Tumor: A Rare Cause of Genital Warts.

The Buschke-Löwenstein tumor (BLT), also known as giant condylomata acuminata (GCA), is a pseudo-epithelial proliferation engendered by the human papillomavirus (HPV). Interestingly, its location at the anal margin, or perianal skin, is rare. The authors present the case of a gentleman who became unstable while standing, stating that his ears were ringing. His emergency presentation, clinical course, and imaging findings are discussed. The patient presented with signs of condyloma acuminata and BLT. This can be excised through surgery and removed with the help of adjuvant treatments, but there is still much to learn about this disease.

Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department.

Objective We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. Methods This was a cross-sectional survey study of American emergency medicine (EM) physicians with a self-administered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. Results There were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). Conclusion Barriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings.

Aortic Dissection as the Culprit for Seizure.

The authors present a case of syncope that was caused by aortic dissection. As the main artery to the system circulation, aortic dissection can manifest in numerous ways. This case reminds the clinician of the high index of suspicion necessary to diagnose this potentially life-threatening problem. Indeed, the mortality rate increases 2% per hour in the first 24 hours for a type A aortic dissection, so prompt diagnosis is imperative. The diagnostic complexity in this case is compounded by the very broad differential diagnosis for both aortic dissection and syncope.

Massive necrotizing Fournier's gangrene.

Despite its rarity, Fournier's gangrene remains a potentially deadly disease. Rapid assessment and treatment is absolutely critical for patient survival. We present herein a classic case of Fournier's gangrene in an older male with uncontrolled diabetes mellitus and hypertension, including ultrasonographic and computed tomography imaging. The necrotizing infection involved the patient's entire scrotum and spread to the perineum as well, necessitating scrotectomy, and partial colostomy in addition to extensive debridement and skin grafting.