Multiple embolic cerebral infarcts as the first manifestation of metastatic ovarian cancer.

A 36-year-old woman presented to the emergency department with a 3-day history of an occipital headache associated with transient visual impairment and short-term memory loss. MRI of the brain showed innumerable focal embolic infarcts of differing ages, for which a cause could not be determined. The patient was discharged and readmitted 7 weeks later with acute aphasia and a right-sided hemiplegia. CT of the abdomen revealed a right-sided ovarian mass and prominent retroperitoneal nodes, which cytology confirmed to be metastatic ovarian cancer.

CORKSCREW 2013 CORK study of children's realistic estimation of weight.

BACKGROUND: In a resuscitation situation involving a child (age 1-15 years) it is crucial to obtain a weight as most interventions and management depend on it. The APLS formula, '2×(age+4)', is taught via the APLS course and is widely used in Irish hospitals. As the prevalence of obesity is increasing the accuracy of the formula has been questioned and a newer formula has been suggested, the Luscombe and Owens (LO) formula, '(3×age)+7'. AIMS AND OBJECTIVES: To gather data on the weights and ages of the Cork paediatric population (ages 1-15 years) attending services at the Cork University Hospital (CUH), and to identify which of the two age-based weight estimation formulae has best diagnostic accuracy. SETTING: CUH, Ireland's only level one trauma centre. METHODS: Retrospective data collection from charts in the Emergency Department, Paediatric Assessment Unit and the Paediatric wards of CUH. RESULTS: 3155 children aged 1-15 years were included in the study. There were 1344 girls and 1811 boys. The formula weight='2×(age+4)' underestimated children's weights by a mean of 20.3% (95% CI 19.7% to 20.9%) for the ages of 1-15 years. The LO formula weight='(3×age)+7' showed a mean underestimation of 4.0% (95% CI 3.3% to 4.6%) for the same age range. CONCLUSIONS: The LO formula has been validated in several studies and proven to be a superior age-based weight estimation formula in many western emergency departments. This study shows that the LO formula leads to less underestimation of weights in Irish children than the APLS formula. It is a simple, safe and more accurate age-based estimation formula that can be used over a large age range (1-15 years).