Imaging findings of fibroid torsion in pregnancy: A case report

When our patient presented emergently to labor and delivery at 18 weeks pregnant with severe right abdominal pain, the common diagnoses (such as appendicitis, cholecystitis, etc.) were on the top of the differential. However, US and MRI revealed a rarer cause of her pain, a pedunculated fibroid. The most important question then became whether this fibroid had torsed, which would require surgical intervention to prevent life-threatening sequelae. Unfortunately, presurgical imaging diagnosis of fibroid torsion in pregnancy is difficult. We offer a description of our patient's imaging findings, which align with other radiologic descriptions of fibroid torsion in pregnancy in the literature, to contribute to the radiologist's diagnostic confidence in this patient population.

A Community-Based Pancreatic Cancer Screening Study in High-Risk Individuals: Preliminary Efficacy and Safety Results

INTRODUCTION

Pancreatic cancer (PC) screening recommendations have been based on studies performed solely at high-volume academic centers. To make PC screening more widely available, community-based efforts are essential. We implemented a prospective PC screening study in the community of Fairfield County, CT, and report our early safety and efficacy results.

METHODS

Eligible individuals were enrolled into an investigator-initiated study and underwent a baseline and 3 annual magnetic resonance imagings/magnetic resonance cholangiopancreatographies (MRIs/MRCPs) with gadolinium, biannual blood donations for biobanking, and assessments for anxiety and depression. All MRIs were presented at a multidisciplinary board to determine whether further investigation was warranted.

RESULTS

Seventy-five individuals have been enrolled and 201 MRIs performed over a 2.6-year average length of follow-up. Abnormal pancreatic findings (predominantly small cysts) were detected in 58.7% of the participants. Among these, 6.7% underwent endoscopic ultrasound, with 1 case complicated by postprocedural pancreatitis. One surgical resection was performed on a 4.7-cm intraductal papillary mucinous neoplasm with a focus on low-grade pancreatic intraepithelial neoplasia. One incidental finding of fibrosing mediastinitis was detected. Anxiety and depression scores decreased over the course of this study from 21.4% to 5.4% and 10.7% to 3.6%, respectively.

DISCUSSION

This preliminary report supports the feasibility of performing MRI/magnetic resonance cholangiopancreatographies-based PC screening as part of a clinical trial in a community setting. A longer follow-up is needed to better assess safety and efficacy. To the best of our knowledge, this is the first report from a community-based PC screening effort ( clinicaltrials.gov ID: NCT03250078).

Peritoneal tuberculosis: A case report on a rare cause of tumor marker elevation

Peritoneal tuberculosis (TB) is a rare extrapulmonary manifestation of TB with non-specific clinical characteristics which can produce test results mimicking malignancy and granulomatous peritonitis. This case describes a Filipino 59-year-old, nulliparous woman who was admitted with abdominal pain, ascites, and an elevated CA-125 level. Radiographically, peritoneal nodules were visualized and initial suspicion was high for malignancy. Following a bilateral salpingo-oophorectomy and peritoneal biopsy, histology was negative for malignancy but revealed non-caseating granulomas. She was discharged then readmitted with progressive abdominal pain, and a repeat laparoscopic biopsy yielded specimens with growth of acid-fast bacilli (AFB). A delay in diagnosis and treatment of tuberculous peritonitis increases mortality rates, making early diagnosis with laparoscopic biopsy of paramount importance in prompt diagnosis and initiation of therapy. This patient was initiated on standard anti-TB therapy and experienced no complications.

The ACE Insertion Deletion polymorphism relates to dementia by metabolic phenotype, APOEepsilon4, and age of dementia onset

The renin-angiotensin system (RAS) may play a role in dementia pathogenesis because of its effects on vascular and metabolic homeostasis, amyloid metabolism, and learning and memory. The angiotensin-converting enzyme (ACE), a pivotal RAS protein, is encoded for by a gene containing a functional ID variant, which has been related to dementia risk. We examined the relationship between the ACE Insertion Deletion (ACE ID) variant and dementia with consideration for metabolic phenotypes, age and APOEepsilon4 using a population-based, cross-sectional sample of 891 Swedish women and men aged 70-92 years, of whom 61 people were demented. The odds of dementia was two-fold higher among those with ACE II genotype, and ranged from 2.18 to 4.35 among those with dementia onset <or=70 years, an APOEepsilon4 allele, systolic blood pressure <160 mmHg, body mass index <25 kg/m(2), and in women only, waist circumference <or=88 cm and hip circumference <101 cm. Variations among reports on the relationship between the ACE ID polymorphism and dementia may be due to lack of consideration for gene-gene and gene-phenotype associations.

Women living with drug abuse and HIV disease: drug abuse treatment access and secondary prevention issues

In collaboration with the National Institute on Drug Abuse, the Health Resources and Services Administration is conducting a multisite, longitudinal study on issues of service needs, service utilization, and access to care for drug abusers with HIV. This article discusses access to drug abuse treatment and HIV secondary prevention for 116 women interviewed during the study's first year in five U.S. cities. Using interview data from 115 service providers in those same cities, it also discusses drug abuse treatment availability and barriers to service expansion for drug users with HIV. Study findings indicate that there are highly significant gaps between the drug abuse treatment services these women feel they need and those they have been able to receive; these were particularly pronounced for drug detoxification and residential and outpatient drug-free treatment. Women who used crack cocaine or injection drugs had particularly high levels of need for residential and outpatient drug abuse treatment, while women who use crack were found to have significantly less experience with the drug abuse treatment system than IDUs. HIV secondary prevention was also found to be a critical need for these women, many of whom were engaging in behaviors that place them at risk for reinfection, infection with other diseases, and transmission to others. Providers indicated that lack of funding was the major barrier to expanding services for this population; other barriers, such as lack of ancillary services and transportation, were also noted. Two positive findings were that many drug abuse treatment agencies in these cities provide a wide range of ancillary services and that many different kinds of agencies offer drug abuse treatment services.

Women living with substance abuse and HIV disease: medical care access issues

This paper presents first-year findings from a multi-site, longitudinal study being coordinated by the Health Resources and Services Administration (HRSA) in collaboration with the National Institute on Drug Abuse (NIDA) on access to care for drug abusers with HIV. The sample of 116 women and 187 men in five sites (Denver, Detroit, New Haven, New Orleans, and St. Louis) were interviewed regarding HIV testing history, HIV disease course, and use of health and social services. For both men and women, there were significant gaps between the medical services they reported needing and those they received. Significantly more women needed and received mental health services. Cost and waiting times emerged as the most important barriers to care. The study also found that significantly fewer women than men subjects received pre- and post-test counseling and were advised to get medical services after their first positive HIV test. Overall, first-year study results suggest that multiple barriers in access to service exist for drug-using women, the largest group of women affected by HIV in the United States.

“Blended” anaesthesia in urological oncological surgery: Our experience

Some major urological surgery may cause post-operative pain, which is difficult to control, as well as systemic metabolic stress. “Blended” anaesthesia, which is an association of regional anaesthesia and a light general anaesthesia, minimizes the stress on the neuro-vegetative system and reduces drug administration. We treated 39 patients: our data suggest that “blended” anaesthesia is very good for the elderly as well as for younger patients, expecially in Hospitals without a post-operative Intensive Care Unit.

Is the postpartum period a time of crisis for some mothers?

This was a small descriptive study designed to discover the problems encountered by 3 primiparas and 3 multiparas during the 6 weeks following the birth of their babies. The size and type of sample allows no generalizations to larger groups. Since many problems surfaced for these few families, nurses should continue to explore this maturational period in the family's growth cycle to develop a greater understanding of their potential nursing intervention role.