Review article: Late post-hysterectomy ectopic pregnancy

Ectopic pregnancy after hysterectomy is a rare but potentially life-threatening condition requiring prompt diagnosis to prevent the increased mortality associated with rupture. Twenty-seven cases of late post-hysterectomy ectopic pregnancy reported in the English literature since 1918 were reviewed and analysed for presenting symptoms, missed diagnosis rate at initial presentation, location of ectopic and rupture rate at diagnosis. The presenting symptoms were found to be non-specific. The diagnosis in this population is twice more likely to be missed than in women with intact uteri. The rupture rate is 63%, compared with 37% in women with intact uteri. The majority of late post-hysterectomy ectopic pregnancies (62%) were located in the fallopian tubes. Because of the potential risk of mortality, emergency physicians should always consider the possibility of ectopic pregnancy in childbearing women whose surgical history includes hysterectomy without oophorectomy. Evaluation of abdominal pain in this population should include a pregnancy test to ensure prompt diagnosis when the possibility of pregnancy exists clinically

Incidental diagnosis of sternoclavicular septic arthritis with Moraxella nonliquefaciens

An 83-year old man presented acutely to the emergency department with generalized weakness and subjective fevers. A month earlier he had undergone resection of a large intramuscular sarcoma from his thigh. The cancer staging work-up was still underway and a decision about adjuvant therapy was still pending. Although initial laboratory assessment showed leukocytosis, this normalized soon after admission without the use of antimicrobials. No fevers were documented. During the admission an 18F-FDG PET/CT was performed in continuation of his sarcoma staging workup. This revealed unexpected abnormal radiotracer uptake in the left sternoclavicular joint with fluid collections extending into the sternocleidomastoid muscle and the mediastinum. Imaging findings were consistent with septic arthritis and abscess formation, despite lack of fever or localizing symptoms. Ultrasound-guided aspiration revealed purulent fluid that grew Moraxella nonliquefaciens. Given the unusual presentation, ongoing clinical uncertainty about the true cause of the septic joint, and concern for an occult sarcoma metastasis, surgical debridement and resection of the joint was carried out. Pathology and microbiology evaluation confirmed septic arthritis with osteomyelitis and abscess extension into the mediastinum. No tumor cells were identified. Postoperative course was complicated by hematoma, but otherwise the patient responded well to antimicrobial therapy. Keywords: Moraxella nonliquefaciens, Incidental, Sternoclavicular septic arthritis, F-18 FDG, PET/C

Barriers to mammography screening: How to overcome them

Background: Screening mammography is an established intervention that leads to early breast cancer detection and reduced mortality. The Lebanese Ministry of Health has initiated yearly awareness campaigns and provided free mammography in multiple centers around the country. Methods: The study took place in two major areas of Lebanon - Beirut and South Lebanon. This cross-sectional survey aimed to assess knowledge about breast cancer screening and screening behaviors in the Lebanese population. The primary outcome of the study was to assess the reasons that prevented women from performing screening mammography based on our categories of questions: lack of knowledge about breast cancer, lack of access to screening facilities, failure of primary care physician to encourage screening behavior, and other reasons. Results: The major barriers to seek screening that had statistically significant P-values, in order of prevalence, included: lack of knowledge about breast cancer, followed by social reasons and lack of access. Conclusion: Given the prevalence of breast cancer in our population, it is important to understand the pitfalls that we experience in promoting awareness. Our study is the first study to reach out to the community to assess perceived barriers against screening and provide solutions for such barriers.SCOPUS: ar.jinfo:eu-repo/semantics/publishe