Primary angiosarcoma of the breast in a postmenopausal patient

Primary angiosarcoma of the breast is a rare entity forming 0.04% of primary breast tumors. It is a highly aggressive tumor with a high propensity for locoregional and distant metastasis. Surgery in the form of mastectomy or wide excision remains the cornerstone of treatment. Radiotherapy and chemotherapy have been tried with varying results

Grain refinement of deoxidized copper

This study reports the current status of grain refinement of copper accompanied in particular by a critical appraisal of grain refinement of phosphorus-deoxidized, high residual P (DHP) copper microalloyed with 150 ppm Ag. Some deviations exist in terms of the growth restriction factor (Q) framework, on the basis of empirical evidence reported in the literature for grain size measurements of copper with individual additions of 0.05, 0.1, and 0.5 wt pct of Mo, In, Sn, Bi, Sb, Pb, and Se, cast under a protective atmosphere of pure Ar and water quenching. The columnar-to-equiaxed transition (CET) has been observed in copper, with an individual addition of 0.4B and with combined additions of 0.4Zr-0.04P and 0.4Zr-0.04P-0.015Ag and, in a previous study, with combined additions of 0.1Ag-0.069P (in wt pct). CETs in these B- and Zr-treated casts have been ascribed to changes in the morphology and chemistry of particles, concurrently in association with free solute type and availability. No further grain-refining action was observed due to microalloying additions of B, Mg, Ca, Zr, Ti, Mn, In, Fe, and Zn (~0.1 wt pct) with respect to DHP-Cu microalloyed with Ag, and therefore are no longer relevant for the casting conditions studied. The critical microalloying element for grain size control in deoxidized copper and in particular DHP-Cu is Ag

Evaluation of shearing time sufficient for effective liquid metal processing

Melt shearing has been suggested to be an efficient means of structure refinement through oxide dispersion and fragmentation. One of the process parameters that needs to be optimized is the shearing time. In this paper, the effect of shearing time on alumina powder refinement was studied in a model system with water as a working fluid. The established time was taken as a first approximation for experiments with the liquid metals processing by a high shear device based on a rotor–stator technology. The water model findings were confirmed experimentally on liquid aluminum alloys, and indicate that the optimal time of mixing is equal to 4 min in fully agitated conditions for the volume of 2.7 dm3.Allocation of the equipment in the BCAST, Brunel University London is highly appreciated. The first author is grateful for Ph.D. study funding from Institute of Materials and Manufacturing, Brunel University London. The authors would like to acknowledge Prof Z. Fan who initiated this research

Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development.

OBJECTIVE: Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. STUDY DESIGN: COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. SETTING: Stakeholders from the United Kingdom. SUBJECTS AND METHODS: Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. RESULTS: Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'. CONCLUSION: The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life

Splenic artery aneurysm rupture in pregnancy: a learning experience

Splenic artery aneurysm (SAA) is a rare clinical entity that carries a risk of rupture and life threatening hemorrhage. The objective of this clinical case report is to highlight this rare occurrence during pregnancy to avoid misdiagnosis. A 25 year old primigravida in her 3rd trimester of pregnancy was brought to trauma and emergency care with severe epigastric pain with rapid onset of unexplained shock. The shock was out of proportion to external or visible blood loss or any other injury. She was taken for emergency laparotomy. Intra-operatively, hemoperitoneum was encountered in peritoneal cavity due to ruptured splenic artery aneurysm. Massive transfusion protocol was activated and aneurysmectomy with splenectomy was performed. Post operatively, the patient was transferred to intensive care unit. Unfortunately, the patient succumbed due to complications of irreversible shock. Pregnant women with SAA can present with non-specific symptoms and hypovolemic shock. In such cases of hemorrhage, obstetricians should always keep in mind the other non-obstetric causes of intra-abdominal bleeding.

Pheochromocytoma of the urinary bladder: A rare cause of severe hypertension

Paraganglioma of the urinary bladder is a rare entity, and accounts for less than 0.5% of all bladder tumors. In the genitourinary tract, the urinary bladder is the most common site for paragangliomas. These tumors commonly present with hematuria and intermittent hyper-tension during micturition along with generalized symptoms due to raised catecholamines. Surgical removal is the treatment of choice, with most of the patients requiring at least a partial cystectomy. We herewith report a 38-year-old lady who presented with a two month history of pain abdomen, burning micturition, headache and uncontrolled hypertension. Detailed investi-gations revealed a pheochromocytoma of the urinary bladder, which was treated with partial cystectomy, following which her blood pressure stabilized

Primary angiosarcoma of the breast in a postmenopausal patient

Primary angiosarcoma of the breast is a rare entity forming 0.04% of primary breast tumors. It is a highly aggressive tumor with a high propensity for locoregional and distant metastasis. Surgery in the form of mastectomy or wide excision remains the cornerstone of treatment. Radiotherapy and chemotherapy have been tried with varying results