Diaphragmatic Adjacencies: Pulmonary Embolism Presenting as Abdominal Pain

Pulmonary embolism is a common yet potentially life-threatening diagnosis that should not be missed in the Emergency Department. Common presenting symptoms include dyspnea, pleuritic chest pain, cough, hemoptysis, syncope or pre-syncope. Less often, however, presenting symptoms can include abdominal pain. A clinician should recognize that pain adjacent to the diaphragm (including the lower chest and upper abdomen), can be secondary to underlying pathology either above or below the diaphragm. Here we describe an unusual case of pleuritic, post-prandial, right upper quadrant abdominal pain that was a result of pulmonary embolism

Spontaneous Iliac Arteriovenous Fistula, High-Output Heart Failure, and Cardiac Arrest

High-output heart failure is a potentially life-threatening condition that can lead to cardiac arrest. The most common causes of this condition are obesity, liver disease, arteriovenous shunts, lung disease, and myeloproliferative disorders, however the exact prevalence remains uncertain [1]. Here we describe an unusual case of cardiac arrest as a consequence of high-output heart failure, secondary to rupture of an iliac artery aneurysm into the common iliac vein, with arteriovenous (AV) fistula formation

Is there a role for homeopathy in breast cancer surgery? A first randomized clinical trial on treatment with Arnica montana to reduce post-operative seroma and bleeding in patients undergoing total mastectomy

Aim: This study aimed to evaluate the benefits of Arnica montana on post-operative blood loss and seroma production in women undergoing unilateral total mastectomy by administering Arnica Montana 1000 Korsakovian dilution (1000 K). Materials and Methods: From 2012 to 2014, 53 women were randomly assigned to A. montana or placebo and were followed up for 5 days. The main end point was the reduction in blood and serum volumes collected in drainages. Secondary end points were duration of drainage, a self-evaluation of pain, and the presence of bruising or hematomas. Results: The per-protocol analysis revealed a lower mean volume of blood and serum collected in drainages with A. montana ( 1294.40 ml; 95% confidence interval [CI]: 22.48-211.28; P = 0.11). A regression model including treatment, volume collected in the drainage on the day of surgery, and patient weight showed a statistically significant difference in favor of A. montana ( 12106.28 ml; 95% CI: 9.45-203.11; P = 0.03). Volumes collected on the day of surgery and the following days were significantly lower with A. montana at days 2 (P = 0.033) and 3 (P = 0.0223). Secondary end points have not revealed significant differences. Conclusions: A. montana 1000 K could reduce post-operative blood and seroma collection in women undergoing unilateral total mastectomy. Larger studies are needed with different dilutions of A. montana to further validate these data

Acaricide resistance of the two-spotted spider mite (Tetranychus urticae) in Pacific Northwest hops

The two-spotted spider mite (Tetranychus urticae) is one of the greatest economic plantfeeding pests of agriculture in the world, attacking food crops, trees, and ornamentals, resulting in serious economic injury and occasionally plant death. In the Pacific Northwest, T. urticae is a common and severe pest in hops (Humulus lupulus), a perennial plant grown for its economically important strobile (or cone) that is used as a flavoring and stability agent in beer. Hops are a valuable commodity in Washington, Oregon, and Idaho, the most important hop growing regions in the U.S., accounting for nearly all of U.S. hop production. Severe infestations of T. urticae, however, can cause defoliation and dry, brittle cones, thereby reducing quantity of hop cones, as well as quantity and quality of alpha and beta acid constituents. Production of high quality hop plants and cones requires a rigorous integrated pest management program for T. urticae, and current control relies almost exclusively on the application of acaricidal pesticides. Unfortunately, T. urticae has a well-documented history of rapidly developing tolerance and/or resistance to most of the acaricides registered for their control. A greater understanding of the v mechanisms involved in developing resistant populations is expected to improve mite management strategies in hops. My current study investigated the response of T. urticae to acaricide exposure in three distinct experiments. First, I determined baseline toxicity of a naïve T. urticae laboratory population to the acaricides, abamectin, bifenazate, and bifenthrin. Second, I established mite colonies resistant to acaricides through artificial selection. Third, I tested field populations for their susceptibility to the three candidate acaricides. Baseline lethal concentrations (LC50) values were identified after direct exposure using a Potter spray tower. In the second test, I determined that T. urticae are capable of developing increased tolerance to abamectin, bifenazate, and bifenthrin. Following ten acaricide applications, the LC50 of the abamectin-resistant strain increased 26-fold, the bifenazate-resistant strain increased 14-fold, and the bifenthrin-resistant strain increased 5-fold. In a comprehensive survey of field populations I detected a wide range of responses to the acaricides. During the 2012 and 2013 hop seasons, T. urticae response to abamectin was calculated at 1.29-107-fold, while bifenazate was calculated at 2.29-96.3-fold greater than the naïve laboratory population