Ciliated Foregut Cyst of the Pancreas

Cystic lesions of the pancreas are relatively uncommon. We describe the case of a young man with a complex cystic mass located within the head of the pancreas. The patient underwent exploration with resection of the mass. Pathology revealed a ciliated epithelial cyst, a rare cystic lesion of the pancreas

Analysis of Cases inWhich a Biopsy Specimen Is Positive and an Excised Lesion Is Negative for Nonmelanoma Skin Cancer

Nonmelanoma skin cancers (NMSCs), including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), are the most common types of cancer with the fastest-growing treatment costs in the United States.1 Standard treatment requires biopsy for histologic confirmation, followed by excision. Oftentimes, no residual carcinoma is detected, implying spontaneous clearance at rates reported to vary from 24% to 76%.2- 5 These types of lesions have been investigated by others2- 5 and are not fully understood. Our study aims to determine the lesion and patient characteristics that would most strongly predict a histologically negative result for an excised lesion after a biopsy specimen had positive margins

Ultrasonography-Guided Identification With Methylene Blue Tattooing of the Ilioinguinal Nerve for Neurectomy for Chronic Pain: A Case Series

Chronic ilioinguinal pain is a common but morbid complication of inguinal herniorrhaphy for 12% to 62% of patients.1 Although pharmacologic options exist (such as nerve blocks), long-term pain relief is inferior to surgical neurectomy.2,3 We present our experience in ilioinguinal neurectomy with preoperative ultrasonography-guided identification and perineural injection of methylene blue to tattoo the nerve

Comparison of Neurologic Trauma and Motorcycle Helmet Use in Drivers vs Passengers

This study compares postcrash prevalences of neurological and head and neck injuries in motorcycle drivers and passengers, stratified by helmet use

Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital

Objectives: To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing. Methods: The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team.Results: Since implementing the LES, total test volume has decreased by a mean of 11.18% per year compared with our pre-LES test volume. This change was not attributable to fluctuations in outpatient visits or inpatient days of care. Laboratory cost savings were estimated at $151,184 and$163,751 for 2012 and 2013, respectively. A significant portion of these cost savings was attributable to reductions in high-volume, large panel testing. No adverse effects on patient care were reported, and mean length of stay for patients remained unchanged. Conclusions: Electronic laboratory utilization systems can effectively reduce unnecessary laboratory testing without compromising patient care

Spontaneous Rupture of the Urinary Bladder in the Alcoholic Patient.

A case of a young man with an acute abdominal condition and hematuria is presented. BUN and SCr levels were markedly elevated. Retrograde cystography revealed intraperitoneal extravasation of contrast material. At exploration, a large intraperitoneal bladder perforation was noted and repaired in two layers. Recovery was uneventful. The presentation, diagnosis, and treatment of spontaneous rupture of the urinary bladder are discussed

Age at Diagnosis as a Relative Contraindication for Intervention in Facial Nonmelanoma Skin Cancer

Facial nonmelanoma skin cancers (fNMSCs), consisting of basal cell carcinoma and squamous cell carcinoma, are the most common cancers diagnosed worldwide and increase with age. Standard treatment for fNMSCs requires biopsy for pathological confirmation, followed by excision. Excision can lead to a pathological diagnosis of no residual carcinoma (NRC) due to no identifiable carcinoma within the excisional specimen. This situation can occur owing to wound healing in the specimen clearing the carcinoma or to the original biopsy shaving off the entire lesion. This study assesses the utility of excising fNMSCs according to age, with the hypothesis that the indolent nature of fNMSCs and the high NRC rate, coupled with increasing age-related all-cause mortality, should cause the surgeon to counsel patients differently. Such counseling may prevent surgery among elderly patients (>90 years) who may never see a benefit from fNMSC excision

Assessing the influence of fly ash and polypropylene fiber on fresh, mechanical and durability properties of concrete

This paper focuses on the investigation of fresh, mechanical, and durability properties of concrete with the influence of fly ash and polypropylene fiber. In this study, cement was partially replaced by 15 % and 30 % fly ash content in weight, whereas polypropylene fiber was incorporated in concrete mixes at 0.06 %, 0.12 %, and 0.18 % by volume. Twelve concrete mix proportions were developed, and slump, density, ball penetration, and compacting factor tests were conducted to examine the fresh concrete properties. Besides, mechanical characteristics, including the uniaxial compressive and splitting tensile strength of concrete, were evaluated at 7, 28, and 90 days. Further tests of concrete durability, including rapid chloride permeability test, sorptivity, and water penetration, were performed at 90 days. The results exhibited that the incorporation of fly ash developed fresh concrete properties, while polypropylene fiber decreased the fresh characteristics of concrete. Furthermore, the combination of fly ash and polypropylene fiber in concrete was substantially attained to improve the mechanical and durability characteristics compared to the control mix. Mix proportion of 15 % fly ash and 0.12 % polypropylene fiber exhibited a pronounced influence on compressive strength, chloride permeability, sorptivity, and water penetration compared to other concrete mixtures