Progressive macular thickening under the array was common and corresponded to decreased electrode-retina gap over time. By month 12, the array was completely apposed to the macula in approximately half of the eyes.
Management of a ruptured hepatocellular adenoma during pregnancy is a rare and potentially life-threatening entity. Few case reports have described management of the pregnant patient who presents in haemorrhagic shock secondary to a ruptured liver adenoma. A 30-year-old primigravid woman at 31 weeks pregnant presented with abdominal pain and fetal bradycardia. After stat caesarean delivery of the infant, she had continued hemoperitoneum and was in shock secondary to an undiagnosed ruptured liver mass. General surgery was consulted intraoperatively and performed an exploratory laparotomy, packing and temporary closure. She was subsequently taken to interventional radiology (IR) for angioembolisation of the left hepatic artery. After stabilisation, she underwent formal abdominal closure. Management of a ruptured hepatocellular adenoma in pregnancy requires urgent multidisciplinary care including obstetrics gynaecology, general surgery and IR.
INTRODUCTION:One in five to seven birthing people are affected by perinatal mood disorders. While screening for gestational diabetes is well defined, the efficacy of standardized assessment of mood disorders is less understood. Between 2018 and 2020, screening at an academic center was highly variable, demonstrating need for improvement. Remote surveillance using novel integrated technology was used to improve patient participation in routine antenatal screening.METHODS:A prospective observational cohort of 81 patients from two clinical sites in the Babyscripts (BRx) Maternal Mental Health Module received digital Edinburgh Postnatal Depression Scale (EPDS) screening at 12 and 28 weeks of gestation. The control group consisted of 81 randomly selected patients who received in-person standardized screening from 2018 to 2020. In a midpoint analysis, EPDS completion was assessed at weeks 12 and 28 in the intervention group and compared to the control group using χ2 analysis. The study was reviewed and exempted by the George Washington University IRB.RESULTS:The BRx treatment group totaled 45 patients enrolled prior to week 14 and 74 patients enrolled prior to week 30. At week 14, 38% of BRx patients (17/45) had completed an EPDS survey, compared with 10% of patients in the control group (8/81). At week 30, 36% of BRx patients (27/74) had completed an EPDS survey, compared with 21% of control (17/81). Improved EPDS response rates of the BRx cohort were statistically significant at both assessments (P<.01 and P=.03).CONCLUSION:Remote mood screening resulted in significantly higher rates of adherence in the first and second trimesters as compared to standard methods. In the next phase of analysis, we plan to assess adherence of screening through 12 months postpartum. Future analysis is planned to determine noninferiority as compared to in-office methods among a larger cohort. We hypothesize that novel telehealth mood screenings will help to sustain engagement with providers and reduce time to intervention.
ObjectiveEndocervical curettage (ECC) during colposcopy is recommended in certain circumstances; however, diagnostic use remains unclear. We evaluate the utility of ECC among patients with non-fully visualized squamocolumnar junction (SCJ) and certain patient socioeconomic factors.MethodsRetrospective chart analysis was completed for patients aged older than 21 years who underwent a colposcopy at 2 study sites between 2012 and 2021. Demographics and histopathologic results were analyzed.ResultsA total of 1,516 colposcopies were reviewed; 73.8% (n = 1,119) had an ECC with colposcopy. Of those, 92.1% (n = 1,031) had benign ECC whereas 13.9% (n = 156) had a positive ECC at time of colposcopy. Most patients with benign ECC had benign/low-grade squamous intraepithelial lesion pathology on colposcopy biopsy (82.3%; n = 914; p < .001), and most patients with high-grade squamous intraepithelial lesion (HSIL) on ECC had HSIL on colposcopy biopsy (63.4%; n = 52; p < .001) However, when looking at patients with high-grade pathology on colposcopy biopsy, it was seen that most had benign or low-grade squamous intraepithelial lesion on ECC (79.5%; n = 205; p < .001). Most patients with adequately visualized SCJ on colposcopy were noted to have HSIL on biopsy and negative ECC (73%; n = 81; p < .001). This result was similar in patients with non-fully visualized SCJ, although not statistically significant. When stratified by socioeconomic status, most patients with high-grade lesions had a benign ECC.ConclusionsEndocervical curettage has been described to increase the identification of high-grade lesions at time of colposcopy. This descriptive study shows that many high-grade lesions at time of excisional procedure had a benign ECC on colposcopy, with no demonstrated clear additional utility in high-risk groups.
The postpartum period presents an opportunity to engage patients in discussions on alcohol use and associated risks for the mother and infant. This study examined the prevalence of postpartum alcohol use, screening, and counseling.
Introduction: Metastatic lesions to the ovary, also known as Krukenberg tumors, account for approximately 5-30% of ovarian neoplasms. The location of primary sites and survivability widely varies. Patients with a pancreatic primary site have lower survival rates compared to other primary sites such as colon and breast. Despite this dismal outcome, there is a paucity of data examining the pancreas as the primary site and it is associated clinical, radiologic, and pathologic features. Case Report: Four women who presented with severe abdominal pain were found to have pancreatic cancer that metastasized to the ovary. Only one woman did not have metastasis to the ovary at time of presentation. Three of the four had bilateral ovarian involvement. One woman's mass was deemed unresectable while the other three women had cytoreductive surgery including bilateral salpingooophorectomy. Imaging, pathology, and tumor markers were trended over time. Discussion: Characteristics which may support a pancreatic origin of Krukenberg tumors include bilateral, large, multiloculated cystic ovarian masses, surface ovarian involvement, and specific immunohistochemical staining patterns. Comprehensive clinical, radiologic, and pathologic evaluation is essential as identification of pancreatic Krukenberg tumors has a significant impact on patient treatment and prognosis.
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