Non-operative management strategy for blunt pulmonary artery pseudoaneurysm: A case report.

Traumatic pulmonary artery pseudoaneurysms (PAP) are rare findings and are often associated with penetrating trauma to the chest. We present a case of a pulmonary artery pseudoaneurysm following blunt trauma. A 49-year-old man presented after a motor vehicle collision. Contrast enhanced computed tomography scans of the neck, chest, abdomen, and pelvis were obtained demonstrating a proximal right pulmonary artery pseudoaneurysm, small volume hemopericardium, left first rib fracture, and focal non-flow limiting dissection of left subclavian artery. For the management of right PAP, we adopted a non-operative management strategy with an esmolol infusion for strict heart rate and blood pressure control. An echocardiogram was obtained the next day revealing no cardiac tamponade. Angiography of the chest was done after 24 h which showed stable appearance of the right PAP and hemopericardium. Patient was discharged home on hospital day 11.

A comparison of the quality of life of ulcerative colitis patients after IPAA vs ileostomy.

BACKGROUND: Total proctocolectomy with IPAA is frequently considered the procedure of choice for surgical patients with ulcerative colitis, presumably owing to an expectation of improved quality of life in comparison with an ileostomy. OBJECTIVE: The goal of our study was to determine whether long-term quality of life among patients with a pelvic pouch is better than those who chose a permanent stoma. DESIGN: This investigation is a cross-sectional observational study using a prospective database. SETTING: This study was conducted at an academic medical center. PATIENTS: Consecutive patients who had undergone IPAA or a permanent ileostomy for ulcerative colitis by a single surgeon, presenting for their annual follow-up visit from July through September 2011, were offered participation in the study. A randomly chosen group of subjects who did not have scheduled appointments during the study period were sent a letter inviting them to participate in the study. MAIN OUTCOME MEASURES: The primary outcome measures used were EQ-5D-3L, the Short Quality of Life in Inflammatory Bowel Disease questionnaire, the Cleveland Global Quality of Life instrument, the Fecal Incontinence Quality of Life scale, and the Stoma Quality of Life scale. RESULTS: Thirty-five patients with a pelvic pouch and 24 ostomates were accrued and comprehensively studied. Global quality-of-life scores were virtually identical for the 2 groups. Patients with a pelvic pouch had better subscores in current quality of health and energy level, Fazio score, sexuality/body image, and work/social function. LIMITATIONS: This study was limited by its small sample size, and some of our patients were enrolled through mailed surveys and, hence, nonresponse bias may be present. The follow-up time since surgery was longer in the pelvic pouch group than in the ileostomy group. CONCLUSION: Informed patients with ulcerative colitis choosing an ileostomy have a health-related global quality of life very similar to patients with a pelvic pouch. Better outcomes in patients with an ileal pouch were most evident in the areas of sexuality/body image and work/social function.

Isolated skeletal malformations in a child with a small mosaic ring microduplication of 18 p11.21q11.2: genotype-phenotype correlations.

We describe a developmentally normal Amish child who has a karyotype with 47 chromosomes, including a supernumerary ring-shaped chromosome 18 in each metaphase studied. The only phenotypic findings in the patient were hemivertebrae and rib anomalies. Further analysis of interphase cells revealed an additional, less frequent mosaic, apparently normal cell population. Genes in the triplicated region that possibly are contributing to her skeletal phenotype include GATA6, MC2R, MC5R, RBBP8, ESCO1, and ROCK1, among others. By studying such patients with abnormal genetic dosage, genotype-phenotype correlations can be used to refine gene function.