Isolated neurofibroma of the urinary bladder incidentally discovered during cystoscopy.

Isolated neurofibromas of the urinary bladder are rare benign tumors typically associated with neurofibromatosis type 1 (NF-1). Herein highlights a bladder neurofibroma incidentally discovered during cystoscopy following midurethral sling removal in a 61-year-old woman without NF-1 sequela. Despite malignancy concerns due to smoking history, histology confirmed a benign neurofibroma. These tumors differ from NF-1-associated neurofibromas in origin and presentation; they are rare, often asymptomatic, and likely stem from somatic mutations. Conservative management is preferred, with surgical intervention indicated only for obstructive masses.

Outcomes After Selective Fasciotomy for Revascularization of Nontraumatic Acute Lower Limb Ischemia.

Objectives: Limited data support the use of fasciotomies in acute limb ischemia (ALI) in patients with isolated arterial occlusion. This study describes an experience in which fasciotomies are not regularly performed post-revascularization. Methods: Using International Classification of Diseases, Ninth and Tenth Edition codes, patients presenting to the University of California Davis Medical Center between January 2003 and July 2018 with ALI, excluding those with traumatic injuries were identified. The primary outcome was major amputation, and the secondary outcome was foot drop. Additionally, the characteristics of those patients in each category of ischemic severity excluding those with grade 3 ischemia were summarized. Results: Of the 253 patients identified, revascularization was successful in 230 patients with 11 total fasciotomies performed. One hundred thirty-five patients were Rutherford Class 1/2A and 95 were 2B. In those with 1/2A ischemia, 134 (102 had >6 hours of symptoms) did not undergo fasciotomy with only one amputation occurring in this group. In those with 2B ischemia, 65 had >6 hours of symptoms; 58 did not undergo fasciotomy with 4 major amputations. In the 30 patients with ≤6 hours of ischemic symptoms, 27 did not undergo fasciotomy with 1 major amputation occurring in this group. There were no amputations in those patients who underwent fasciotomies. Additionally, there were 14 patients with a foot drop, of which 11 were in patients with 2B ischemia without fasciotomy. Conclusions: The data suggest that regardless of ischemic duration, 1/2A patients may not need fasciotomies, while those patients with 2B ischemia may benefit.

Correlation of Patient Activation Measure Level with Patient Characteristics and Type of Vascular Disease.

BACKGROUND: Patient activation or level of engagement in one's medical care is linked to hospital readmissions and worse outcomes in a number of diseases. Patients with higher levels of activation are typically guiding their care rather than acting as passive observers of care. This study aims to determine if either patient demographics or type of vascular disease can predict patient activation. METHODS: All patients presenting over a 4-month period to an outpatient vascular clinic were asked to complete the Patient Activation Measure (PAM) survey. In total, 257 completed surveys were collected. Survey responses were scored on a Likert scale with anchors. Responses are tallied with a score of 1-100 and converted to summary levels 1-4 in accordance with the previously validated scoring system. Level 1 patients are considered disengaged and overwhelmed. Patients in level 2 are becoming aware of their health care, but still struggle. Level 3 patients are taking action, while level 4 represents patients who are maintaining healthy behaviors and pushing further. Chi-squared test and multivariable regression were then performed to determine if patient characteristics or type of disease correlated with activation levels. RESULTS: In total, 257 patients completed the survey. The mean participant age was 67 years (±15). Sixteen percent of patients lived alone, 58% were married, and in 39% mean household income was <$50,000. Overall, 21 patients (8.2%) were classified as level 1, 65 (25%) level 2, 94 (37%) level 3, and 77 (30%) level 4. The group comprised 32% peripheral artery disease (PAD), 20% carotid, 18% aortic/aneurysm, 14% venous, and 16% were various other vascular diseases. Over each disease group there was a wide range of activation, but no significant difference between the type of vascular disease and activation level. Chronic limb-threatening ischemia (CLTI) patients comprised 35% (n = 29) of the PAD group, and 66% of these patients reported an activation level of 3 (n = 10) or 4 (n = 9). There was no difference in the levels of activation reported by the CLTI patients compared to the general PAD cohort (P = 0.99). Multivariable analysis demonstrated that age, level of education, household income, and type of vascular disease correlated with PAM score, but there was no correlation between length of symptoms, race, or gender. CONCLUSIONS: Patient activation is unpredictable using patient characteristics or type of vascular disease, and CLTI patients report high activation levels. Quality databases that collect only patient demographics may not fully capture patient predictors of poor outcomes. Use of the PAM survey should be further explored in vascular patients to correlate activation level with vascular-specific outcomes.