Left gastric artery aneurysm rupture: a rare cause of retroperitoneal bleeding: a case report.

INTRODUCTION: Visceral artery aneurysms are very rare. Patients usually present as emergency secondary to the sudden rupture of the aneurysm or as an incidental finding on ultrasound, MRI or abdominal computed tomography. Among these, splenic artery aneurysms are the most common ones accounting for 60% of all splanchnic aneurysms and gastric and gastroepiploic aneurysms account for only about 4%. CASE PRESENTATION: We present a 61-year-old Caucasian male previously fit and well, presenting with sudden onset epigastric pain due to retroperitoneal haemorrhage secondary to ruptured left gastric artery aneurysm. Apart from a tender epigastrium, there were no other obvious signs elicited on abdominal examination. He had persistent tachycardia and haemoglobin drop from 10 g/dl to 6.7 g/dl. He underwent a contrast computed tomography which identified the ruptured left gastric artery. The aneurysm was controlled successfully with coil embolisation of the left gastric artery. At three-month follow-up, there was no evidence of the aneurysm. CONCLUSION: Clinical presentations that do not correlate with examination finding should prompt immediate extensive investigation. The aid of contrast computed tomography and minimally invasive radiological interventional is the key to a fruitful outcome for this very rare entity.

Working Conditions and Workplace Barriers to Vocal Health in Primary School Teachers.

OBJECTIVES: The purpose of this study was to identify the working conditions and workplace barriers to vocal health in primary school teachers. The relationship between working conditions and voice is analyzed. STUDY DESIGN: This is a survey study in 42 randomized schools from a restricted geographical area. METHODS: An 85-item questionnaire was administered to 550 primary school teachers in 42 schools in Dublin. It was designed to obtain information on demographics, vocal use patterns, vocal health, work organization, working conditions, and teacher's perceptions of the conditions in teaching that might cause a voice problem. The relationship between voice and overstretched work demands, and voice and class size, was examined. A chi-squared test was run to test the null hypothesis that the variables overstretched work demands and voice and class size and voice are independent. Subjects were given the opportunity to give their opinion on their working conditions and on the availability of advice and support within the workplace. A final question sought their opinion on what should be included in a voice care program. RESULTS: A 55% response rate was obtained (n = 304). It was found with 96.52% confidence that the variables overstretched work demands and voice are related. Likewise, it was found that the variables class size and voice are related with 99.97% confidence. CONCLUSIONS: There are workplace barriers to vocal health. The working conditions of primary school teachers need to be fully adapted to promote vocal health. Changes by education and health policy makers are needed to achieve this goal. There is a need for future research which focuses on the working conditions of teachers.