A Penetrating Neck Injury Resulting in the Complete Transection of the Ipsilateral Common Carotid Artery, Delayed Contralateral Pneumothorax, and Occult Esophageal Injury: A Case Report With a Multidisciplinary Approach to Management.

A 29-year-old male presented with a zone one penetrating neck injury resulting in complete transection of the left carotid sheath and its contents. The proximal common carotid artery and internal jugular vein injuries were successfully managed with vessel ligation without adverse neurological sequelae. The patient also developed a contralateral pneumothorax, which was due to an occult through-and-through esophageal injury at the junction of the cervical and thoracic esophagus. The esophageal injury was successfully managed with surgical repair and wide drainage of the neck and right chest.

Aberrant Diagnostic Imaging Resulting in Misdiagnosed Acute Perforated Appendicitis: A Case Report.

A 31-year-old male with a history of diverticulitis presented for acute abdominal pain and was found to have several small areas of free air on computed tomography (CT) of the abdomen/pelvis. Due to inflammatory changes seen around the sigmoid colon and small bowel, he was diagnosed with perforated diverticulitis. The patient complained of significant right-sided abdominal pain with significant tenderness on abdominal examination. The patient was initially treated with diagnostic laparoscopy and was actually found to have acute perforated appendicitis with mild appendiceal adherence to the sigmoid colon. This case highlights the importance of careful history and physical examination in an era where imaging often precedes the surgeon's evaluation. The case also provides support for laparoscopy in select cases of pneumoperitoneum, sparing patients the morbidity of undergoing an open laparotomy.

Campylobacter rectus, an Uncommon Isolate of Multiple Splenic Abscesses, in a 79-Year-Old Chinese Woman With an Attempt at Conservative Management Followed by Operative Intervention: A Case Report.

Splenic abscesses are rare pathologic conditions in which Actinomyces and Campylobacter species are rarely isolated. We present a 79-year-old female with multiple splenic abscesses from unknown sources with both Actinomyces species and Campylobacter rectus being isolated. She was initially treated conservatively with percutaneous drainage but eventually needed splenectomy. To our knowledge, this is the first documented case of Campylobacter rectus isolated from a splenic abscess.

What Risk Factors Are Associated With Poorer Quality of Life in Patients With Head and Neck Cancer?

PURPOSE: Head and neck cancer (HNCA), as well as the sequelae of its treatment, has a significant negative impact on the quality of life (QOL) for patients. We aim to identify patient and surgical factors negatively influencing QOL of patients with HNCA. MATERIALS AND METHODS: A cross-sectional study was used to identify specific risk factors associated with a poorer QOL. The University of Michigan Head and Neck Quality of Life (HNQOL) instrument was used to assess QOL. Predictor variables included risk factors (smoking, alcohol, past medical history), demographic (sex, age, marital status), anatomical features (tumor location, tumor stage), perioperative adjuncts (utilization of a feeding tube, tracheostomy, neck dissection), and postoperative adjuncts (chemotherapy or radiation therapy utilization). The primary outcome variable was the HNQOL score. Descriptive statistics were completed for all the variables. Association between the predictor variables and HNQOL scores were examined using bivariate statistics, and statistical significance was set at P < .05. RESULTS: The study sample composed of 78 patients with HNCA who underwent surgery at Head and Neck Maxillofacial and Reconstructive Surgery Clinic at Ascension Macomb-Oakland from January 2017 to August 2018. Of the 78 patients meeting inclusion, 31 patients completed the HNQOL survey. The median HNCA QOL score was 18 with a maximum score of 80, representing a worse QOL. Radiation therapy (21 vs 5.5, P = .033), and perioperative feeding tube (31 vs 9, P = .012) had statistically significant negative impacts on QOL scores. Variables associated with poorer QOL scores in descending order: radiation therapy perioperative feeding tube utilization of chemotherapy (12.5 vs 9.0, P = .60), male gender (17 vs 9.5, P = .39), perioperative tracheostomy (26 vs 14.5 P = .26), tobacco use (19.5 vs 11.5, P = .81), single marital status (27 vs 16, P = .48), neck dissection (17.5 vs 15.5, P = .91), and alcohol use (18.5 vs 16.0, P = .65). CONCLUSIONS: Feeding tube and radiotherapy utilization had a statistically significant decrease of QOL scores among patients with HNCA. Additional risk factors associated with poorer QOL include chemotherapy, male sex, tracheostomy utilization, tobacco use, single or divorced marital status, neck dissection, and alcohol abuse.