Bryn Mawr Hospital,Main Line Health

Excision followed by radiofrequency ablation (eRFA) is an intraoperative method that utilizes intracavitary hyperthermia to create an additional tumor-free zone around the lumpectomy cavity in patients with breast cancer, similar to partial breast irradiation. We hypothesized that intraoperative eRFA extends the “final” tumor-free margin, decreases local recurrence, and maintains cosmesis without the need for radiation (XRT). Patients with unifocal ER+PR+HER2− or DCIS tumors less than or equal to 3 cm with clinically negative nodes were included. After standard lumpectomy, the RFA probe was deployed 1 cm circumferentially into the walls of the lumpectomy cavity. RFA was performed at 100°C for 15 min, followed by validated intraoperative Doppler sonography. Pain and cosmesis were assessed with the Radiation Therapy Oncology Group (RTOG) scales. A total of 242 subjects were accrued to the study, with a median follow-up of 44 months (range 12–96 months); 60

Background:Tetralogy of Fallot (TOF) is a congenital heart anomaly usually corrected surgically in childhood. Reports of adults with unrepaired TOF indicate that they are at high risk of endocardial infections and sequelae such as distant abscesses. Case Presentation:A 63-year-old man born and raised in Vietnam presented with unrepaired TOF and 5 days of dizziness, dysarthria, and left-sided weakness. Magnetic resonance imaging (MRI) of the brain demonstrated a 2.9-cm rim-enhancing pontine lesion with associated edema and a punctate acute infarct in the right cerebellum. Echocardiogram of the heart revealed right-to-left shunting, while chest computerized tomography (CT) showed a left apical cavitary mass. Initial studies were negative for bacteremia and endocarditis. Due to clinical suspicion and a positive QuantiFERON Gold tuberculosis (TB) test, antituberculous therapy was initiated. Biopsy of the central nervous system (CNS) lesion was deferred due to risk, and therapy was continued with antituberculous agents and steroids. The patient improved with a final diagnosis of tuberculous brainstem abscess. Conclusion:This case highlights early recognition and awareness of potential complications associated with untreated TOF as well as suspicion for TB in the proper clinical setting. Complex cases involving rare diagnoses should be approached systematically, evaluating possible diagnoses in order of urgency and basing invasive procedures on patient risk-benefit.

Background:Localized amyloidosis of the breast is a rare diagnosis that is most often found incidentally during screening breast examinations or on imaging. This diagnosis can be associated with systemic amyloidosis or malignancy, making further investigation a necessity. Rarely, localized amyloidosis of the breast has been associated with lymphoplasmacytic lymphoma. Case Report:A female in her early 70s presented with a mass noted on breast examination. After biopsy, she was diagnosed with localized amyloidosis of the breast. After bone marrow biopsy, the patient was diagnosed with lymphoplasmacytic lymphoma. No evidence of systemic amyloidosis was found. Because the patient is asymptomatic, she is not undergoing treatment, but she is monitored clinically every 6 months. Conclusion:Breast amyloidosis is a rare diagnosis that should be considered when patients present with a breast mass. This case emphasizes the importance of a full diagnostic workup when breast amyloidosis is diagnosed to rule out systemic amyloidosis or an associated malignancy.

Surgery results in external scars and internal scars (subcutaneous fibrous banding). Although external scarring is well understood, internal fibrous banding is less studied, despite its impact on comfort, mobility, and recovery in surgical patients. Alastin ReFORM & RePAIR COMPLEX with TriHex Technology (R&R) is a peptide-based formula that remodels the extracellular matrix (ECM). It has been tested in multiple clinical trials, showing it stimulates autophagy and macrophage repolarization. The aim was to outline the mechanistic and clinical evidence related to both internal and external scarring. They conducted a secondary analysis of 3 split-body clinical trials, with proposed mechanistic explanations extrapolated. Endpoints assessed included patient-reported outcome measures, blinded investigator ratings, ultrasound, histology, and photographic scar evaluations. Cellular secretome, interleukin-6 (IL-6) modulation, and autophagic clearance of lipid droplets and ECM remodeling provide a mechanistic explanation for the observed effects. In body contouring procedures, R&R significantly accelerated the resolution fibrous banding compared with comparators in split-body studies. Ultrasound confirmation and histology showed reconstituted ECM on the R&R-treated side. External scar assessment revealed improved subjective scar quality over time. These outcomes are mechanistically linked to the autophagic clearance of lipid droplets, ECM remodeling, and macrophage polarization, which are influenced by IL-6 and modulate the transition from inflammation to regeneration. R&R influences the spectrum of surgical scarring, affecting both internal and external scars. The scar spectrum broadens traditional views of postoperative healing, emphasizing internal fibrous banding as a measurable outcome and positioning a topical formulation as a credible additional tool in perisurgical care. Level of Evidence: 2 (Therapeutic).

INTRODUCTION:Patient and visitor violence and aggression against emergency department clinicians is a complex phenomenon requiring a multifaceted approach and recognition that interventions require time to integrate into practice. The purpose of this study was to determine the efficacy of a multimodal intervention on frequency of workplace violence incidents and clinicians' perceptions of safety in one emergency department. METHODS:A quasi-experimental, longitudinal design was used to answer study questions. Environmental changes, an algorithmic response guideline that included a rapid de-escalation program, and improvements in the formal incident reporting system were implemented. Participants completed an online, anonymous survey that included demographic information, the Personal Workplace Safety Instrument for Emergency Nurses, and a violence and aggression frequency checklist prior to and for three quarters following implementation. RESULTS:Surveys were sent to all 140 emergency department clinicians. Response rate was highest at baseline but decreased over time. There was no significant difference in number of incidents experienced by clinicians during the study. Perceptions of safety decreased from baseline during the course of the study, but there was a significant increase in the number of formal incident reports submitted. DISCUSSION:Despite significant efforts, it was difficult to decrease violent and aggressive acts committed by patients and visitors and to improve emergency department clinicians' perceptions of safety in the emergency department. Timing and severity of violent and aggressive acts may have influenced results. More work needs to be done using different research, implementation, and evaluation methods to determine best practices for preventing WPV in the emergency department.