Epilepsy affects the quality of life of patients in the Hispanic community physically, socially, and psychologically 1,2 and is associated with the outcome of the disease and their prognosis. The recurrence risk after a first seizure of untreated patients is 40% within 2 years. 3 Hispanic communities with low income may lack knowledge about seizures and have false perceptions about epilepsy. 4 Hispanic populations with less than a high school education may be likely to believe that epilepsy is contagious or is a sin, perceiving that an exorcism would be a good remedy for epilepsy. 2 These perceptions can lead to poor self-efficacy of patients with epilepsy, a perceived stigma because of their condition, and negative outcomes in their health care.Hispanic patients with epilepsy are at risk for undertreatment of depressive comorbidity. 5 Moreover, in patients living in medically underserved populations that have a history of stroke, glioblastoma multiforme, traumatic brain injury, or Alzheimer disease, the risk of lateonset unprovoked seizures is high 6 and the lack of neurological education could limit opportunities for early diagnosis of a seizure. Hispanic communities may benefit from epilepsy education: 53% agreed their family was likely to hide evidence of a family member with epilepsy, and 68% agreed that the family member with this disease required total supervision. 7 Stigma and lack of education about epilepsy limit the diagnosis and treatment of epilepsy in Hispanic communities.Therefore, to understand the current association between epilepsy and cultural barriers to treatment and diagnosis in Hispanic communities, it is important to address issues, such as (1) characteristics of the commu-
While metastatic disease to the breast has been documented from many primary neoplasms with incidence ranging from 0.2% to approximately 2.7% among reported clinical cases, breast cancer metastases resulting from a primary lung neoplasm is significantly less commonly reported in the literature. Routes of metastatic spread of lung neoplasms include both hematologic and lymphatic routes. We present a case of biopsy proven lymphangitic spread of primary lung neoplasm to the ipsilateral breast and axillary nodes mimicking inflammatory breast cancer. It remains crucial to differentiate between extramammary diseases with metastatic deposits in the breast from a primary breast neoplasm as treatment remains very different between these entities. As in this case, the pathologic, histologic, and immunohistochemistry analyses are critical in determining the origin of the malignant cells and formulating a treatment plan.
Objective: Occult pneumothoraces (OPTXs) are defined by air within the pleural space that is not visible on conventional chest radiographs (CXR). The aim of this study was to understand how frequently the Extended Focused Assessment with Sonography for Trauma (eFAST) examination identifies occult PTX in a pediatric blunt trauma population as compared with a criterion standard of chest computed tomography (CCT).Methods: This study is a secondary analysis of blunt trauma patients younger than 18 years who underwent CCT at Los Angeles County +USC Medical Center Emergency Department from October 2015 to April 2017. The eFASTexamination was performed and documented by an emergency medicine resident with attending oversight or by an emergency medicine attending for each trauma. The eFAST results were reviewed for patients diagnosed with small or trace pneumothoraces identified on CCT.Results: Of 168 pediatric trauma patients undergoing CCT, 16 had OPTXs not seen on CXR and 4 patients had a small/trace PTX without a corresponding CXR performed. None were identified on eFAST.Conclusions: Although the sample size in this data set was small, our eFASTexaminations identified none of 16 proven and 4 presumed OPTXs. The standard eFAST examination performed poorly in the detection of OPTXs in this single-center study of pediatric blunt trauma victims.
Primary hyperparathyroidism is most commonly caused by adenoma formation in one of the 4 parathyroid glands. The presence of ectopic parathyroid tissue is relatively common and can lead to difficulties in identification and treatment if affected by adenoma. This report describes the case of a 45-year-old female who presented 10 years status post thyroidectomy with symptomatic hyperparathyroidism and found to have ectopic parathyroid adenoma in the anterior mediastinum. Parathyroid scintigraphy with 99m-Technetium sestamibi and computed tomography were used for localization of the adenoma to a 1.9-centimeter para-aortic nodule. Computed tomography-guided transsternal cryoablation was subsequently performed for treatment, with intraoperative evaluation of serum parathyroid and calcium levels for confirmation. This case highlights that a sharp increase in parathyroid hormone immediately after cryoablation is not necessary for successful confirmation of the procedure. It additionally contributes to the growing literature on computed tomography-guided cryoablation as a legitimate alternative to surgery for treatment of ectopic parathyroid adenoma.
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