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Emergency intubation of obese trauma patients can be safely and successfully performed in a high volume Level I trauma center. Obesity is not a predictor of postintubation airway complications or mortality. Larger studies are needed to validate these finding in the morbidly obese patients.

Purpose:The purpose of this study was to describe the breast ultrasonography (US) features and to investigate whether performing a core biopsy is warranted in young women having palpable solid breast masses.Methods:A total of 76 solid palpable masses in 68 consecutive women (≤25 years old) underwent tissue diagnosis by percutaneous core biopsy. Two radiologists, who were blinded to the clinical history and histopathology, independently evaluated the US features according to Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The frequency of benign and malignant descriptor terms that were used to characterize the lesions were compared to the final pathology.Results:All 76 palpable solid masses yielded benign pathology. On the US, the shape of the mass was described by radiologists 1 and 2 as oval or round (63.2% and 71.1%), margin as circumscribed (68.4% and 77.6%) and orientation as parallel (85.5% and 90.8%); the frequency of using all three benign descriptors was 61.8% and 68.5%, respectively. Suspicious descriptors were used less frequently by radiologists 1 and 2 including irregular shape (9.2% and 13.1%), non-circumscribed margin (31.6% and 22.4%) and non-parallel orientation (14.5% and 9.2%); the frequency of using all three suspicious descriptors was 9.2% and 11.8%, respectively.Conclusion:Despite the variable US features, breast malignancy seems extremely low in 25 years or younger women for palpable breast lesions. Using the BI-RADS lexicon, US accurately predicted benignity in about two thirds of our patients, supporting US surveillance as a safe alternative to invasive tissue sampling in this setting.

Extracorporeal circulatory support revolutionized the field of cardiothoracic surgery, initially in the form of cardiopulmonary bypass (CPB) and then in its modified form, extracorporeal membrane oxygenation (ECMO). Although initial cannulation techniques involved open intrathoracic approaches, the increased prevalence of reoperative sternotomies and the emergence of minimally invasive surgery encouraged the development of peripheral cannulation methods and configurations. The Avalon Elite Bicaval Dual Lumen catheter (Avalon Laboratories, LLC, CA) can be placed in the right internal jugular vein to provide venovenous (VV) ECMO. However, some patients on VV ECMO then develop compromised cardiac performance. We describe two ways in which the Avalon Elite was used, first for complete venous drainage through a single peripheral site for CPB and in the other to convert a patient on VV ECMO to axillary artery venoarterial (VA) ECMO.