Introduction Vernix caseosa peritonitis (VCP) is a rare peripartum complication secondary to the introduction of fetal vernix into the maternal peritoneal cavity. Vernix caseosa peritonitis typically manifests a few hours to days after a cesarian section and is often initially misdiagnosed as a more common disease process resulting in delayed diagnosis. We report the computed tomography (CT) findings in 2 patients with VCP and reviewed the previously reported CT findings of VCP. Cases Two patients, aged 17 and 24 years, presented with signs and symptoms of peritonitis within days of undergoing a cesarian section. In both cases, CT scans of the abdomen and pelvis demonstrated ascites and multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules which were most prominent around the liver and became larger and more numerous over time. Antibiotic therapy was not effective, subsequent laparoscopic peritoneal biopsy demonstrated VCP, and patients were successfully treated with lavage and the addition of intravenous steroids. Conclusions Vernix caseosa peritonitis is an underrecognized disorder that is most often mistaken for other more common causes of peritonitis. In the setting of peripartum peritonitis, the CT findings of ascites with multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules, especially adjacent to the liver, which grow in size and number strongly suggests VCP.
Objective: The state of radiology varies among countries. The purpose of this country report is to analyze the state of radiology in Mexico, how it has changed over the past several years, and how it compares to other countries.Materials and Methods: A review was completed using the University at Buffalo (UB) catalog and database search, as well as a general Google search for articles regarding radiology in Mexico.Results: While the state of radiology has improved over the past several years, the system in Mexico still lacks an adequate number of medical imaging units and an adequate number of radiologists. Both of these factors have contributed to the stagnant state of radiology in Mexico.Conclusion: There are many factors contributing to the state of radiology in Mexico, including a high poverty percentage and low expenditure on healthcare. It is important to increase the number of medical imaging units throughout the country and replace the current aging scanners to help all patients.
Technetium Tc-99m sulfur colloid (99mTc-SC) breast lymphoscintigraphy is commonly performed to identify the sentinel lymph node (SLN) in patients diagnosed with breast carcinoma undergoing lumpectomy. The purpose of this report is to describe how the use of 2% topical lidocaine jelly immediately after the completion of needle localization and prior to scintigraphy may substantially reduce pain associated with the injection of 99mTc-SC. Materials and methods This was a quality improvement project. Patients were asked to score the severity of pain associated with the periareolar 99mTc-SC injections for sentinel node lymphoscintigraphy. In order to decrease the discomfort, topical lidocaine was applied to the periareolar skin after the completion of the needle localization, but prior to transferring the patient from the mammography room to the nuclear medicine department for the 99mTc-SC injections. At the time of 99mTc-SC injection, patients were asked to score the pain of injection from 0 (none) to 10 (worst).
Objective: The purpose of this country report is to analyze the state of radiology in Brazil from its origins to its present state. We detail both the country’s advancements in the field and the areas that could stand to be improved, including increased access to radiology in its less populous, more rural regions. We detail the imaging equipment available in the country and seek to stratify this data among different geographic areas. Materials and Methods: The review was completed using the University at Buffalo catalog and database search. A search was conducted for both U.S. and Brazil based journal articles focused on radiology in Brazil. A general Google search for articles was conducted to obtain information regarding the socioeconomic status and history of Brazil. The Brazilian government’s health system database website was used to obtain data regarding the availability of different diagnostic equipment. Results: Brazil is the largest radiology market in Latin America. It has taken great strides over the past few decades to advance its work in the radiology sector. There are two main areas still in need of improvement: first of all, providing diagnostic imaging resources to remote and rural regions, and second of all, expanding the use of PACS software to all hospitals. Conclusion: The state of radiology in Brazil has vastly improved over the past few decades. Continued investment in diagnostic imaging equipment — while prioritizing less populous and poorer areas — will help both the field of Brazilian radiology and the individuals it serves.
Objective: Healthcare systems vary among nations. From public/private partnerships to national systems, quality and equality varies. The purpose of this review is to analyze the effect that the National Health Service (NHS) in the United Kingdom (UK) has on inequality in comparison to the mixed healthcare model in the US. Materials/Methods: A review was completed using the University at Buffalo catalog and database search. A general Google search for articles regarding US healthcare costs was also done. Pubmed was also utilized. Results: The UK national healthcare system correlates with decreased inequality among all groups, while the US healthcare system exacerbates inequality. By strengthening the primary care system, the NHS has been able to efficiently care for the large majority of the UK population. The effectiveness of the NHS can also be traced to the fact that it is available to all citizens and therefore allows citizens to get care without being burdened by cost of services. The NHS was also associated with better overall performance and equity compared to the US system. While the US has made some advances in reducing healthcare inequality, medical debt and inequity in care remains a large burden for the healthcare system. The Gini index in the US before and after consideration of medical expenses remains higher than the UK and these medical expenses have also pushed citizens into poverty. Conclusion: Addressing inequality necessitates analyzing how a nation's healthcare system impacts the poor. A more centralized system that scales costs in coordination with income and a progressive tax system could help prevent and keep people from going into poverty. The UK national healthcare system has made strides in reducing inequality and providing effective care for the population, while overreliance on employer-dependent private insurance in the US can overburden those with lower incomes. While the Patient Protection and Affordable Care Act has reduced the number of people who are uninsured, it has done little to reduce inequality.
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