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Diffuse optical spectroscopic imaging (DOSI) is an emerging near-infrared imaging technique that noninvasively measures quantitative functional information in thick tissue. This study aimed to assess the feasibility of using DOSI to measure optical contrast from bone sarcomas. These tumors are rare and pose technical and practical challenges for DOSI measurements due to the varied anatomic locations and tissue depths of presentation. Six subjects were enrolled in the study. One subject was unable to be measured due to tissue contact sensitivity. For the five remaining subjects, the signal-to-noise ratio, imaging depth, optical properties, and quantitative tissue concentrations of oxyhemoglobin, deoxyhemoglobin, water, and lipids from tumor and contralateral normal tissues were assessed. Statistical differences between tumor and contralateral normal tissue were found in chromophore concentrations and optical properties for four subjects. Low signal-to-noise was encountered during several subject's measurements, suggesting increased detector sensitivity will help to optimize DOSI for this patient population going forward. This study demonstrates that DOSI is capable of measuring optical properties and obtaining functional information in bone sarcomas. In the future, DOSI may provide a means to stratify treatment groups and monitor chemotherapy response for this disease.

We present a case with extremely late diagnosis of type II hereditary angioedema (HAE). Given recent advances in HAE treatment, we want to bring physician awareness to this condition and aid in earlier detection. HAE is a disorder associated with episodes of angioedema of the face, larynx, lips, abdomen, or extremities. Late diagnosis of HAE can lead to significant morbidity and is severely impairing due to recurring attacks. The diagnosis of HAE is ordinarily made during childhood and adolescence. Delayed diagnoses in early and middle adulthood have been documented in the literature. Gastrointestinal symptoms are common features of HAE and can be misdiagnosed as disease of primary gastrointestinal pathology, such as irritable bowel syndrome, recurrent pancreatitis, or appendicitis. These attacks are characterized by recurrent attacks of subcutaneous and submucosal edema without the presence of urticaria.We present a case of an elderly veteran whose diagnoses was extremely delayed into the eighth decade of life subsequent to unexplained abdominal symptoms. After diagnosis, the patient's symptoms were well controlled with medication due to advances in HAE treatment. To prevent further atypically delayed diagnoses, physicians should consider HAE in patients with recurrent attacks of unexplained abdominal pain.

Pulmonary embolism remains an endemic challenge for public health care. The first line of treatment for venous thromboembolic disorder has been anticoagulation; however, in the absence of appropriate pharmacologic treatment, because of failure or contraindication, caval filter placement has been widely performed in the prevention of pulmonary embolism. Initially an open surgical procedure, technological advancements have allowed filter placement to be done percutaneously. Bedside filter placement in the intensive care unit with ultrasonographic imaging has been reported to be safe, effective, and reliable. In this report, we present an example, discuss our technique, and review the literature.

INTRODUCTION Plain abdominal radiographs commonly form a part of medical assessments. Most of these films are interpreted by the clinicians who order them. Interpretation of these films plays an important diagnostic role and, therefore, influences the decision for admission and subsequent management of these patients. The aim of this study was to find out how well doctors in different specialties and grades interpreted plain abdominal radiographs.

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A 23-year-old male with a history of previous abdominal surgery was involved in a road traffic accident. He was discharged after initial assessment but represented several days with small bowel obstruction secondary to a mesenteric haematoma. He underwent resection and recovered well but represented later on the day of discharge with a leaking surgical wound consistent with an enterocutaneous fistula. This was managed conservatively and closed spontaneously after ten days. This case serves to highlight that adhesions from previous surgery can tether the small bowel causing mesenteric injury following blunt-force trauma. It also demonstrates that postoperative ileus can result in an enterocutaneous fistula that has the appearance of an anastomotic breakdown but which resolves more rapidly.

DESCRIPTIONWe present a case of a 73-year-old woman with gradual onset severe neck pain for 5 days, radiating to head and shoulders. Her medical history included osteoarthritis and cervical spondylosis. On examination she was non-feverish, systemically well with no neurological signs. Movements were limited by pain and no focal spinal tenderness was found. A C reactive protein of 263 and erythrocyte sedimentation rate of 83 in the absence of a clear alternative infective source prompted further investigation.MRI of the cervical spine in the short T1 inversion recovery sequence demonstrated a subtle increase in signal in the C5-C6 disc with prevertebral and postvertebral oedema (figure 1). The T1 sequence is highly suspicious of an early discitis, with disruption of the usually smooth end plate of C5 (figure 2). A repeat MRI with gadolinium highlights more clearly the high signal in the anterior disc and surrounding soft tissues (figure 3).Spondylodiscitis can have serious consequences from local destruction, neurological involvement or as a source of sepsis. Patients can present with nonspecific pain only with fever in as few as 14% of cases, 1 and positive blood culture in as few as 39%.2 MRI with gadolinium enhancement significantly improves sensitivity enhancing the disc, vertebral surfaces and surrounding soft tissue giving better distinction between degenerative changes and infective lesions.3 There are numerous treatment regimens but in the absence of positive cultures empirical intravenous antibiotics targeting Staphylococcus aureus were used. A 2-week course of flucloxacillin with teicoplanin for 4 weeks as an outpatient showed resolution both clinically and biochemically. There is enhancement (high signal) within the C5/6 disc anteriorly and within the adjacent C5 and C6 vertebrae. There is also enhancement within the thickened prevertebral soft tissues and within the soft tissues adjacent to the cervical posterior elements.