Takotsubo cardiomyopathy (TCM) is an important condition for the emergency physician to consider in patients with cardiovascular symptoms. A 70-year-old woman presented with chest pain and nausea following emotional trauma. She had an elevated troponin and a normal electrocardiogram with no history of previous cardiac disease. Point-of-care focused cardiac ultrasound (FOCUS) showed reduced left ventricular systolic function with mid to apical hypokinesis. Cardiac catheterization revealed clean coronary arteries and confirmed the suspected diagnosis of TCM. Few reports emphasize the importance of FOCUS in the diagnosis and management of TCM in the emergency department. We detail FOCUS findings that assisted with diagnosis of TCM and describe how this quick, noninvasive imaging modality can be used to assess and manage emergent conditions.
The surgical treatments for neurogenic bladder are extremely variable. The lack of specific treatment guidelines makes this disease process even more challenging to treat. We present a case of a 55-year-old female with neurogenic bladder secondary to spinal cord injury (SCI). Her incontinence was conservatively managed with indwelling Foley drainage. Despite continued upsizing of the Foley catheters, the patient continued to have urinary leakage. The patient subsequently underwent a transvaginal bladder neck closure (BNC) with suprapubic bladder neck diversion (SPC). The urethra was successfully closed and uniquely supported with the use of cadaveric pericardial tissue (CPT). This surgical approach of neurogenic bladder provides durable continence with short operative times, minimal patient morbidity, decreased hospital length, and low risk of progressive renal dysfunction. BNC with SPC can provide an excellent management solution for neurogenic bladder from spinal cord injury refractory to conservative management.
INTRODUCTION: The objective of this study is to explore the patient understanding of HPV and its vaccine and to ascertain any pertinent biases. The human papilloma virus (HPV) vaccine was recently FDA approved to extend coverage to age 45 instead of age 26. The vaccine is recommended by ACOG for males and females aged 9-45. METHODS: Between April and June 2019, patients of WVU Medicine OBGYN completed a one-time survey at their well-woman examination. The survey was created to assess associations between socioeconomic variables, sexual history, and the patient perception of the HPV virus and vaccine. RESULTS: A total of 200 women participated. The average age was 45 with most currently sexually active (84%). While most women reported that they were in support of vaccines (95%), the majority of women without a previous HPV vaccination reported they were not interested in receiving the vaccine themselves (48%) but were more likely to be in favor to vaccinate their sons (57%). It should be noted 0 women reported all of the correct cancers associated with HPV with only 7 women reporting the association with head and neck cancers. Almost a quarter of women (21%) incorrectly believed HPV had links to uterine and ovarian cancer. CONCLUSION: There are visible gaps regarding HPV and its vaccine. A major gap is the paucity of knowledge of the types of cancers HPV can cause. Physicians can recognize potential candidates and implement more education within the well-woman visit to make sure women are well-informed about HPV and the vaccine.
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