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Open Access Publications from the University of California

Case Report

Point-of-Care Ultrasound Appearance of Cystic Ovarian Teratoma Causing Ovarian Torsion

We present a case of ovarian torsion due to a nine-centimeter cystic ovarian teratoma diagnosed on transabdominal point-of-care ultrasound (POCUS). A 29-year-old female presented with abrupt onset of 10/10 left lower quadrant pain for one hour. She had a known left-sided ovarian cyst. Patient was normotensive, not tachycardic, and afebrile. Bimanual exam showed a seven-centimeter left, adnexal mass. POCUS revealed a nine-centimeter cystic structure in the left adnexa with a three-centimeter echogenic focus, consistent with a dermoid plug. A radiology-performed transvaginal ultrasound confirmed the left sided mass with absent blood flow. Emergent diagnostic laparoscopy showed the cyst was torsed twice and was found to contain adipose tissue and hair on pathologic evaluation consistent with a benign cystic teratoma. The patient did well postoperatively and was discharged the next day. Ovarian torsion is a gynecologic surgical emergency. The characteristic appearance of a cyst with “dermoid plug” in the appropriate clinical setting can lead to earlier diagnosis and treatment.

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Posterior Knee Dislocation Following a Knee Arthroplasty

Total knee arthroplasty is one of the most commonly performed surgeries in the United States. Complications following knee arthroplasty are uncommon, especially dislocations. Knee dislocations can be associated with popliteal artery injuries, which are potentially catastrophic and limb threatening. Emergency Department (ED) physicians should be familiar with the management of knee dislocations and complications following total knee arthroplasty. A 61-year-old female presented to the ED with acute right knee pain approximately 10 weeks after undergoing a total knee replacement for tricompartmental osteoarthritis. While at her first outpatient physical therapy evaluation, the patient felt a pop while going from a seated to standing position. Subsequently, she experienced a popping sensation and was unable to bear weight or extend the knee. On exam, she was in obvious pain, her surgical scar was well healed, and her knee was flexed to about 90 degrees and could not be extended. She had a palpable dorsalis pedis pulse and brisk capillary refill. Radiography revealed a posterior dislocation of her tibial prosthesis relative to her femoral prosthesis. Under procedural sedation, the dislocation was reduced and placed in a knee immobilizer. Her neurovascular exam was intact pre and post-reduction. Several months later she experienced another episode of spontaneous dislocation during a routine office visit requiring a second ED visit for reduction under procedural sedation. She was subsequently scheduled to undergo a revision of her total knee replacement due to suspected flexion instability with an inadequate extensor mechanism.

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Review Article

Outpatient Management of Cancer Patients During the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China. In no time, SARS-CoV- 2 found its way to the whole world, to be declared as a pandemic by the World Health Organization (WHO) on March 11th, 2020. As this disease continues to take its toll on the world as a whole, we, at the American University of Beirut Medical Center (AUBMC), believe that it is essential to protect those who are at a particularly high-risk for contracting the virus, namely cancer patients. Besides complying with all the protective measures recommended by WHO, we developed quality improvement plans for the outpatient management of febrile neutropenia, pneumonia and pulmonary embolism in cancer patients. The aim of such plans is to offer adequate management for cancer patients on an outpatient basis, whenever possible, and thus limit their admission rates together with their risk of contracting the novel virus, SARS-CoV- 2.

Special Contribution

Volunteer-Operated Field Medical Tents During Civilian Protests in Beirut, Lebanon: Challenges and Lessons

In October 2019, the worsening political, economic, and perceived corruption in Lebanon led to civil unrest. In anticipation of injuries, a group of healthcare professionals and social activists summoned paramedics, nurses, and physicians through social media, to provide medical assistance in the protest area. These volunteers established a physician-led advanced first-aid tent, whose aim was to reduce the patient load on Emergency Departments in local hospitals. We present the experience of volunteers, lessons learned, and challenges faced during the establishment of the physician-led first aid tent. In this manuscript, we discuss the following aspects of our efforts that can serve as relevant lessons we learned about medical volunteerism: spontaneity in volunteerism, operations, location and storage, supplies, roaming team, coordination with emergency services, safety, documentation, communication, special situations, and transition from acute to primary care.