J Emerg Med
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Charles McBurney published a treatise on appendicitis in 1891, in which he described the exact point on the abdomen at which tenderness was maximal in cases of acute appendicitis--the point now known as "McBurney's point." He also described his approach to both the diagnosis and management of appendicitis, which at the time consisted of careful observation, total disuse of the stomach, and early laparotomy. Since 1891, many advances in the diagnosis of acute appendicitis have been made. Emergency physicians evaluating patients with abdominal pain may rely on laboratory studies, particularly the white blood cell count, and abdominal imaging with either ultrasound or computed tomography in addition to the history and physical examination. Despite these advances, tenderness to palpation over McBurney's point remains a key finding on abdominal examination in the assessment of patients with abdominal pain.
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Posterior fossa strokes, particularly those related to basilar occlusion, pose a high risk for progression and poor neurological outcomes. The clinical history and examination are often not adequately sensitive or specific for detection. ⋯ Head NCCT imaging is frequently insensitive for detecting posterior fossa infarction. Temporal evolution of strokes in this distribution, coupled with beam-hardening artifact, may contribute to this limitation. When a posterior fossa stroke is suspected and the NCCT is non-diagnostic, MRI is the preferred imaging modality to exclude posterior fossa infarction.
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Multicenter Study
Whole fentanyl patch ingestion: a multi-center case series.
Fentanyl is a potent synthetic opioid with large abuse potential. A common preparation of fentanyl is a sustained-release transdermal patch. To our knowledge, there are only two published case reports of whole patch ingestion. A case series of 76 patients with a history of whole patch ingestion is reported. ⋯ Ingestion of whole fentanyl patches may lead to prolonged and significant toxicity based on these poison center data.
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Case Reports
Pneumoperitoneum after sexual assault in a patient who had hysterectomy 30 years ago: case report.
A non-surgical etiology accounts for approximately 10% of cases of pneumoperitoneum. However, in the patient with pneumoperitoneum, one must be suspicious of the less common non-surgical etiologies, including coitus, to avoid unnecessary laparotomy. ⋯ This case is an important reminder that a thorough sexual and gynecologic/obstetrical history is an essential tool in identifying the patient who does not require laparotomy.