Biliary obstruction secondary to malignancy is a common clinical problem. Rarely, biliary obstruction is due to non-Hodgkin's lymphoma. Obstructive jaundice in these patients usually presents late in the course of the disease. Burkitt's lymphoma is a subtype of non-Hodgkin's lymphoma. Unlike other forms of non-Hodgkin's lymphoma, Burkitt's lymphoma presents as an extranodal disease. We present the case of a patient suffering from non-endemic Burkitt's lymphoma whose initial presenting symptom was obstructive jaundice.

The interventional radiologist and the multidisciplinary team approach can be activated already on severe trauma patient arrival. ABO usage and other endovascular methods are becoming more widely spread, and can be used early in trauma management, without delay, thus justifying the early activation of this multidisciplinary approach.

BackgroundRecent studies have reported significant morbidity and mortality in patients with multiple rib fractures, even without flail chest. The aim of this study was to compare the clinical outcome and incidence of associated chest injuries between patients with and without flail chest, with three or more rib fractures.MethodsThis study included patients with blunt trauma with at least three rib fractures, hospitalised during 2010–2019 in the Hillel Yaffe Medical Center in central Israel (level II trauma centre). Patients with and without radiologically defined flail chest were compared with regard to demographics, Injury Severity Score (ISS), GCS, systolic blood pressure (SBP) on admission, radiological evidence of flail chest, associated chest injuries, length of stay in intensive care unit, length of hospitalisation and mortality.ResultsThe study included 407 patients, of which 79 (19.4%) had flail chest. Overall, pneumothorax and haemothorax were more common among patients with flail chest (p<0.05). When comparing patients with three to five rib fractures, there was no difference in length of intensive care and length of hospitalisation or mortality; however, there was a higher incidence of pneumothorax (24.6% vs 50.0%, p<0.05). When comparing patients with six or more rib fractures, no difference was found between patients with and without flail chest.ConclusionIn patients with three to five rib fractures, pneumothorax is more common among patients with flail chest. Clinical significance of flail chest in patients with more than six rib fractures is questionable and flail chest may not be a reliable marker for severity of chest injury in patients with more than six fractures.

Electric bicycles and scooters have gained popularity among riders; studies assessing these device-related injuries have not specified ocular trauma. Our study examined the types and risk factors for ocular and periocular injuries associated with electric devices compared to motorcycle accidents. The study was conducted on the National Trauma Registry database from 20 trauma centers, including patients involved in accidents with electric bicycles, scooters, and motorcycles between 2014 to 2019. Injured riders were assigned into two groups: motorcycle group (M) and electric bicycle & scooter group (E). Data such as gender, age, protective gear use, ocular injury type, injury severity score (ISS), and ocular surgery were captured. Logistic regression models were conducted for injury types and the need for surgery. 8181 M-riders and 3817 E-riders were involved in an accident and hospitalized. E-riders suffered from ocular injury more than M-riders. Males were most vulnerable and the ages of 15–29. Orbital floor fracture was the most common injury, followed by ocular contusion, eyelid laceration, and other ocular wounds. Electric bicycle and scooter riders are more likely to suffer from ocular injury than motorcycle riders. Riders without helmets are at greater risk for injuries, specifically orbital floor fractures. ISS of 16 + was associated with injury demanding ocular surgery.

Hypothesis: Routine repeat head Computed Tomography (CT) for patients with traumatic head injury, initially presenting with GCS of 14-15, does not change therapeutic policy in these trauma patients. Methods: This was a retrospective cohort study of trauma patients with Glasgow Coma Scale (GCS) of 14-15 on admission, suffering from different types of intracranial bleeding who were admitted for observation in a level II trauma center. The size of hematoma on initial head CT was measured and compared to findings of repeat CT performed following 12hours. Patients were evaluated as to changes in neurologic status and treatment. Results: 68 patients treated over a period of 5 years were evaluated. Forty two (61.8%) were male and 24 (38.2%) were female. Mean age was 56.2 years and mean ISS score was 12 ± 5.1. Initial GCS was 15 in 51 patients and 14 in 15 other patients. CT scan revealed 7 epidural hematomas, 20 subdural hematomas, twenty eight intraparenchymal bleeding, and 13 subarchnoid hemorrhages. Repeat CT revealed an increase in size of the hematoma in 8 eight patients. None of these patients suffered from clinical deterioration. Repeat CT in 12 patients who's GCS deteriorated, did not show any significant changes on the repeat CT scan. None of the patients underwent intervention after a routine repeat CT. Conclusions: Routine repeat CT scan of head, performed 12 hours after the initial scan did not change the therapeutic policy in GCS 14-15 head trauma patients. The need for mandatory CT of head in mild traumatic brain injury should be questioned.