No abstract

Granulomatous mastitis is a chronic inflammatory breast disease with an enigmatic clinical presentation that can delay diagnosis and perpetuate ineffective treatments. We report our experience with the diagnosis and management of eighteen cases of granulomatous mastitis in the setting of an urban public hospital. The patients were identified after a retrospective review of pathology and surgery databases. Demographic, clinical, radiographic, histopathological data and treatment responses were reviewed. Out of a total of 18 patients, 8 patients were noted to be from Mexico. The mean age at presentation was 35 years and 11 of the 18 patients reported a pregnancy in the last four years. Most cases were unsuccessfully managed as bacterial breast infections initially; definitive treatment involved surgical excision and steroids. A complete symptomatic and radiographic resolution was documented in 8 of the 18 patients. Despite posing a challenge for the unsuspecting physician, an early diagnosis of granulomatous mastitis improves patient outcomes.

Extremity muscles are grouped and divided by strong fascial membranes into compartments. Multiple pathological processes can result in an increase in the pressure within a muscle compartment. An increase in the compartment pressure beyond the adequate perfusion pressure has the potential to cause extremity compartment syndrome. There are multiple sites where compartment syndrome can occur. In this article, an arm and forearm compartment syndrome ensued secondary to a minor crushing injury that lead to supracondylar and medial epicondylar non-displaced fractures. A pure motor radial and ulnar nerve deficits noted on presentation, worsened with progression of the compartment syndrome. Ultimately, a surgical fasciotomy was carried out to release all compartments of the right upper arm and forearm.

Pediatric burns in the urban environment present special problems. Communities in the inner-city may be unique with hardships due to various socioeconomic factors. Few, if any, papers have specifically sought to analyze pediatric burns in the inner-city, and there has been no report to date reviewing Harlem New York City, one of the most challenged areas in the nation. The aim of this study is to understand the prehospital circumstances and socioeconomic factors of affected patients, hospital care, and management of pediatric patients admitted with burns in Harlem. A retrospective review was performed of all the patients aged 0 to 18 years old admitted to the burn care unit from January 2006 to May 2017. Data collected included age, gender, ethnicity, burn mechanism, total burn surface area, first aid and management, socioeconomic factors including parental supervision, single or binary parenting, caregiver financial and employment status, New York City Administration for Children's Services (ACS) child protective services reporting for child abuse or neglect. Analysis was done using Microsoft Excel 2016 and SPSS statistics v23. A total of 177 pediatric burn patient admissions were included. The majority of the patients were toddlers (1-5 years of age). The most common type was scald burns. The average TBSA burnt was approximately 9%. Nearly all the injuries occurred at home with more being during winter months. Strikingly, the majority of patients, over 75%, did not receive appropriate first aid measures. Moreover, socioeconomic issues were significant with 60% of patients having single parents, approximately 35% with lack of supervision and neglect or abuse reported in 25% of these cases. Unemployment rate of the caregiver was high, with 50% unemployed or in between jobs. In 73% of the patients, their parents were receiving some form of social aid for childcare and sustenance of family needs. Pediatric burns are a major public health issue. An understanding of community variations with these injuries is essential taking into account socioeconomic challenges that these children face. Our inner-city hospital pediatric burn admissions have substantial caregiver and socioeconomic challenges in excess of traditionally reported in the literature. Most injuries occurred at home and the majority lacked proper prehospital first aid care. This analysis is informative, providing professionals and caregivers topics of consideration regarding safe practices at home, appropriate first aid measures, prevalent socioeconomic issues in our community in Harlem. There is a need to address socioeconomic factors which may potentially prevent pediatric burn admissions in these inner-city communities.