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The article examines traditional understanding of top-down organizational leadership against spontaneous, self-initiated leadership/followership theory. It also denotes the relationship between spontaneous and self-initiated expression of alternative, grassroots, and rogue leadership as a construct of alternating leadership behaviors. The research furthers the leadership research focus that is identified as Alternating Leadership and acknowledges leader/follower dual function within each individual. The constructs are augmented by a matrix that contrasts the strength of the leadership and followership roles among traditional versus non-traditional leadership theories. Conclusions suggest a confirmation of the dual Alternating Leadership role existing within all employees or managers and the creation of worker-centered, real-time interventions to increase employee interaction and synergy. The impact of generational leadership on the AlternatingLeadership Model is also examined.

Retroperitoneal bleeding is a rare and difficult to diagnose condition, defined as bleeding in the retroperitoneal space without associated trauma or iatrogenic manipulation. It has been associated with hematologic diseases and malignancies and is more common in patients receiving systemic anticoagulation. A 50-year-old man on aspirin presented with abdominal pain. Physical examination revealed abdominal tenderness and a palpable mass at the left abdominal area. An abdominal CT revealed a spontaneous retroperitoneal hematoma due to bleeding of an intraparenchymal branch of the left renal artery. The patient underwent left nephrectomy in order to control the bleeding. Pathology of the kidney showed evidence of acute and chronic microangiopathy, renal artery stenosis, and renal vein thrombosis. Further work-up led to diagnosis of primary antiphospholipid syndrome. Treatment of spontaneous retroperitoneal bleeding varies from conservative in hemodynamically stable patients to invasive or even surgery in hemodynamically unstable patients. In our case, open surgery was performed due to the rapidly deteriorating patient's condition and the inability to embolize the bleeding vessel by interventional radiology. Physicians should always think of retroperitoneal bleeding in patients presenting with abdominal pain and signs of hypovolemia, especially if they have a bleeding disorder or receive anticoagulants or antiplatelets.