Background Actinomycosis is a rare infectious disease caused by Actinobacteria. It has a wide spectrum of presenting symptoms depending on anatomical location and can occasionally mimic pelvic malignancy and cause diagnostic difficulty. Case A female in her seventies presented with altered bowel habit, anorexia and abdominal discomfort with a history of diverticulosis. CT-AP revealed a sigmoid lesion causing large bowel obstruction. She underwent a laparoscopic defunctioning sigmoid loop colostomy and limited sigmoidoscopy. Subsequent endoscopy showed no dysplastic change but obvious stricturing. A diagnosis of locally perforated diverticular disease was made. Subsequent imaging showed rapid progression with hydroureter and hydronephrosis, now suggesting locally perforated sigmoid tumour or gynaecological malignancy. Tumour markers were normal. She underwent surgical exploration and resection. Specimen evaluation revealed Actinomyces likely originating from diverticular disease. Treatment involved long-term antibiotics for 12 months. Conclusion Pelvic Actinomyces is a difficult diagnosis to make on clinical and radiological findings. It should be considered in differential diagnoses of progressive pelvic lesions.

ObjectivePatients with implanted cardiac devices may wait extended periods for interrogation in emergency departments (EDs). Our purpose was to determine if device interrogation could be done safely and faster by ED staff.MethodsProspective randomized, standard therapy controlled, trial of ED staff device interrogation vs. standard process (SP), with 30-day follow-up. Eligibility criteria: ED presentation with a self-report of a potential device related complaint, with signed informed consent. SP interrogation was by company representative or hospital employee.ResultsOf 60 patients, 42 (70%) were male, all were white, with a median (interquartile range) age of 71 (64 to 82) years. No patient was lost to follow up. Of all patients, 32 (53%) were enrolled during business hours. The overall median (interquartile range) ED vs. SP time to interrogation was 98.5 (40 to 260) vs. 166.5 (64 to 412) minutes (P=0.013). While ED and SP interrogation times were similar during business hours, 102 (59 to 138) vs. 105 (64 to 172) minutes (P=0.62), ED interrogation times were shorter vs. SP during non-business hours; 97 (60 to 126) vs. 225 (144 to 412) minutes, P=0.002, respectively. There was no difference in ED length of stay between the ED and SP interrogation, 249 (153 to 390) vs. 246 (143 to 333) minutes (P=0.71), regardless of time of presentation. No patient in any cohort suffered an unplanned medical contact or post-discharge adverse device related event.ConclusionED staff cardiac device interrogations are faster, and with similar 30-day outcomes, as compared to SP.

In a community-based setting, DBT is a cost-equivalent or potentially cost-effective alternative to FFDM and has the capacity for improving cancer detection and recall rates.

No abstract