We sought to determine the efficacy of remaking initially unsatisfactory cervicovaginal ThinPrep (Cytyc, Boxborough, MA) specimens with and without the addition of glacial acetic acid (GAA) and the effect on human papilloma virus (HPV) Hybrid Capture II (HC2; Digene, Gaithersburg, MD) testing. A total of 583 initially unsatisfactory ThinPrep slide preparations were identified, and remakes were made with the residual in the PreservCyt (Cytyc) vials with (n = 455) or without (n = 128) GAA. Clinical follow-up information was obtained. The addition of GAA resulted in a 56.5% reduction in unsatisfactory cases, compared with a 26.6% reduction without GAA. Neoplasia and atypia were detected in the reprocessed specimens. The addition of GAA resulted in false-positive HC2 test results in 10 of 10 cases. Neutralization of the specimen may reverse this effect. Reprocessing unsatisfactory ThinPrep specimens with GAA can substantially reduce the overall unsatisfactory rate and result in the detection of significant lesions. However, the addition of GAA can result in false-positive results on HC2 HPV tests.

A case of penile abscess after amphetamine injection into the penis is reported. A 45-year-old male patient was successfully treated with surgical drainage and antibiotics. There were no 3-month consequences of treatment at follow-up, and the patient maintained potency, without any penile deformity. The aetiology, diagnosis, and management of penile abscesses are discussed.

Study Objectives: To determine the diagnostic accuracy of the four standard echocardiography views (parasternal long axis [PLAX], parasternal short axis [PSAX], apical four-chamber [A4CH], and subcostal [SC]) in detecting pericardial effusion. Methods: 120 point-of-care echocardiograms were selected from our echocardiography database; all studies were performed by echocardiographers and interpreted by board certified cardiologists. We selected 60 studies with and 60 without pericardial effusion as determined by the final interpretation with effusions ranging from small to large. The cine loops were de-identified, randomized, and sent to three ultrasound fellowship-trained emergency medicine faculty for review. Reviewers were asked to determine whether an effusion was present and the size of the effusion. Sensitivity, specificity, and accuracy were calculated by comparing the reviewer consensus of each view with the composite cardiology report. Results: Accuracy was high for all views with PLAX and SC achieving 88%, followed by A4C at 87% and PSAX at 83%. Using PSAX as the comparison, there was not a difference in accuracy between PLAX and PSAX (p¼0.20), SC and PSAX (p¼0.18), or A4C and PSAX (p¼0.39). Except for PLAX + PSAX (p¼0.40), each combination of views increased the accuracy compared with PSAX alone: p¼0.010 for PLAX + A4C, p¼0.001 for PLAX + SC, p¼0.026 for PSAX + A4C, p¼0.005 for PSAX + SC, and p¼0.004 for A4C + SC. The combinations of PLAX + SC and A4C + SC resulted in the highest accuracy at 94% while the combined PLAX and PSAX was not superior to a single view. Conclusions: Overall accuracy was high for all views; however, the combination of PLAX + SC and A4C + SC provided the highest accuracy. For the detection of pericardial fluid, providers should consider using a minimum of two views, with at least one of them being the SC view, to improve diagnostic accuracy.