The cumulative dose converted to the equivalent dose in 2-Gy fractions (EQD2) was calculated using the linear-quadratic model with α/β = 3 for the OAR. The cumulative EQD2 values of the minimum dose to the most irradiated 2 cc (D2cc) of the bladder and small bowel were 90.2 Gy and 79.5 Gy, respectively. These values exceeded the upper limits of the dosimetric criteria of the OAR, suggesting an association with both vaginal fistulas. As the adoption of IGBT is too slow in some countries, it is noteworthy that a reduced bladder volume may result in a significant increase in the dose to the small bowel and bladder in 2D-ICBT.The swallowed or aspirated foreign body is a common pediatric emergency medicine complaint for which emergency providers must be familiar with the intricacies of management. Most swallowed foreign bodies will harmlessly pass through the GI tract, but children with GI tract abnormalities may have an increased risk of object impaction. There are few reported cases of foreign object ingestion in children with GI tract abnormalities, specifically ostomies. The Foley catheter is a versatile tool that is easily accessible in the ED setting. We present a novel case of foreign body ingestion in an infant with a colostomy secondary to Hirschsprung's disease managed with Foley catheter retrieval through an ileostomy stoma. A 17-month-old infant presented to the ED with a chief complaint of an episode of bloody vomiting. He had a two-day history of increased irritability and intolerance of feeds with emesis after every feed. The child's medical history is pertinent for Hirschsprung's disease, for which the patient had abjects if the patient is stable and symptoms are not severe.Most head and neck cancers require aggressive surgical resection followed by external beam radiation therapy. The carotid artery can be injured by surgery or radiation resulting in a delayed "blowout." A patient who had undergone orbital exenteration for a lacrimal adenoid cystic carcinoma (ACC) followed by external beam radiation presented 16 years later with arterial bleeding from the orbit caused by "blowout" of the cavernous internal carotid artery (ICA). We review the literature on carotid blowout syndrome (CBS) and treatment. The patient was emergently transferred to a hybrid operating room and underwent a balloon occlusion test (BOT) and endovascular sacrifice of the ICA with no neurological deficits postoperatively. Emergent endovascular embolization is an effective treatment for an intracranial ICA blowout in this first reported case of a blowout through the orbit. Elevated radiation dose and lack of tissue coverage may put the cavernous ICA at risk for this delayed complication.Lightning strikes are a relatively uncommon emergency department presentation, and due to the very high energy involved, can present quite dramatically, including cardiac arrest. However, as with many chief complaints, sometimes these patients can be discharged home after a benign emergency department evaluation. We present one such case of a male who was struck to the ground by lightning outside his truck, which subsequently caught on fire. He demonstrated the classic Lichtenberg figures associated with a lightning injury that evolved over time but was otherwise hemodynamically stable. After an unremarkable laboratory evaluation and electrocardiogram, he was safely discharged home.Serologic tests for syphilis can be quite complex. The screening and confirmatory tests, which number at least eight, are mathematically interpreted as a total of 16 possible combinations, if we choose one test from each of two sets of four. However, this bewildering complexity is simplified if we apply certain principles. We reiterate and propose four axioms.  https://www.selleckchem.com/products/act001-dmamcl.html  First, we distinguish between treponemal versus non-treponemal tests. The former, the treponemal test, is specific for the spirochete, treponema pallidum, and is used as a confirmatory test. It rarely declines over time. The latter, the non-treponemal test, is a screening test and reflects treponemal or tissue damage, is reported as a titer, and is used to monitor disease activity. We usually need both for screening and confirmatory diagnostic testing. Secondly, for rapid plasma reagin (RPR) tests, a non-treponemal serology test titer of at least 18 is suggestive of syphilis, but not necessarily neurosyphilis. A false-negative test usually registers below this dilution level and may be due to the "prozone phenomenon". Serum RPR titers are usually greater than 132. Thirdly, a negative treponemal test in the cerebrospinal fluid excludes neurosyphilis and a positive test is highly sensitive but lacks specificity, usually due to blood contamination. Most patients with neurosyphilis will have a positive non-treponemal test in the cerebrospinal fluid (CSF) with elevated protein and pleocytosis. Fourthly, a serological cure is defined as at least a four-fold decline in a non-treponemal test titer at three and six months, or a persistently low titer after treatment. Patients who do not fulfill these criteria are known as "serofast". We describe the case of a 38-year-old man with human immunodeficiency virus-type 1 who developed bilateral optic disc edema with photopsias and transient visual obscurations.Pericallosal lipomas are rare benign intracranial masses that arise during embryonic development, typically categorized into tubulonodular and curvilinear subtypes. A mixed variant of both tubulonodular and curvilinear subtypes is very rare. Patients with pericallosal lipomas may be asymptomatic or may have different presentations, such as headaches. Conservative medical management is the mainstay of therapy for those without epileptic seizures or associated vascular malformations. We present a case of a mixed variant pericallosal lipoma in a patient with chronic headaches that were diagnosed using head computed tomography (CT) and brain magnetic resonance imaging (MRI).The present systematic review and meta-analysis provides a comprehensive assessment of the sciatic nerve (SN) variants relative to the piriformis muscle (PM) and compares those variants' prevalence among different geographical populations with respect to gender and laterality. A database search was conducted to identify cadaveric studies pertinent to SN variants relative to the PM. A total of 44 articles were included. The typical morphological pattern (type A, with the SN passing undivided below the PM) was found to be the most common variant, with 90% pooled prevalence. SN variants were more common among East Asians, with a 31% pooled prevalence of total variants. No significant differences were established with respect to gender and laterality. In greater than 10% of the population, the SN coursed through or above piriformis. Patients' epidemiological characteristics may predispose them to certain variants. The common peroneal nerve (CPN) is more susceptible to injury during a total hip arthroplasty or a hip arthroscopy where anomalies are encountered.