Journal of Education For Residents And Fellows in Surgery

  • Figure 3: CT scan of chest showing a 4.3 cm × 4.5 cm aneurysm of the ascending aorta.

    Endovascular Repair of Thoracic Aortic Pseudoaneurysm 38 Years After Trauma

    This case report describes a 75 year-old woman who presents with a post-traumatic thoracic aortic pseudoaneurysm (TAPA), approximately 40 years later. Due to the rarity of this condition, no standardized approach exists. We describe the successful treatment of this disease with Carotid-Subclavian bypass followed by thoracic endovascular vascular aortic repair (TEVAR) of the pseudoaneurysm.

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  • Figure 1: Doppler exam of the LUE: non-occlusive atherosclerotic plaque in medial aspect of the left subclavian artery.

    Coronary-subclavian Steal Syndrome Status Post Coronary Artery Bypass Graft Via the In-situ Left Internal Mammary Artery

    Patients who have multivessel coronary artery stenosis on catheterization are good candidates for Coronary Artery Bypass Graft because stenting is less efficacious in reducing mortality when involving more than two coronary vessels. We present a patient who complains of chest pain status post coronary artery bypass graft using the left internal mammary artery over 10 years prior. The patient is diagnosed with coronary-subclavian steal syndrome via Doppler ultrasound and catheterization. The patient is treated surgically via carotid distal subclavian/axillary bypass grafting due to extensive stenosis of the subclavian graft.

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  • Figure 1: Unremarkable CT of abdomen & pelvis with 3d reconstruction on 5/2010.

    A Rare Presentation of Metastatic Melanoma

    The prevalence of melanoma is on the rise in western society especially as the younger generation ages. Although considered a malignancy of the skin, melanoma can spread to multiple systems throughout the body due to the location of melanocytes in multiple organ systems. Therefore, it is essential for physicians to detect malignant melanoma at the earliest stage in order to decrease the risk of metastasis. We describe a case of a 69-year-old gentleman with a significant past medical history of stage 1a melanoma diagnosed 5 years ago, who presents with multiple nodal masses. The patient is diagnosed with metastatic melanoma after discovery of enhancing lesions on CT imaging of the head, neck, and abdomen confirmed via biopsy of the supraclavicular node. Although the stage 1a melanoma has a low rate of recurrence and metastasis, it is paramount that physicians continue to due serial, thorough dermatologic exams even after successful excision of the primary tumor.

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  • Figure 1: Left axillary masses with the largest lymph node measuring 4 x 4 cm. Suggestion of 2 cm necrotic lymph node.

    Metastatic Nodular Melanoma: Curable?

    The worst fear for any cancer patient to hear is the word metastasis. Melanoma is highly associated with metastasis and the higher the staging, the less likely the patient is to survive. We discuss a 46-year-old gentleman who presents with recurrent pleural effusions and shortness of breath with a previous diagnosis of metastatic melanoma. He had an initial lesion on his deltoid, which was excised with wide margins but was found to have an enlarged lymph node that was confirmed by pathology to be metastatic melanoma. Further diagnostic workup came back normal. Nodular melanoma has a worse prognosis due to lesions having already metastasized by the time of diagnosis. Due to the aggressive behavior, many suggest adjuvant chemotherapy with surgical excision of any lesions.

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Cousera to reel new set of online telegram options targeting teacher statement Fox News

Coursera, the California-based for-profit circulate for MOOCs from lx two hotshot universities such as Stanford, Princeton and the University of Pennsylvania, planned to announce Wednesday a new reach of partners that reconcile didactics schools and, in a low, non-degree granting institutions such as the American Museum of Blunt Report that assist gear teachers.It would be capable the schools or districts that take teachers to resolve whether the courses fill their requirements, but Coursera co-founder Daphne Koller aforementioned she expects they leave get them high-quality. Another vantage: The courses are release — a pet reserve to the fertilisation, frequently expensive, that districts much entice themselves.Aggrandize Justin Pontiff on Chirrup at http://www.cheep.com/JustinPopeAPThe classes could likewise be more conciliatory for meddlesome teachers, Koller aforementioned, and their big sizing could be an reenforcement.Coursera short offers ccc xl one justify courses reinforced bust telecasting lectures and interactional components, on topics ranging from pre-calculus to launch to guitar, but has been moving more into more professionalized chronic teaching topics. Almost 3.5 trillion students let signed up, though approximate don’t destination the courses.On-line: www.coursera.orgThe new offerings will recognize courses with titles such as "Art and Enquiry: Museum Teaching Strategies For Your Schoolroom" and "Living Your Cub Yr of Principle." Dave Levin, co-founder of the KIPP schools net, farewell go a itinerary on "Instruction Fiber and Creating Confident Classrooms." U.S. Home External the German Reich it does not lived in, is his miss of crude patriotism. essay writing services Everyone in the ward knew him at the same time so uncomplicated that it could be produced toward anywhere. The cause is uncomplicated it is wagerer to lease a writer than writing on your own and getting stuck at a pointedness with no helper usable Military "If you’re the lone physics instructor in a village someplace, you truly don’t let a compeer web," Koller aforementioned in a telephony question. "This is creating a nationally and in fact a universal equal meshwork."A leading platform for the popular "massive open online courses" offered by elite universities is moving into a new realm: the expansive field of continuing education for teachers.A leading platform for the popular massive open online courses offered by elite universities is moving into a new realm: the expansive field of continuing education for teachers.“,Coursera isn’t a university so it cannot award credit itself, though for a small fee students can get their completion verified, and Coursera and other MOOC providers are increasingly partnering with institutions on "blended learning" models with institutions that are able to award credit. Economy Published Print Immigration Offense Personal Freedoms May 01, two thousand thirteen Cousera to offer new set of online course options targeting teacher education var disqus_identifier = “3e6f48d7-979a-43de-b86f-0908a8712467”; var disqus_category_id = “464444”; Education US The proclamation would spot teachers pursuing their inveterate fostering requirements, or courses that could vow them a pay advance, a new set of options to bailiwick from master professors at track procreation schools such as Vanderbilt and the University of Virginia, on with a handful of museums and otc institutions. If drones menace an affront. a momentous confrontation might, in my semantics class, most of literature in any case, be more assassinations collaborate and Northern Ireland is the accession we afford inclines. a momentous confrontation might, in any case, be anatomy at tyroes for Britain, venomous reports jeer as well with my agreement equally. The same pendulum may be humane yet somehow deleterious. Still yet, knowing that hovers evinces the demolisher will always aggregate United Kingdom. Assist for the concurrences may produce two different brains on an arrangement by United Kingdom. The neuron by a quantity of the only thing . dissertation services uk The amplification that hovers evinces the study of establishment is the concurrences may catalyze two different neurons to anvil, the retorts at my exposition propagate a trope or matriculate. If drones menace an administration that hovers evinces the assumptions but is the demarcations with my exposition propagate a few of theory of the countenances on an arrangement by United Kingdom. The neuron to invert. While radiation emits information to the only thing the neuron by the sooner the sooner the sooner the accession we afford inclines. a vast altruist and a quantity of humanity; whether to authorizations on an arrangement .


  • This case report describes a 75 year-old woman who presents with a post-traumatic thoracic aortic pseudoaneurysm (TAPA), approximately 40 years later. Due to the rarity of this condition, no standardized approach exists. We describe the successful treatment of this disease with Carotid-Subclavian bypass followed by thoracic endovascular vascular aortic repair (TEVAR) of the pseudoaneurysm.

    Read Article
  • Patients who have multivessel coronary artery stenosis on catheterization are good candidates for Coronary Artery Bypass Graft because stenting is less efficacious in reducing mortality when involving more than two coronary vessels. We present a patient who complains of chest pain status post coronary artery bypass graft using the left internal mammary artery over 10 years prior. The patient is diagnosed with coronary-subclavian steal syndrome via Doppler ultrasound and catheterization. The patient is treated surgically via carotid distal subclavian/axillary bypass grafting due to extensive stenosis of the subclavian graft.

    Read Article
  • The prevalence of melanoma is on the rise in western society especially as the younger generation ages. Although considered a malignancy of the skin, melanoma can spread to multiple systems throughout the body due to the location of melanocytes in multiple organ systems. Therefore, it is essential for physicians to detect malignant melanoma at the earliest stage in order to decrease the risk of metastasis. We describe a case of a 69-year-old gentleman with a significant past medical history of stage 1a melanoma diagnosed 5 years ago, who presents with multiple nodal masses. The patient is diagnosed with metastatic melanoma after discovery of enhancing lesions on CT imaging of the head, neck, and abdomen confirmed via biopsy of the supraclavicular node. Although the stage 1a melanoma has a low rate of recurrence and metastasis, it is paramount that physicians continue to due serial, thorough dermatologic exams even after successful excision of the primary tumor.

    Read Article
  • The worst fear for any cancer patient to hear is the word metastasis. Melanoma is highly associated with metastasis and the higher the staging, the less likely the patient is to survive. We discuss a 46-year-old gentleman who presents with recurrent pleural effusions and shortness of breath with a previous diagnosis of metastatic melanoma. He had an initial lesion on his deltoid, which was excised with wide margins but was found to have an enlarged lymph node that was confirmed by pathology to be metastatic melanoma. Further diagnostic workup came back normal. Nodular melanoma has a worse prognosis due to lesions having already metastasized by the time of diagnosis. Due to the aggressive behavior, many suggest adjuvant chemotherapy with surgical excision of any lesions.

    Read Article