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Recognition of suicide risk factors in patients presenting with psychotic illness is of the utmost importance. In their study, the authors identified two important issues in the cohort of patients who died of unnatural causes/suicide, highlighting a need for clinicians to be aware of these risk factors and make efforts to establish a therapeutic relationship, providing appropriate support to patients to help them to develop an awareness of their suicide risk and to empower them to resist their suicidal thoughts. [ABSTRACT FROM AUTHOR]

Fibroadenomas are benign breast masses that often occur in adolescence and young adulthood. Primary management options include observation or surgical excision, but little is known about long‐term outcomes after fibroadenoma excision in adolescents. In the present study, we reviewed the medical records of females aged 13‐35 years who underwent fibroadenoma excision at our institution from 1986 through 2010. Patients were included if they had excision of at least 1 fibroadenoma (confirmed by histopathology) smaller than 5 cm in maximal diameter. We collected information pertaining to clinical presentation, management, and outcomes. In addition, an investigator‐designed long‐term outcome survey was sent to 138 eligible participants to assess patient satisfaction, as well as the recurrence of fibroadenoma, and the need or desire for further surgical intervention. Most patients (126 of 138) underwent 1 operation for fibroadenoma excision. Three women underwent immediate breast reconstruction at fibroadenoma excision. Fifty‐seven patients completed the investigator‐designed survey (response rate, 41.3%) with a median follow‐up time of 13.5 (range, 2.0‐26.7) years. Nine of 55 patients (16.4%) reported postoperative breast asymmetry and the desire to pursue reconstructive surgery. Three survey responders reported breast pain. Fourteen of 56 women (25.0%) reported the diagnosis of 1 or more additional fibroadenomas after the initial excision; another 7 reported recurrence of the mass at the site of excision. Most survey participants were satisfied with the aesthetic outcome of their fibroadenoma excision; however, a small proportion believed that they would benefit from reconstructive breast surgery. The recurrence and development of additional fibroadenomas should be addressed by providers during counseling for treatment options and postoperative follow‐up. [ABSTRACT FROM AUTHOR]

Introduction Thyroid ultrasound (US) is a widely used tool for evaluating thyroid nodules. Various US features have been suggested as predictors of thyroid cancer in children. Objective To conduct a systematic review and meta-analysis to assess the diagnostic accuracy of different thyroid US features in detecting thyroid cancer in children. Methods We searched multiple online databases for cohort studies that enrolled paediatric patients with thyroid nodules (age <21 years) and evaluated the accuracy of 12 relevant ultrasound features. Diagnostic measures were pooled across studies using a random effects model. Results The search strategy yielded 1199 citations, of which 12 studies met the predefined inclusion criteria (750 nodules). The prevalence of thyroid cancer was 27·2% (40·8% in patients with a history of radiation exposure and 23·2% in patients without a history of exposure to radiation). The most common cancer was papillary thyroid cancer (86·7%). The presence of internal calcifications and enlarged cervical lymph nodes were the US features with the highest likelihood ratio [4·46 (95% CI: 1·87-10·64) and 4·96 (95% CI: 2·01-12·24), respectively] for thyroid cancer. A cystic nodule was the feature with highest likelihood ratio for benign nodules [1·96 (95% CI: 0·87-4·43)]. Conclusion Thyroid US features are not highly accurate predictors of benign or malignant aetiology of thyroid nodules in children. Internal calcification may predict malignancy, and cystic appearance may suggest benign aetiology. [ABSTRACT FROM AUTHOR]

A case study is presented of a 14 year-old female presented with breast cysts rapidly enlarging with replacement of breast parenchyma and asymmetry. Ultrasound of the abdomen and pelvis excluded cyst development in other organs; and bilateral skin sparing mastectomy was performed with angiography. She was treated of diffuse cystic changes with periductal fibrosis and ductal hyperplasia.