Biliary Cyst: An Unusual Cause of Cholestasis Post Cholecystectomy.

Biliary cysts are relatively uncommon and they can be congenital or acquired and can have various presentations such as cholelithiasis, cholangitis, jaundice, and pancreatitis. Biliary cysts are associated with a high risk of biliary cancers and such risk increases with age. Identification of biliary cysts warrants an aggressive approach to lower cancer risk.

Pneumomediastinum and Pneumorrhachis Associated With Cannabinoid Hyperemesis Syndrome.

More complications continue to be reported with the increasing use of marijuana (MJ) in the United States, including the increasing prevalence of Cannabinoid Hyperemesis Syndrome (CHS). To our knowledge, based on a thorough review of the literature, we present the third case of CHS with associated pneumomediastinum (PM) and the first case of pneumorrhachis (PR) in a young healthy patient. The main objective of this paper is to heighten awareness of CHS and its potential complications.

Case Reports of Heroin Injection Site Necrosis: A Novel Antecedent of Nicolau Syndrome.

Heroin injection-site necrosis (HISN) is a novel and poorly understood complication of intravenous drug abuse (IVDA). We present three cases of HISN that were evaluated and treated in Charleston, West Virginia, in 2019 and 2020. The documented cases show similarities involving patient care, follow-up, clinical progression, patient demographic, and dermatologic sequelae.

The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience.

Interest in ultrasound education in medical schools has increased dramatically in recent years as reflected in a marked increase in publications on the topic and growing attendance at international meetings on ultrasound education. In 2006, the University of South Carolina School of Medicine introduced an integrated ultrasound curriculum (iUSC) across all years of medical school. That curriculum has evolved significantly over the 9 years.

Diabetic ketoalkalosis in children and adults.

Objectives: Diabetic ketoacidosis (DKA) with metabolic alkalosis (diabetic ketoalkalosis [DKALK]) in adults has been described in the literature, but not in the pediatric population. The discordance in the change in the anion gap (AG) and the bicarbonate is depicted by an elevated delta ratio (DR; rise in AG/drop in bicarbonate), which is normally approximately 1. The primary aim of this study was to determine whether DKALK occurs in the pediatric population, as has been seen previously in the adult population.

Perioperative management of diabetes and hyperglycemia in patients undergoing orthopaedic surgery.

Persons with diabetes undergo more surgical procedures, have a higher perioperative risk of complications, and have longer hospital stays than do persons who do not have diabetes. Persons with diabetes are frequently overweight, have a high prevalence of cardiovascular risk factors, and are more likely to suffer from chronic musculoskeletal conditions and traumatic injuries that require orthopaedic attention. Surgery frequently disrupts usual diabetes management, requiring adjustments to the treatment regimen.

The Heimlich maneuver: breaking down the complications.

The very young and the very old are vulnerable to choking, and there are over 4000 choking-related deaths annually in the United States. Complications from the Heimlich maneuver (HM), as reported in infrequent case reports, predominantly relate to the elderly. It is doubtful that the denominator, numerator, appropriateness, expertise, and problems of maneuvers applied to choking victims will ever be known.

Mycobacterium chelonae vertebral osteomyelitis.

Mycobacterium chelonae is a rapidly growing mycobacterium (RGM) in Runyon group IV. This group includes all other nontuberculous mycobacterium (NTM) except the mycobacterium tuberculosis complex. The most commonly infected organ by RGM is the lung, usually in immunosuppressed patients or those with underlying lung disease.

Osteogenesis imperfecta and aortic dissection.

Osteogenesis imperfecta (OI) is a group of autosomal dominant disorders affecting Type I collagen synthesis with the predominant clinical manifestations in skeleton, skin, eyes, and teeth. Valvular cardiac manifestations and aortic root changes have long been reported. However, aortic dissection and repair were not described until 1993, with only 3 more proximal aortic dissections and repair noted.

A case of pellagra and a South Carolina history of the disorder.

This case raises many questions about pellagra in the 21st century. Why are so few cases diagnosed in industrialized societies? Are physicians and other health care providers overlooking many cases? Should we treat any "sick" person and those with unexplained skin, mental status changes or gastrointestinal complaints with safe, inexpensive doses of niacin? Should an inexpensive, reliable laboratory test for pellagra be developed? Clearly the quote, "if you keep pellagra in mind, you will recognize it when you see it" is valid. But perhaps that is not sufficient and pellagra is frequently invisible.

Anabolic steroid use among adolescents in a rural state.

Background: Anabolic-androgenic steroid use is an increasing problem among high school students. Previous reports have been mainly from metropolitan areas.

Methods: We report the first study of anabolic-androgenic steroid use to concentrate on rural communities.

Large soft tissue tumor of the chest occurring after trauma.

The unusual soft tissue tumor we have described may be the largest yet reported. The tumor was considered benign, and its histologic features were most consistent with fibromatosis arising in a region that had been previously traumatized. Although the patient is doing well, it is premature (2 years later) to conclude that the tumor will not recur.

Cardiac conduction manifestations of Reiter's syndrome.

This study shows that conduction abnormalities may occur frequently in Reiter's syndrome of new onset or short duration. Since these conduction defects may be initially life threatening or may progress to life-threatening abnormalities, anyone with RS should be followed up. Because of the strong association between RS and HIV infection, we suggest HIV testing for all patients with RS.

Self-mutilation resulting in bacterial meningitis.

Self-mutilation and particularly self-destructive dermatoses are not usually life-threatening. This case involves a man who met the DSM-III R diagnostic criteria for delusional (paranoid) disorder, somatic type. His destructive behavior involving the face and scalp resulted in osteomyelitis and pneumococcal meningitis.

Tracheal carinal angle and left atrial size.

Left atrial enlargement is a significant finding, usually indicating elevated left ventricular end-diastolic pressure. An increased tracheal carinal angle has been reported as one indicator on chest radiography of left atrial enlargement. This study retrospectively compared echocardiographically determined left atrial size with carinal angle on plain films.

Effectiveness of low-dose lovastatin in lowering serum cholesterol. Experience with 56 patients.

This study reviews the progress of 56 consecutive patients with type IIa and IIb hyperlipoproteinemia following treatment with lovastatin. Lovastatin, a potent inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, has been shown to have a cholesterol-lowering effect in doses ranging from 10 to 80 mg/d. Thus far, however, no large study has been performed to show the effectiveness of low-dose lovastatin (20 mg/d) for more than a 6-week duration.

Sudden Death: Myocardial Infarction in a Runner With Normal Coronary Arteries.

In brief: Sudden death during or following exercise is a dramatic event. In people over 40 years of age, coronary artery disease Is implicated in nearly 90% of exercise-related deaths. For those under 30 years of age, hypertrophic cardiomyopathy, abnormal coronary arteries, and coronary artery disease are the largest contributors.

Endurance athletes: physiologic changes and nonorthopedic problems.

The current increased participation in long distance running and endurance events brings new challenges to the physician. Adaptive changes of exercise must be differentiated from disease states. Left ventricular hypertrophy, Wenckebach rhythm, elevated creatine kinase (myocardial fraction), gastrointestinal bleeding, hematuria, hemoglobinuria, amenorrhea, and apparent anemia may all be exercise related.