Anterior spinal cord syndrome of unknown etiology.

A spinal cord injury encompasses a physical insult to the spinal cord. In the case of anterior spinal cord syndrome, the insult is a vascular lesion at the anterior spinal artery. We present the cases of two 13-year-old boys with anterior spinal cord syndrome, along with a review of the anatomy and vasculature of the spinal cord and an explanation of how a lesion in the cord corresponds to anterior spinal cord syndrome.

Virtual coaching for the high-intensity training of a powerlifter following coronary artery bypass grafting.

A 55-year-old powerlifter in Tennessee learned about the sport-specific, high-intensity cardiac rehabilitation training available in Dallas, Texas, and contacted the staff by phone. He was recovering from quadruple coronary artery bypass grafting (CABG) and had completed several weeks of traditional cardiac rehabilitation in his hometown, but the exercise program no longer met his needs. He wanted help in returning both to his normal training regimen and to powerlifting competition but was unable to attend the Dallas program in person.

Hairy cell leukemia presenting with a lytic bone lesion.

Hairy cell leukemia (HCL) is an indolent neoplasm of small mature B lymphoid cells with characteristic morphologic features usually involving the peripheral blood, bone marrow, and spleen. It constitutes approximately 2% of adult leukemias and has a male predominance. Patients usually present with weakness, splenomegaly, and pancytopenia.

Sweet syndrome and its association with hematopoietic neoplasms.

The Sweet syndrome, or acute febrile neutrophilic dermatosis, is rare and has characteristic clinical, physical, and pathologic findings: abrupt onset of pyrexia, elevated neutrophil count, tender erythematous skin lesions, and a diffuse infiltrate of mature neutrophils in the reticular dermis with edema in the papillary dermis. The Sweet syndrome can be further classified based on the clinical setting: classical, malignancy-associated, and drug-induced. Diagnosis can alert the clinician to the presence of an underlying malignancy or the recurrence of a malignancy.

Eosinophilic variant of chromophobe renal cell carcinoma.

Chromophobe renal cell carcinoma is a distinct subtype of renal cell carcinoma that accounts for 5% of all renal tumors. This subtype is further subdivided into two variants, classic and eosinophilic, with the latter variant being less frequent. We report two cases of the eosinophilic variant of chromophobe renal cell carcinoma diagnosed at our institution between January 2008 and December 2012.

Hepatic angiosarcoma associated with disseminated intravascular coagulation.

We present a case of hepatic angiosarcoma that presented with disseminated intravascular coagulopathy to highlight the difficulty in diagnosing this disease due its aggressive clinical course, the overlapping features of various coagulopathies, and the nonspecific appearance of angiosarcomas on imaging.

Lobular carcinoma of the breast with gastrointestinal metastasis.

We present the case of a 74-year-old woman with metastatic lobular carcinoma with an occult breast primary presenting as a suspected ampullary tumor due to its ampullary metastasis. The patient's clinical presentation is of interest in two aspects. First, lobular carcinoma of the breast metastatic to the ampulla is extremely rare.

Intracranial germinoma.

Pineal region tumors make up less than 1% of all intracranial neoplasms, with the majority being of germ cell origin. We describe the diagnostic evaluation and treatment of a patient presenting with neurological deficits who was found to have a germinoma of the pineal gland.

The Laugier-Hunziker syndrome.

We describe a 46-year-old Hispanic woman who was incidentally found to have hyperpigmentation of the oral mucosa and nails during a routine full body skin examination. The patient reported having these changes for years with no symptoms. A diagnosis of the Laugier-Hunziker syndrome (LHS) was made.

Second trimester placenta percreta presenting as acute abdomen.

Diagnosing placenta percreta can be difficult. We describe a 41-year-old woman presenting at 21 weeks' gestation with intraabdominal bleeding and no signs of placental abnormality on ultrasound. The disagreement between results of the ultrasound and magnetic resonance imaging made definitive diagnosis difficult.

Metformin-induced lactic acidosis with emphasis on the anion gap.

The presence of an anion gap in a diabetic patient, especially if associated with evidence of compromised renal function, should prompt clinicians to consider metformin as a contributing factor. This consideration is especially important in patients with severe anion gaps associated with lactic acidosis out of proportion to the patient's clinical presentation.

Ascending paralysis associated with HIV infection.

We present two patients with a high viral load of HIV-1 who developed symptoms of ascending paralysis leading to respiratory failure and autonomic instability. One patient had symptom improvement with highly active antiretroviral therapy (HAART) and a subsequent decrease in viral load. The other patient improved with intravenous immunoglobulin therapy and did not show much improvement on HAART alone.

Comparison of length of stay and outcomes of patients with positive versus negative blood culture results.

In the United States, sepsis is the leading cause of death in critically ill patients. The fatality rate for severe sepsis is about 40%, and treatment costs over $16 billion annually. It is critical to identify and treat the source of sepsis.

Impact of Henda's law on the utilization of screening breast magnetic resonance imaging.

Female breast tissue is composed of variable proportions of fat and fibroglandular tissue, and in general, an increased ratio of fibroglandular tissue to fat corresponds to increased mammographic density. Studies suggest that mammographic density is an independent risk factor for breast cancer, and the sensitivity of mammography can be lower with heterogeneously dense or extremely dense breasts. Nineteen states have legal statutes requiring that patients be notified if they have dense breasts, including the state of Texas.

Risk of colon perforation during colonoscopy at Baylor University Medical Center.

Colonoscopy is an important procedure in preventing colon cancer. The risk of colonic perforation during colonoscopy at the Baylor University Medical Center (BUMC) Gastrointestinal Laboratory was chosen as a surrogate marker for the safety of colonoscopy. A recent 2-year experience at BUMC was examined and compared with reports in the medical literature.

Increasing the supply of kidneys for transplantation by making living donors the preferred source of donor kidneys.

At the present time, increasing the use of living donors offers the best solution to the organ shortage problem. The clinical questions raised when the first living donor kidney transplant was performed, involving donor risk, informed consent, donor protection, and organ quality, have been largely answered. We strongly encourage a wider utilization of living donation and recommend that living donation, rather than deceased donation, become the first choice for kidney transplantation.

Painful periostitis in the setting of chronic voriconazole therapy.

A 72-year-old woman on chronic voriconazole therapy for recurrent histoplasmosis developed a painful forearm mass. Laboratory and imaging findings were consistent with a diffuse periostitis. Her symptoms resolved after discontinuation of voriconazole.

Clear cell carcinoma of the ovary associated with increased risk of venous thrombosis.

Clear cell carcinoma of the ovary (CCCO) is an uncommon, clinically aggressive neoplasm that has a propensity for the development of venous thrombosis and embolization, especially when compared to other subtypes of ovarian malignancies. We present a fatal case of a 59-year-old woman with a clinical course complicated by venous thrombosis and pulmonary thromboembolism that was attributed to CCCO discovered initially at autopsy.

Angiolymphoid hyperplasia with eosinophilia.

A patient with multiple erythematous nodules on her posterior scalp presented to our dermatology clinic. Biopsy confirmed the diagnosis of angiolymphoid hyperplasia with eosinophilia. The etiology of this disorder is unclear.

Nontraumatic intracerebral hemorrhage unassociated with arterial aneurysmal rupture as a cause of sudden unexpected death.

Sudden death from intracerebral hemorrhage was observed in two patients admitted to Baylor University Medical Center at Dallas in a single month. Each had been drinking alcohol at the time of onset of first symptoms. Intracerebral hemorrhage was diagnosed in one patient by computed tomography, but not in the second patient who clinically was diagnosed as having acute coronary syndrome.

Syncope secondary to second-degree atrioventricular block with donepezil use.

Donepezil, an acetylcholinesterase inhibitor, is approved for the treatment of mild to moderate dementia secondary to Alzheimer's disease. Although most prescribers are aware of the common gastrointestinal side effects of donepezil, cardiovascular side effects are rarely observed. Cardiovascular side effects of donepezil have almost always been observed in patients with a history of conduction defects or sick sinus syndrome.

Acute myelogenous leukemia at Baylor Charles A. Sammons Cancer Center, 2010 to 2012: retrospective analysis of molecular genetic evaluation.

Over the last several decades, advancements in the understanding of genetic and molecular origins of acute myeloid leukemia (AML) have brought about significant changes in how the disease is classified, diagnosed, and treated. The change from the traditional French-American-British classification system to that of the World Health Organization redefined how the disease is diagnosed not only morphologically but genetically. With genetic information proving to have prognostic value, the newer classification system, which incorporates results of cytogenetic and molecular analyses, allows better definition of disease and risk stratification, ultimately guiding treatment choices.