Spinal cord ependymoma presenting with neurological deficits in the setting of trauma.

Ependymomas represent 4% of all primary central nervous system neoplasms in adults, with 30% occurring in the spinal cord. We describe a young man with neurological deficits following a motor vehicle accident who was found to have an intramedullary cervicothoracic ependymoma.

Basilar artery thrombosis in the setting of antiphospholipid syndrome.

Antiphospholipid syndrome is an autoimmune disorder characterized by arterial or venous thrombosis, recurrent first-trimester pregnancy loss, and multiple additional clinical manifestations. We describe a man with severe atherosclerotic basilar artery stenosis and superimposed in situ thrombus who was found to have antiphospholipid syndrome.

Function of the ligamentum teres in limiting hip rotation: a cadaveric study.

Purpose: The purpose of this cadaveric study was to evaluate the function of the ligamentum teres (LT) in limiting hip rotation in 18 distinct hip positions while preserving the capsular ligaments.

Methods: Twelve hips in 6 fresh-frozen pelvis-to-toes cadaveric specimens were skeletonized from the lumbar spine to the distal femur, preserving only the hip ligaments. Hip joints were arthroscopically accessed through a portal located between the pubofemoral and iliofemoral ligaments to confirm the integrity of the LT.

Relationship between enhanced intensity of contrast enhanced ultrasound and microvessel density of aortic atherosclerostic plaque in rabbit model.

The aim of this study was to evaluate the relationship between enhanced intensity of contrast enhanced ultrasound and microvessel density of aortic atherosclerotic plaque in rabbit model. The abdominal aortas of thirty-six male New Zealand rabbits were damaged by balloon expansion and the animals were then fed a high fat diet for 12 weeks. Twenty-seven plaques on the near aortic wall were detected using conventional ultrasound examination.

Ethical issues regarding related and nonrelated living organ donors.

The ethics of the clinical practice of transplanting human organs for end-stage organ disease is a fascinating topic. Who is the "owner" of the transplantable organs of a deceased, brain-dead patient? Who should have a right to receive these organs? Who set the boundaries between a living donor's autonomy and a "paternalistic" doctor? What constitutes a proper consent? These questions are only some of the ethical issues that have been discussed in the last 60 years. All of these ethical issues are intensified by the fact that supply of human organs does not match demand, and that, as a consequence, living-donor organ transplantation is widely utilized.

Imaging manifestations of a dreaded obstetric complication in the immediate postpartum period.

HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome is a dreaded complication that may develop during pregnancy or in the immediate postpartum period. Rarely this syndrome manifests itself with imaging findings. We report a case of HELLP syndrome in which the diagnosis was reaffirmed via imaging findings.

Renal failure due to Capnocytophaga canimorsus generalized Shwartzman reaction from a dog bite (DF-2 nephropathy).

We report a case of a 54-year-old man who developed gram-negative sepsis with multiorgan failure and generalized Shwartzman reaction after sustaining a dog bite. The causative organism was the fastidious gram-negative rod Capnocytophaga canimorsus, which is a commensal organism found in the oral flora of dogs and cats. More than 30 years after it was first described and despite technological advances in identification techniques, proper identification of this organism remains a challenge.

Methemoglobinemia precipitated by benzocaine used during intubation.

Methemoglobinemia is a rare cause of tissue hypoxia that can quickly become fatal without immediate recognition and prompt treatment. It refers to an increase in methemoglobin in the red blood cells, which can be due to genetic deficiency of the enzymes responsible for reducing hemoglobin or can develop after exposure to oxidizing agents or xenobiotics. Local anesthetics, particularly benzocaine, have long been implicated in the formation of methemoglobin.

Fatal abdominal hemorrhage associated with gallbladder perforation due to large gallstones.

Gallbladder perforation is a relatively uncommon complication of acute cholecystitis and may occur with or without gallstones. Prophylactic cholecystectomy has been recommended for patients with very large stones (>3 cm) due to an increased risk of gallbladder cancer. We present the case of a 68-year-old woman who died of hemorrhagic shock following gallbladder perforation due to very large gallstones.

Triple-hit lymphoma.

We report a case of a triple-hit lymphoma in a 72-year-old man. This lymphoma was diagnosed using morphology, flow cytometry, immunochemistry, and cytogenetics. Since many triple-hit lymphomas have not been documented in the literature, it is important to bring attention to this entity, as this lymphoma has different prognostic and therapeutic implications than other diffuse large B-cell lymphomas, thus making a correct and early diagnosis important.

Bilateral diaphragmatic paralysis associated with the use of the tumor necrosis factor-alpha inhibitor adalimumab.

A 51-year-old woman was referred for evaluation of progressive dyspnea of 3 months- duration. She had received 3 doses of adalimumab for treatment of rheumatoid arthritis prior to the onset of her dyspnea. Her chest examination revealed absent diaphragmatic movement with inspiration.

Opsoclonus myoclonus syndrome: an unusual presentation for West Nile virus encephalitis.

A record number of West Nile virus (WNV) cases and fatalities seen in 2012 have brought to light the numerous manifestations of neuroinvasive disease. We report a case of opsoclonus myoclonus syndrome attributed to WNV and its clinical course after treatment with a combination of steroids and intravenous immunoglobulin. Our objective is to highlight opsoclonus myoclonus syndrome as a potential manifestation of WNV encephalitis.

Impact of a surveillance screening program on rates of methicillin-resistant Staphylococcus aureus infections with a comparison of surgical versus nonsurgical patients.

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of health care-associated infection. The overall effectiveness of surveillance screening programs is not well established. A retrospective cohort study was performed to evaluate the impact of a surveillance screening program on the rates of health care-associated MRSA infection (HA-MRSA-I) at a single institution.

Validation of Rules of Two™ as a paradigm for assessing asthma control.

Assessing asthma control at each patient encounter is an essential task to determine pharmacologic requirements. Rules of Two (Ro2) was created from the original 1991 National Asthma Education Program guidelines to determine the need for controller therapy. This study determined the degree of agreement between Ro2 and the Expert Panel Report (EPR-3) definition of "in control" asthma and compared that value with the Asthma Control Test (ACT) in a group of asthmatics for the purpose of validating this tool.

Epidemiology, treatment patterns, and outcomes of metastatic soft tissue sarcoma in a community-based oncology network.

Purpose. To assess epidemiology, treatment patterns, and outcomes of metastatic soft tissue sarcoma (mSTS) patients in USA community oncology practices. Methods.

The role of mammalian target of rapamycin inhibitors in the management of post-transplant malignancy.

Post-transplant malignancies, which occur either de novo or as cancer recurrences, are due to chronic exposure to immunosuppressive agents and are often more aggressive than those that develop in the non-transplant setting. Mammalian target of rapamycin (mTOR) inhibitors have antitumor and immunosuppressive effects. The dual effects of this class of agents may provide adequate immunosuppression to prevent organ rejection while simultaneously reducing the risk of post-transplant malignancy.

Anti-tumor efficacy of ultrasonic cavitation is potentiated by concurrent delivery of anti-angiogenic drug in colon cancer.

This study investigated the efficacy of concurrent delivery of an anti-angiogenic drug and ultrasonic cavitation therapy in a mouse model of human colon cancer. A biotinylated form of the anti-angiogenic drug Endostar was conjugated to a streptavidin-coated microbubble (MB). Mice bearing subcutaneous tumors (HT29) were divided into 4 groups.

Evidence for instant blood-mediated inflammatory reaction in clinical autologous islet transplantation.

A nonspecific inflammatory and thrombotic reaction termed instant blood-mediated inflammatory reaction (IBMIR) has been reported when allogenic or xenogenic islets come into contact with blood. This reaction is known to cause significant loss of transplanted islets. We hypothesized that IBMIR occurs in patients undergoing total pancreatectomy followed by autologous islet transplantation (TP-AIT) and tested this hypothesis in 24 patients and in an in vitro model.

Comparison of force exerted on the sternum during a sneeze versus during low-, moderate-, and high-intensity bench press resistance exercise with and without the valsalva maneuver in healthy volunteers.

Sternal precautions are intended to prevent complications after median sternotomy, but little data exist to support the consensus recommendations. To better characterize the forces on the sternum that can occur during everyday events, we conducted a prospective nonrandomized study of 41 healthy volunteers that evaluated the force exerted during bench press resistance exercise and while sneezing. A balloon-tipped esophageal catheter, inserted through the subject's nose and advanced into the thoracic cavity, was used to measure the intrathoracic pressure differential during the study activities.

Infective endocarditis superimposed on a massively calcified severely stenotic congenitally bicuspid aortic valve.

We describe a 55-year-old man who presented with a stroke resulting from active infective endocarditis (IE) involving a heavily calcified bicuspid aortic valve. The case highlights the infrequency of IE involving a heavily calcified valve, the inability of the infection to penetrate the calcific deposits, and the ability of the infection to spread to the adjacent soft tissues, leading to ring abscess and its multiple complications.

Mucocele of the appendix.

Mucocele of the appendix is a term used to describe a dilated, mucin-filled appendix. It is most commonly the result of epithelial proliferation, but can be caused by inflammation or obstruction of the appendix. Two cases of mucocele of the appendix are presented with a discussion of the histologic and radiologic features as well as the surgical management.

Multicentric Castleman's disease and HIV.

Multicentric Castleman's disease (MCD) is a rare lymphoproliferative disorder found with a higher frequency in HIV-seropositive patients. Human herpes virus 8 is found in virtually all cases of HIV-associated MCD. The majority of cases of MCD in patients with HIV are also associated with Kaposi's sarcoma.

Smooth muscle neoplasms of the vulva masquerading as Bartholin gland duct cysts.

Smooth muscle neoplasms of the vulva can be mistaken for Bartholin duct cysts, which can lead to a delay in diagnosis. We present a case of vulvar leiomyoma and a case of leiomyosarcoma that clinically mimicked Bartholin duct cysts. Identification of leiomyosarcomas in this region is particularly important; due to the risk of recurrence, patients may need radiation and/or chemotherapy in addition to adequate surgical treatment and appropriate follow up.

Systemic mastocytosis with associated acute myelogenous leukemia.

Systemic mastocytosis (SM) is a condition associated with a clonal neoplastic proliferation of mast cells. Approximately 40% of patients with SM present with an associated clonal hematological non-mast cell lineage disorder. Patients presenting with SM-acute myeloid leukemia (AML) have the worst prognosis.