Low Back Pain and Swelling as an Atypical Presentation of IgA Vasculitis.

Introduction: Immunoglobulin A vasculitis (IgA vasculitis), formerly Henoch-Schonlein purpura, is the most common vasculitis in children.

Case Report: A 6-year-old female presented with low back pain and swelling, difficulty ambulating, and rash two weeks after a respiratory infection. She was approached with a broad differential and ultimately diagnosed with IgA vasculitis.

Radiograph Interpretation Discrepancies in a Community Hospital Emergency Department.

Introduction: In many hospitals, off-hours emergency department (ED) radiographs are not read by a radiologist until the following morning and are instead interpreted by the emergency physician (EP) at the time of service. Studies have found conflicting results regarding the radiographic interpretation discrepancies between EPs and trained radiologists. The aim of this study was to identify the number of radiologic interpretation discrepancies between EPs and radiologists in a community ED setting.

Gastric Perforation after Chicken Bone Ingestion.

Chicken bone ingestion is a common occurrence that usually passes uneventfully through the digestive tract and rarely results in complications such as perforation, which occurs very rarely within the stomach. We report here a case of a chicken bone ingestion resulting in gastric perforation, which ultimately required surgical correction.

Hemoptysis in Pediatric Patients.

Hemoptysis is defined as the expectoration of blood or blood-tinged sputum. Blood-tinged sputum is a rare finding in the pediatric population. Finding the cause and treatment of the hemoptysis in pediatric patients is largely dependent on the history.

MicroRNA Biomarkers for Patients With Muscle-Invasive Bladder Cancer Undergoing Selective Bladder-Sparing Trimodality Treatment.

Purpose: Trimodality therapy with maximal transurethral resection of bladder tumor and definitive chemoradiation reserving cystectomy for salvage of local recurrence is an accepted treatment alternative to upfront cystectomy for selected patients with muscle-invasive bladder cancer. There is a need for molecular biomarkers to predict which patients will respond to bladder preservation therapy.

Methods And Materials: We sought to identify biomarkers with the ability to predict response to chemoradiation and survival after selective bladder preservation therapy in a cohort of 40 patients using a microRNA profiling approach.

The Effect of a Medical Toxicology Inpatient Service in an Academic Tertiary Care Referral Center.

Introduction: Morbidity and mortality from poison- and drug-related illness continue to rise in the USA. Medical toxicologists are specifically trained to diagnose and manage these patients. Inpatient medical toxicology services exist but their value-based economic benefits are not well established.

Not All Sore Throats Are Pharyngitis.

Presentations to the emergency department (ED) can often appear to be simple and common. Only when a physician begins to think outside the box when confronting what seems to be a simple condition can a life-threatening situation be avoided. This case provides insight into a common chief complaint seen everyday in the ED - "sore throat.

Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal.

Objectives: Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal.

Design: Retrospective observational cohort study.

Obstructive sleep apnea in adults with type 1 and type 2 diabetes: perspectives from a quality improvement initiative in a university-based diabetes center.

Objective: Obstructive sleep apnea (OSA) and diabetes are frequent comorbid conditions. Screening for OSA in patients with diabetes is recommended but the frequency with which this is done in clinical practice is unknown. The objectives of this quality improvement initiative were to identify clinician and patient perceptions regarding OSA and to identify the prevalence of patients at high risk for OSA (HROSA).

Primary retroperitoneal mature cystic teratoma (dermoid cyst) in a 51-year-old male:Case report and historical literature review.

Objectives: Primary retroperitoneal mature cystic teratomas are exceedingly uncommon in males aged 50 years and above, and only seven cases have been reported in the literature so far. They usually occur in infants less than 6 months and young females. The aim of this article is to present a rare case of a 51-year-old male with a primary retroperitoneal mature cystic teratoma located in the right infrarenal area adherent to the psoas muscle and to discuss a historical literature review.

Synchronous single-port access laparoscopic right hemicolectomy and laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy.

Laparoscopic surgery through a single incision is gaining popularity with different stakeholders. The advantages of improved cosmetics, decreased postoperative pain and blood loss continue to attract patients from different surgical fields. Multidisciplinary approach to different surgical entities through a single incision has just been introduced.

Surgical excision outcome after radial scar without atypical proliferative lesion on breast core needle biopsy: a single institutional analysis.

Radial scar (RS) has been recognized as a risk factor for developing breast cancer, and excision is recommended for patients with RS identified on core needle biopsy (CNB). However, recent literatures suggest that the increased risk may be caused by concurrent proliferative lesions on the biopsy, rather than radial scar itself. In this study, we investigated the follow-up excision (FUE) results for patients with RS on CNB with no history of a prior or a concurrent breast cancer or atypical proliferative lesions (APLs).

Case of ischemic colitis in a young adolescent associated with triphasic hormonal contraceptive therapy: a case report and review of the literature.

There has been speculation that third generation hormonal contraceptives may be less prone to inducing clotting than the earlier generation products. We present a case of colonic ischemia in a young adolescent receiving pharmacotherapy with a third-generation hormonal contraceptive. Ischemic colitis is an uncommon adverse effect in young adolescents associated with hormonal contraception, especially the third generation agents.

Door-to-balloon time for primary percutaneous coronary intervention: how does Northern West Virginia compare?

Background: The National Registry of Myocardial Infarction reported that only 4% of patients transferred for primary percutaneous coronary intervention (PCI) achieved the recommendation of a door-to-balloon time of < 90 min.

Objectives: To see if the American College of Cardiologists/American Heart Association (ACC/AHA) guideline of < 90 min door-to-balloon time for primary PCI is being met in a rural area of West Virginia, and compare to the national average.

Methods: A chart review of all cases of emergent primary PCI for ST-segment elevation myocardial infarction (STEMI) performed in the northern panhandle of West Virginia.

Aortic dissection with vascular abnormalities.

A limited number of cases have been reported in the medical literature in which aortic dissection occurs with an aberrant right subclavian artery and a common carotid trunk. The authors report the case of a 59-year-old man who presented to the emergency department with sudden onset pain of 30 minutes duration on the right side of the buttocks. After presentation, the patient developed chest pain, which radiated to the back.

Multiple subcutaneous mycetomas caused by Pseudallescheria boydii: response to therapy with oral potassium iodide solution.

We describe the case of a sixteen-year-old male who presented with multiple subcutaneous mycetomas proven on culture to be secondary to Pseudallescheria boydi., The lesions responded completely to oral potassium iodide solution. To our knowledge this has never been reported in humans.

Candida endophthalmitis: focus on current and future antifungal treatment options.

Candida endophthalmitis is a sight-threatening manifestation of disseminated candidiasis. The occurrence of endogenous candida endophthalmitis in patients with candidemia has ranged from 0-45% in the published literature. In critically ill patients, it has even been associated with increased mortality.