Hemorrhagic Cervical Synovial Cyst With Atypical Chest Pain Presentation.

Cervical synovial cysts are rare, especially hemorrhagic cervical synovial cysts. The patient was a 58-year-old male with a five-month history of tingling in his right shoulder region, radicular pain in his right arm, and increased pain on the right chest wall that worsened with lying supine down. The patient was diagnosed with a right-sided hemorrhagic synovial cyst at the C7-T1 level.

Acute Necrotizing Pancreatitis Leading to Hemosuccus Pancreaticus and Hemorrhagic Shock in the Setting of Decompensated Cirrhosis.

Hemosuccus pancreaticus (HP) is a rare, life-threatening cause of upper gastrointestinal bleeding, often linked to chronic pancreatitis and pseudoaneurysm rupture into the pancreatic duct. However, its occurrence in acute necrotizing pancreatitis with decompensated cirrhosis is exceedingly rare and poses significant diagnostic and treatment challenges. We report a case of a 34-year-old male with decompensated alcoholic cirrhosis who developed hemorrhagic shock from HP following acute necrotizing pancreatitis.

Dame Cicely Saunders: Pioneering Palliative Care and the Evolution of Hospice Services.

Dame Cicely Saunders was a pioneer in palliative care and the founder of the modern hospice movement. Her visionary work, particularly in establishing St. Christopher's Hospice in 1967, reshaped the way healthcare professionals approach the care of patients with life-limiting illnesses.

Carotid Cavernous Fistula and Its Association With Spine Surgery: A Case Report.

A carotid cavernous fistula (CCF) is a disruption in the carotid arteries within the cavernous sinus. The pooling of blood in the sinus causes a myriad of neurological deficits. When correctly diagnosed, this condition can be easily managed through surgical intervention.

Precocious Puberty as a Unique Presentation of Hepatoblastoma in a Pediatric Patient: A Case Report.

Hepatoblastoma is a rare pediatric cancer. Hepatoblastoma typically presents asymptomatically with an enlarging abdominal mass but can be associated with paraneoplastic secretion of beta-gonadotropin leading it to present like peripheral precocious puberty. This case highlights a rare initial presentation of hepatoblastoma as precocious puberty in a two-year-old patient who presented with persistent abdominal and genital pain.

Personalized Cutoffs for the Diagnosis of Neutropenic Fever Based on Patients' Baseline Body Temperature: A Retrospective Pilot Study.

Background The management of neutropenic fever patients remains challenging. Patients' individual baseline body temperature may provide diagnostic and prognostic value. Methods This study is a retrospective analysis of 92 adults admitted for neutropenic fever to model the length of stay (LOS) and the ability to find a definitive diagnosis using the deviation of patients' temperature on admission from their outpatient baseline, acuity on admission, neutropenia level and persistence, fever persistence, and patients' age.

Severe Cardiopulmonary Complications and Stroke in a Patient With HIV and Chronic Substance Abuse: A Case Report.

This case report presents a 37-year-old male with a complex medical history, including HIV, chronic methamphetamine and cocaine use, and an atrial septal defect, who developed severe pulmonary arterial hypertension (PAH), biventricular failure, and recurrent stroke. The patient was admitted with acute neurological deficits and respiratory failure, which rapidly progressed despite intensive management. Laboratory and imaging studies revealed severe cardiac dysfunction and elevated pulmonary vascular resistance.

Amniotic Fluid Embolism After Cervical Ripening.

Amniotic fluid embolism (AFE) is a rare condition that can have catastrophic maternal and infant consequences. It can lead to rapid multisystem failure and is responsible for a significant portion of maternal deaths. The diagnosis is frequently made late in the pathological process, and the treatment is mainly supportive and infant delivery.

A Case of Pediatric Internal Hernia Heralded by Constipation.

Meckel's diverticulum (MD) is the most common gastrointestinal congenital anomaly of the small intestine. A small subset of patients with MD develops a mesodiverticular band (MDB), creating a snare-like opening and the potential for internal hernias (IHs). IHs are a known possible cause of small bowel obstructions and are most common in adults post bariatric surgery.

An Incidental Case of Sarcoidosis in a Young Male Patient Presenting With Symptomatic Chronic Cholecystitis.

Sarcoidosis is a multisystem disease process with a bimodal distribution typically affecting African American women and those of Scandinavian descent characterized by noncaseating granulomatous disease. We present a case of a 29-year-old African American male patient who was seen in the clinic for recurrent symptomatic cholelithiasis. He had no past medical history or symptoms besides intermittent postprandial right upper quadrant (RUQ) pain with imaging confirming cholelithiasis.

Effect of Clonidine on Duration of High-Volume, Low-Concentration Caudal Epidurals.

Introduction: Caudal blocks are a common pediatric regional anesthesia technique used to alleviate intra- and postoperative pain following circumcision. The addition of the alpha-2 agonist clonidine has been shown to increase the duration of the block. Another method for prolonging the effect of the block is using a high-volume, low-concentration (HVLC) local anesthetic in the caudal solution.

Coping With the Crash: Intraoperative Management of Ventricular Wall Rupture During Coronary Artery Bypass Graft Surgery.

Left ventricular (LV) free wall rupture is a rare and often fatal complication of an acute myocardial infarction. We report the case of an LV free wall rupture after the induction of general anesthesia in an elderly woman who presented for a coronary artery bypass graft (CABG) procedure in the setting of an inferior wall ST elevation myocardial infarction (STEMI) four days prior. This case emphasizes both the differential diagnosis for and the management of refractory hypotension.

A Comparative Study of Radiation Dose From Chest CT Scan Examinations in Two Imaging Centers in Duhok Province, Kurdistan, Iraq.

Background CT is among the most widely used diagnostic imaging techniques worldwide, providing significant advantages and invaluable diagnostic insights for detecting a wide range of diseases across various organs. However, it involves exposing patients to relatively high levels of ionizing radiation. Objective This study aims to document the radiation doses from chest CT scans performed at Azadi Teaching Hospital in Duhok Province and compare them with those recorded at the 3-Tesla Center for Advanced MRI and CT Scanning, also located in Duhok, using diagnostic reference levels (DRLs) as a benchmark.

Traumatic Cystic Artery Pseudoaneurysm After Transjugular Liver Biopsy: A Case Report.

Cystic artery pseudoaneurysms are a rare but life-threatening entity that commonly occurs as a sequela to acute cholecystitis. We present a case of a 52-year-old male with a past medical history of decompensated alcoholic liver cirrhosis who underwent a transjugular liver biopsy (TJLB) after correction of his baseline coagulopathy. On post-operative day one, the patient had significant blood loss with an inappropriate response to blood transfusions and without an identifiable source of bleeding.

Analysis of Orthopaedic Surgery Residency Match Results: 2016 to 2022.

: Objective data examining match trends and applicant characteristics are in high demand given the stakes involved with the orthopaedic surgery match. Our study sought to analyse the trends among matched orthopaedic surgery applicants to clarify how medical students can best prepare for and assess their chances of a successful orthopaedic residency match. : We used the publicly available National Residency Matching Program (NRMP) tool to gather characteristics for matched and unmatched orthopaedic surgery applicants from 2016 to 2022 and compare the probability of matching for all applicants versus each subgroup of reported applicant characteristics using risk difference (RD) and two-tailed p-values.

Rotavirus-Associated Myocarditis in an Immunocompetent Adult: A Case Report.

A previously healthy, 28-year-old man presented with a two-day history of diarrhea and chest pain, suggestive of infectious myocarditis. Initial workup revealed elevated troponin-I levels and diffuse ST-segment elevations on electrocardiogram (ECG). Transthoracic echocardiography showed a reduced left ventricular ejection fraction (40-45%), posteroinferior wall akinesis, and a small pericardial effusion.

Evolving Treatment Strategies for Systemic Lupus Erythematosus in Clinical Practice: A Narrative Review.

Systemic lupus erythematosus (SLE) is an autoimmune disease that more commonly affects African American people, although it is seen in people of all racial backgrounds. This condition is characterized by a dysregulated immune response resulting in widespread inflammation. Clinical manifestations caused by this inflammation include arthritis, anemia, cutaneous rashes, pleuritis, and nephritis.

Surgical Obliteration of a Filum Terminale Arteriovenous Fistula Following Aborted Endovascular Embolization: Illustrative Case Report and Literature Review.

Arteriovenous fistulas of the filum terminale are rare vascular malformations that predominantly affect males and can present with various neurological symptoms. In this study, we indexed previously published cases of filum terminale arteriovenous fistulas demonstrating that endovascular and microsurgical management are both proven to be appropriate and successful treatment modalities with low complication rates. Endovascular treatment is far less invasive; however, it is associated with higher failure rates, which need to be managed surgically.

Masquelet Technique in the Management of Segmental Bone Defect of the Ulna: A Case Report.

Surgeons periodically encounter challenging clinical scenarios that require them to develop nuanced management strategies to achieve the best outcome for the patient. This is especially true in medically underserved patient populations, where follow-up and proper recovery protocols are often not accomplished. In this report, we discuss the case of a 26-year-old female with a history of medical non-compliance who presented to the emergency department with signs and symptoms of surgical site infection two months following the repair of her comminuted ulna fracture caused by a gunshot wound.

Single-Nucleotide Polymorphisms in Thrombotic Thrombocytopenic Purpura: A Genetic Predisposition to Immune Thrombotic Thrombocytopenic Purpura.

There are two main classifications for thrombotic thrombocytopenic purpura (TTP): immune and hereditary. The majority of TTP cases are immune in nature and are due to inhibitor autoantibodies against ADAMTS13. Hereditary TTP is caused by biallelic pathogenic variants in the ADAMTS13 gene.

Improving Advanced Care Planning Discussions at an Internal Medicine Clinic.

Objective: The project aimed to standardize advanced care planning (ACP) at an internal medicine clinic by initiating physician-patient communication regarding the patient's knowledge, understanding, and openness to pursuing advanced medical directives.

Methods: Data collection was conducted from February 1 to April 1, 2024, with the study concluding on April 24, 2024. ACP was facilitated through an initial standardized six-question pre-intervention survey in both English and Spanish.

Repeat GammaTile Brachytherapy in the Long-Term Management of Recurrent High-Grade Glioma: A Case Report.

Over the past two decades, despite the emergence of various novel therapies for glioblastoma, patient survival outcomes remain poor, particularly in the recurrent stage of the disease. Cesium-131 (Cs-131) brachytherapy presents a promising treatment option for patients with newly diagnosed and recurrent brain neoplasms, enabling the initiation of radiation therapy at the time of tumor resection. This approach eliminates the typical delay in therapy following surgery and the need for multiple return visits for fractionated external beam radiotherapy.

Efficacy of Acetazolamide for Treatment of Iatrogenic, Traumatic, and Spontaneous Cerebrospinal Fluid Leaks of the Anterior Skull Base: A Systematic Review.

A cerebral spinal fluid (CSF) leak from the anterior skull base is a challenging neurosurgical issue that requires prompt recognition and treatment. Options for treatment include medical and surgical repair. A systematic review was performed screening for both retrospective and prospective clinical studies evaluating the efficacy of acetazolamide in the event of CSF leaks of the anterior skull base.

Trimethoprim-Sulfamethoxazole-Induced Pancytopenia: A Case Report.

Pancytopenia is defined as a decrease in all three myeloid cell lines, usually from a precipitating factor such as an autoimmune condition, prescription drug, or several other factors. The etiology of pancytopenia can be determined through laboratory testing, a peripheral blood smear, and a thorough history and physical examination. Trimethoprim-sulfamethoxazole (TMP/SMX, also known by the brand name of Bactrim® or Septra®) is known to cause pancytopenia in rare cases.

Atraumatic Fracture of Newer Generation Ceramic Head Three Days Post-op: A Case Report.

A 73-year-old female experienced an atraumatic fracture of a BIOLOX delta ceramic femoral head following uncomplicated right total hip arthroplasty using a ceramic-on-polyethylene bearing. The fracture occurred post-operatively, as revealed by radiography after the patient reported a clunking sensation and leg shortening. Revision surgery involved replacing the fractured head and liner with careful removal of ceramic debris.