Sinus Bradycardia as a Rare and Unusual Presentation of Partial Empty Sella Syndrome: A Case Report.

BACKGROUND Empty sella syndrome (ESS) occurs when the pituitary gland becomes flattened or shrinks, which leads to filling of the sella turcica with cerebrospinal fluid. This causes the appearance of empty sella on imaging. ESS is often diagnosed after the workup of pituitary disorders, or as an incidental finding after brain imaging.

Bilirubin Correlation May Preclude MRCP in Acute Cholecystitis Patients With Normal Common Bile Duct Diameter.

In patients with acute cholecystitis (AC), accurate identification of a common bile duct (CBD) stone before cholecystectomy is of concern for surgeons, gastroenterologists, and radiologists. This study evaluates the utility of preoperative MRCP taking into consideration both sonographic findings and biochemical predictors for choledocholithiasis. Fifty-seven patients (58% women; mean age, 54 years old) with signs of AC on right upper quadrant (RUQ) ultrasound (US) who underwent subsequent MRCP from 2007 to 2017 were identified using a text-based search and retrospectively analyzed, using ERCP as the reference standard.

Spontaneous Rectus Sheath Hematoma: An Uncommon Cause of Acute Abdominal Pain.

BACKGROUND A clinical condition that is often misdiagnosed, rectus sheath hematoma (RSH) is usually seen in the context of blunt abdominal trauma and/or anticoagulation therapy, rarely occurring spontaneously. We present a case of spontaneous rectus sheath hematoma (SRSH) without obvious risk factors and review the literature regarding diagnosis modalities and management. The aim of this case presentation is to highlight this rare clinical condition and emphasize the role of the physical exam in determining the appropriate treatment approach.

Superior Vena Cava Syndrome in Conjunction with Pulmonary Vasculature Compromise: A Case Study and Literature Review.

BACKGROUND Superior vena cava (SVC) syndrome can result from external compression or invasion of the vessel from structural pathology within the mediastinum. Here we present a case of a patient that had no airway compromise, but who had hemodynamic instability due to pulmonary vasculature compression requiring urgent intervention. CASE REPORT A 61-year-old male who presented with severe dyspnea was found to have newly diagnosed small cell carcinoma of the right lung.

Atrial septal defect can be easily missed in chromosome 18q deletion syndrome.

The frequency of 18q- is estimated to be approximately 1/40 000 live births and is more commonly associated with certain clinical features including short stature, intellectual disability and malformations of many major organ systems. Congenital cardiac abnormalities are present in 24-36% of cases and screening can prove difficult. A 28-year-old Caucasian female with a history of long arm chromosome 18q deletion was evaluated for persistent dyspnea and decreased activity level.

Sampling Utility of the Convex Probe Endobronchial Ultrasound Visible Intrapulmonary Lesion.

Background: The value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the mediastinal staging of lung cancer has been well established. However, data regarding its utility in the diagnosis of intrapulmonary lesions has been sparse. This study assesses the sampling utility of convex probe EBUS-visible intrapulmonary lesions not visualized by the white-light bronchoscopy.

Collagenous Gastritis in a Young Female With IgA Deficiency.

Collagenous gastritis, without colonic involvement, is exceptionally rare. It is not known to be associated with IgA deficiency and scleroderma. This is the first report of this type of association.

Mixed Connective Tissue Disorder Complicated by Polymyositis, Sjogren's Syndrome, Pleural Effusion and Pericarditis.

We report a case of a 24-year-old female with a history of asthma and gastroesophageal reflux disease (GERD). She presented to the emergency room with severe chest pain, chest tightness, and shortness of breath following an upper respiratory tract infection. The patient reported that she had a cough and runny nose one week prior to this presentation, followed by a sudden sharp pain in the center of the chest 8/10 in intensity on the visual analog scale and pleuritic in nature, which aggravated by deep breathing and lying down flat.

Extra-Adrenal Myelolipoma Containing Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia: A Case Report and Review of the Literature.

Myelolipoma is a benign tumor consisting of mature fat interspersed with hematopoietic elements resembling bone marrow. The vast majority occurs within the adrenal glands, but several cases of extra-adrenal myelolipomas (EAMLs) have been reported. We report a case of a 64-year-old male who presented with complaint of lower abdominal discomfort.

Ewing's sarcoma of the cervix, a diagnostic dilemma: a case report and review of the literature.

Introduction: Ewing's sarcoma belongs to a spectrum of neoplastic diseases known as Ewing's family of tumors. This family of tumors is usually seen in osseous sites. Ewing's sarcoma of the cervix is extremely rare, with only 18 cases reported in the English literature.

Gastric Electrical Stimulation and Sacral Electrical Stimulation: A Long-Term Follow-Up Study of Dual-Device Treatment.

Aims: The objective of this study was to investigate sacral electrical stimulation (SES) and gastric electrical stimulation (GES) by comparing upper and lower gastrointestinal (GI) and genitourinary (GU) symptoms and quality of life, before treatment and in the long term after treatment. We hypothesized that dual-device treatment would greatly improve upper and lower gastrointestinal and genitourinary symptoms, as well as quality of life.

Methods: Fifty-four patients who underwent dual-device treatment (GES and SES) were enrolled in this study.

Initial experience with a dual-balloon catheter for the management of postpartum hemorrhage.

Objective: When uterotonics fail to cause sustained uterine contractions and satisfactory control of hemorrhage after delivery, tamponade of the uterus can be effective in decreasing hemorrhage secondary to uterine atony.

Study Design: These data are from a postmarketing surveillance study of a novel dual-balloon catheter tamponade device, the Belfort-Dildy Obstetrical Tamponade System (ebb).

Results: A total of 57 women were enrolled: 55 women had the diagnosis of postpartum hemorrhage, and 51 women had uterine balloon placement within the uterine cavity.

A first survey. Measuring burnout in emergency medicine physician assistants.

Using the Maslach Burnout Inventory (a device used in prior studies on emergency physicians) and the EMPA Demographic, Work, and Lifestyle Characteristics Survey, we assessed the burnout levels of emergency medicine physician assistants (EMPAs) and the presence of characteristics associated with higher burnout levels. Fifty-nine percent had moderate or high burnout levels on the Emotional Exhaustion subscale; 66% on the Depersonalization subscale; and only 34% on the Personal Accomplishment subscale. Several associations were found between EMPA burnout and individual characteristics, including insomnia and low satisfaction with physician supervision.

Feasibility of epidural morphine for postoperative analgesia in a small community hospital.

The first 6-mo experience of a two-physician APS using primarily epidural morphine in a community hospital is presented. After-hours anesthesia coverage was from home. The only monitoring was by nursing service observation.