The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society最新文献

Acute abdominal pain is one of the most common presentations encountered in the emergency department (ED). The differential diagnosis of acute abdominal pain is extensive and identifying the underlying etiology can be challenging. Spontaneous renal artery thrombosis is a rare cause of acute abdominal pain. We review a case of acute presentation of renal artery thrombosis in a patient without risk factors for thromboembolism, and highlight the importance of considering this rare cause of abdominal pain.

Dermoid cysts are largely considered benign, developmental neoplasms that frequently present during childhood. Orbitofacial dermoids represent a unique group of embryologically derived soft tissue masses that often present as localized, well-circumscribed swellings along the embryonal suture lines. Clinical presentation is variable, but in rare instances, may be preceded by local trauma, possibly suggesting an inciting event as the initial stimulus to cyst enlargement. Although dermoid cysts tend to remain clinically benign, their natural history of gradual enlargement necessitates complete surgical excision to prevent complications.

Erythema ab igne is a rare, reticular erythematous hyperpigmentation resulting from repeated thermal injury. We describe our assessment of a 22-year-old woman with bilateral shin discoloration of 3 weeks' duration. Upon questioning, she revealed that she had been standing near a portable heater for extended periods. She was advised to avoid further exposure to the heat source. By the time of a follow-up clinic visit, the discoloration had resolved. Patients with hyperpigmented patches should be questioned about heat exposure. Erythema ab igne can progress to serious dermatologic conditions, but if the cause is eliminated, it usually resolves without medical intervention.

Background: Wegener's Granulomatosis (WG) is classically characterized by the triad of sinonasal, pulmonary, and renal manifestations. However, a growing body of research has demonstrated that atypical head and neck pathologies including retropharyngeal and parapharyngeal lesions are often the presenting feature of patients found to have WG.

Case: This report describes the hospital course of a patient who presented with a parapharyngeal mass with secondary superior cervical chain compression and Lemierre's Syndrome. We discuss how a stepwise approach involving a multidisciplinary team led to the diagnosis of WG.

Conclusions: To our knowledge, this report is the first description of a patient presenting with a parapharyngeal mass causing superior cervical chain compression with simultaneous Lemierre's Syndrome who was ultimately diagnosed with WG. We highlight how the early consideration of WG in patients with atypical head and neck lesions refractory to multiple treatment regimens can led to an expeditious diagnosis and the coordination of appropriate short-term and long-term care.

An MRI of the brain and spine of an 11-year-old male revealed the following abnormality which is consistent with his chronic condition.

Objective: We aimed to characterize utilization of evidence-based health promotion practices not included in Alcohol Withdrawal Syndrome (AWS) guidelines, such as vaccinations and counseling services, hypothesizing that missed opportunities for health promotion intervention would abound.

Methods: Retrospective medical record review of 99 patients presenting to a safety-net academic medical center with AWS between August 1, 2012 and March 31, 2013.

Results: Thiamine replacement (70%), tobacco cessation counseling (28%), influenza or pneumonia vaccination (25% and 28% respectively), psychiatric counseling (70%), referral to alcohol support group or treatment center(40%), and screening for viral hepatitis and HIV (39% and 44%, respectively) were documented by healthcare providers at lower than optimal frequency.

Conclusions: Provision of health promotion interventions was not consistent with evidence-based practices. Integration of these measures into AWS protocols and guidelines could help clinicians provide consistent, cost-effective, evidence- based care.

A 48-year-old female presented to her physician complaining of intermittent lower abdominal pain radiating to the right lower back. At the time of presentation, she was afebrile and denied any urinary symptoms such as dysuria, frequency or urgency. Physical exam was unremarkable, other than obesity, and her abdominal exam was noncontributory. Medical history, however, was notable for recurrent, Proteus mirabilis culture-proven urinary tract infections requiring antibiotic treatment for the prior three years along with hypertension, uterine fibroids post hysterectomy, diabetes and asthma. Complete blood count was within normal limits, and urine dipstick showed 1+ blood, 1+ protein and 2+ leukocytes. Full renal function labs, urine cytology, radioisotope renography and abdominopelvic CT scanning with contrast were all ordered and a laparoscopic right nephrectomy was recommended based on the results. The bisected right kidney is shown below in Figure 1. She was discharged home on post-operative day one and her follow up urology appointments indicate resolution of both her urinary tract infections and her abdominal pain.

Unlike mosquitoes, ticks transmit the broadest range of pathogens, including bacteria, viruses, and parasites. Ticks have capitalized on many competitive advantages offered to them by changes in climate and human lifestyle and a greater abundance of wild animal reservoir hosts no longer effectively controlled. As a result, tick-transmitted coinfections are increasing today with both recognized and newly discovered pathogens that complicate differential diagnosis and antimicrobial treatment. Without the support of immunological and molecular diagnostic techniques, usually only available at federal and some state laboratories, the initial differential diagnosis of tickborne coinfections is complicated and antimicrobial therapy may not cover coinfections. Therefore, the objectives of this review were to identify the newly emerging tickborne pathogens in the United States, to describe the evolving epidemiology of tick-transmitted coinfections, to design a decision tree analysis approach to the clinical diagnosis and management of tickborne coinfections, and to recommend effective strategies for the control and personal prevention of tickborne diseases. Clinicians should suspect tickborne coinfections in returning travelers and vacationers with clinical and immunological evidence of multiple infecting agents, especially in cases of unusual presentation or severity, prolonged duration, or nonresponse to single antibiotic therapy, typically with doxycycline. Decision tree models based on pathogen prevalence rates in ticks and their zoonotic reservoirs may assist clinicians in diagnosing tickborne coinfections and guiding initial antimicrobial therapy.

Unicuspid aortic valve (UAV), which is a rare congenital anomaly, usually presents as aortic stenosis and/or aortic regurgitation. Here we present a case of UAV co-existent with an ascending aortic aneurysm. A 26-year-old male with no significant past medical history presented to the hospital after two episodes of syncope. Transthoracic echocardiogram showed an ejection fraction of 62%, severely stenotic aortic valve, and moderate aortic regurgitation. Computed tomography revealed calcification of the aortic valve, compatible with aortic stenosis and aneurysm of the ascending aorta measuring 4.3 cm in diameter. He underwent successful aortic valve replacement and repair of ascending aortic aneurysm. He recovered well without any complications. This case suggests that any young patient who presents with syncope, aortic stenosis would be a differential and further workup by any available non-invasive modality needs to be performed.

While robotic surgery has seen much success in the treatment of gynecologic malignancies, the technical aspects of this approach raise concern for spreading tumor cells within the peritoneal cavity and to trocar sites. To date, robotic trocar site metastases have been identified following surgery for both endometrial and cervical cancer.