{"title":"Robotic Dorsal-Onlay Urethroplasty: A Case Report","authors":"Amjad Alwaal, MD, James C. Jensen, MD","doi":"10.21885/wvmj.2018.17","DOIUrl":"https://doi.org/10.21885/wvmj.2018.17","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80052965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peripartum cardiomyopathy, or pregnancy-associated cardiomyopathy, is the development of left ventricular dysfunction usually occurring during the last trimester of pregnancy, shortly after delivery, or five months postpartum. As a result of the cardiovascular strain of pregnancy, patients who have developed peripartum cardiomyopathy, particularly those with persistent left ventricular dysfunction, are strongly advised against subsequent pregnancies. If a subsequent pregnancy should occur in the setting of a diminished left ventricular ejection fraction, the risk of fetal and maternal morbidity and mortality increases significantly. This case describes a 25-year-old Caucasian female patient who became pregnant eighteen months after developing peripartum cardiomyopathy. The association between barriers to adequate care and increased development of peripartum cardiomyopathy in both a rural and global setting has been recognized by several researchers. Literature has shown that expectant mothers from underserved areas, those of African descent and those who smoke, have hypertension, or use cocaine carry a greater risk of developing peripartum cardiomyopathy. Therefore, in addition to the related complications of peripartum cardiomyopathy, practitioners in underserved areas with high-risk populations should be aware of the risk factors and pathophysiologic manifestations inherent with the disease.
{"title":"Revisiting Peripartum Cardiomyopathy: A Subsequent Pregnancy","authors":"Amanda Krauss, MS-IV, Barker, MD Barker, MD, Kaitlin McGrogan, DO, Adam Franks, MD","doi":"10.21885/wvmj.2018.16","DOIUrl":"https://doi.org/10.21885/wvmj.2018.16","url":null,"abstract":"Peripartum cardiomyopathy, or pregnancy-associated cardiomyopathy, is the development of left ventricular dysfunction usually occurring during the last trimester of pregnancy, shortly after delivery, or five months postpartum. As a result of the cardiovascular strain of pregnancy, patients who have developed peripartum cardiomyopathy, particularly those with persistent left ventricular dysfunction, are strongly advised against subsequent pregnancies. If a subsequent pregnancy should occur in the setting of a diminished left ventricular ejection fraction, the risk of fetal and maternal morbidity and mortality increases significantly. This case describes a 25-year-old Caucasian female patient who became pregnant eighteen months after developing peripartum cardiomyopathy. The association between barriers to adequate care and increased development of peripartum cardiomyopathy in both a rural and global setting has been recognized by several researchers. Literature has shown that expectant mothers from underserved areas, those of African descent and those who smoke, have hypertension, or use cocaine carry a greater risk of developing peripartum cardiomyopathy. Therefore, in addition to the related complications of peripartum cardiomyopathy, practitioners in underserved areas with high-risk populations should be aware of the risk factors and pathophysiologic manifestations inherent with the disease.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85432892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
**Introduction:** There have only been 9 cases of Spigelian hernias containing incarcerated vermiform appendix in the medical literature. Prior to our case, only one other case was diagnosed with ultrasound. **Case Report:** We report an ultrasound guided diagnosis of an incarcerated appendix within a Spigelian hernia in a 72-year-old female. Ultrasound expedited the patient’s care by avoiding CT scan protocol. Upon laparoscopic evaluation the appendix was visualized within the hernia and photographed, we converted to an open appendectomy with a hernia repair without mesh to avoid contamination. She did very well post operatively and had no signs of recurrence or other complications several months after the operation. **Conclusion:** Incarcerated appendix within Spigelian hernia is a once in a lifetime experience for a general surgeon. Ultrasound has been shown now in two reported cases to assist in the diagnosis of this rare entity. Tissue repair as we performed for this type of hernia avoids the risk of infected mesh.
{"title":"Ultrasound Assisted Diagnosis of Incarcerated Appendix in Spigelian Hernia.","authors":"Shane W Monnett, B. Dyer","doi":"10.21885/wvmj.2018.15","DOIUrl":"https://doi.org/10.21885/wvmj.2018.15","url":null,"abstract":"**Introduction:** There have only been 9 cases of Spigelian hernias containing incarcerated vermiform appendix in the medical literature. Prior to our case, only one other case was diagnosed with ultrasound.\u0000**Case Report:** We report an ultrasound guided diagnosis of an incarcerated appendix within a Spigelian hernia in a 72-year-old female. Ultrasound expedited the patient’s care by avoiding CT scan protocol. Upon laparoscopic evaluation the appendix was visualized within the hernia and photographed, we converted to an open appendectomy with a hernia repair without mesh to avoid contamination. She did very well post operatively and had no signs of recurrence or other complications several months after the operation. \u0000**Conclusion:** Incarcerated appendix within Spigelian hernia is a once in a lifetime experience for a general surgeon. Ultrasound has been shown now in two reported cases to assist in the diagnosis of this rare entity. Tissue repair as we performed for this type of hernia avoids the risk of infected mesh.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"18 1","pages":"5118"},"PeriodicalIF":0.0,"publicationDate":"2018-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78484242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transient intussusception is a rare condition and often presents a unique diagnostic challenge to healthcare providers. Although intussusception is generally a disease of infancy, it has been described in older individuals as well, where it may often present with an array of non-specific gastrointestinal symptoms. Diagnosis may often require imaging and laparoscopy. We present an unusual case of an adolescent male who was admitted to our facility with symptoms of an acute abdomen and was eventually diagnosed with transient small bowel intussusception.
{"title":"Transient Jejunojejunal Intussusception in an Adolescent Patient","authors":"Charles B. Chen, C. Vijay","doi":"10.21885/WVMJ.2018.13","DOIUrl":"https://doi.org/10.21885/WVMJ.2018.13","url":null,"abstract":"Transient intussusception is a rare condition and often presents a unique diagnostic challenge to healthcare providers. Although intussusception is generally a disease of infancy, it has been described in older individuals as well, where it may often present with an array of non-specific gastrointestinal symptoms. Diagnosis may often require imaging and laparoscopy. We present an unusual case of an adolescent male who was admitted to our facility with symptoms of an acute abdomen and was eventually diagnosed with transient small bowel intussusception.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"11 1","pages":"5046"},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80674503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Susac syndrome is a neurological condition which affects the brain, the eyes and the ears, hence presenting with a triad of encephalopathy, sensorineural hearing loss and branch retinal artery occlusion. It is a very rare condition. Only about 300 cases of Susac syndrome have been reported. It is theorized that Susac syndrome has an immunologic basis. This case report aims to add its share to the limited number of cases of Susac syndrome seen worldwide. This case report sheds light on a Caucasian woman diagnosed with Susac syndrome in West Virginia. The patient presented to the ER with syncope and altered mental status. The MRI showed multiple infarcts involving corpus callosum. Differential diagnoses were ruled out and she was started on intravenous methylprednisolone and intravenous immunoglobulin to treat her condition.
{"title":"Microangiopathy of the Brain, Eyes and Ears: A Case Report","authors":"Ahmad Mumtaz, M. Ward, M. T. Khan","doi":"10.21885/wvmj.2018.12","DOIUrl":"https://doi.org/10.21885/wvmj.2018.12","url":null,"abstract":"Susac syndrome is a neurological condition which affects the brain, the eyes and the ears, hence presenting with a triad of encephalopathy, sensorineural hearing loss and branch retinal artery occlusion. It is a very rare condition. Only about 300 cases of Susac syndrome have been reported. It is theorized that Susac syndrome has an immunologic basis. This case report aims to add its share to the limited number of cases of Susac syndrome seen worldwide. This case report sheds light on a Caucasian woman diagnosed with Susac syndrome in West Virginia. The patient presented to the ER with syncope and altered mental status. The MRI showed multiple infarcts involving corpus callosum. Differential diagnoses were ruled out and she was started on intravenous methylprednisolone and intravenous immunoglobulin to treat her condition.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"80 1","pages":"4809"},"PeriodicalIF":0.0,"publicationDate":"2018-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85737595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leah Stalnaker, MD, Cornelius Thomas, MD, Suzanne Holroyd, MD
The pathogenesis of bipolar disorder is multi-factorial and not fully understood, having polygenetic inheritance which may cause changes in neurotransmitter systems and dysfunction of fronto-limbic neuronal circuits. We aim to present a case which supports the hypothesis that right hemispheric hypofunctioning may contribute to the pathogenesis of bipolar disorder. Our manuscript includes a case of a 62-year-old male with new onset mania following resection of right sided temporal oligodendroglioma, suggesting that the hypofunctioning of this hemisphere may have lead to increased blood flow and activation of the left hemisphere.
{"title":"Late Onset Mania after the Removal of Right Anterior Temporal Lobe Oligodendroglioma","authors":"Leah Stalnaker, MD, Cornelius Thomas, MD, Suzanne Holroyd, MD","doi":"10.21885/wvmj.2018.11","DOIUrl":"https://doi.org/10.21885/wvmj.2018.11","url":null,"abstract":"The pathogenesis of bipolar disorder is multi-factorial and not fully understood, having polygenetic inheritance which may cause changes in neurotransmitter systems and dysfunction of fronto-limbic neuronal circuits. We aim to present a case which supports the hypothesis that right hemispheric hypofunctioning may contribute to the pathogenesis of bipolar disorder. Our manuscript includes a case of a 62-year-old male with new onset mania following resection of right sided temporal oligodendroglioma, suggesting that the hypofunctioning of this hemisphere may have lead to increased blood flow and activation of the left hemisphere.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73175281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Casey, J. W. Urian, Danielle B. Lancaster, J. Yoost
Marshall Teen Talk is an established, successful afterschool program that teaches reproductive health to high school students in McDowell County using telehealth. This study focuses on the expansion of this program involving the addition of online reproductive health modules on the program website (www.marshallteentalk.org). The purpose of this study was to identify if the use of online modules contributed to overall reproductive health knowledge among a group of high school students. Topics covered in the afterschool telehealth sessions and online modules included Anatomy, Relationships, Birth Control, and STD prevention. Knowledge scores were measured by a set of 20 reproductive health questions given as a pre and post test before and after the program. Thirty-five students voluntarily participated in at least one telehealth session and/or online module. The majority of students who completed the modules liked the format and found the information to be easily understood. The differences in overall knowledge scores were significantly improved from pre to post test (14.38 vs 17.14, p<0.001), however, the completion of the online modules did not contribute significantly to an improvement in reproductive health knowledge.
马歇尔青少年谈话是一个成功的课后项目，通过远程医疗向麦克道尔县的高中生传授生殖健康知识。本研究的重点是扩大该方案，包括在方案网站(www.marshallteentalk.org)上增加在线生殖健康模块。本研究的目的是确定在线模块的使用是否有助于一组高中生的整体生殖健康知识。课后远程医疗会议和在线模块涵盖的主题包括解剖学、人际关系、生育控制和性病预防。知识得分是通过一组20个生殖健康问题来衡量的，这些问题是在项目前后进行的前后测试。35名学生自愿参加了至少一次远程保健会议和/或在线模块。完成模块的大多数学生都喜欢这种格式，并且发现信息很容易理解。总体知识得分的差异从测试前到测试后显著改善(14.38 vs 17.14, p<0.001)，但在线模块的完成对生殖健康知识的改善没有显著贡献。
{"title":"Teaching Reproductive Health through Telehealth Sessions and Online Modules to Rural High School Students","authors":"E. Casey, J. W. Urian, Danielle B. Lancaster, J. Yoost","doi":"10.21885/wvmj.2018.10","DOIUrl":"https://doi.org/10.21885/wvmj.2018.10","url":null,"abstract":"Marshall Teen Talk is an established, successful afterschool program that teaches reproductive health to high school students in McDowell County using telehealth. This study focuses on the expansion of this program involving the addition of online reproductive health modules on the program website (www.marshallteentalk.org). The purpose of this study was to identify if the use of online modules contributed to overall reproductive health knowledge among a group of high school students. Topics covered in the afterschool telehealth sessions and online modules included Anatomy, Relationships, Birth Control, and STD prevention. Knowledge scores were measured by a set of 20 reproductive health questions given as a pre and post test before and after the program. Thirty-five students voluntarily participated in at least one telehealth session and/or online module. The majority of students who completed the modules liked the format and found the information to be easily understood. The differences in overall knowledge scores were significantly improved from pre to post test (14.38 vs 17.14, p<0.001), however, the completion of the online modules did not contribute significantly to an improvement in reproductive health knowledge.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"234 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89033000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew S. Martin, MD, J. Cottrell, MD, Michael V. Korona Jr, MD, FACR, David G. Chaffin, MD, FACGO
BACKGROUND: Headache is often the only presenting symptom of subarachnoid hemorrhage. Its incidence in pregnancy of 5 per 100,000 is dwarfed by more common, benign causes of headache, complicating diagnosis. CASE: We presented a 41 year old at 38 weeks 5 days gestational age that presented local hospital reporting a “terrible brain freeze” after eating ice cream. After transfer of care to a tertiary care center a non-contrast computed tomography scan revealed subarachnoid blood layering in the basal cistern suspicious for sequelae of aneurysm rupture. After a cesarean section was performed the patient was transported to the interventional radiology suite where rupture of a 3mm left paraopthalmic artery aneurysm was confirmed and coiled. A non-ruptured 4mm right paraopthalmic artery aneurysm was also diagnosed. The patient was moved to the Intensive Care Unit in stable condition following the procedures and was discharged post-op day 7. She returned one month later for coiling of the right paraopthalmic artery. CONCLUSION: Headaches during pregnancy can indicate a variety of disease processes. Subarachnoid hemorrhage has high morbidity and mortality for mother and fetus making prompt diagnosis and treatment crucial. This case highlights the safety and importance of prompt cranial imaging in pregnancy when clinically appropriate.
{"title":"An “Ice Cream Headache” in a Term Gravida: A Case Report","authors":"Andrew S. Martin, MD, J. Cottrell, MD, Michael V. Korona Jr, MD, FACR, David G. Chaffin, MD, FACGO","doi":"10.21885/wvmj.2018.9","DOIUrl":"https://doi.org/10.21885/wvmj.2018.9","url":null,"abstract":"BACKGROUND: Headache is often the only presenting symptom of subarachnoid hemorrhage. Its incidence in pregnancy of 5 per 100,000 is dwarfed by more common, benign causes of headache, complicating diagnosis.\u0000\u0000CASE: We presented a 41 year old at 38 weeks 5 days gestational age that presented local hospital reporting a “terrible brain freeze” after eating ice cream. After transfer of care to a tertiary care center a non-contrast computed tomography scan revealed subarachnoid blood layering in the basal cistern suspicious for sequelae of aneurysm rupture. After a cesarean section was performed the patient was transported to the interventional radiology suite where rupture of a 3mm left paraopthalmic artery aneurysm was confirmed and coiled. A non-ruptured 4mm right paraopthalmic artery aneurysm was also diagnosed. The patient was moved to the Intensive Care Unit in stable condition following the procedures and was discharged post-op day 7. She returned one month later for coiling of the right paraopthalmic artery. CONCLUSION: Headaches during pregnancy can indicate a variety of disease processes. Subarachnoid hemorrhage has high morbidity and mortality for mother and fetus making prompt diagnosis and treatment crucial. This case highlights the safety and importance of prompt cranial imaging in pregnancy when clinically appropriate.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78472062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam Franks, MD, Kevin McCann, MD, Melissa Saab, MD, Kathryn Bell, MD
{"title":"Chronic Fatigue Syndrome through Postural Orthostatic Tachycardia Syndrome to Hypermobile Ehlers Danlos Syndrome: a Journey Through Unclear Diagnoses","authors":"Adam Franks, MD, Kevin McCann, MD, Melissa Saab, MD, Kathryn Bell, MD","doi":"10.21885/wvmj.2018.8","DOIUrl":"https://doi.org/10.21885/wvmj.2018.8","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74425635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An Unusual Cause of Isolated Fundal Gastric Varix","authors":"Fahad Chaudhary, MD, Hiren Vallabh, MD, Sardar Momin Shah-Khan, MD, Anshu Mahajan, MD","doi":"10.21885/wvmj.2018.7","DOIUrl":"https://doi.org/10.21885/wvmj.2018.7","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74792052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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