Cullendamgaard5033

We present a case of a 55-year-old poorly controlled diabetic who presented to the hospital with facial pain, ophthalmoplegia, vision changes, and diabetic ketoacidosis and was diagnosed with rhinocerebral mucormycosis due to Rhizopus microsporus. He was started on liposomal amphotericin B and micafungin and went for nasal endoscopy and debridement, but the infection had progressed through the base of the skull and he received the maximum tolerated debridement. Posaconazole was added and discontinued due to elevated liver chemistry tests and was replaced with oral isavuconazole. After 6 weeks of therapy with liposomal amphotericin B and isavuconazole, he was switched to oral isavuconazole monotherapy. He underwent 30 sessions of hyperbaric oxygen therapy. Imaging showed improvement with subsequent biopsies that were negative for mucormycosis. At 13 months of therapy, his monotherapy was discontinued. He continues to have long-term sequelae including left facial droop and inability to close his left eye.Synovial chondromatosis (SC) is a benign metaplastic proliferation of cartilaginous nodules within the synovial membrane. Primary SC, though a rare monoarticular disease, significantly impacts patients' functional and pain-related outcomes. We outline the case of a 52-year-old man who presented with a large mass on the volar-ulnar aspect of his left wrist. Biopsy and workup revealed SC of the distal radio-ulnar joint. Though most cases of SC can be managed with arthroscopic or intralesional resection of the mass, a subset of extremely aggressive cases of SC may ultimately fail intralesional resection. Patients must be counseled about the possibility of amputation as an ultimate treatment option for the resolution of their pain and symptoms.Actinomycosis is an uncommon, chronic granulomatous disease caused by the filamentous, gram-positive bacterium Actinomyces israelii. It causes indolent, painful wound infections commonly presenting with oral-cervicofacial manifestations, but other infections of the chest wall and gastrointestinal and genital tract are also seen. A high level of suspicion is required for diagnosis, as it may be missed or mistaken for malignancy. Severe cases may involve the central nervous system and require surgical intervention. We present a case report of actinomycosis causing a brain abscess.Syphilis is a multisystem disease caused by the spirochete Treponema pallidum. Among various organs affected, liver involvement is seen infrequently and can be missed. Here we present a case of hepatitis due to secondary syphilis that completely resolved with penicillin G therapy.Cholangiocarcinoma is one of the most lethal tumors because of its complex location and lack of good chemoradiotherapy options. When it is diagnosed, urgent intervention is needed, often involving radical surgical resection. It generally presents as a liver mass with biliary obstruction. We discuss the case of a young patient presenting with liver dysfunction and imaging mimicking a liver mass concerning for cholangiocarcinoma, where he actually had a liver infarct from splanchnic venous thrombosis from primary myelofibrosis.We report a rare case of gastroschisis with extracorporeal liver suspected on late first trimester ultrasound and confirmed with second trimester ultrasound and magnetic resonance imaging in one fetus in a twin pregnancy. Liver herniation is common in omphalocele, a membrane-covered abdominal wall defect associated with other congenital anomalies. However, it is highly uncommon in gastroschisis, an uncovered abdominal wall defect aside of the cord insertion. Presence of liver herniation complicates prenatal differentiation between omphalocele and gastroschisis. The twins were born at 31 weeks' gestation due to preterm labor. The baby was treated with a silo device, followed by biologic mesh and a wound vac with instillation of fluid to prevent desiccation. Ultimately, the baby died of sepsis, with multiorgan failure and polymicrobial infection.Renal angiomyolipomas are the most common benign tumors of the kidneys. They are prone to rupture, which may result in massive hemorrhage and often requires lifesaving nephrectomy. Delay in treatment is likely to result in death. We report two cases of ruptured angiomyolipoma compressing the renal parenchyma, causing secondary hypertension (Page kidney). Both patients presented with abdominal pain, hypertension, and reduced or dropping hemoglobin counts. The delay in diagnosis and treatment resulted in their adverse outcomes. We highlight the need to promptly diagnose and treat symptomatic renal hematomas to avoid subsequent morbidity and mortality.Pancreaticopleural fistula is an extremely rare complication of pancreatitis. We present a case of pancreaticopleural fistula in a patient with recurrent acute pancreatitis who presented with right-sided symptomatic pleural effusion. Pancreatic sphincterotomy and pancreatic duct stenting led to resolution of pleural effusion and withdrawal of the chest tube within 3 weeks.Full-thickness skin grafts are a commonly used reconstructive method following Mohs micrographic surgery. The literature varies on the most appropriate methods of suturing and securing grafts as well as best practices to dress the graft postoperatively. Our objective was to review various approaches to management of full-thickness skin grafts, including suturing the graft, securing the graft, and topical emollient use on the graft postoperatively. It was found that absorbable sutures, plain gut, provide preferable outcomes with full-thickness skin grafts. The tie-over bolster is the most-used method for securing skin grafts after placement, although several other methods have demonstrated efficacy, including the polyurethane foam, sandwich, and quilting suture methods. While various topical emollients are used in the immediate postoperative period, plain white petrolatum is the least likely to form allergic contact dermatitis.Baylor Scott & White Health Central Texas displayed the diversity and growth of scholarly pursuits during Scholars Day, which debuted online on May 7, 2021. Residents and fellows, medical students, nurses, and research staff were among those showcasing their scholarly activity in areas such as medical innovation, clinical vignettes, research, and quality improvement. A selection of Scholar Day abstracts is presented here.Contrast-associated acute kidney injury (CA-AKI) is a well-known complication following angiography. Peripheral angiograms have been delayed or canceled for fear of worsening renal function leading to dialysis dependence. With the emergence of preventive measures, it is hypothesized that the risk of CA-AKI may be lower than previously observed. We performed a retrospective chart review of a single surgeon's 118 cases who underwent angiographic procedures from September 2019 through August 2020, recording patient characteristics and serum creatinine values. This cohort was comprised of 65 (55%) men and had a median age of 69 years [quartile 1 = 60, quartile 3 = 75]; 55 (47%) had diabetes mellitus and the median estimated glomerular filtration rate was 64 [45, 84] mL/min/1.73 m2. We observed a statistically significant decrease in paired serum creatinine (-0.02 mg/dL) following the procedure, and only 4 patients (3.4%) developed CA-AKI, with older age and elevated baseline creatinine being associated with reduced kidney function. We did not detect an adverse relationship between contrast volume and CA-AKI. While CA-AKI continues to be a concern for patients who require peripheral angiographic procedures, this study found the overall risk to be low. This may be partly attributable to the use of pre- and postprocedure hydration protocols and lower contrast volumes.Systemic inflammation seen in inflammatory bowel disease (IBD) may cause electrophysiological changes in the atria leading to atrial fibrillation (AF). We analyzed data from the National Inpatient Sample for 2018 to identify all adult hospitalizations with a primary diagnosis of IBD, which were further divided based on the presence or absence of AF. The primary outcome was inpatient mortality while the secondary outcomes included inpatient complications, mean length of stay, and mean total hospital charge. We identified 92,055 IBD hospitalizations, of which 3900 (4.2%) had AF and 88,155 (95.8%) served as controls. IBD hospitalizations with AF were older (70.9 vs. 45.0 years, P less then 0.001) and had a higher association with comorbidities compared to the non-AF cohort. Furthermore, the AF cohort had significantly higher adjusted odds of inpatient mortality (2.05% vs. 0.24%; adjusted odds ratio 2.07; 95% confidence interval [CI] 1.09-3.90; P = 0.025), longer length of stay (6.5 vs. 4.9 days; incidence rate ratio 1.23; 95% CI 1.14-1.33; P less then 0.001), and higher total hospital charge ($14,587 vs. $11,475; incidence rate ratio 1.26; 95% CI 1.15-1.38; P less then 0.001). Additionally, complications such as acute respiratory failure, pulmonary embolism, and necessity of blood product transfusion were more common for IBD hospitalizations with AF than those without.This study aimed to assess gender differences in hospitalization incidence, 30-day mortality, and 30-day readmission rates for acute myocardial infarction (AMI) in a Southwestern US medical center. Hospital billing records for AMI admissions were compiled from January 2013 to June 2019, resulting in a sample size of 2394. Billing data included gender, age, principal procedure, insurance status, principal diagnosis, and race/ethnicity. Multivariate logistic regression was used to estimate gender differences in mortality after adjustment for the aforementioned factors. Men were hospitalized for AMI over twice as frequently, yet women had higher AMI mortality than men (9.3% vs. 6.1%, P  less then  0.01). Female AMI patients were older on average and slightly less likely to undergo percutaneous transluminal coronary angioplasty than men. Thirty-day readmission rates did not differ by gender. In absolute terms, AMI hospitalizations and deaths are larger in number in men, but AMI hospitalizations more frequently end in death in women.In stroke patients, a high neutrophil-to-lymphocyte ratio (NLR) has been associated with poor functional outcome at 3 months, higher mortality, and a higher hemorrhagic transformation. We assessed the role of NLR in patients with acute ischemic stroke who received thrombolysis. find more The charts of 98 patients treated between 2015 and 2019 were retrospectively reviewed. The mean NLR was compared using an independent Student's t test. At 3 months, a good functional outcome was seen in 31 patients (32%) and a poor functional outcome was seen in 67 patients (68%). Patients with NLR >2.39 had a poor functional outcome (odds ratio 2.7; 95% confidence interval 1.11-6.39; P  less then  0.02). Our study revealed that patients who present with acute ischemic stroke and have an increased NLR at the time of administration of thrombolysis have a poor functional outcome at 3 months.Cannabis is the most commonly consumed recreational drug in the world. As more states legalize cannabis use in some form, the incidence of cannabinoid hyperemesis syndrome (CHS) is expected to rise. CHS is a constellation of symptoms including severe cyclical nausea and vomiting and epigastric or periumbilical abdominal pain as a result of long-term cannabis use. Recognizing the diagnosis and educating patients on the benefits of cessation is essential, as these patients often undergo extensive and repeated evaluations in the clinic, emergency department, and inpatient setting that could be avoided with extensive history taking and early recognition of the syndrome. In this study, we compared costs incurred by patients in various settings to determine if there is a difference between patients with and without CHS. Although there were not statistically significant cost differences between groups for all cost categories, it is clear that patients with CHS consume considerably more health care dollars than patients who deny cannabis use, and obtaining a detailed social history is imperative to prevent unnecessary workups and increased financial burden on the health care industry.