Friedmanmccollum5913

This is an interesting cardiovascular imaging and coronary angiography case of a 67-year-old female patient who presented with chest pain, abnormal electrocardiogram (EKG), and heart failure who was subsequently found to have spontaneous coronary artery dissection (SCAD) and Takotsubo cardiomyopathy (TCM) on imaging studies. Desferrioxamine B The case presentation highlights the importance of imaging studies and prompt diagnosis in these patients. This study may also highlight the need for early medical intervention in patients with suspected systolic dysfunction due to either of these pathophysiologic processes.A 48-year-old lady presented with a parotid mass found to be secondary to recurrent sialadenitis. She was also found to have microcytic anemia, renal dysfunction, an elevated gamma gap, and an isolated alkaline phosphatase elevation. Later, she developed altered mental status and shock, and was found to have adrenal insufficiency, pulmonary hypertension, and pulmonary nodules. A liver biopsy was consistent with amyloid deposition. The constellation of findings was consistent with systemic amyloid A (AA) amyloidosis secondary to recurrent sialadenitis with hepatic, renal, pulmonary, and adrenal involvement. The patient later passed away due to acute hypoxic respiratory failure. This case demonstrates rare sequelae of systemic AA amyloidosis of pulmonary hypertension and adrenal insufficiency.Lemierre's syndrome is a rare but life-threatening condition characterized by an oropharyngeal infection typically secondary to Fusobacterium necrophorum resulting in septic thrombophlebitis of the internal jugular vein. Streptococcus intermedius is a particularly rare cause of Lemierre's syndrome with only a few cases reported in the literature. Here we describe a rare case of Lemierre's syndrome, caused by Streptococcus intermedius, likely secondary to an odontogenic infection, found to have a cervical epidural abscess with concomitant large retropharyngeal and prevertebral abscesses on presentation, in whom the clinical course was further complicated by an extensive cerebral venous sinus thrombosis. However, despite grave complications, early diagnosis and appropriate emergency management including intravenous antibiotics and surgical intervention led to a successful recovery, thus demonstrating that aggressive measures can potentially lead to a favorable outcome.Ventriculoperitoneal shunt catheter migration is a rare but documented complication. The exact mechanism of this occurrence is not well understood. We report the case of an 81-year-old male who initially presented with symptoms consistent with normal pressure hydrocephalus. A ventriculoperitoneal shunt was placed uneventfully. Four months later, the patient presented complaining of a persistent headache despite multiple adjustments in the shunt setting. Shunt series radiographs demonstrated the distal catheter passing through the superior vena cava and looping into the right cardiac atrium and ventricle. Catheter retrieval was attempted from a proximal retroauricular incision but required a combination of snare technique by interventional radiology and, ultimately, surgical venotomy by a cardiothoracic surgeon. The distal catheter was replaced in the abdomen, and the patient had no further complications. This case is the first of its kind reported in the literature that includes a treatment team comprising neurosurgery, interventional radiology, and cardiothoracic surgery. We highlight the importance of a multidisciplinary approach to best address the migrated catheter.Introduction Multiple barriers have been described for reducing opioid prescribing by primary care providers. We describe a quality improvement report on the effects of a series of focused interventions on opioid prescribing after the release of the Centers for Disease Control and Prevention (CDC) guidelines while monitoring patient satisfaction. Material and methods The study began as an intervention project to inform and educate providers about the CDC's guidelines and to improve adherence. A convenience sample of 165 providers from 33 outpatient clinics of a healthcare system was utilized. This quality improvement study compared a 20-month preintervention baseline period with a 16-month post-intervention period ending on December 31, 2017, using the health system's electronic medical record. Interrupted time series analysis was used to assess the effect of the intervention on opioid prescribing. Providers were given quarterly individual reports on their prescribing patterns of schedule II opioids and compatterns, and seeking physicians' collaboration. Future healthcare initiatives can utilize similar methods to evaluate interventions impacting the opioid epidemic.A 36-year-old female presented with lethargy, anorexia, nausea, hyperpigmentation, weight loss and amenorrhea for six months. On examination, she had hyperpigmentation of face, hands and oral mucosa. Investigations revealed adrenal insufficiency and subclinical hyperthyroidism with elevated anti-thyroid peroxidase antibodies. Adrenal insufficiency in combination with Grave's disease and/or type 1 diabetes mellitus occurs in type 2 autoimmune polyglandular syndrome. It is a polygenic disorder occurring due to mutations in the human leukocyte antigen complex on chromosome 6. The patient was treated with oral hydrocortisone which led to improvement in all the symptoms.Fracture of the capitellum is a rare injury, accounting for about 1% of the fractures around the elbow. We report the case of a young adult with elbow pain and swelling presenting to us three weeks after the injury. Radiographs suggested a comminuted fracture of the capitellum extending medially to the trochlea. Using the anterolateral approach to the elbow, an open reduction and internal fixation of the fracture with screws was done. The procedure had an excellent functional outcome. Through this case report, we aim to highlight the importance of radiographic assessment and decision-making regarding the surgical approach and choice of the implant in the treatment of comminuted capitellar fractures.The emergence of immune checkpoint inhibitors (ICIs) in recent years has transformed the landscape of the management of solid tumors. The advancement of immunotherapy has resulted in a brand new set of adverse outcomes not previously seen in classical chemotherapy. One such adverse effect has been termed as hyperprogressive disease (HPD), a phenomenon characterized by rapid tumor progression, which often leads to devastating outcomes. In this report, we present a unique case of a 48-year-old African American female who initially presented with abdominal pain, fatigue, and weight loss. Subsequent CT scan showed extensive irregular wall and luminal narrowing with an eccentric mass and adenopathy along the portacaval space. Tumor markers were found to be elevated and genetic testing was done. The patient was diagnosed with stage IIIC colon cancer with K-RAS wild type, associated with Lynch syndrome. The patient underwent surgical resection, chemotherapy, and targeted therapy for progressive/stage IV disease. In light of the progression of the disease, pembrolizumab was introduced into the treatment regimen.