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

{"title":"Spontaneous Spinal Epidural Hematoma Report.","authors":"Sunil Kukreja,&nbsp;Anil Nanda","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We report a case of spontaneous spinal epidural hematoma in a 12-year-old female, who presented with significant upper and lower extremities weakness preceded by pain around the neck and shoulder girdle. Magnetic resonance imaging revealed epidural hematoma extending from C6-T2 with characteristic heterogeneously hyperintensity on T2 and homogenously isointensity on T1. Emergent spinal decompression was performed. However, the patient remained substantially weak in her lower extremities and was wheelchair bound at 3 months postoperatively. We have discussed clinical features, predisposing events, pathogenesis and treatment guidelines described in the literature. We also aim to reinforce the notion of keeping a high degree of clinical suspicion to identify and intervene at the earliest stage to prevent the physically and socially challenging consequences of SSEH. </p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":"168 4","pages":"140-2"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34366576","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":"Retroperitoneal Hematoma Causing Peritoneal Dialysis Catheter Malfunction.","authors":"Alison A Smith,&nbsp;Adam N Fonseca,&nbsp;Mihran V Naljayan,&nbsp;Anil S Paramesh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>We present the unusual complication of peritoneal dialysis catheter dysfunction in a patient who developed a retroperitoneal hematoma following an endoscopic procedure and review the existing literature regarding this rare complication.</p><p><strong>Case report: </strong>A 60-year-old male with end stage renal disease presented with PD catheter dysfunction. A computerized tomography scan of his abdomen showed a large left retroperitoneal hematoma. He underwent a diagnostic laparoscopy and PD catheter revision. The retroperitoneal hematoma had ruptured into the peritoneum with clots clogging the catheter. Clots were evacuated and the catheter was flushed. He restarted on low--volume PD three days after surgery and increased to full-volume within a week with no further issues.</p><p><strong>Conclusions: </strong>This case summarizes the unusual complication of a retroperitoneal bleed from an endoscopic procedure which manifested as PD catheter dysfunction. The increasing utilization of PD catheters requires surgeons remain aware of potential complications.</p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":"168 4","pages":"137-9"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34366575","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":"Reconsidering Olanzapine as a Possible Culprit for Drug Fever, defying \"Incomplete Neuromalignant Syndrome\".","authors":"Alan Georges,&nbsp;Mary Jo Fitz-Gerald","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This case is important because it is the first time Olanzapine-induced fever has been described in the absence of neuroleptic malignant syndrome. In the context of the available antipsychotics with the atypical agents dominating the pool, only few of those are known to be well tolerated among the patients. Fever may be looked at by the physicians as a minor problem yet, it can be disabling to the large set of patients. Fever was not considerably listed as one of the side effects for Olanzapine and should not be confused with the incomplete neuromalignant syndrome. </p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":"168 4","pages":"123-4"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34366568","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":"Katrina Kinetics: The Physician Supply.","authors":"Perry Gardner Rigby,&nbsp;Ramnaryan Paragi Gururaja","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the aftermath of Hurricane Katrina 10 years ago, acute changes were recognized and reported; acute kinetic destruction and desperation. Physicians performed heroically, but after the flood and the closing of hospitals, most left at least briefly. The chronic recovery began with spirit, but was uncharted and unplanned with the recognition that individual decisions were a necessity. The documentation of physician numbers of practicing doctors, residents and fellows, from the AMA as related to geography, population, and other circumstances tells an additional story of renewal, more objectively without the hype. The fall and rise of the physician population occurred, and was and is remarkable in its consistency, smaller than expected variations. Its effect generated promise for continuous chronic conditions of recovery and positive change. </p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":"168 4","pages":"132-6"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34366571","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":"ECG of the Month: Subtle ECG Change in a 31 Year-Old Man with Recent Chest Pain.","authors":"D Luke Glancy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 31-year-old man had an hour of pain across the upper portion of his chest anteriorly, and it radiated down the inner aspects of both arms. The pain came while he was walking and gradually disappeared as he sat quietly. Six Rolaid tablets did not seem to alter the pain. The pain was unaccompanied by dyspnea, sweating, nausea or vomiting. The night before the patient had had similar pain relieved by Rolaids and belching. After the second episode of pain, he went to the emergency department of a local hospital where an ECG was recorded. </p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":"168 4","pages":"146-7"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34420526","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":"Pathology Image Of the Month: Rapidly Progressive Hemorrhagic Cellulitis of Bilateral Lower Extremities with Subsequent Septic Shock and Death.","authors":"Ellen E Connor,&nbsp;Nicole R Jackson,&nbsp;Robin R McGoey","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 51-year-old man presented to a community based emergency department with bilateral lower extremity swelling that began four days prior and that had evolved into recent blister formation on the left lower extremity. Medical history was significant only for hypertension and a recent self-described episode of \"food poisoning\" five days earlier characterized by diarrhea, nausea, and vomiting that quickly resolved. Physical exam revealed marked bilateral lower extremity edema and an ecchymotic rash below the knee. In addition to the rash, there were large flaccid bullae on the left leg, mostly intact but some notable for draining of scanty serosanguinous fluid. The patient was tachycardic with a rate of 114 bpm and initial labs showed thrombocytopenia (platelets 56 x 103/uL [140-440 x 103/uL]), hypoglycemia (15mg/dl [70-105mg/dl]), an elevated creatinine (2.7mg/dL [0.7- 1.25mg/dL]), and aspartate aminotransferase (AST 156U/L [5- 34U/L]). Two sets of blood cultures were drawn, broad spectrum antibiotics including doxycycline were empirically initiated and then he was subsequently transported to a tertiary care hospital for escalation of care. Within hours of presentation to the tertiary care facility, the rash appeared progressively hemorrhagic and bullous, lactic acidosis and coagulopathy developed and hemodynamic instability and septic shock necessitated endotracheal intubation and vasopressors. He was taken to the operating room for skin debridement but was emergently converted to bilateral above the knee lower extremity amputations due to the extent of the soft tissue necrosis. The patient remained intubated and in critical condition following surgery and the ecchymotic rash reappeared at the amputation sites. A newly developed ecchymotic rash with bullae formation was noted on the right upper extremity forearm. At that time, the clinicians were notified that four out of four blood culture bottles from admission were rapidly growing a microorganism. The family elected for withdrawal of care, and the patient died approximately 72 hours following presentation. A full and unrestricted autopsy was authorized by the Coroner's Office. </p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":"168 3","pages":"109-12"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34645853","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":"Delayed Presentation of a Carotid Artery Dissection Following Blunt Trauma in a Young Adult with Minimal Risk Factors.","authors":"Jason Talburt,&nbsp;Steward T Cayton,&nbsp;Shannon Alwood,&nbsp;Mandi Musso","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 22-year-old woman presented to the emergency department (ED) after suffering injuries as a restrained driver in a head-on motor vehicle accident. Upon presentation to the ED, her Glasgow Coma Score (GCS) was 15. A computed tomography (CT) of the head and neck was negative. She was taken to surgery for orthopedic injuries. Recovery from general anesthesia was somewhat prolonged due to somnolence. Roughly two hours after transfer, her family noticed that she was not moving her left arm. Trauma staff noted she had a new left hemiparesis. She was promptly taken for a repeat head CT which showed a dense area of ischemia in her right cerebral hemisphere, in the distribution of the right middle cerebral artery (MCA). A CT angiogram of the head and neck revealed a large dissection of the right carotid artery below the level of C2-C3, complete occlusion of the right internal carotid artery beginning 2 cm superior to the bifurcation, and developing cerebral edema with subsequent leftward shift. </p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":"167 3","pages":"112-5"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34531280","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":"Management of Complications of Acute Otomastoiditis in Solid Organ Transplant Patients.","authors":"Douglas Hildrew,&nbsp;Austin Adams,&nbsp;Ryan Winters,&nbsp;Rizwan Aslam","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>There are over 183,000 patients living with a functioning solid organ transplant in the United States, and almost no data exist discussing complications of acute otomastoiditis in this vulnerable population. Early recognition and treatment of acute otomastoiditis is essential in patients whose immune system is not normal, as progression can lead to sepsis, meningitis, brain abscess, Bezold's abscess, sigmoid sinus thrombosis, or other potentially fatal sequelae.</p><p><strong>Methods: </strong>Case report with extensive literature review.</p><p><strong>Results: </strong>A 63 year-old man presented 3 years after cadaveric renal transplant with otorrhea and altered mental status. His acute otitis media progressed to meningitis with sigmoid sinus thrombosis and sepsis, and management included IV and otic antibiotics, tympanostomy tube placement, and cortical mastoidectomy. The patient made a full recovery without residual neurologic deficit.</p><p><strong>Conclusion: </strong>Extrapolating data from patients immunosuppressed for other reasons, patients immunosuppressed after solid organ transplant should receive prompt recognition and aggressive treatment of acute otomastoiditis to prevent or address potentially devastating intracranial or systemic complications.</p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":"168 3","pages":"104-6"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34645852","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":"Radiology Of The Month: Spontaneous Bilateral Pneumothoraces in an HIV-Infected Patient.","authors":"Megan Curtis,&nbsp;Anish Patel,&nbsp;Kyle Degeyter,&nbsp;Harold Neitzschman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 36-year-old woman with past medical history of HIV/AIDS not on HAART therapy (CD4 count of 34) and recurrent Pneumocystis jiroveci pneumonia presented to the emergency room for cough, chest pain, and worsening shortness of breath over the past 72 hours. </p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":"168 3","pages":"120-1"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34647442","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":"Obstructive Jaundice from Metastatic Squamous Cell Carcinoma of the Lung.","authors":"Abhishek Seth,&nbsp;Thomas R Palmer,&nbsp;Jason Campbell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Obstructive jaundice from metastatic lung cancer is extremely rare. Most reported cases have had small cell cancer of lung or adenocarcinoma of lung as primary malignancy metastasizing to the biliary system. We report the case of a patient presenting with symptoms of obstructive jaundice found to have metastatic involvement of hepatobiliary system from squamous cell cancer (SCC) of lung. ERCP (endoscopic retrograde cholangiopancreatography) with biliary stenting is the procedure of choice in such patients. Our case is made unique by the fact that technical difficulties made it difficult for the anesthesiologists to intubate the patient for an ERCP. As a result percutaneous transhepatic cholangiogram (PTC) with internal-external biliary drainage was performed. </p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":"168 3","pages":"107-9"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34645851","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}