American Journal of the Medical Sciences最新文献

{"title":"Fever and hypotension vs. frank septic shock: Elderly patients taking vasodilators who present with fever and hypotension have a higher incidence of negative blood cultures. A retrospective analysis of 3,726 patients","authors":"Guy Dumanis MD. ,&nbsp;Adva Vaisman MD. ,&nbsp;Mariana Issawy MD. ,&nbsp;Mayan Gilboa MD. ,&nbsp;Chava Landau Zenilman MD. ,&nbsp;Edward Itelman MD. ,&nbsp;Gad Segal MD.","doi":"10.1016/j.amjms.2025.11.002","DOIUrl":"10.1016/j.amjms.2025.11.002","url":null,"abstract":"<div><h3>Background</h3><div><strong>S</strong>eptic shock is a leading cause of mortality. Yet, blood cultures are negative in many cases, questioning the diagnosis. In the quest for characterization of “culture negative septic shock”, the impact of chronic vasodilating medications was questioned.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of patients with vital signs compatible with septic shock (fever &gt; 37.9 or &lt; 36 °C and systolic blood pressure &lt; 90 mmHg).</div></div><div><h3>Results</h3><div>The study included 3,726 patients (ages 65 to 90). Of these, 1,382 (37.1%) took chronic vasodilators. This group of patients had a lower rate of positive blood cultures compared to the group that did not receive vasodilators (28.5% vs. 32%; P = 0.026). They were older (median 80 vs. 78 years; P = 0.001), and their background included more cardiovascular diseases (P &lt; 0.001). Their total length of hospital stay was shorter (median 4 vs. 6 days; P &lt; 0.001) yet, they had a higher risk of in-hospital mortality (39% vs. 35.1%; P = 0.019). Taking chronic vasodilators was associated with decreased risk for bacteremia by 16% (P = 0.023). Older age, positive bacterial culture, and chronic vasodilation treatment were independently associated with increased risk for in-hospital mortality by 3% (HR = 1.03, 95% CI 1.02 – 1.04; P &lt; 0.001), 36% (HR = 1.36, 95% CI 1.18 – 1.57; P &lt; 0.001), and 21% (HR = 1.21, 95% CI 1.05 – 1.4; P = 0.009) respectively.</div></div><div><h3>Conclusions</h3><div>Chronic use of vasodilators amongst elderly patients presenting with fever and hypotension is associated with a higher incidence of negative blood cultures. We suggest these patients exhibit a combination of sepsis and shock rather than frank septic shock.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 3","pages":"Pages 221-225"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CircCOL3A1 ameliorates myocardial ischemia-reperfusion injury by regulating miR-29b-3p/MDM2-mediated apoptosis","authors":"Lihua Sun MMed ,&nbsp;Siyan Shi MMed ,&nbsp;Weihao Wang MMed ,&nbsp;Ying Zhang MMed","doi":"10.1016/j.amjms.2025.08.021","DOIUrl":"10.1016/j.amjms.2025.08.021","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular diseases (CVDs) are leading causes of mortality globally, with myocardial ischemia-reperfusion (I/R) injury being a critical challenge in clinical settings. Circular RNAs (circRNAs) have emerged as significant molecular players in various pathophysiological conditions, including myocardial I/R injury.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the role of circCOL3A1 in myocardial I/R injury and its potential regulatory mechanisms involving miR-29b-3p and MDM2.</div></div><div><h3>Methods</h3><div>Using a mouse model and H9c2 cardiomyocyte cells, we examined the expression levels of circCOL3A1 under I/R and hypoxia/reoxygenation (H/R) conditions. We utilized RT-qPCR, Western blotting, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), and dual-luciferase reporter assays to explore the interaction between circCOL3A1, miR-29b-3p, and MDM2.</div></div><div><h3>Results</h3><div>CircCOL3A1 was significantly downregulated in both I/R-treated mice and H/R-treated H9c2 cells. Overexpression of circCOL3A1 reduced apoptosis and improved cell viability by modulating the miR-29b-3p/MDM2 axis. These effects were reversed by overexpressing miR-29b-3p or silencing MDM2.</div></div><div><h3>Conclusions</h3><div>CircCOL3A1 plays a protective role in myocardial I/R injury by acting as a miR-29b-3p sponge, thereby regulating the MDM2-mediated apoptosis pathway. This identifies circCOL3A1 as a potential therapeutic target for treating myocardial I/R injury.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 3","pages":"Pages 286-294"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trace element imbalance as a possible factor in long-COVID pathophysiology: Links to disease duration and inflammation","authors":"Wasim Talib Al Masoodi PhD ,&nbsp;Sami Waheed Radhi PhD ,&nbsp;Hussein Kadhem Al-Hakeim PhD ,&nbsp;Habiba Khdair Abdalsada PhD","doi":"10.1016/j.amjms.2025.10.013","DOIUrl":"10.1016/j.amjms.2025.10.013","url":null,"abstract":"<div><div>Background. Long-COVID is defined by persistent symptoms following an initial COVID-19 infection. The normal immune function depends on a precise balance of trace elements, which can provide fresh insights into prospective therapeutic strategies while maintaining oxidative balance and limiting excessive inflammation. Zinc, copper, cobalt, and manganese deficits or excesses can alter the immune system’s normal functions and oxidative stress. The study aims to study the trace element profile for predicting long-COVID.</div><div>Methods. The levels of serum copper and zinc were measured spectrophotometrically. In contrast, cobalt and manganese were measured using flameless atomic absorption spectrophotometry in 60 long-COVID patients and compared with the 30 controls who had previous SARS-CoV-2 infection but were free from long-COVID symptoms.</div><div>Results. Serum levels of copper, cobalt, manganese, and the copper/zinc ratio were considerably elevated in long-COVID patients compared to the control groups. Nonetheless, there was no significant change in zinc levels relative to the control group. The cobalt concentration increases with the duration of the disease and inflammation. Serum manganese level is significantly and negatively correlated with weight. The duration of disease is inversely linked to serum zinc concentrations. There is a substantial correlation between serum copper levels and the period of recovery from acute SARS-CoV-2 infection.</div><div>Conclusions. Long-COVID is associated with alterations in serum trace elements (copper, cobalt, and manganese). The imbalances in the trace elements are associated with inflammation, duration of disease, and age. These imbalances may contribute to prolonged symptoms and greater disease severity, suggesting that trace element monitoring could be beneficial in managing long-COVID.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 3","pages":"Pages 259-266"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Lipoprotein(A) levels and post-revascularization major cardiac events in coronary artery disease and diabetes","authors":"Brian Brereton MBBS, MSc ,&nbsp;Rupak Desai MBBS ,&nbsp;Pratiksha Shankarlal Nathani MD ,&nbsp;Shisheer Havangi Prakash MD ,&nbsp;Amritha Nair MD ,&nbsp;Chantal Lewis MBBS, FACE ,&nbsp;Amreen Sidhu MBBS ,&nbsp;Sadiya Usman MD ,&nbsp;Shaylika Chauhan MD, FACP ,&nbsp;Vinutha Akki Vivekanand MD ,&nbsp;Athmananda Nanjundappa MD ,&nbsp;Praveena Sunkara MD","doi":"10.1016/j.amjms.2025.09.009","DOIUrl":"10.1016/j.amjms.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Lipoprotein (a) [Lp (a)] may confer pro-thrombotic potential, and high concentrations may be an independent risk for MI. This systematic review sought to investigate the association of Lp (a) levels with post-revascularization Major Adverse Cardiac Events (MACE) in patients with CAD, ACS, and DM.</div></div><div><h3>Methods</h3><div>A systematic literature search for original investigations was performed using PubMed/MEDLINE, Embase, Scopus, and Google Scholar, searching for articles (meeting inclusion criteria) focusing on the relationship between Lp(a), DM, and PCI in patients with ACS, MI, or IHD and the impact on cardiovascular outcomes. The data was abstracted and descriptively summarized.</div></div><div><h3>Results</h3><div>The systematic review selected four relevant articles: 3 prospective Konishi et al., (2016); Silverio et al., (2022); and Li et al., (2023) and one retrospective (Takahashi et al., 2020). Total population: 4624, total males: 3719. Konishi et al. (2016) concluded that an elevated Lp(a) is an independent risk factor for cardiac death and/or ACS recurrence in diabetics undergoing PCI. The adjusted OR for cardiac death and ACS in the high Lp(a) group vs. the low Lp(a) group was 1.20 (CI 1.00–1.42), p = 0.04. Takahashi et al. (2020) showed that after adjusting for clinical covariates, high Lp(a) was independently associated with a higher frequency of MACE and poorer long-term outcomes compared to low Lp(a). The adjusted OR for the risk of MACE in patients with high Lp (a) vs. low Lp (a) was 1.83 (CI 1.16–2.95), p = 0.009. Silverio et al. (2022) showed that while there was an increased risk of recurrent MI in this patient population without DM, it was not confirmed in patients with DM. Compared with the lowest Lp (a) category, non-DM patients with very high Lp (a) &gt;70 mg/dl vs. low Lp (a) showed a higher risk of recurrent MI and all-cause death; adjusted OR 2.839 (CI 1.382–5.832), p = 0.005. In diabetics, high Lp (a) vs. low Lp (a) = 1.115 (CI 0.405–3.071), p = 0.833.</div></div><div><h3>Conclusions</h3><div>There is some evidence that Lp (a) levels are an independent risk factor for MACE in patients who underwent PCI for CAD. There is also some evidence that elevated Lp (a) levels are associated with a worse prognosis in patients with DM after PCI, but this association is not consistent in the literature. Further prospective multicenter studies are required in order to elucidate this association.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 3","pages":"Pages 274-280"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in hypertensive renal disease with renal failure-related mortality among gender ethnicity and states in the United States from 1999–2020","authors":"Muhammad Shaheer Bin Faheem MBBS ,&nbsp;Faiza Ikram MBBS ,&nbsp;Muhammad Saad Iqbal MBBS ,&nbsp;Muhammad Owais Mazhar MBBS ,&nbsp;Hurmat Fatima MBBS ,&nbsp;Awais Akhtar MBBS ,&nbsp;Uzair Irfan MBBS ,&nbsp;Muhammad Omar Ashfaq MBBS ,&nbsp;Ahmed Faraz MBBS ,&nbsp;Raheel Ahmed MBBS, MRCP, PhD","doi":"10.1016/j.amjms.2025.10.003","DOIUrl":"10.1016/j.amjms.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive renal disease impacts approximately 753 million individuals worldwide each year. This study evaluates trends in hypertensive renal disease mortality from 1999 to 2020 in the US, focusing on disparities related to gender, race, and urbanization by examining the Age-Adjusted Mortality Rate (AAMR) to inform targeted intervention and improve outcomes.</div></div><div><h3>Methods</h3><div>The CDC WONDER database analyzed hypertensive renal disease with renal-failure-related mortality from 1999 to 2020, calculating mortality rates and a 95 % confidence interval to assess national trends.</div></div><div><h3>Results</h3><div>Throughout the study period, males constantly exhibited a higher Age-Adjusted Mortality Rates (AAMR) for hypertensive renal disease with renal-failure-related mortality 148.92 (95 % CI: 148.37 – 149.48) than females 106.11 (95 % CI: 105.73 – 106.49). African American individuals exhibited the highest overall AAMR at 286.29 (95 % CI: 284.68 – 287.9), starting at 186.23 in 1999 (95 % CI: 179.34 – 193.13) and increasing to 529.72 in 2020 (APC: 5.27; 95 % CI: 520.77 – 538.67). From 1999 to 2020, AAMR rose in metropolitan areas from 197.57 (95 % CI: 187.88–207.26) to 1112.12 (APC: 10.00; 95 % CI: 1093.39–1130.85), and in non-metropolitan areas from 97.35 (95 % CI: 90.63–104.08) to 643.06 (APC: 11.81; 95 % CI: 627.76–658.37).AAMRs varied significantly by state, from 61.23 (95 % CI: 59.29–63.16) in Connecticut to 225.06 (95 % CI: 214.96–235.16) in the District of Columbia.</div></div><div><h3>Conclusions</h3><div>From 1999 to 2020, the mortality rate from hypertensive-related renal diseases rose uncertainly, with a sharp incline starting from 2013 to a sudden surge in 2020 due to COVID-19-related renal complications. Higher deaths were observed in males, African American ethnicity, and individuals living in non-metropolitan areas. Addressing these problems requires a multifactorial public health approach focusing on early detection, equitable care, and targeted intervention to reduce disease burden.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 3","pages":"Pages 247-254"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stercoral colitis from constipation to complication: A systematic review","authors":"Thomas Stirrat BS ,&nbsp;Deeptha Bejugam BS ,&nbsp;Stella Kim BS ,&nbsp;Sophia Dahmani MD ,&nbsp;Joseph Atarere MD ,&nbsp;Joseph Alukal MD ,&nbsp;Priyanka Kanth MD","doi":"10.1016/j.amjms.2025.12.003","DOIUrl":"10.1016/j.amjms.2025.12.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Stercoral colitis is an underrecognized, life-threatening complication of refractory constipation.</div></div><div><h3>Methods</h3><div>We systematically reviewed Embase, PubMed/MEDLINE, Web of Science, and CINAHL for presentation, imaging, management, and outcomes. Fifty-three studies (58 patients) met inclusion. Mean age was 55.8 years (range 9–94); 62.1% were female. Chronic constipation (75.9%) and opioid exposure (13.8%) were common. CT was used in 86.2%, showing fecaloma and wall thickening (65.5%); perforation occurred in 29.3% and ischemic colitis in 44.8%. Conservative measures, manual disimpaction, enemas, laxatives, were common; endoscopic disimpaction was rare; surgery was reserved for deterioration, peritonitis, or perforation. Overall in-hospital/30-day mortality was 22.4% (operative 26.9% vs non-operative 0.0%).</div></div><div><h3>Conclusions</h3><div>SC should be suspected in at-risk patients with refractory constipation; only 75.9% had abdominal pain, so its absence does not exclude disease. Early CT, especially with elevated WBC, CRP, or lactate, and severity-guided escalation to conservative therapy or timely surgery are essential; standardized criteria and prospective studies are needed.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 3","pages":"Pages 267-273"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small bone, big problem: Brodie's abscess of digit in adolescent male","authors":"H Berndt ,&nbsp;A Caffery ,&nbsp;L Blasen ,&nbsp;C Landreneau ,&nbsp;T Bates ,&nbsp;L Reilly","doi":"10.1016/j.amjms.2025.12.086","DOIUrl":"10.1016/j.amjms.2025.12.086","url":null,"abstract":"<div><h3>Case Report</h3><div>Intro: A Brodie's abscess is a localized subacute to chronic form of osteomyelitis most commonly occurring in males in the second or third decades of life after minor trauma or prior infection (Van de Naald, 2019 and Salik, 2021). Persistent pain in the area is often the only complaint, as swelling or other physical manifestations only occur in about half of cases (Van de Naald, 2019). Because infection is contained, patients are often afebrile, with no leukocytosis or elevation in inflammatory markers (Agarwal, 2017). Although the clinical presentation may be subtle, the radiologic features are distinctive, showing a sharply demarcated osteosclerotic shell filled with pus (Adler, 2013).</div></div><div><h3>Case</h3><div>A 15-year-old male with a previous history of right fourth digit cellulitis initially presented to the ER with fever, vomiting, and progressive pain and swelling of the right third digit. Five days prior, he suffered a puncture wound on this digit secondary to catfish barb injury in brackish water and cleaned the wound with bleach water. The site developed a gradually enlarging pustule and he began to experience daily subjective fevers with chills, emesis, and decreased oral intake for several days. Laboratory evaluation was notable for leukocytosis and elevated ESR and CRP levels. The patient was started on intravenous vancomycin, levofloxacin, and doxycycline for broad spectrum coverage given exposure in brackish water on recommendation from the infectious disease team. Cultures later revealed <em>Streptococcus pyogenes</em>. Radiographs showed possible erosion of the head of the third proximal phalanx, with MRI showing a circumscribed lesion with increased sclerosis around the margins concerning for Brodie's abscess. Orthopedics deferred surgery in hopes lesion could be managed pharmacologically. The patient improved quickly and was discharged with a four-week course of amoxicillin and close orthopedic and infectious disease follow up.</div></div><div><h3>Discussion</h3><div>Brodie's abscesses of the hand have not been frequently documented, as most common locations are the long bones of the lower extremity. In one review, hand involvement was only reported in .06% of studied cases (Van de Waald, 2019). Because of our patient's history with trauma in a setting of brackish water, there was concern for gram-negative bacterial involvement. However, given that our patient's cultures grew Strepococcus pyogenes, it is unlikely that his infection was related to inoculation with brackish water and more consistent with continued inflammation after prior infection. The standard management of a Brodie's abscess is a surgical debridement of the abscess cavity which is then filled with cancellous bone grafting to promote healing in combination with an antibiotic course of up to six weeks (Olasinde, 2011). However in smaller abscesses, surgical management may not be indicated or required.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 ","pages":"Page S52"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel strategy for testing valve stability during transcatheter pulmonary valve replacement","authors":"N Bhalla ,&nbsp;S Shuja ,&nbsp;E Mejia","doi":"10.1016/j.amjms.2025.12.015","DOIUrl":"10.1016/j.amjms.2025.12.015","url":null,"abstract":"<div><h3>Case Report</h3><div>Background: Tetralogy of Fallot is among the most common cyanotic congenital heart diseases. Relief of right ventricular outflow tract (RVOT) obstruction with transannular patch enlargement frequently leaves residual RVOT dysfunction. Over time, these defects can impair right ventricular (RV) performance and necessitate pulmonary valve replacement. Transcatheter pulmonary valve replacement (TPVR) has emerged as a less invasive alternative to surgery, with valve choice dictated by RVOT anatomy and prosthesis availability. Pre-procedural testing typically involves inflation of a compliant balloon of the intended valve diameter to rule out coronary artery compression, but this approach provides limited information on valve stability and sealing in patients with large, compliant RVOTs. These limitations can result in uncertainty, leading to aborted procedures despite otherwise suitable anatomy. We describe the use of a non-compliant balloon for pre-procedural testing as a novel strategy to predict valve stability, an approach not previously reported in literature.</div></div><div><h3>Case Presentation</h3><div>A 13-year-old female with repaired Tetralogy of Fallot via transannular patch presented with severe pulmonary regurgitation. Echocardiography showed severe pulmonary insufficiency with preserved left ventricular ejection fraction (65%). Hemodynamic evaluation confirmed candidacy for TPVR: no coronary compression, normal pulmonary artery pressures, and mildly elevated RV end-diastolic pressure. A 28 mm True Dilatation non-compliant balloon was deployed in the RVOT and subjected to traction. This maneuver demonstrated adequate tissue adherence and stability of the landing zone. Based on these findings, a 29 mm Sapien valve was implanted successfully, with immediate elimination of regurgitation and improved RVEDP. At one-month follow-up, the patient remained asymptomatic with echocardiography confirming continued absence of pulmonary insufficiency.</div></div><div><h3>Discussion</h3><div>Standard TPVR planning incorporates multimodal imaging and compliant balloon testing to exclude coronary compromise. While effective for assessing coronary risk, compliant balloons often fail to provide reliable information about prosthetic stability in large or distensible RVOTs. As a result, uncertainty about procedural success may lead to deferred or abandoned procedures, limiting the number of patients who can benefit from percutaneous valve replacement. Our case demonstrates that non-compliant balloon testing can better simulate actual prosthesis deployment by directly assessing tissue adherence and anchoring. This method offers a practical way to anticipate procedural success in anatomically challenging RVOTs. Importantly, such testing may enable more patients to undergo TPVR who might otherwise be excluded, thereby expanding access to less invasive therapy.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 ","pages":"Pages S6-S7"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocarditis as a presentation of MINOCA","authors":"S Basavanhalli,&nbsp;M Capella,&nbsp;Y Park,&nbsp;S Sanne,&nbsp;N Jain","doi":"10.1016/j.amjms.2025.12.022","DOIUrl":"10.1016/j.amjms.2025.12.022","url":null,"abstract":"<div><h3>Case Report</h3><div>Introduction: Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA) is defined by its name. Typically affecting younger individuals, MINOCA risks being overlooked or undermanaged when coronary artery obstruction is not found on angiography to explain the myocardial infarction (MI). Given the many etiologies of MINOCA, an effective treatment lies in finding the cause. Diagnostic tools are of great importance to the morbidity and mortality of this heterogeneous syndrome.</div></div><div><h3>Case</h3><div>A 30-year-old male with a notable family history of early-onset of cardiovascular disease presented with acute left-sided chest pain radiating to the left arm and neck, associated with dyspnea, dizziness, diaphoresis, nausea, and blurry vision. His symptoms initially improved with acetaminophen but recurred, prompting his presentation. He does not take any home medications and reported recently testing positive for Influenza A. He reported drinking 2-3 beers daily, occasional cocaine and marijuana use along with chewing tobacco. He denied cocaine use in the days leading up to admission. His is vital signs and physical exam were unremarkable for any significant abnormality. He had a high sensitivity troponin of 2,293 ng/L and electrocardiogram (ECG) with non-specific ST changes. Bedside echocardiogram showed a possible anteroseptal wall motion abnormality. The patient was aspirin and heparin loaded and started on a heparin drip. He was given sublingual nitroglycerin and reported mild relief of his chest pain. Cardiology took the patient for an urgent coronary angiogram that was unremarkable, without evidence of obstructive coronary artery disease, and showed a normal left ventricle (LV) end diastolic pressure, consistent with MINOCA. As part of MINOCA workup, our differential diagnoses included coronary vasospasm, microvascular disease, and myocarditis. Post-angiography echocardiogram showed mild impairment of the LV systolic function with an ejection fraction of 50-55% with normal diastolic function, and hypokinetic basal anterolateral segment. Further workup with cardiac magnetic resonance imaging (MRI) was consistent with myocarditis. The patient was discharged home in stable condition, with resolution of symptoms after initiation of aspirin, atorvastatin, metoprolol succinate, losartan, and a 7-day course of high-dose prednisone with sublingual nitroglycerin as needed.</div></div><div><h3>Discussion</h3><div>This case highlights the importance of considering alternative etiologies in patients presenting with an NSTEMI without coronary obstruction on angiography. In this case, our patient had a history of cocaine use and a recent infection with Influenza A, raising suspicion for coronary vasospasm versus myocarditis. Myocarditis of unknown etiology was confirmed through cardiac MRI, highlighting the importance of early cardiac MRI to help determine the etiology of MINOCA.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 ","pages":"Pages S11-S12"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient with intramuscular infantile hemangioma associated with pulmonary hypertension and high output cardiac failure","authors":"K Barkemeyer,&nbsp;M Sonenklar,&nbsp;A Tufton,&nbsp;J Patrick","doi":"10.1016/j.amjms.2025.12.053","DOIUrl":"10.1016/j.amjms.2025.12.053","url":null,"abstract":"<div><h3>Case Report</h3><div>Infantile hemangiomas are made up of a collection of blood vessels that form incorrectly and multiply rapidly. Intramuscular hemangiomas are a rare subtype of hemangiomas that make up approximately 0.8% of all benign soft tissue tumors. The rarity of these lesions often leads to delay of diagnosis and management.</div><div>A late pre-term male infant was admitted to the neonatal intensive care unit due to prenatal history of non-immune hydrops fetalis consisting of bilateral pleural effusions and polyhydramnios requiring four amnioreductions. At delivery, a faint discolored soft tissue mass was noted on the right chest wall and flank. Due to concerns for possible vascular malformation, thoracentesis was deferred, and he was transferred to Manning Family Children's. Initial imaging showed mediastinal shift concerning for large pleural effusion, small left pleural effusion, and partially obscured cardiac silhouette. Interventional radiology performed a right thoracentesis. Subsequently, a chest tube was placed. Worsening pulmonary hypertension and heart failure led to escalation of medical support. Ultrasound and MRI of the mass confirmed tortuous, dilated intercostal, mammary, and phrenic arteries which appeared to communicate with the network of tortuous high-flow vessels along the lateral thoracic/abdominal wall. Sirolimus was initiated after multi-specialty discussion with Hematology-Oncology and Surgery as it has been shown to be an effective treatment for unresectable vascular anomalies.</div><div>On day of life 8 he was transferred to Texas Children's Hospital for further management of the vascular malformation. A biopsy was performed, and pathology confirmed an infantile intramuscular hemangioma. His pulmonary hypertension worsened requiring extracorporeal membrane oxygenation ultimately leading to multi-organ failure. Seizures were noted on exam and EEG showed worsening global hypoxic ischemic brain injury and flat electrical activity between seizures.</div><div>A family meeting was held and disclosed the patient's neurological injury, worsening clinical status, and long-term prognosis. Family requested withdrawal of life-sustaining treatment and patient died on day of life 21.</div><div>High-output cardiac failure and pulmonary hypertension can be seen in infants with large, complex venous malformations. Low resistance flow through the malformation can cause a “steal” mechanism which results in a rise in cardiac output to compensate. Our patient highlights a rare care of intramuscular hemangioma complicated by severe pulmonary hypertension and high cardiac output that, unfortunately, could not undergo embolization or other treatment due to his clinical instability.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 ","pages":"Pages S29-S30"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}