HCA healthcare journal of medicine最新文献

{"title":"Myxedema Coma with Cardiogenic Shock: Diagnostic Challenges and Risks of Amiodarone in Acute Thyroid Failure.","authors":"Jean Carlos Ramos Cardona, Gunjan Mundhra, Munachiso Egbo, Veniamin Melnychuk, Suzanne Quinn Martinez","doi":"10.36518/2689-0216.2441","DOIUrl":"https://doi.org/10.36518/2689-0216.2441","url":null,"abstract":"<p><strong>Background: </strong>Myxedema coma is a rare but life-threatening manifestation of severe hypothyroidism characterized by altered mental status, hypothermia, bradycardia, and multiorgan dysfunction. Delayed diagnosis is common, particularly in elderly patients with multiple comorbidities. Cardiac complications, including malignant arrhythmias, are underrecognized contributors to morbidity and mortality. Profound hypothyroidism compromises cardiac myocyte function through reduced activity of enzymes involved in calcium uptake, leading to impaired myocardial contraction and relaxation. This results in decreased heart rate, reduced cardiac output, and altered left ventricular function, which may be further exacerbated in patients with heart failure with reduced ejection fraction. Prolongation of the ventricular action potential and QT interval is frequently observed, predisposing the patient to ventricular irritability and malignant arrhythmias, including acquired torsades de pointes.</p><p><strong>Case presentation: </strong>A 72-year-old woman with hypothyroidism, heart failure with reduced ejection fraction, chronic kidney disease, and a history of breast cancer presented to the emergency department with progressive weakness, dyspnea, edema, and confusion. Laboratory evaluation revealed the thyroid-stimulating hormone to be greater than 150 mIU/L and free thyroxine to be less than 0.3 ng/dL, which is consistent with severe hypothyroidism. A Popoveniuc diagnostic score of 95 was calculated, supporting a diagnosis of myxedema coma. The patient developed transient wide-complex tachycardia and was treated with intravenous (IV) amiodarone. She subsequently experienced worsening encephalopathy, hypotension, and bradyarrhythmia, which required intubation, multiple vasopressors, IV levothyroxine, hydrocortisone, fludrocortisone, and mechanical ventilation. Transthoracic echocardiography demonstrated a left ventricular ejection fraction of 12%. Her course progressed to cardiogenic shock necessitating biventricular mechanical circulatory support and continuous renal replacement therapy prior to transferring to a tertiary care center.</p><p><strong>Conclusion: </strong>This case illustrates the complex interplay between severe hypothyroidism, advanced systolic heart failure, QT prolongation, and ventricular tachyarrhythmias in myxedema coma. Although amiodarone is commonly used for ventricular arrhythmia management due to its acute electrical stabilizing properties, its effects on thyroid hormone metabolism warrant caution in patients with underlying thyroid disease. Early recognition and coordinated endocrine cardiac management are critical to improving outcomes in this high-risk population.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 4","pages":"451-457"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Expression of Estrogen Receptors, Progesterone Receptors, and Human Epidermal Growth Factor Receptor 2 Between Initial Biopsy and Excision Specimens in Invasive Breast Carcinoma Cases. Is There a Need for Universal Repeat Testing? Experience From a Community Hospital.","authors":"Astrid M Sacasa, Gul Emek Wymer, Susana Ferra","doi":"10.36518/2689-0216.2338","DOIUrl":"https://doi.org/10.36518/2689-0216.2338","url":null,"abstract":"<p><strong>Background: </strong>The current national recommendation is that breast biomarkers estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2) testing should be done on all primary invasive breast carcinomas and on recurrent or metastatic tumors. Repeat testing on a subsequent excision specimen is not indicated unless results appear discordant with the histopathologic findings. The objective of the current study was to evaluate the need for adopting universal reflex re-testing of breast biomarkers in excision specimens in our institution.</p><p><strong>Methods: </strong>The study population included 70 sequential invasive breast cancer patients where the results of ER, PR, and HER2 in the initial diagnostic biopsy were available for comparison with our repeated ER, PR, and HER2 testing in the resection specimens. We aimed to identify if there are a significant number of discordant cases and if there are any significant tumor variables (size, ductal carcinoma in situ [DCIS], nodal [N] stage, neoadjuvant therapy) in the discordant cases.</p><p><strong>Results: </strong>Of the 70 patients, 10 (14%) had discordant results. Seventeen (24.3%) received neoadjuvant therapy. The discordance rate was 7.5% in the control (non-neoadjuvant therapy) group and 35.3% in the neoadjuvant therapy group (<i>P</i> = .0091). Three (37.5%) patients with hormone receptor-positive results became excision negative. Two (50%) biopsy HER2 positive patients became excision negative, and 5 (7.6%) biopsy HER2 negative patients became excision positive. Additionally, a tumor size greater than 2 cm was significantly associated with a higher discordance rate (<i>P</i> = .0082).</p><p><strong>Conclusion: </strong>Adopting universal reflex re-testing of breast biomarkers in all excision specimens is not justified by our results. Our center will implement reflex re-testing as the new standard of care for all post-neoadjuvant therapy cases, as well as for tumors measuring greater than 2 cm.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 4","pages":"405-412"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentations of Cutaneous Disease in Various Skin Pigmentations: Hidradenitis Suppurativa.","authors":"Jamie Y Choe, Henry Lim, Marshall Hall, Christian Scheufele, Dustin V Wilkes, Michael Carletti, Stephen E Weis","doi":"10.36518/2689-0216.2330","DOIUrl":"https://doi.org/10.36518/2689-0216.2330","url":null,"abstract":"<p><p>Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by recurrent deep-seated nodules and painful abscesses with scars, fistulae, and sinus tracts that predominately affect the intertriginous sites. Onset typically occurs soon after puberty. Depending on disease severity, HS can lead to varying levels of pain, disability, and disfiguration with significant impacts on quality of life. Hidradenitis suppurativa is diagnosed clinically, and no diagnostic tests are specific to the disease. Therefore, clinicians must have the knowledge and competence to identify the clinical features of HS accurately. The purpose of this report is to provide descriptions of characteristic clinical presentations of HS across the full spectrum of skin tones. Although the diagnosis of HS can be challenging, empowering primary care clinicians to identify the key features of this disorder will decrease delays in diagnosis and expedite the initiation of appropriate management in afflicted patients.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 4","pages":"417-430"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blaschko-Linear Lupus Erythematosus in a Pediatric Patient.","authors":"Marshall Hall, Olivia Mayer, Henry Lim, Dustin V Wilkes, Michael Carletti, Stephen E Weis","doi":"10.36518/2689-0216.2449","DOIUrl":"https://doi.org/10.36518/2689-0216.2449","url":null,"abstract":"<p><p>The lines of Blaschko represent epithelial cell migration during embryonic development. Rare forms of cutaneous lupus erythematosus may manifest along these lines, and lesions are termed Blaschko-linear lupus erythematosus (BLE). The purpose of this case study is to present a rare manifestation of linear cutaneous lupus erythematosus following the lines of Blaschko in a pediatric patient. To date, there are very few reports of BLE. We present a 17-year-old female with a 2-month history of a mildly tender growing lesion along the right nasofacial sulcus. The patient denied lesions elsewhere and any systemic, joint, or mucosal symptoms. A biopsy of the lesion was consistent with cutaneous lupus erythematosus. Given the distribution and pathology, the patient was diagnosed with BLE. The patient was treated with intralesional triamcinolone, topical pimecrolimus, and systemic hydroxychloroquine with an emphasis on strict photo-protection. Despite these therapies the patient's disease persisted.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 4","pages":"431-434"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Drainage: Can Pleural Effusion Naturally Tamponade Tumor Hemorrhage? Literature Review of Hypotheses for Possible Mechanisms.","authors":"Pratyush Kumar, Kumar Abhishek, Pankti Shah, Amelia Goslin, Archana Machavarapu, Catherine Joyce, Michael J Waxman, Kari Nilsen","doi":"10.36518/2689-0216.2521","DOIUrl":"https://doi.org/10.36518/2689-0216.2521","url":null,"abstract":"<p><strong>Background: </strong>Malignant pleural effusion (MPE) is a common complication of advanced lung cancer and is typically treated with therapeutic drainage to relieve symptoms. Although this is a well-established palliative approach, removing pleural fluid-especially in cases of necrotic or post-radiation tumors-may disturb the fragile pressure balance within the thoracic cavity. The question of whether pleural effusion can act as a natural tamponade against tumor-related vascular fragility has not been thoroughly investigated.</p><p><strong>Case presentation: </strong>We report a case of a 49-year-old man with stage IIIB non-small cell lung cancer (NSCLC) who experienced a catastrophic hemorrhage shortly after pleural fluid removal via a tunneled pleural catheter. The patient demonstrated radiographic tumor regression following chemoradiation but later developed a recurrent exudative effusion adjacent to a necrotic, partially cavitated tumor bed. After 2 episodes of therapeutic drainage, including 850 mL at the time of catheter placement, he experienced a small sentinel episode of hemoptysis, followed by a massive one 18 hours later that caused cardiovascular collapse. No procedural trauma, coagulopathy, or vascular invasion were evident. The sequence of clinical events suggests that removing the pleural fluid may have eliminated a hydrostatic counterforce that was preventing rupture of intratumoral vessels.Through a targeted literature review, we synthesize mechanistic evidence suggesting that pleural effusion may temporarily stabilize fragile tumor microvasculature, similar to tamponade physiology. Rapid decompression can sharply increase transmural vascular pressure, exert shear and traction on necrotic or post-radiation vessels, and trigger delayed hemorrhage, especially in patients with trapped lungs, cavitation, or recent chemoradiation. Published data describing decompression-related complications, re-expansion pressure shifts, sentinel bleeds, and radiation-induced vascular injury collectively support this proposed mechanism.</p><p><strong>Conclusion: </strong>In certain oncologic settings, pleural effusion can function as a physiological tamponade, and its removal might lead to catastrophic bleeding in structurally fragile tumors. Manometry-guided controlled drainage, heightened vigilance for early hemoptysis, and individualized procedural strategies for patients with necrotic or cavitary tumors may help mitigate this risk. Additional prospective research is needed to better understand pleural pressure dynamics and confirm this mechanistic hypothesis.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 4","pages":"459-466"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoiding Unnecessary Surgery in Acute Longus Colli Calcific Tendinitis: A Clinical Image of a Retropharyngeal Abscess Mimicker.","authors":"Brandon M Nielsen, Oluyemi O Omotoso","doi":"10.36518/2689-0216.2463","DOIUrl":"https://doi.org/10.36518/2689-0216.2463","url":null,"abstract":"<p><p>Acute calcific tendinitis of the longus colli (LCT) is a rare, benign condition that frequently mimics retropharyngeal abscesses (RPA), a true surgical emergency. We present a 34-yearold woman presenting with 4 days of severe posterior neck pain, stiffness, and odynophagia. Initial evaluation revealed significantly elevated inflammatory markers (erythrocyte sedimentation rate [ESR] 113 mm/hr, C-reactive protein [CRP] 128 mg/L) and leukocytosis, raising immediate concern for deep neck infection. Contrast-enhanced computed tomography (CT) demonstrated a retropharyngeal fluid collection; however, the absence of peripheral ring enhancement and the presence of a pathognomonic calcification anterior to the C1 arch pointed toward LCT. This distinction allowed for successful conservative management with NSAIDs and steroids, preventing unnecessary surgical drainage. This case underscores the critical utility of contrast CT in distinguishing the benign, non-enhancing effusion of LCT from the ring-enhancing abscess of RPA. Recognition of this radiographic pattern is essential to avoid potential morbidity associated with misdiagnosis and overtreatment.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 4","pages":"439-442"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gallbladder Ascariasis Presenting as Acalculous Biliary Colic.","authors":"Carmen A Urbina, Luigi G Cubeddu, Luigi X Cubeddu","doi":"10.36518/2689-0216.2457","DOIUrl":"https://doi.org/10.36518/2689-0216.2457","url":null,"abstract":"<p><p>We detail a case of gallbladder ascariasis, presenting as an acute episode of acalculous biliary colic, nausea, bloating, an unremarkable abdominal ultrasound, and negative helminth and protozoa stool smears. A follow-up ultrasound provided unexpected images consistent with gallbladder infection by <i>Ascaris lumbricoides</i>. Repeat ultrasonography performed 10 days after anthelmintic therapy showed no live worms and 2 newly appearing echogenic areas suggestive of gallbladder calculi that were confirmed following elective cholecystectomy. The case course highlights key clinical, diagnostic, and management considerations in gallbladder ascariasis and underscores the value of repeated ultrasonographic evaluation in affected patients.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 4","pages":"435-438"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coping Beyond Cancer: Exploring Fear of Recurrence in Colorectal Cancer Survivors-A Pilot Investigation.","authors":"Emily M Su, Steve Paciorek, Erica L Laipply, Anuja L Sarode","doi":"10.36518/2689-0216.2168","DOIUrl":"https://doi.org/10.36518/2689-0216.2168","url":null,"abstract":"<p><strong>Background: </strong>Evidence is limited on the fear of cancer recurrence (FCR) among colorectal cancer (CRC) survivors in the US, especially regarding patterns and trends of post-recovery coping mechanisms. This pilot mixed-methods study quantified FCR, examined its associations with Brief COPE domains, and contextualized coping through qualitative analysis.</p><p><strong>Methods: </strong>Twenty-three patients who successfully underwent CRC surgery were included in this pilot study. Fear of cancer recurrence was measured using the FCR Inventory (FCRI) Short Form, and coping strategies were assessed with the Brief Coping Orientation to Problems Experienced (COPE) survey. Descriptive statistics summarized participant characteristics, FCR, and COPE scores. Spearman correlation and univariate linear regression analyses were used to examine the associations within coping strategies and with FCR. Qualitative data from the FCRI and Brief COPE were presented as direct participant quotations.</p><p><strong>Results: </strong>The cohort was predominantly female (70%) and white (78%), with a mean age of 66. Elevated levels of FCR (scores ≥ 12) were reported by 70% of participants. Behavioral disengagement (detachment, reduced effort) was associated with higher FCR (β = 3.1; <i>P</i> = .03). Significant positive and negative correlations were observed within several COPE domains. Qualitative findings showed that faith, family support, and acceptance were notable coping mechanisms. Participants reported external reminders, such as treatment side effects and medical appointments, and internal factors, such as interpersonal interactions, as significant FCR triggers.</p><p><strong>Conclusion: </strong>This study identified a high level of FCR among CRC survivors in the US and underscored the complex interplay between coping strategies and FCR. The findings highlighted the need for tailored interventions and further research to enhance the understanding and management of FCR in this population.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 4","pages":"369-382"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sebaceous Gland Heterotopia of the Esophagus: A Rare Incidental Finding During Upper Endoscopy.","authors":"Samuel Ramos, Margaret-Anne Huntley, Eric Vargas, Jignesh Parikh, Vania Zayat","doi":"10.36518/2689-0216.2205","DOIUrl":"https://doi.org/10.36518/2689-0216.2205","url":null,"abstract":"<p><p>Esophageal heterotopic sebaceous glands (EHSG) are an extremely rare finding within the esophageal epithelium. These glands are typically benign, presenting as small, yellow-white plaques or lesions observed on endoscopy, often in the middle third of the esophagus. Esophageal heterotopic sebaceous glands are generally asymptomatic, and surveillance is not required. While their origin is unclear, proposed mechanisms include metaplastic transformation and congenital development. Recognition and histologic confirmation are essential to distinguish EHSG from other esophageal lesions and to avoid unnecessary interventions. We report the case of a 55-year-old man in whom multiple diminutive plaques were identified in the mid-esophagus during esophagogastroduodenoscopy (EGD) performed to evaluate persistent gastroesophageal reflux disease (GERD). Pathological examination revealed esophageal sebaceous gland heterotopia without associated malignancy or concerning features. We present an endoscopic image and a photomicrograph demonstrating the gross and histologic appearance of EHSG, respectively.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 4","pages":"413-416"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Presentation of Cutaneous Large B-Cell Lymphoma, Leg Type.","authors":"","doi":"10.36518/2689-0216.2651","DOIUrl":"https://doi.org/10.36518/2689-0216.2651","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.36518/2689-0216.2006.].</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 4","pages":"367"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}