HCA healthcare journal of medicine最新文献

{"title":"Ovarian Dysgerminoma With Tubo-Ovarian Torsion in an 11-Year-Old Child: A Rare Occurrence but a Significant Differential Diagnosis in Acute Abdomen.","authors":"Charu Chandra, Keeranmayee Mishra, Rahul Mangal, Chirag Doshi, Apurba Anshuman Mishra","doi":"10.36518/2689-0216.1992","DOIUrl":"10.36518/2689-0216.1992","url":null,"abstract":"<p><strong>Background: </strong>Ovarian tumors are quite uncommon in the premenarchal age group, with the majority being functional cysts. Malignant tumors are unusual in this age group, making the diagnosis of ovarian malignancy in children quite challenging. Dysgerminoma is the most common malignant ovarian germ cell tumor in females. The clinical symptoms often include abdominal pain, distension, a palpable mass, reduced appetite, nausea, and vomiting.</p><p><strong>Case presentation: </strong>We discuss the case of an 11-year-old premenarchal girl who was brought to the emergency department with abdominal pain persisting for 3-4 days, which had intensified over the 24 hours before she arrived at the emergency department. The pain was accompanied by vomiting. On examination, her lower abdomen showed tenderness, guarding, and rigidity, and a firm mass approximately 10 x 8 cm in size was palpable in the midline. Ultrasonography of the abdomen and pelvis revealed a large hypoechoic mass lesion, approximately 99 x 56 x 92 mm, in the right adnexa. A magnetic resonance imaging with contrast of the abdomen and pelvis was performed for confirmation, which substantiated the diagnosis of the right ovarian lesion with torsion. Following the patient's exploratory laparotomy, a right salpingo-oophorectomy and left oophoropexy were performed. The histopathological report confirmed the diagnosis of dysgerminoma.</p><p><strong>Conclusion: </strong>Malignant ovarian tumors are quite rare in the premenarchal age group, and the primary goal should be to offer fertility-preserving surgeries. This allows the individual to retain reproductive functions. However, close monitoring is essential, and if needed, radical surgery should be considered to save the patient's life.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"367-372"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066246","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":"Educational Point-of-Care Ultrasound Discovers Adrenal Cortical Carcinoma, a Case Report: Clinical Implications and Review of the Literature.","authors":"Minh Q Ngyuyen, Moshe Bengio, Vu H Tran","doi":"10.36518/2689-0216.1944","DOIUrl":"10.36518/2689-0216.1944","url":null,"abstract":"<p><strong>Introduction: </strong>Point-of-care ultrasound (POCUS) has become an indispensable tool for emergency physicians in assessing intra-abdominal pathology due to its real-time visualization, portability, and cost-effectiveness. While POCUS is not traditionally focused on adrenal gland assessment, incidental findings of adrenal masses during examinations have been reported. Our patient presented with a chronic obstructive pulmonary disease (COPD) exacerbation and was found to have a large adrenal mass, discovered incidentally, during thoracic ultrasound.</p><p><strong>Case presentation: </strong>This case report presents the discovery of an adrenal mass in a patient with respiratory distress due to a COPD exacerbation, emphasizing the importance of sonographers' ability to identify abnormal imaging within their POCUS framework. The clinicians promptly communicated the incidental finding to the patient, leading to further imaging and labs while in the emergency department and subsequent hospital admission. Traumatic arteriovenous fistulas and visceral vascular injuries are rare.</p><p><strong>Conclusion: </strong>Although adrenal glands are not the primary focus for emergent pathology, the identified mass prompted a comprehensive evaluation, ultimately revealing a nonhormone-secreting adrenal cortical carcinoma. The rarity of this malignancy and the discrepancy between imaging and laboratory results underscore the need for a thorough investigation, with the focus suggesting that POCUS, despite its limitations, can play a crucial role in prompting additional imaging for accurate diagnosis and informed patient management. This case also highlights the significance of transparent communication while empowering patients and guiding further investigations for a comprehensive understanding of the pathology.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"349-354"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066551","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":"A Hard Problem: Managing Constipation in the Geriatric Population.","authors":"William G Jones, Veeraen Jonnalagadda, Alexandra E Thomson, Victoria Grumbles, Chase Cottle, Christian Robertson, Maulikkumar Patel","doi":"10.36518/2689-0216.1955","DOIUrl":"10.36518/2689-0216.1955","url":null,"abstract":"<p><p>Description Constipation is a common condition among geriatric patients with different presenting symptoms and potential serious complications. Additionally, the condition causes a significant burden on our healthcare system. Here, we summarized recommendations from several societies, including the American College of Gastroenterology, American Geriatrics Society, and American Academy of Family Physicians to provide guidance on managing constipation with geriatric patients. Our aim was to emphasize the importance of prevention of constipation in this population and methods to do so. We also give recommendations on how to manage constipation when it does develop and how to manage it across different healthcare settings. These recommendations should aid providers in managing this prevalent and burdensome condition.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"303-309"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066508","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":"An Acknowledgement to the <i>HCA Healthcare Journal of Medicine</i>'s Reviewers and Editors for the First Half of 2025.","authors":"Juan A Sanchez, Graig Donini","doi":"10.36518/2689-0216.2333","DOIUrl":"10.36518/2689-0216.2333","url":null,"abstract":"<p><p>Description The <i>HCA Healthcare Journal of Medicine</i> would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our peer reviewers, authors, and board members.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"299-301"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066482","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":"Converting USMLE Step 1 to Pass or Fail: The Potential Impact on Applicants Who Are Female or From Underrepresented Groups.","authors":"Haris Ahmed, Peter Yu, Brendan Rosamond, Jonathan Lall, Scott Zimmerle, Said Maldonado, Nicole Lyons, Ashlynn N Mills, Yoolim Alex Seo, Angelica C Rodriquez, Jacqueline E Levesque, Oluwatunmininu A Anwoju, Zuhair Ali, Rajeev Raghavan, Mike Liang","doi":"10.36518/2689-0216.1895","DOIUrl":"10.36518/2689-0216.1895","url":null,"abstract":"<p><strong>Background: </strong>In January 2022, the United States Medical Licensing Examination (USMLE) Step 1 exam became pass/fail and the transition to using USMLE Step 2 scores for residency interview screening appeared imminent. While this change was intended to result in holistic reviews of residency applicants, the impact remains unclear. In this study, we aimed to determine how USMLE scoring changes might affect female candidates and applicants from underrepresented groups (URM).</p><p><strong>Methods: </strong>We performed a retrospective cross-sectional study of all applicants to a single institution. Data for applicants were extracted from their 2021-2022 residency applications and included age, race, sex, medical school, region, USMLE Step 1 score, and USMLE Step 2 scores. All applicants who graduated from a US medical school with both USMLE Step 1 and Step 2 scores were eligible for inclusion. Our primary outcome was the difference between USMLE Step 1 versus Step 2 scores. Two comparisons were made; female candidates were compared to male candidates and URM compared to non-URM.</p><p><strong>Results: </strong>On regression analysis, we noted that female candidates (coefficient = 4.007; 95% CI, 2.64-5.37, <i>P</i> < .001) had greater improvements between USMLE Step I and Step II scores compared to male applicants, while URM (coefficient = -5.056; 95% CI, -7.6 to -2.5, <i>P</i> < .005) demonstrated smaller differences between USMLE scores compared to the reference group (non-URM).</p><p><strong>Conclusion: </strong>Making USMLE Step 1 pass/fail may benefit female candidates during the interview process, while adversely impacting URM. As the application process evolves, the impacts on female and URM need to be carefully evaluated to achieve equitable representation in residency programs.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"311-318"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066567","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":"Brown Umbilical Nodule: A Case of Primary Cutaneous Endometriosis.","authors":"Richard G Bindernagel, Aleia Boccardi, Taylor C Jindia, Parth Patel, Jaimie Bryan, Addie Walker, Summer Moon, Richard Miller","doi":"10.36518/2689-0216.1974","DOIUrl":"10.36518/2689-0216.1974","url":null,"abstract":"<p><strong>Background: </strong>Endometriosis is a common condition in which endometrial glands and stroma are implanted outside the uterine cavity. Rarely, the skin can be involved.</p><p><strong>Case presentation: </strong>We describe a case of a 41-year-old woman who presented to the dermatology clinic complaining of a brown umbilical nodule with slight erythema. It was occasionally painful and hemorrhagic. She denied a history of endometriosis and abdominal surgeries. A shave biopsy of the nodule was consistent with a diagnosis of cutaneous endometriosis. The patient was referred to her gynecologist for further evaluation and treatment.</p><p><strong>Conclusion: </strong>This unique case demonstrates primary cutaneous endometriosis in the umbilicus of a female patient. Cutaneous endometriosis can be classified as primary or secondary. Primary cutaneous endometriosis is rarer and has an unclear etiology, developing seemingly spontaneously without history of surgical interventions. Secondary cutaneous endometriosis typically arises within surgical scars following abdominal operations, which is believed to be a result of iatrogenic implantation of endometrial cells. Definitive treatment involves surgery. This case highlights the importance of considering cutaneous endometriosis in the differential diagnosis of a female patient with painful and intermittently hemorrhagic skin nodules.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"363-366"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066526","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":"\"Good Enough Mother\": Accepting the Imperfections of Motherhood in Medicine.","authors":"France M Leandre","doi":"10.36518/2689-0216.1906","DOIUrl":"10.36518/2689-0216.1906","url":null,"abstract":"<p><p>Description This article draws attention to Winnicott's concept of the \"good enough mother\" and how it can be applied to those in medicine. It emphasizes that no one is perfect, and our children learn best from our imperfections. I was reminded of that while kayaking on the Lost Spring Lake in Ocala, FL, and took this picture. If we can find beauty in nature's imperfections, we can also find it within our own imperfections.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"385-386"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066492","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":"Using Dexcom G7 in Critically Ill Infant With Hyperinsulinemia on High Frequency Oscillatory Ventilation Support.","authors":"Chad E Ward, Timothy Clark, Eric Velazquez","doi":"10.36518/2689-0216.1927","DOIUrl":"10.36518/2689-0216.1927","url":null,"abstract":"<p><strong>Introduction: </strong>Life threatening hypoglycemia can occur during critical illness in infants with underlying hyperinsulinemia or metabolic conditions, such as glycogen storage diseases. Using a continuous glucose monitor (CGM) can provide insight into glycemic trends with this high-risk patient population in the intensive care setting. Barriers to usage of CGMs in the intensive care unit include familiarity with CGMs devices among staff, safety, and cost.</p><p><strong>Case presentation: </strong>We describe the first reported case of safely utilizing the newest Dexcom G7 continuous glucose monitor in an infant with hyperinsulinemia undergoing high frequency oscillatory ventilator (HFOV) support for acute respiratory distress syndrome (ARDS) to detect early hypoglycemic episodes during critical illness while on continuous glucose infusion.</p><p><strong>Conclusion: </strong>There is limited information on using the Dexcom G7 CGM device in infants with underlying hypoglycemic conditions on HFOV support. The use of HFOV poses a unique physiological challenge for using a CGM device. We demonstrate that the Dexcom G7 is safe to use while on HFOV. The device provided important glycemic trends, which helped to reduce the number of point-of-care tests and allowed for early detection of hypoglycemia.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"339-344"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066455","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":"Nondominant Right Coronary Artery Occlusion Leading to an Anterior ST-Segment Elevation Myocardial Infarction.","authors":"Taha Ahmed, Taylor Wood, Austin Harris, Rajan Desai, Garima Handa, Noaki Misumida, Amartya Kundu","doi":"10.36518/2689-0216.2072","DOIUrl":"10.36518/2689-0216.2072","url":null,"abstract":"<p><strong>Background: </strong>A nondominant right coronary artery supplies a small portion of the myocardium. Albeit rare, an acute occlusion of a nondominant right coronary artery is believed to be inconsequential with minimal clinical relevance.</p><p><strong>Case presentation: </strong>We present a case of a middle-aged man who presented with chest pain and an electrocardiogram demonstrating anterior ST-segment elevation. An emergent coronary angiogram revealed acute thrombotic occlusion of the proximal nondominant right coronary artery with no significant obstructive atherosclerotic disease in the dominant left coronary circulation. Balloon angioplasty of the occluded vessel followed by implantation of a drug-eluting stent resulted in the resolution of the chest pain and ST-segment elevation.</p><p><strong>Conclusion: </strong>While electrocardiographic ST-segment elevations in the anterior precordial leads are highly suggestive of a left anterior descending artery occlusion, herein, we present a rare case of an acute anterior ST-segment elevation myocardial infarction secondary to a nondominant right coronary artery occlusion.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"373-376"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066236","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":"A Case Report and Evaluation of Intrauterine Gas of Unknown Origin.","authors":"Chrystal Stallworth, Diane Gilbertson, Michele L McCarroll, Timothy Kremer","doi":"10.36518/2689-0216.1764","DOIUrl":"10.36518/2689-0216.1764","url":null,"abstract":"<p><strong>Introduction: </strong>Most reports of intrauterine or endometrial gas have been reported in the setting of underlying gynecologic malignancy or infection. The significance of this case report is to give a presentation of a patient presenting with intrauterine gas who subsequently was identified as having neither an infectious nor malignant cause for such a finding.</p><p><strong>Case presentation: </strong>The patient is a 56-year-old postmenopausal woman who presented with \"hip pain\" and was found to have incidental intrauterine gas on a pelvic computed tomography. She underwent in-office and outpatient hysteroscopies with resection of a submucosal fibroid. Her final pathology was returned as benign, and ultimately no apparent cause for her intrauterine gas was found.</p><p><strong>Conclusion: </strong>Our case report differs in that our patient was found to have no fistulous abnormalities, was not postpartum or post procedure, and had no evidence of malignancy on permanent pathology. Our primary goal was to evaluate all potential causes for such finding and provide a differential diagnosis that is not commonly presented in current literature reviews. This case report adds to the literature by providing an alternative presentation for incidental intrauterine air that is not commonly reported.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"335-338"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066501","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}