HCA healthcare journal of medicine最新文献

{"title":"Staphylococcal Scalded Skin Syndrome in Melanated Skin: A Pediatric Case Report.","authors":"Aleah LaFrancis-Ream, Scott Gutovitz, Hannah Chotiner","doi":"10.36518/2689-0216.2151","DOIUrl":"10.36518/2689-0216.2151","url":null,"abstract":"<p><strong>Background: </strong>Staphylococcal scalded skin syndrome (SSSS) is a dermatologic emergency that most commonly affects young children, requiring prompt recognition and treatment to avoid severe symptoms and fatal sequelae. It is characterized by a desquamation of the skin caused by exotoxins produced by the <i>Staphylococcus aureus</i> species and may present differently in melanated skin.</p><p><strong>Case presentation: </strong>Our case describes a 6-month-old Black infant girl who presented to the emergency department with SSSS that was unrecognized on 2 prior encounters. This delay in diagnosis and the misapplication of topical antibacterial agents and steroids may have contributed to the worsening of her symptoms when she presented for the third visit.</p><p><strong>Conclusion: </strong>Emergency medicine providers should be aware of how SSSS presents in children with melanated skin to decrease misdiagnosis or delay in treatment.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 6","pages":"563-566"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968140","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":"Presentation of Cutaneous Large B-Cell Lymphoma, Leg Type.","authors":"Francisca I Valenzuela, Michael R Hohnadel","doi":"10.36518/2689-0216.2006","DOIUrl":"10.36518/2689-0216.2006","url":null,"abstract":"<p><p>Description A 91-year-old man presented with 2 violaceous, ulcerated plaques on his left lower leg, which developed over a 4-month period following a fall. The patient reported the initial formation of a solitary lump, which gradually enlarged and began bleeding a few weeks before his clinic visit. A histological examination of 2 biopsy samples revealed a dermal proliferation of large, severely atypical lymphoid cells with mitotic figures. Immunohistochemistry showed positivity for CD20, Bcl2, Bcl6, and MUM1, with cytokeratin 20 (CK20) negativity and a high percentage (80%-90%) of C-MYC positivity, which was consistent with a primary cutaneous diffuse large B-cell lymphoma (PCDLBC-LT). Given the findings, the patient was referred to oncology for further management.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 6","pages":"527-529"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968109","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 Colorful Enigma: A Case of Orange Palpebral Spots in a 63-Year-Old Woman.","authors":"Obarikanemi Nwogu, Karl Kellawan","doi":"10.36518/2689-0216.2130","DOIUrl":"10.36518/2689-0216.2130","url":null,"abstract":"<p><strong>Background: </strong>The thin, vascularized skin of the eyelids makes them prone to irritation and discoloration, potentially revealing underlying issues, such as subcutaneous deposits, and an abundance of pigments like carotenoids and lipofuscins. First described in 2008 by Assouly et al, orange palpebral spots (OPS) present as painless orange-yellow lesions on the upper eyelids, primarily affecting White women with Fitzpatrick skin types I to III. Despite various hypotheses, the exact cause of OPS remains elusive, with no established links to malignancy or systemic illnesses.</p><p><strong>Case presentation: </strong>A 63-year-old woman, with a medical history including basal and squamous cell carcinoma, diabetes mellitus, hypertension, and hypercholesterolemia, was found to have asymptomatic orange-yellow patches on bilateral eyelids during a routine dermatological exam. There was no prior treatment for these lesions. A clinical diagnosis of OPS was made without obtaining biopsies.</p><p><strong>Conclusion: </strong>Orange-yellow discoloration of the eyelids suggests lipid deposition in the dermis, leading to differentials including xanthelasma and carotenoderma. Biopsies of OPS show increased lipid deposition without xanthelasma's characteristic lipid-laden macrophages, also described as foamy histiocytes. Carotenoderma primarily affects sweat and sebum, leading to pigmentation in specific areas, like palms, soles, and nasolabial folds. Though the cause of OPS is unknown, factors like microscopic fat cells, increased pigments, and local trauma, are implicated. However, further research is needed to determine the etiology. Orange palpebral spots remain poorly recognized, with no established treatments, underscoring the need for accurate diagnosis to avoid unnecessary biopsies and provide reassurance to patients.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 6","pages":"559-561"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968010","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":"Mitochondrial Disorders Should Be Considered as a Differential Diagnosis of Thiamine Deficiency.","authors":"Josef Finsterer","doi":"10.36518/2689-0216.2014","DOIUrl":"10.36518/2689-0216.2014","url":null,"abstract":"<p><p>Description This letter to the editor addresses limitations to diagnosing thiamine deficiency for multisystem disorders and discusses the potential differential diagnoses that must be considered.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 6","pages":"499-500"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968030","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":"The Top Twenty-Five Most Influential Articles in Surgery for Colorectal Cancer.","authors":"Dana Poloni, Andrew Anklowitz, Fred Kobylarz, Christina Monaco Poloni, Ankit Dhiman, Pamela Burgess, Andrew Schlussel","doi":"10.36518/2689-0216.2126","DOIUrl":"10.36518/2689-0216.2126","url":null,"abstract":"<p><strong>Background: </strong>This article provides surgical trainees with a ranked list of the foundational literature that guides the contemporary surgical management of colorectal cancer and shows the evolution of surgical techniques in the field.</p><p><strong>Methods: </strong>We assessed the surgical literature using the Web of Science and other ranking systems to create a ranked list of published articles on colorectal cancer surgery.</p><p><strong>Results: </strong>We compiled a ranked list of the top 25 articles in the surgical management of colorectal cancer, based on the citation density score (mean number of citations per year) and the individual author H-index. The mean density score of the 25 papers was 29.9, and the journal most frequently represented on our list was the <i>Annals of Surgery</i> (36% of top papers). The Web of Science (primary) and alternative databases (secondary) H-index values for each author were identified. The range, mean, and median of the primary H-index values were 7.0-84.0, 31.8, and 29.0, respectively. The range, mean, and median of secondary H-index values were 4.0-108.0, 48.6, and 45.0, respectively. A 2-tailed, unpaired <i>t</i>-test was used to determine whether a significant difference existed between the primary and secondary H-index values for primary authors; <i>P</i> = .0376 (95% confidence interval, 1.02-32.58). A citation density score was calculated for each article, which represented the mean number of citations per year.</p><p><strong>Conclusion: </strong>We provided a ranked list (citation density score) of the top-cited 25 articles in colorectal cancer surgery, a ranking of the associated primary authors by H-index, and a comparison of H-index scores between primary and secondary database sources. We believe this list is a useful resource for surgical trainees and researchers in colorectal cancer field and provides easy access to the top papers in this discipline.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 6","pages":"501-511"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968115","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":"Lewy Glacier.","authors":"João Guilherme Bochnia Küster","doi":"10.36518/2689-0216.2143","DOIUrl":"https://doi.org/10.36518/2689-0216.2143","url":null,"abstract":"<p><p>Description This poem explores the complex intersection of memory, identity and the challenges imposed by Lewy body dementia, using the metaphor of a lost expedition traversing an isolated icy landscape. A profound sense of solitude reflects the disconnection that accompanies the dementia and tremors that follow, while also highlighting the danger of memory loss with mythological sirens representing its perilous allure (with some inspiration from <i>The Odyssey</i>). Through vivid imagery and lyrical language, it delves into the complexities of cognitive decline, providing an artistic reflection on dementia and offering a unique view of the emotional landscape of those affected by this condition.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 6","pages":"575-576"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967983","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":"Rainflakes, Ripples, and the Moonlit Ocean.","authors":"Saptarshi Biswas","doi":"10.36518/2689-0216.2309","DOIUrl":"https://doi.org/10.36518/2689-0216.2309","url":null,"abstract":"<p><p>Description Raindrops, ripples, and a moonlit sky evoke not just poetic imagery but also profound physiological and psychological responses from deep inside. In a kaleidoscope of colors, rain flakes spiral down like whispers from the cosmos, each droplet a tiny universe reflecting the dreams of wandering souls. They dance upon the surface of puddles, sending ripples that shimmer like liquid silver, weaving a tapestry of sound that resonates with the heartbeat of the earth. As moonlight drips softly from the sky, each moondrop creates a symphony of luminescent echoes, cascading through the air like stardust, inviting us to lose ourselves in the enchantment of this vibrant, surreal symphony. In this trippy embrace of nature, time melts away, and we are suspended in a dreamscape where the ordinary transforms into the surreal.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 6","pages":"577-578"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968106","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 Unusual Presentation of Lichen Planus Pigmentosus Inversus Responsive to Topical Tacrolimus: A Case Report.","authors":"Valeria J González-Molina, Sujitha Yadlapati, Michael R Hohnadel, Rick Lin","doi":"10.36518/2689-0216.2043","DOIUrl":"10.36518/2689-0216.2043","url":null,"abstract":"<p><strong>Background: </strong>Lichen planus pigmentosus inversus (LPPI) is a rare variant of lichen planus pigmentosus (LPP), characterized by sharply defined violaceous-brown to gray macules, papules, patches, or plaques primarily affecting the intertriginous and flexural areas. Unlike LPP, which predominantly affects Fitzpatrick skin types III to IV in sun-exposed areas, LPPI spares these regions and has been predominantly reported in White and Asian patients.</p><p><strong>Case presentation: </strong>We discuss a 66-year-old man with Fitzpatrick skin type III who presented with a year-long history of mildly itchy, hyperpigmented plaques on the inframammary folds. These plaques developed after being hospitalized for a chronic urinary tract infection that was treated with antibiotics. He felt self-conscious and anxious due to the changes in skin, which affected his quality of life. His medical history included controlled diabetes and dyslipidemia, and he reported no systemic symptoms or prior topical medication use. A physical examination revealed well-demarcated, violaceous-brown plaques without scaling. Tests for fungal organisms, antinuclear antibodies, thyroid function, and hepatitis C were negative, and routine blood work was normal. A biopsy confirmed LPPI. Initial treatments with triamcinolone were ineffective, and hydroquinone was discontinued after 2 weeks due to irritation. The patient improved with tacrolimus 0.1% ointment twice daily, showing significant reduction in hyperpigmentation and improvement in skin texture at 4 and 8 weeks, with no side effects noted.</p><p><strong>Conclusion: </strong>This case report highlights the diagnostic and therapeutic challenges associated with LPPI and discusses its potential response to topical tacrolimus. Our findings indicate that tacrolimus 0.1% ointment provides a safe and effective nonsteroidal treatment alternative for LPPI. Given the possible impact of LPPI on quality of life, timely diagnosis and appropriate management are crucial. Due to the absence of established treatment protocols for LPPI, further studies are necessary to better understand treatment responses and guide therapeutic strategies, particularly for individuals with darker skin tones.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 6","pages":"553-557"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967990","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 New Application for Bolt Cutters in Urogynecology: Challenging Removal of an Impacted Pessary.","authors":"Carolyn M Payne, Courtney B Ritchie, Tanaz R Ferzandi","doi":"10.36518/2689-0216.2165","DOIUrl":"10.36518/2689-0216.2165","url":null,"abstract":"<p><strong>Background: </strong>Pessaries are commonly used to treat pelvic organ prolapse. While these devices generally pose negligible risk, serious morbidity can be associated with neglected use.</p><p><strong>Case presentation: </strong>A 91-year-old woman began to experience acute pain related to an impacted pessary. An Exam in the operating room under anesthesia revealed that the pessary was deeply embedded within the vaginal canal and was noted to have a hard metal wire under a rubber exterior. An intraoperative orthopedic consult was obtained to facilitate discussion and selection of tools outside the typical gynecological scope to remove the pessary. A combination of bolt cutters and rongeur forceps were used to successfully remove the pessary.</p><p><strong>Conclusion: </strong>Consideration of instruments outside traditional gynecology including bolt cutters may be considered when faced with a difficult removal of foreign bodies embedded in gynecological tissues.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 6","pages":"567-570"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967998","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":"Rock Outcropping, Kaliakra Peninsula, Black Sea, Bulgaria.","authors":"Barbara L Gracious","doi":"10.36518/2689-0216.2370","DOIUrl":"10.36518/2689-0216.2370","url":null,"abstract":"<p><p>Description This photo, taken in June 2024 at the Northern Bulgarian Black Sea Coast, captures our fleeting time against that of ocean and rocks. Cape Kaliakra (\"Beautiful Headland\") has been fought over by various tribes and groups across centuries. Succession included the Dacians, Greeks, Ottoman Turks, the Russian Navy, and in the last century, the communist government of Bulgaria. Now a nature reserve, dolphins play off the coast and cormorants seek its updrafts. Cape Kaliakra sits on the Via Pontica, an ancient Greek road and major bird migration route from Africa into Eastern and Northern Europe. Its beauty and its importance in controlling the shoreline propelled men to capture it as a status and military vantage point, as if the awe and wonder it engenders could ever be fully owned.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"497-498"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497583","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}