Spartan medical research journal最新文献

{"title":"Discovering Pathologies in the Anatomy Lab: The Case of Brachial Plexopathy Mimicking Neurological Thoracic Outlet Syndrome.","authors":"Ryley Mancine, Paul Kowalski, William McMillan, Nicole Geske, Loro Kujjo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Context: </strong>Well-established human anatomy labs with access to expert faculty are exceedingly valuable tools to medical student education. In this manuscript, we detail an infero-lateral subclavicular lipoma which was discovered as a result of the utilization of both those labs and expert faculty. This lipoma may have caused brachial plexopathy or may serve as an unusual cause of neurologic thoracic outlet syndrome (NTOS) due to the location of the mass.</p><p><strong>Educational case presentation: </strong>During prosection of a donor in the human anatomy lab, a mass was discovered by a medical student. This medical student utilized the human anatomy lab faculty members and resources to identify the mass as a lipoma. The lipoma compressed the lateral cord of the brachial plexus and the suprascapular nerve, but no diagnosis of NTOS or brachial plexopathy was made during the life of the donor, nor was any surgical intervention indicated. Removal of the lipoma immediately relieved stress upon the nerves. Histochemical analysis confirmed the diagnosis of a lipoma and demonstrated almost only mature adipocytes.</p><p><strong>Conclusion: </strong>The authors concluded that the lipoma of this patient was not identifiable with computerized tomography imaging modalities, despite ultrasound demonstrating a hyperechoic outline of the mass in the cadaver of the patient. It is very likely that this lipoma had not been diagnosed previously due to the atypical location of the tumor. Equally, typical surgical methods associated with brachial plexopathy or NTOS treatment would be difficult or more complicated, due to the lateral and inferior location of the lipoma. Physicians treating thoracic outlet syndrome-type symptoms without resolution should consider potential non-malignant obstruction located outside the thoracic outlet, toward the extremity. Deep palpatory methods and physical therapy should be considered until diagnosis is certain, as ultrasound would be difficult and typical transaxillary surgical methods would be nonhelpful. Medical students and early-career residents and physicians should be aware of the resources provided to them via campus human anatomy laboratories which they may utilize to further their understanding and knowledge of specific pathologies.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"5 2","pages":"14179"},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41184462","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":"Lingual Osseous Choristoma: A Systematic Review of Lesion Presentation, Histology, and Morphology","authors":"Zaid J. Shareef, S. Shareef, C. Kerndt, Arielle Aughenbaugh, Anthony Di Ponio","doi":"10.51894/001c.17543","DOIUrl":"https://doi.org/10.51894/001c.17543","url":null,"abstract":"INTRODUCTION Osseous choristomas of the tongue are rare, benign tumor-like lesions composed of abnormally placed bone and cartilage tissue. The few publications to date concerning this condition have been primarily limited to case reports. This systematic review aimed to clarify the clinical presentations of osseous choristomas and how to delineate them from other oral pathologies. METHODS The authors utilized PubMed, Embase, and Cochrane Library reference databases from 1971 to mid-2020. Search terms were “osseous choristoma,” “oral cavity,” and “lingual.” Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to aggregate relevant data from each study. The authors specifically collected data regarding patient demographics, clinical findings, symptoms, treatments, and subsequent outcomes relating to lingual osseous choristomas. RESULTS A total of 35 (14.6% of total identified) publications that met inclusion criteria were identified concerning a total of 69 lingual osseous choristoma cases. Results were compiled focusing on sex and age, presenting symptoms, histology, appearance of the lesion base being most commonly pedunculated (e.g., stalk or stem-like), the lesion’s location on the tongue, and subsequent treatments. Osseous choristomas had a higher rate of occurrence in females, 48 (70%) and those under the age of 40. Symptomatic presentations occurred in 38 (55%) patients, with the most common presenting symptoms being gagging/globus (i.e., lump or foreign body) sensation (n = 47, 68%) and dysphagia (n = 20, 29%). Identified masses were pedunculated in 33 (80%) of cases and eight (20%) were identified as sessile (i.e., immobile). A total of 41 (59%) lesions were more commonly located in the posterior one third of the tongue compared to 28 (41%) in the anterior two thirds of the tongue. Of those 49 (71%) cases requiring surgical mass excisions, recurrence was reported in 0% of cases. CONCLUSIONS Although osseous choristomas are benign processes that rarely arise from the tongue, providers should carefully inspect patients with a gagging/globus sensation and pedunculated mass toward the back of the tongue. Surgical resection remains the best treatment to prevent recurrence.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49251214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discovering Pathologies in the Anatomy Lab: The Case of Brachial Plexopathy Mimicking Neurological Thoracic Outlet Syndrome","authors":"Ryley Mancine, P. Kowalski, W. McMillan, N. Geske, L. Kujjo","doi":"10.51894/001c.14179","DOIUrl":"https://doi.org/10.51894/001c.14179","url":null,"abstract":"CONTEXT Well-established human anatomy labs with access to expert faculty are exceedingly valuable tools to medical student education. In this manuscript, we detail an infero-lateral subclavicular lipoma which was discovered as a result of the utilization of both those labs and expert faculty. This lipoma may have caused brachial plexopathy or may serve as an unusual cause of neurologic thoracic outlet syndrome (NTOS) due to the location of the mass. EDUCATIONAL CASE PRESENTATION During prosection of a donor in the human anatomy lab, a mass was discovered by a medical student. This medical student utilized the human anatomy lab faculty members and resources to identify the mass as a lipoma. The lipoma compressed the lateral cord of the brachial plexus and the suprascapular nerve, but no diagnosis of NTOS or brachial plexopathy was made during the life of the donor, nor was any surgical intervention indicated. Removal of the lipoma immediately relieved stress upon the nerves. Histochemical analysis confirmed the diagnosis of a lipoma and demonstrated almost only mature adipocytes. CONCLUSION The authors concluded that the lipoma of this patient was not identifiable with computerized tomography imaging modalities, despite ultrasound demonstrating a hyperechoic outline of the mass in the cadaver of the patient. It is very likely that this lipoma had not been diagnosed previously due to the atypical location of the tumor. Equally, typical surgical methods associated with brachial plexopathy or NTOS treatment would be difficult or more complicated, due to the lateral and inferior location of the lipoma. Physicians treating thoracic outlet syndrome-type symptoms without resolution should consider potential non-malignant obstruction located outside the thoracic outlet, toward the extremity. Deep palpatory methods and physical therapy should be considered until diagnosis is certain, as ultrasound would be difficult and typical transaxillary surgical methods would be nonhelpful. Medical students and early-career residents and physicians should be aware of the resources provided to them via campus human anatomy laboratories which they may utilize to further their understanding and knowledge of specific pathologies.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70847899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Peritraumatic Ketamine Reduce Symptoms of Post-Traumatic Stress Disorder?","authors":"Jack Brodeur, Ryley Mancine, Alyse Ley, Jed Magen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are chronic diseases which can affect patients following a severe trauma. As these patients typically first present to the emergency department, it is critical for emergency physicians to remain updated on the use of ketamine or other anesthetic agents which may impede development or reduce symptoms which may impair normal functioning. The purpose of this clinical review was is to review the literature regarding how the use of peritraumatic ketamine could decrease the incidence of ASD and PTSD. In 2019, the authors completed a MEDLINE search was performed yielding 25 articles which were initially evaluated by the first and second authors. Four articles which met inclusion criteria are discussed in this manuscript.</p><p><strong>Summary of evidence: </strong>Although two earlier research groups have found that peritraumatic ketamine administration contributed to increased symptoms of PTSD (e g., reexperiencing, dissociation, avoidance, and hyperarousal), two later studies have indicated that ketamine had no effect on PTSD development. Additionally, one 2012 study group has suggested propofol use may alleviate PTSD symptoms at six months post-trauma. Another 2017 study team found that the number of surgical procedures was directly correlated with increased PTSD development.</p><p><strong>Conclusions: </strong>Based on the literature to date, peritraumatic ketamine does not appear to influence the prevention nor development of ASD and subsequent PTSD. More research is needed to clarify the psychopharmacologic effects of ketamine when used in the management of reactions to acute trauma experiences. Based on the results of the two later works, future research is indicated considering whether propofol may contribute to PTSD development.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"5 2","pages":"17647"},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25431774","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":"Wilkie's Weight Loss Wonder, A Case Series.","authors":"Akhlema Haidar, Alexandra Davies, Afzal Hussain, Samuel Gregerson, Dheeraj Thammineni, Johnathon Markus","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Wilkie's Syndrome, also known as Superior Mesenteric Artery Syndrome (SMAS), is a rare cause of bowel obstruction that can contribute to vague abdominal symptoms on clinical presentation. This syndrome occurs when the aortomesenteric angle decreases, compressing the third portion of the duodenum between the aorta and the superior mesenteric artery. An acute decrease in the mesenteric fat pad cushion between these two blood vessels is the primary etiology, although other causes (e.g., anatomical, postoperative, functional, and pubescent etiologies) have also been described.</p><p><strong>Case presentation: </strong>In the present cases, 2 females with a common history of recent weight loss presented to our institution with similar symptoms of abdominal pain, nausea and vomiting. Each patient was subsequently diagnosed with SMAS following imaging studies. Both patients experienced successful resolution of symptoms with conservative nutritional management.</p><p><strong>Discussion: </strong>Common presenting complaints of SMAS include nausea, vomiting, early satiety and postprandial pain. These symptoms overlap with other gastrointestinal disorders (i.e., mesenteric ischemia, intestinal volvulus, peptic ulcer disease) making diagnosis difficult. SMAS can be identified through imaging modalities including barium studies and computer tomography. First line therapies typically include conservative nutritional support and promotion of weight gain. If conservative therapies fail, various surgical procedures can be pursued. Delayed diagnosis can lead to further pathological sequelae, including duodenal compromise, ischemia and necrosis. As the syndrome progresses, success of conservative nutritional support is less likely, and surgical correction becomes increasingly necessary.</p><p><strong>Conclusion: </strong>Therefore, a clinical goal for SMAS should include as swift a recognition and diagnosis as possible.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"5 2","pages":"13485"},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25430839","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":"Lingual Osseous Choristoma: A Comprehensive Systematic Review of Lesion Presentation, Histology, and Morphology.","authors":"Zaid J Shareef, Sarah J Shareef, Connor C Kerndt, Arielle Aughenbaugh, Anthony Di Ponio","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Osseous choristomas of the tongue are rare, benign tumor-like lesions composed of abnormally placed bone and cartilage tissue. The few publications to date concerning this condition have been primarily limited to case reports. This systematic review aimed to clarify the clinical presentations of osseous choristomas and how to delineate them from other oral pathologies.</p><p><strong>Methods: </strong>The authors utilized PubMed, Embase, and Cochrane Library reference databases from 1971 to mid-2020. Search terms were \"osseous choristoma,\" \"oral cavity,\" and \"lingual.\" Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to aggregate relevant data from each study. The authors specifically collected data regarding patient demographics, clinical findings, symptoms, treatments, and subsequent outcomes relating to lingual osseous choristomas.</p><p><strong>Results: </strong>A total of 35 (14.6% of total identified) publications that met inclusion criteria were identified concerning a total of 69 lingual osseous choristoma cases. Results were compiled focusing on sex and age, presenting symptoms, histology, appearance of the lesion base being most commonly pedunculated (e.g., stalk or stem-like), the lesion's location on the tongue, and subsequent treatments. Osseous choristomas had a higher rate of occurrence in females, 48 (70%) and those under the age of 40. Symptomatic presentations occurred in 38 (55%) patients, with the most common presenting symptoms being gagging/globus (i.e., lump or foreign body) sensation (n = 47, 68%) and dysphagia (n = 20, 29%). Identified masses were pedunculated in 33 (80%) of cases and eight (20%) were identified as sessile (i.e., immobile). A total of 41 (59%) lesions were more commonly located in the posterior one third of the tongue compared to 28 (41%) in the anterior two thirds of the tongue. Of those 49 (71%) cases requiring surgical mass excisions, recurrence was reported in 0% of cases.</p><p><strong>Conclusions: </strong>Although osseous choristomas are benign processes that rarely arise from the tongue, providers should carefully inspect patients with a gagging/globus sensation and pedunculated mass toward the back of the tongue. Surgical resection remains the best treatment to prevent recurrence.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"5 2","pages":"17543"},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41184463","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":"Evaluation of a COVID-influenced Curriculum to Address Food Insecurity in a Detroit Family Medicine Residency Clinic","authors":"Amrien Ghouse, W. Gunther, Matthew Sebastian","doi":"10.51894/001c.17649","DOIUrl":"https://doi.org/10.51894/001c.17649","url":null,"abstract":"CONTEXT To date, numerous projects have demonstrated that an ongoing limited access to nutritionally dense food (i.e., “food insecurity”) plays a key role in the overall health and wellbeing of lower income at-risk populations. METHODS For this 2019-2020 pilot project, the resident physician authors first created and administered a simple five-item questionnaire screening process to systematically identify food insecure patients in their metropolitan Detroit residency clinic. A sample of patients who had been identified as food insecure and pre-diabetic were then provided improved access to healthy foods, supplemented by a six-week program of nutritional education classes using a nationally recognized “Cooking Matters’’ six-week long curriculum with a licensed chef and nutrition educator RESULTS After institutional review board approval, the authors enrolled a sample of 10 adults. The authors successfully measured both pre- and post-program Hemoglobin A1c (HbA1C) levels for all participants who completed the required course and subsequent clinic follow up visits. Using a series of initial non-parametric Wilcoxon Signed Rank matched pair tests, post-program follow-up at three months revealed statistically significant reductions in documented HbA1c levels from baseline for six enrolled patients (W=1, Z = - 2.226, p = 0.026) and six-month follow up (i.e., more than four months after completion of the program) (W = 1, Z = - 2.060, p = 0.039). In post-program surveys, each respondent indicated that they found the class content to be generally beneficial to increase their nutritional knowledge. CONCLUSIONS In the authors’ setting, this food insecurity program has subsequently led to a more formal screening process to evaluate and identify food insecure patients. The authors discuss the scheduling difficulties they experienced from the COVID-19 pandemic for their sample patients. However, these pilot results suggest that prolonged benefits may require ongoing “virtual” teaching sessions with pre-diabetic patients to address the complex factors influencing food insecurity levels identified in similar inner-city settings.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44583304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Specialty Care for Second-Degree Pressure Cooker Explosion Burn Injuries","authors":"Casey P. Schukow, Billy R. Nordyke","doi":"10.51894/001c.17738","DOIUrl":"https://doi.org/10.51894/001c.17738","url":null,"abstract":"CONTEXT Although pressure cookers are very common kitchen utensils used in the United States, only a few cases of serious injuries secondary to pressure cooker explosions have been reported in the medical literature. When second-degree (i.e., “partial-thickness”) burns result from pressure cooker explosions, wounds involving near to or greater than 10% of total body surface area typically require multidisciplinary treatment, with burn center referral for proper wound care, potential fluid resuscitation, and eventual scar management. EXAMPLE CASE The example patient described in this report was an African American female in her early 30s who presented during the summer of 2020 after suffering varying levels of second-degree burns to her bilateral upper torso and left wrist (i.e., approximately 10%, total body surface area). The authors first saw the patient during a primary care office visit a week after her initial injury when she first went to a local urgent care clinic. Upon her arrival to the second author’s family medicine clinic, a multi-specialty wound recovery plan was initiated since her first urgent care visit treatment had been minimal without prophylactic antibiotic therapy or placement of a burn center referral. CONCLUSIONS Partial and full-thickness burn injuries generally warrant immediate clinical (i.e., body surface area burn assessment, fluid resuscitation, empiric antibiotics) as well as ongoing (burn center referral, debridement procedures, active scar management, provision of psychological support) treatment needs. This paper discusses the critical opportunities posed for more extensive burn patients’ physicians to first categorize the extent of burn wounds and initiate subsequent specialty care in other settings.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42215866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological and Perioperative Outcome of Appendiceal Tumors: Case Review of 31 Patients","authors":"Haroutioun H. Boyajian, Vanessa Majeski, A. Flores, D. Sturtz, Fadi Baidoun, Mohammed Dughayli","doi":"10.51894/001c.13487","DOIUrl":"https://doi.org/10.51894/001c.13487","url":null,"abstract":"INTRODUCTION Neoplasms of the appendix are quite rare and found in approximately 1% of appendectomy specimens. These neoplasms have been pathologically categorized into various subgroups depending on cell of origin, and surgical treatment varies according to histological subtype and disease stage. PURPOSE The purpose of this case series review was to evaluate the clinicopathological presentation and survival outcome of a sample of patients with appendiceal tumors. METHODS Before data collection, this project design was approved by the authors’ institutional review board. Pathology records at our institution were reviewed for cases of appendiceal tumors from January 2007 to December 2016. A total of 31 patients were identified over this 10-year period. Retrospective data collection included patient demographics, presenting symptoms, tumor size, histologic diagnosis, initial and secondary management, perioperative and postoperative outcome, and survival benefits. RESULTS Thirty one patients with four different appendiceal tumor subtypes were included in the study: Mucinous Cystadenoma, Mucinous Adenocarcinoma, Goblet Cell, and Carcinoid. The sample was comprised of 17 women (54.8%) and 14 men (45.2%) with an overall mean age of 50.1 (SD = 22.3). Subgroups of 13 (42%) patients had Carcinoid tumor, 12 (39%) had Mucinous Cystadenoma, four (13%) had Goblet cell tumor, and two (6%) had Mucinous Adenocarcinoma. The stage at presentation and tumor size also varied by histologic subtype. The most common presenting symptom was abdominal pain (64.5%), followed by a radiological identified mass (12.9%). Overall, 27 (87.1%) patients survived, and four (12.9%) were deceased. CONCLUSIONS The findings from this case series review provides a retrospective analysis of appendiceal tumor characteristics, follow up, and survival. Based on these results, the prognosis and management of patients with these tumors should be based on the histologic subtype and the extent of their disease.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46961588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All's Not Well(ens) that Ends Well: Case Study of Significant Thebesian Veins Mimicking Wellens Syndrome.","authors":"Keith Frank","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Thebeisan veins are microfistulous connections between a coronary arterial branch directly to a ventricular or atrial chamber. Extensive thebesian veins that empty into the left ventricle can cause typical chest pain symptoms, troponin elevation, and ischemic EKG changes from coronary steal leading to acute coronary syndrome in extreme cases. Literature review exposed a consistent pattern of EKG findings among patients with extensive thebesian veins involving all three major coronary arteries. We present a case study as an example of this rare anatomic finding of extensive thebesian veins draining into the left ventricle causing acute coronary syndrome in a symptomatic patient with elevated troponin and ischemic changes on EKG. This same EKG pattern that is present in our patient was discovered to be consistent among available case studies reviewed that had included an EKG tracing in their report. A newly proposed association between the ischemic changes on EKG due to extensive thebeisan veins and those of a severe proximal left anterior descending coronary artery stenotic lesion was discovered. The newly discovered consistency in the EKG pattern with acute coronary syndrome caused by extensive thebesian veins is the same pattern as that seen in Wellens Syndrome.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"12881"},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25430836","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}