- Factors Associated With Inadequate Intraoperative Baseline Lower Extremity Somatosensory Evoked Potentials. [Journal Article]
- JCJ Clin Neurophysiol 2018 Jun 21
- CONCLUSIONS: Adequate baselines are paramount for successful intraoperative neurophysiologic monitoring. However, certain patient-specific factors are associated with inadequate baseline SEP signals. Physical examination findings and a detailed chart review can be done to identify these factors and guide expectations during monitoring. Further research related to patient-specific factors amenable to modification can further improve our capacity to protect the nervous system during surgery.
- Saddle pulmonary embolus resulting in cardiovascular collapse requiring extracorporeal membrane oxygenation in a postoperative patient with endometrial cancer. [Journal Article]
- GOGynecol Oncol Rep 2018; 24:36-38
- CONCLUSIONS: Saddle pulmonary embolus is a potentially catastrophic and fatal postoperative complication. This case demonstrates a successful implementation of directed thrombolysis, veno-arterial extracorporeal membrane oxygenation and multidisciplinary management in a case of postoperative saddle pulmonary embolus.
- Mass Compression from Recurrent Lymphoma Mimicking Lower Extremity Cellulitis. [Journal Article]
- CCureus 2018 Apr 12; 10(4):e2466
- Cellulitis is a common skin and soft tissue infection with substantial misdiagnosis rates due to its nonspecific clinical characteristics. In this report, we present a patient with recurrent metastat...
Cellulitis is a common skin and soft tissue infection with substantial misdiagnosis rates due to its nonspecific clinical characteristics. In this report, we present a patient with recurrent metastatic diffuse large B-cell lymphoma (DLBCL) masquerading as a unilateral lower extremity cellulitis. A 62-year-old man with a history of DLBCL, in remission for two years, presented with a two-week history of swelling and erythema of the right thigh and leg. Despite treatment with clindamycin and cephalexin, the redness and swelling continued to progress. On presentation to the emergency department, vitals were within normal limits, laboratory workup was significant only for borderline anemia and thrombocytopenia, and bilateral lower extremity ultrasound was negative for a clot. The patient was evaluated by a dermatologist who recommended further imaging workup for proximal vascular compression given the uniformity of inflammation and edema in the absence of fever or systemic symptoms. Imaging revealed retroperitoneal lymphadenopathy, right pelvic side wall and right inguinal lymphadenopathy, an intramuscular lymphomatous involvement of the right iliopsoas muscle, and mass compression of the right external iliac vein. Bone marrow and soft-tissue biopsies confirmed recurrent and metastatic DLBCL. In this patient, the atypical cellulitis-like features are likely due to venous and lymphatic obstruction secondary to mass effect from metastasis. Going forward, clinicians should consider compression-induced edema as a sign of primary or recurrent malignancy in patients with refractory or atypical cellulitis.
- Lymphedema techniques to manage edema after SCI: a retrospective analysis. [Journal Article]
- SCSpinal Cord 2018 Jun 12
- CONCLUSIONS: We found the mCDT approach to be safe and well-tolerated by the patients with SCI. The intervention was associated with decreased edema, and was feasible for use in a clinical setting. We recommend considering this mCDT approach for management of edema in individuals with SCI, while remaining vigilant about skin inspection.
- Influence of micro- and macro-vascular disease and Tumor Necrosis Factor Receptor 1 on the level of lower-extremity amputation in patients with type 2 diabetes. [Journal Article]
- CDCardiovasc Diabetol 2018 Jun 08; 17(1):81
- CONCLUSIONS: This study suggests that the risk factors associated with the minor vs. major amputation including biomarkers such as TNFR1 should be considered differently in patients with T2D.
- An Assessment of the Relationship Between Abdominal Obesity and the Severity of Upper Extremity Lymphedema. [Journal Article]
- LRLymphat Res Biol 2018 Jun 05
- CONCLUSIONS: Abdominal obesity was significantly correlated with increased MCD and should be considered along with obesity as an aggravating factor for lymphedema severity.
- Case 17-2018: A 40-Year-Old Woman with Leg Swelling and Abdominal Distention and Pain. [Case Reports]
- NEJMN Engl J Med 2018 May 31; 378(22):2124-2132
- Immunoglobulin light chain amyloidosis diagnosis and treatment algorithm 2018. [Review]
- BCBlood Cancer J 2018 May 23; 8(5):44
- Immunoglobulin light chain amyloidosis (AL) should be considered in any patient that presents to a cancer care provider with nephrotic range proteinuria, heart failure with preserved ejection fractio...
Immunoglobulin light chain amyloidosis (AL) should be considered in any patient that presents to a cancer care provider with nephrotic range proteinuria, heart failure with preserved ejection fraction, non-diabetic peripheral neuropathy, unexplained hepatomegaly or diarrhea. More importantly, patients being monitored for smoldering multiple myeloma and a monoclonal gammopathy of undetermined significance (MGUS) are at risk for developing AL amyloidosis. MGUS and myeloma patients that have atypical features, including unexplained weight loss; lower extremity edema, early satiety, and dyspnea on exertion should be considered at risk for light chain amyloidosis. Overlooking the diagnosis of light chain amyloidosis leading to therapy delay is common, and it represents an error of diagnostic consideration. Algorithms will be provided on how to evaluate patients with suspected AL amyloid as well as how to manage patients referred from other medical specialties with biopsy-proven amyloid. An organized stepwise approach to the treatment of patients with light chain amyloidosis, including established and investigational therapies, will be reviewed.
- Cystic Fibrosis and Lower-Extremity Edema: A Case of Intraoperative Diagnosis of Acute Deep Venous Thrombosis and Pulmonary Embolism in a Double-Lung Transplant Recipient Using Point-of-Care Ultrasound. [Journal Article]
- JCJ Cardiothorac Vasc Anesth 2018 Apr 21
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- Idiopathic nodular glomerulosclerosis (ING) in an African American (AA) man with hepatitis C. [Journal Article]
- BCBMJ Case Rep 2018 May 18; 2018
- Idiopathic nodular glomerulosclerosis (ING) in a non-diabetic patient is uncommon. Nodular glomerulosclerosis is hallmark sign of diabetic nephropathy. ING is a very rare clinicopathological disease ...
Idiopathic nodular glomerulosclerosis (ING) in a non-diabetic patient is uncommon. Nodular glomerulosclerosis is hallmark sign of diabetic nephropathy. ING is a very rare clinicopathological disease associated with smoking, obesity and hypertension, chronic obstructive pulmonary disease and metabolic syndrome. A 68-year-old non-obese African American man with hypertension, smoking and history of hepatitis C presented to the clinic with progressive worsening of lower extremity oedema and declining renal function over few months. Renal biopsy demonstrated nodular glomerulosclerosis. In this case, ING is hypothesised to be associated with hepatitis C along with smoking and hypertension (HTN). We present this case to speculate the existence of yet unknown aetiologies of ING.