Nonhepatic hyperammonemic encephalopathy due to undiagnosed urea cycle disorder.
We present a case of a woman with urea cycle disorder diagnosed after an acute peptic ulcer bleed and fasting. PMID: 26130895 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Mahmood T, Nugent K Tags: Proc (Bayl Univ Med Cent) Source Type: research

Anaplastic large-cell lymphoma in AIDS.
We present a case of a newly diagnosed AIDS patient with Pneumocystis jiroveci pneumonia, Epstein-Barr virus, and cytomegalovirus infections who was found to have widely metastatic kinase-negative anaplastic large-cell lymphoma. This case demonstrates the diversity in the malignant presentation of HIV-infected patients, outside of the more commonly observed non-Hodgkin lymphomas. PMID: 26130896 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Krol ML, Podduturi V, Majid-Moosa A, Krause JR, Mora A Tags: Proc (Bayl Univ Med Cent) Source Type: research

Primary follicular lymphoma of the duodenum.
We describe a woman with de novo follicular lymphoma of the duodenum and discuss the features of this remarkably indolent variant of follicular lymphoma. PMID: 26130897 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Graham RL, Mardones MA, Krause JR Tags: Proc (Bayl Univ Med Cent) Source Type: research

Tubulocystic carcinoma of the kidney.
We report a case of TCC arising in the left kidney. PMID: 26130898 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Podduturi V, Adair CF, Zhang H Tags: Proc (Bayl Univ Med Cent) Source Type: research

Unusual presentation of metastatic ovarian carcinoma as an enlarged intramammary lymph node.
Abstract Metastasis to the breast most commonly arises from a contralateral primary breast malignancy; however, metastatic disease can also result from extramammary malignancies by hematogenous or lymphatic dissemination. This case report reviews an unusual presentation of primary ovarian carcinoma with metastasis to an intramammary lymph node. PMID: 26130899 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Mason C, Yokubaitis K, Hamilton R, Oza U, Shah Z, Spigel J, Wang J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Leukoencephalopathic changes on magnetic resonance imaging associated with a thermogenic dietary supplement (Thermatrim).
We describe two such cases in young women taking a commercially available thermogenic dietary supplement who presented with acute neurologic deficits and a common magnetic resonance imaging pattern. PMID: 26130900 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Olivas-Chacon CI, Treviño-Garcia M, Chua-Tuan JJ, Rodriguez-Cordero JM, Gil-Valadez AH, Akle N, Calleros JE, Ramos-Duran LR Tags: Proc (Bayl Univ Med Cent) Source Type: research

Precision medicine: hype or hoax?
PMID: 26130901 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Mennel RG Tags: Proc (Bayl Univ Med Cent) Source Type: research

Update on the Baylor Scott & White Quality Alliance.
Update on the Baylor Scott & White Quality Alliance. Proc (Bayl Univ Med Cent). 2015 Jul;28(3):401-3 Authors: Couch CE PMID: 26130902 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Couch CE Tags: Proc (Bayl Univ Med Cent) Source Type: research

Nobel laureates and their medical schools: who selected whom?
PMID: 26130903 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Weisse AB Tags: Proc (Bayl Univ Med Cent) Source Type: research

On Camel Rides and Moses Maimonides.
PMID: 26130904 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Cantwell JD Tags: Proc (Bayl Univ Med Cent) Source Type: research

David Bruce Hellmann, MD: a conversation with the editor.
PMID: 26130905 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Authors: Hellmann DB, Roberts WC Tags: Proc (Bayl Univ Med Cent) Source Type: research

Facts and ideas from anywhere.
Authors: PMID: 26130906 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - July 1, 2015 Category: Universities & Medical Training Tags: Proc (Bayl Univ Med Cent) Source Type: research

Antibiotic utilization improvement with the Nanosphere Verigene Gram-Positive Blood Culture assay.
Abstract New technologies offer rapid identification of organisms and antimicrobial resistance markers in blood cultures several hours faster than conventional methods. We sought to determine whether implementation of the Verigene® Gram-Positive Blood Culture (BC-GP) assay paired with a well-defined results reporting algorithm would lead to earlier deescalation of empiric therapy for inpatients with methicillin-sensitive Staphylococcus aureus (MSSA) and vancomycin-resistant Enterococcus (VRE) bacteremia. The algorithm design focused on lessening the demand for pharmacist time by using electronic communications...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Beal SG, Thomas C, Dhiman N, Nguyen D, Qin H, Hawkins JM, Dekmezian M, Benavides R Tags: Proc (Bayl Univ Med Cent) Source Type: research

The SUCCESS model for laboratory performance and execution of rapid molecular diagnostics in patients with sepsis.
We present a collaborative SUCCESS model for execution and monitoring of rapid sepsis diagnostics to facilitate timely treatment. Six months after execution of the Verigene Gram-Positive Blood Culture (BC-GP) and the AdvanDx PNA-FISH assays, data were collected on 579 and 28 episodes of bacteremia and fungemia, respectively. Clinical testing was executed using a SUCCESS model comprising the following components: stewardship, utilization of resources, core strategies, concierge services, education, support, and surveillance. Stewardship needs were identified by evaluating the specialty services benefiting from new testing. ...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Dekmezian M, Beal SG, Damashek MJ, Benavides R, Dhiman N Tags: Proc (Bayl Univ Med Cent) Source Type: research

Impact of the DASH diet on endothelial function, exercise capacity, and quality of life in patients with heart failure.
This study examined the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on endothelial function, exercise capacity, and quality of life in patients with chronic symptomatic (stage C) HF. Forty-eight patients were randomized to follow the DASH diet (n = 24) or the general HF dietary recommendations (n = 24). Endothelial function was assessed by measuring large and small arterial elasticity (LAE and SAE) at rest. Exercise capacity (measured with the 6-minute walk test) and quality of life (measured with the Minnesota Living with Heart Failure Questionnaire) at baseline and 3 months were also evaluated. Pat...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Rifai L, Pisano C, Hayden J, Sulo S, Silver MA Tags: Proc (Bayl Univ Med Cent) Source Type: research

A survey-based analysis of symptoms in patients with postural orthostatic tachycardia syndrome.
Abstract Postural orthostatic tachycardia syndrome (POTS) is a type of dysautonomia seen most commonly in young women and children. It is defined as an increase in heart rate of 30 beats per minute (bpm) or more within 10 minutes of standing in adults, or by 40 bpm or more in children in the absence of orthostatic hypotension. In addition to typical autonomic symptoms, POTS patients report a wide range of subjective complaints in multiple organ systems, though the exact frequencies are unclear. To address the symptom frequency, we had 39 patients with POTS at our institution complete an intake form consisting of a...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Deb A, Morgenshtern K, Culbertson CJ, Wang LB, Hohler AD Tags: Proc (Bayl Univ Med Cent) Source Type: research

An interactive web-based project to stimulate internal medicine resident reading using board-type questions.
Abstract Since restricted resident work hours have reduced resident participation in traditional educational activities, we wanted to evaluate e-mail-based education in an internal medicine residency. One internal medicine faculty member sent four clinical case-based questions per week to all internal medicine residents over a 10-month period (132 questions total). The mean percentage of participation on a set of questions was 69% (range, 43% to 97%). The mean percentage of correct answers on all questions for all residents was 70% (range, 15% to 100%). Seventy-three percent of the question sets resulted in an ele...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Tuncel-Kara M, Islam EA, Wang H, Pelley J, Nugent K Tags: Proc (Bayl Univ Med Cent) Source Type: research

The acute respiratory distress syndrome.
Abstract The acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure. Its development leads to high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity. In this review article, we describe updated concepts in ARDS. Specifically, we discuss the new definition of ARDS, its risk factors and pathophysiology, and current evidence regarding ventilation managem...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Modrykamien AM, Gupta P Tags: Proc (Bayl Univ Med Cent) Source Type: research

History of neurologic examination books.
The objective of this study was to create an annotated list of textbooks dedicated to teaching the neurologic examination. Monographs focused primarily on the complete neurologic examination published prior to 1960 were reviewed. This analysis was limited to books with the word "examination" in the title, with exceptions for the texts of Robert Wartenberg and Gordon Holmes. Ten manuals met the criteria. Works dedicated primarily to the neurologic examination without a major emphasis on disease description or treatment first appeared in the early 1900s. Georg Monrad-Krohn's "Blue Book of Neurology" (&quo...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Boes CJ Tags: Proc (Bayl Univ Med Cent) Source Type: research

Cecal adenocarcinoma presenting as colonic intussusception in adulthood.
Abstract Intussusception occurs when a proximal segment of intestine invaginates into a distal segment. It is a common cause of intestinal obstruction in children but is infrequent in adults. A 77-year-old woman presented with a 1-month history of intermittent abdominal pain associated with nausea and distended abdomen. Imaging showed a complex elongated sausage-shaped mass in the transverse colon with no obstructive pattern or free air. Surgery confirmed colonic intussusception in addition to a palpable cecal mass requiring a right hemicolectomy. Histologic study demonstrated adenocarcinoma in situ within a tubul...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Gonzalez-Hernandez J, Garcia F Tags: Proc (Bayl Univ Med Cent) Source Type: research

Large-volume barium aspiration.
We present a case of large-volume barium aspiration in a 56-year-old woman with stage IV tongue squamous cell carcinoma and longstanding dysphagia. The patient rapidly developed hypoxemic respiratory failure from the resultant chemical pneumonitis. However, her respiratory status improved with supportive care alone in 48 hours. Barium aspiration is rare and often produces dramatic radiographic findings, but is generally associated with a favorable prognosis. PMID: 25829647 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Hundemer GL, Kumar V, Vaduganathan M Tags: Proc (Bayl Univ Med Cent) Source Type: research

Effect of resection of an orbital arteriovenous malformation on central venous pressure.
We report the first utilization of intraoperative central venous pressure (CVP) monitoring in the resection of an orbital arteriovenous malformation. A 24-year-old woman with a history of a left orbital mass who had previously undergone resection of a cranio-orbital arteriovenous malformation presented with gradual recurrence in the left orbit. She visited the emergency department with sudden vision loss, which resolved over several hours. This transient vision loss was thought to be due to a steal phenomenon from the ophthalmic artery due to the residual vascular malformation. Further surgical resection was undertaken. A ...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Starks VS, Gilliland G, Hise J, Thacker I, Layton KF Tags: Proc (Bayl Univ Med Cent) Source Type: research

Acute nonrheumatic streptococcal myocarditis resembling ST-elevation acute myocardial infarction in a young patient.
We present the case of a 43-year-old man hospitalized with chest pain that was initially diagnosed as an acute ST-elevation myocardial infarction. Further evaluation confirmed that his chief complaint was due to acute nonrheumatic streptococcal myocarditis. PMID: 25829649 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Aguirre JL, Jurado M, Porres-Aguilar M, Olivas-Chacon C, Porres-Muñoz M, Mukherjee D, Taveras J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Invited Commentary: What is the definition of SPAM? Even if you cannot define it, you must recognize it!
Authors: PMID: 25829650 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Tags: Proc (Bayl Univ Med Cent) Source Type: research

Cardiac arrhythmias during myocardial infarction.
PMID: 25829651 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Glancy DL, Atluri P, Rodriguez JF, Subramaniam PN Tags: Proc (Bayl Univ Med Cent) Source Type: research

Takotsubo cardiomyopathy associated with hyperthyroidism treated with thyroidectomy.
We report a case that highlights takotsubo syndrome in the setting of thyrotoxicosis that required thyroidectomy. The association of takotsubo syndrome and hyperthyroidism has been reported before. We found 13 previously reported cases of thyrotoxicosis-induced cardiomyopathy, most associated with Grave's disease and none treated with thyroidectomy. Awareness of this possible association is important in establishing the diagnosis and instituting proper management. PMID: 25829652 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Omar S, Ali E, Mazek H, Mahmoud T, Soontrapa S, Suarez J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Ventricular tachycardic storm with a chronic total coronary artery occlusion treated with percutaneous coronary intervention.
Abstract A 66-year-old man with a history of coronary artery disease was evaluated due to ventricular tachycardic (VT) storm. The patient continued to have frequent recurrences of VT despite treatment with amiodarone and lidocaine. Since the ventricular arrhythmia could be related to myocardial ischemia related to a chronic total occlusion (CTO) of the right coronary artery, the patient underwent successful percutaneous coronary intervention of the CTO, followed by implantable cardioverter defibrillator implantation. He had no further episodes of VT during his hospital stay. After 9 months of follow-up, he had no ...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Mixon TA Tags: Proc (Bayl Univ Med Cent) Source Type: research

Myocardial ischemic hyperacute T-wave oversensing leading to a defibrillator shock storm.
We present the case of a 45-year-old man presenting with shock storm as a result of T-wave oversensing. Workup revealed a hemodynamically significant stenosis of the left anterior descending artery treated with percutaneous coronary intervention and drug-eluting stent placement. This resulted in the resolution of T-wave missensing and restoration of normal ICD functioning. PMID: 25829654 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Chhabra L, Khalid N, Kluger J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Usefulness of percutaneous closure of patent foramen ovale for hypoxia.
We report a patient with hypoxia secondary to a right-to-left shunt through a patent foramen ovale, following aortic root, valve, and arch replacement due to an aortic dissection in the setting of the Marfan syndrome. Following the operation, he failed extubation twice due to hypoxia. An extensive workup revealed a right-to-left shunt previously not seen. The patent foramen ovale was closed using a percutaneous closure device. Following closure, our patient was extubated without difficulty and has done well postoperatively. PMID: 25829655 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Munkres AG, Ball TN, Chamogeorgakis T, Ausloos KA, Hall SA, Choi JW Tags: Proc (Bayl Univ Med Cent) Source Type: research

Mitral stenosis and acute ST elevation myocardial infarction.
We describe a patient who presented with acute (inferior wall) ST elevation myocardial infarction. Her echocardiogram showed severe mitral stenosis with ball valve thrombus in the left atrial body and thrombus in the left atrial appendage. Coronary angiogram revealed thromboembolic material in the right coronary artery. Mitral valve replacement was scheduled. PMID: 25829656 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Cardoz J, Jayaprakash K, George R Tags: Proc (Bayl Univ Med Cent) Source Type: research

Effectiveness of exclusion of a persistent sciatic artery aneurysm with an Amplatzer™ plug.
Effectiveness of exclusion of a persistent sciatic artery aneurysm with an Amplatzer™ plug. Proc (Bayl Univ Med Cent). 2015 Apr;28(2):210-2 Authors: Lee A, Hohmann SE, Shutze WP Abstract Persistent sciatic artery is a rare developmental anomaly. In its complete form, it provides the major arterial supply to the lower leg since the femoral system is hypoplastic. These unique arteries are prone to aneurysm formation and most commonly present with complications related to aneurysm formation, which can lead to limb loss. We encountered a 68-year-old man presenting with bilateral lower-extremity isch...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Lee A, Hohmann SE, Shutze WP Tags: Proc (Bayl Univ Med Cent) Source Type: research

Immune thrombocytopenia associated with consumption of tonic water.
This article presents the case of a man who developed sudden onset of severe thrombocytopenia associated with the ingestion of quinine-containing tonic water. PMID: 25829658 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Winter FD Tags: Proc (Bayl Univ Med Cent) Source Type: research

Paraneoplastic cerebellar ataxia and the paraneoplastic syndromes.
We describe a patient with severe cerebellar dysfunction attributed to a paraneoplastic neurological syndrome. The case highlights the need to look for paraneoplastic syndromes-both to discover malignancies early, at a treatable stage, and, as in our case, to address very distressing symptoms for the patient's relief even if the malignancy is not curable. PMID: 25829659 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Afzal S, Recio M, Shamim S Tags: Proc (Bayl Univ Med Cent) Source Type: research

Carcinoma of the lungs causing enlarged kidneys.
We report a case of a 67-year-old woman with a 6-month history of productive cough and unintentional weight loss. Cavitary pulmonary lesions and bilateral enlarged kidneys were noted on imaging studies. Hematuria, azotemia, and proteinuria were present. Renal biopsy showed squamous carcinoma cells invading normal-appearing glomeruli and atrophic tubules. The invasive squamous cells stained negative for CK7 and CK 20. Lung biopsy confirmed squamous cell carcinoma. Our case shows that in patients with renal enlargement, even with the absence of a focal mass, renal metastasis should be considered, especially in those with sus...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Srisung W, Mankongpaisarnrung C, Warraich I, Sotello D, Yarbrough S, Laski M Tags: Proc (Bayl Univ Med Cent) Source Type: research

Mixed epithelial and stromal tumors of the kidney discovered incidentally at autopsy.
Abstract Mixed epithelial and stromal tumors (MEST) of the kidney are uncommon neoplasms that were added to the World Health Organization's renal tumor classification in 2004. These entities are biphasic and contain both epithelial and mesenchymal components. MEST most commonly occur in women. Presented are two cases of MEST incidentally discovered at autopsy. PMID: 25829661 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Podduturi V, Guileyardo JM Tags: Proc (Bayl Univ Med Cent) Source Type: research

Superior sagittal sinus thrombosis as the initial presentation of renal cell carcinoma.
We describe a 68-year-old man who presented with headaches, nausea, and dizziness and was found to have a superior sagittal sinus venous thrombosis on magnetic resonance imaging. His initial hypercoagulable workup was negative. Computed tomography of the abdomen revealed a large mass originating from the kidney. A radical nephrectomy was performed at an outside hospital, and histological study of the excised mass disclosed clear cell renal carcinoma. PMID: 25829662 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Reddy MP, Gross LM, Moreland A, DeMarco DC Tags: Proc (Bayl Univ Med Cent) Source Type: research

Hepatocellular carcinoma with extension to the heart via the inferior vena cava.
Abstract Hepatocellular carcinoma (HCC) is the third-leading cause of cancer-related mortality worldwide. Most cases of HCC are associated with cirrhosis from various causes such as alcohol or viral hepatitis. Most patients are symptomatic as a result of cirrhosis itself or secondary to tumor extension. These tumors have an affinity for the vasculature and often invade the portal system. HCC rarely causes invasion of the inferior vena cava or the heart. We, however, present a case of HCC in a patient without cirrhosis who remained asymptomatic despite having tumor extension to the heart by way of the inferior vena...
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Oncale M, Lewis B Tags: Proc (Bayl Univ Med Cent) Source Type: research

Leprosy in a texan.
Abstract A 69-year-old man from Texas with an unremarkable past medical history presented with a 2-year history of a diffuse, spreading annular eruption involving most of his trunk. He noticed progressive numbness of his hands and feet but no other systemic symptoms. He had never traveled outside of the United States. Skin biopsy confirmed a diagnosis of leprosy, and he was initiated on appropriate therapy. PMID: 25829664 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Authors: Vick GL, Tillman EA, Fiala KH Tags: Proc (Bayl Univ Med Cent) Source Type: research

Facts and ideas from anywhere.
Authors: PMID: 25829665 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - April 1, 2015 Category: Universities & Medical Training Tags: Proc (Bayl Univ Med Cent) Source Type: research

Risk of colon perforation during colonoscopy at Baylor University Medical Center.
Abstract Colonoscopy is an important procedure in preventing colon cancer. The risk of colonic perforation during colonoscopy at the Baylor University Medical Center (BUMC) Gastrointestinal Laboratory was chosen as a surrogate marker for the safety of colonoscopy. A recent 2-year experience at BUMC was examined and compared with reports in the medical literature. The results are presented here along with a discussion of problems inherent with different health care systems and their ability to accurately track complications. It was concluded that colonoscopy at BUMC is as safe as that reported by comparable health ...
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Polter DE Tags: Proc (Bayl Univ Med Cent) Source Type: research

Impact of Henda's law on the utilization of screening breast magnetic resonance imaging.
Abstract Female breast tissue is composed of variable proportions of fat and fibroglandular tissue, and in general, an increased ratio of fibroglandular tissue to fat corresponds to increased mammographic density. Studies suggest that mammographic density is an independent risk factor for breast cancer, and the sensitivity of mammography can be lower with heterogeneously dense or extremely dense breasts. Nineteen states have legal statutes requiring that patients be notified if they have dense breasts, including the state of Texas. Henda's law, mandated on January 1, 2012 in Texas, suggests that patients with dens...
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Mason C, Yokubaitis K, Howard E, Shah Z, Wang J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Comparison of length of stay and outcomes of patients with positive versus negative blood culture results.
Abstract In the United States, sepsis is the leading cause of death in critically ill patients. The fatality rate for severe sepsis is about 40%, and treatment costs over $16 billion annually. It is critical to identify and treat the source of sepsis. While there are varying guidelines determining when to draw blood for culture, at Baylor University Medical Center at Dallas, blood cultures are ordered for patients with new onset of fever, immunosuppression, or a suspicion of an underlying infectious etiology. We conducted a retrospective study of patients who had blood cultures after hospital admission or in the e...
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Armstrong-Briley D, Hozhabri NS, Armstrong K, Puthottile J, Benavides R, Beal S Tags: Proc (Bayl Univ Med Cent) Source Type: research

Redundancy and variability in quality and outcome reporting for cardiac and thoracic surgery.
In conclusion, our data indicated a significant discordance in quality reporting for cardiac surgery between the NSQIP and the STS databases. The disparity between databases and duplicate participation strongly indicates that a unified national quality reporting program is required. Consolidation of reporting databases and standardization of morbidity definitions across all databases may improve participation and reduce hospital cost. PMID: 25552787 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Dixon JL, Papaconstantinou HT, Hodges B, Korsmo RS, Jupiter D, Shake J, Sareyyupoglu B, Rascoe PA, Reznik SI Tags: Proc (Bayl Univ Med Cent) Source Type: research

Postextubation Dysphagia.
Abstract Postextubation dysphagia (PED) is a common problem in critically ill patients with recent intubation. Although several risk factors have been identified, most of them are nonmodifiable preexisting or concurrent conditions. Early extubation, small endotracheal tube size, and small bore of nasogastric tube potentially decrease the risk of PED. The majority of patients receive treatment based on only bedside swallow evaluations, which has an uncertain diagnostic accuracy as opposed to gold standard instrumental tests. Therefore, the treatment decision for patients may not be appropriately directed for each i...
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Rassameehiran S, Klomjit S, Mankongpaisarnrung C, Rakvit A Tags: Proc (Bayl Univ Med Cent) Source Type: research

Paul Revere Osler: the other child.
Abstract Sir William Osler (1849-1919) is among the most honored and esteemed physicians of our time. His life, and that of his wife Grace Revere Osler (1854-1928), has been examined in great detail by historians and biographers and continues to be the subject of intensive scrutiny. Their son "Revere" (Edward Revere Osler) (1895-1917), who died in the Great War, is often mistakenly referred to as their only child. Grace had two previous pregnancies, having given birth to Paul Revere Osler, who lived but a week, early in their marriage in 1893 and to a stillborn infant during her first marriage to Dr. Sam...
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Golden RL Tags: Proc (Bayl Univ Med Cent) Source Type: research

Ascending paralysis associated with HIV infection.
We present two patients with a high viral load of HIV-1 who developed symptoms of ascending paralysis leading to respiratory failure and autonomic instability. One patient had symptom improvement with highly active antiretroviral therapy (HAART) and a subsequent decrease in viral load. The other patient improved with intravenous immunoglobulin therapy and did not show much improvement on HAART alone. There are several proposed mechanisms for peripheral neuropathies seen in HIV-infected patients, including a direct action of HIV on the nerve by neurotropic strains or formation of autoantibodies against nerve elements. The c...
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Afzal A, Benjamin M, Gummelt KL, Afzal S, Shamim S, Tribble M Tags: Proc (Bayl Univ Med Cent) Source Type: research

Transient hypothermia in HIV-1 with insulin-like growth factor-1 deficiency and severe protein calorie malnutrition.
We report an HIV-1 patient with transient hypothermia secondary to severe protein calorie malnutrition and elevated HIV viral load. In this patient, it is hypothesized that the etiology of the hypothermia was multifactorial due to severe protein calorie malnutrition, evidenced by decreased insulin-like growth factor-1 levels, severe hypothyroidism, and an elevated HIV viral load, since the patient began to improve with the initiation of highly active antiretroviral therapy, improved nutrition, and continuation of thyroid supplementation. PMID: 25552791 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Choi CH, McNeal T Tags: Proc (Bayl Univ Med Cent) Source Type: research

Metformin-induced lactic acidosis with emphasis on the anion gap.
Abstract The presence of an anion gap in a diabetic patient, especially if associated with evidence of compromised renal function, should prompt clinicians to consider metformin as a contributing factor. This consideration is especially important in patients with severe anion gaps associated with lactic acidosis out of proportion to the patient's clinical presentation. PMID: 25552792 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Blough B, Moreland A, Mora A Tags: Proc (Bayl Univ Med Cent) Source Type: research

Preventing retrograde jejunoduodenogastric intussusception as a complication of a long-term indwelling gastrostomy tube.
Abstract Gastrostomy tubes are frequently used to provide enteral access in a variety of patient populations. Long-term complications are usually minor and include ulceration of the surrounding skin, clogging or dislodgment of the feeding tube, and superficial abscess; severe long-term complications are rare. Here we report a case of a life-threatening complication from an indwelling gastrostomy tube, specifically retrograde jejunoduodenogastric intussusception. Computed tomography and intraoperative images, as well as a review of literature, provide a detailed picture for diagnosis and treatment. Although feeding...
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Govednik C, Cover J, Regner JL Tags: Proc (Bayl Univ Med Cent) Source Type: research

Second trimester placenta percreta presenting as acute abdomen.
We describe a 41-year-old woman presenting at 21 weeks' gestation with intraabdominal bleeding and no signs of placental abnormality on ultrasound. The disagreement between results of the ultrasound and magnetic resonance imaging made definitive diagnosis difficult. The bleeding resolved spontaneously after a blood transfusion, and the patient was hospitalized for the remainder of the pregnancy. Delivery was by scheduled repeat cesarean at 34 weeks' gestation. Spontaneous rupture of the entire fundus occurred at the time of delivery. Placenta percreta was confirmed by histologic examination of the operatively excised uteru...
Source: Baylor University Medical Center Proceedings - January 1, 2015 Category: Universities & Medical Training Authors: Dew L, Harris S, Yost N, Magee K, dePrisco G Tags: Proc (Bayl Univ Med Cent) Source Type: research