Clinical genetic testing in medical education.
Abstract Although clinical geneticists have traditionally monopolized the administration of genetic tests, several genetic test companies have started producing affordable consumer tests for genetic screening and ancestry analysis. With genetic test kits readily available, patients are increasingly using personal genetic testing resources with the intention of sharing their results with their primary care physicians. Therefore, both medical professionals and patients need information and guidelines to interpret and act on personal genetic data. However, medical students, residents, and attending physicians have li...
Source: Baylor University Medical Center Proceedings - January 1, 2019 Category: Universities & Medical Training Authors: Kopel J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Diagnostic and prognostic problems with the Prader-Willi syndrome.
Abstract Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder resulting from chromosomal duplications, deletions, or imprinting within the 15q11-q13 region. In most cases, patients with PWS inherit a de novo paternally inherited deletion, and the remaining result from maternal disomy 15 and imprinting. Currently, DNA methylation analysis remains the gold standard for diagnosing PWS. However, this diagnostic test provides no information concerning the molecular class of PWS. As a result, clinicians remain unable to accurately determine diagnostic and prognostic information for patients with PWS. Furthe...
Source: Baylor University Medical Center Proceedings - January 1, 2019 Category: Universities & Medical Training Authors: Kopel J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Facts and ideas from anywhere.
PMID: 30956622 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - January 1, 2019 Category: Universities & Medical Training Authors: Roberts WC Tags: Proc (Bayl Univ Med Cent) Source Type: research

Utility of routine transesophageal echocardiography in patients with stroke or transient ischemic attack.
Abstract In several series of patients with presumed stroke, transesophageal echocardiography (TEE) has seemed advantageous over transthoracic echocardiography (TTE) in that it improves detection of cardiac sources and can lead to changes in the methods of treatment. We hypothesized that the real-world application of TEE in our institution produced results at variance from those previously reported. Our study of 219 patients, referred for TEE for an indication of stroke or transient ischemic attack, found few relevant findings that would have indicated a new diagnosis or required a change in treatment. These resul...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Schwartz BG, Alexander CT, Grayburn PA, Schussler JM Tags: Proc (Bayl Univ Med Cent) Source Type: research

Intraoperative assessment of pulmonary artery pressure using transesophageal echocardiography in patients undergoing cardiac surgery.
Abstract We performed a retrospective chart review to investigate a potential relation between pulmonary artery (PA) diameter as measured by intraoperative transesophageal echocardiography and PA pressures measured by PA catheter with the aim of determining whether main PA diameter can aid clinicians in the diagnosis of PA hypertension. A total of 82 adult patients undergoing cardiac surgery were included in our study. Main PA diameter showed a moderate correlation with systolic and diastolic pressures, r = 0.576 (95% confidence interval [CI], 0.407-0.703), P 
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Zaki JF, Aijazi M, Wong MA, Choi W, Moise OL, Tran SF, Pawelek TR, Zhou SF, Sheinbaum R, Fonseca AC, Markham T Tags: Proc (Bayl Univ Med Cent) Source Type: research

Analysis of electrocardiographic intervals before and after transcatheter aortic valve implantation to predict the need for permanent pacing.
Abstract Transcatheter aortic valve implantation (TAVI) is growing in utilization in the USA, and atrioventricular heart block is a common complication of the procedure. In patients with conduction system changes following TAVI, there are no clear guidelines for permanent pacing, leading to difficult clinical decisions on how long to leave temporary transvenous pacemakers in place. The aim of our study was to determine whether changes in electrocardiogram characteristics could predict the need for permanent pacing. A retrospective analysis was conducted of 209 consecutive TAVI patients seen from January 2012 to De...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Ball TN, Vasudevan A, Mi Ko J, Assar MD, McCullough PA, Stoler RC Tags: Proc (Bayl Univ Med Cent) Source Type: research

Validation of a low-dose contrast 64-slice cardiac computed tomography angiography protocol for aortic valve annulus sizing.
Abstract Cardiac computed tomography angiography (CCTA) is the gold standard for accurately sizing the aortic valve annulus prior to aortic valve replacement. A reduction of contrast volume administered for CCTA, without sacrificing image quality, is desirable. Signal-to-noise ratio represents final CCTA image quality. Consecutive patients referred to CCTA for aortic valve annulus sizing were retrospectively analyzed. Patients were grouped into a low-dose contrast (LDCT) group and traditional dose contrast (TDCT) group. In the LDCT group, contrast dose was
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Holper EM, Gopal D, Biberstein A, Filardo G, Avila A, Gopal A Tags: Proc (Bayl Univ Med Cent) Source Type: research

Impact of angiotensin-converting enzyme inhibitors and statins on viral pneumonia.
Abstract Angiotensin-converting enzyme (ACE) inhibitors and statins may potentially benefit patients with viral infections and pneumonia. Our study aimed to evaluate the impact of ACE inhibitors and statins on the rates of intubation and death in viral pneumonia. We retrospectively studied 1055 adult patients admitted to a tertiary care center in central Texas with a positive respiratory viral polymerase chain reaction test. Of these, 539 had clinical presentation and imaging consistent with pneumonia. We collected information on demographic characteristics, microbiology, comorbid conditions, medication use, and o...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Henry C, Zaizafoun M, Stock E, Ghamande S, Arroliga AC, White HD Tags: Proc (Bayl Univ Med Cent) Source Type: research

Effect of a low-dose interventional x-ray system on radiation exposure in the higher body surface area patient population.
In conclusion, AlluraClarity significantly reduced overall radiation dose, irrespective of BSA. The largest reduction in radiation was seen in patients with the highest BSA, suggesting that obese patients derive the most benefit. To our knowledge, this is the first study to describe this relationship with BSA and AlluraClarity. The Clarity system also substantially reduced radiation dose despite longer fluoroscopy time. PMID: 30948971 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Memon S, Larsen TR, Mathew J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Efficacy and safety of transarterial chemoembolization with 70- to 150- μm drug-eluting beads alone or in combination with 100- to 300-μm drug-eluting beads.
In conclusion, drug-eluting bead TACE with 70- to 150-μm embolics alone or in combination with 100- to 300-μm embolics is safe and demonstrates good disease control, particularly with small, solitary tumors. PMID: 30948972 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Cura M, Heithaus E Tags: Proc (Bayl Univ Med Cent) Source Type: research

Comparison of utilization of pressurized automated versus manual hand irrigation during ureteroscopy in the absence of ureteral access sheath.
In conclusion, irrigation applied by an automated setup appears safe, with similar outcomes to irrigation applied with a handheld syringe. PMID: 30948973 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Doersch KM, Hart KD, Elmekresh A, Milburn PA, Machen GL, El Tayeb MM Tags: Proc (Bayl Univ Med Cent) Source Type: research

Medication reconciliation in the emergency department performed by pharmacists.
Abstract Patients are at risk of having their medication histories inaccurately documented while being admitted to an emergency department (ED). Allowing a pharmacist to access patient medication history is an effective way of reducing the number of errors. We sought to determine if having a pharmacist (as opposed to the admitting clinical team) verify patients' medication histories would result in fewer discrepancies in inpatient medication regimens. We performed a prospective cohort comparison study of adult ED patients admitted to general medicine floors for continuing care. In the intervention group, pharmacis...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Mogaka B, Clary D, Hong C, Farris C, Perez S Tags: Proc (Bayl Univ Med Cent) Source Type: research

Impact of culinary medicine elective on medical students' culinary knowledge and skills.
Abstract Diet has an important role in the treatment and prevention of chronic illnesses. Physicians are regarded as having proficient knowledge about nutrition, but most believe that they lack an understanding of clinical nutrition. In fall 2016, a group of medical students developed a culinary medicine elective for 20 students at Texas Tech University Health Sciences Center School of Medicine in Lubbock that included four didactic sessions and four interactive cooking labs that culminated in a final contest. The elective was meant to educate medical students about nutrition and dietary habits for their own benef...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Jaroudi SS, Sessions WS, Wang VS, Shriver JL, Helekar AS, Santucci M, Cole L, Ruiz J, Fackrell J, Chauncey K Tags: Proc (Bayl Univ Med Cent) Source Type: research

Solicitation for article submission by electronic journals.
Abstract The business model, editorial policies, and content quality vary significantly in online medical journals. Some online journals have been labeled as predatory journals because their main effort involves collecting article processing charges with little interest in content, peer review, or manuscript presentation. Some of these journals send frequent email solicitations for submissions. One author affiliated with a department of internal medicine collected all email requests for submissions to online journals over a 6-month period. These emails included 210 unique journal names that covered over 40 medical...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Ball S, Kopel J, Alexander R, Nugent K Tags: Proc (Bayl Univ Med Cent) Source Type: research

Percutaneous temporary circulatory support devices and their use as a bridge to decision during acute decompensation of advanced heart failure.
Abstract Temporary mechanical cardiac support (TMCS) devices intend to restore systemic perfusion and prevent further end-organ damage in patients with refractory cardiogenic shock until the insult is addressed. TMCS has been associated with reductions in hospital costs and in-hospital mortality. We review the four primary TMCS modalities available: intra-aortic balloon pump, TandemHeart, veno-arterial extracorporeal membrane oxygenation, and Impella pump. All have their own implantation technique and hemodynamic profile, and their use may therefore be tailored to the specific patient's needs. The appropriate TMCS...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Afzal A, Hall SA Tags: Proc (Bayl Univ Med Cent) Source Type: research

Acute necrotizing esophagitis presenting with severe lactic acidosis and shock.
We describe a 60-year-old man with an acute upper gastrointestinal bleed and sepsis and subsequently acute necrotizing esophagitis. PMID: 30948978 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Iwuji K, Jaroudi S, Bansal A, Rivas AM Tags: Proc (Bayl Univ Med Cent) Source Type: research

Sweet's syndrome in a patient with Crohn's disease.
Abstract Sweet's syndrome, or acute febrile neutrophilic dermatosis, has previously been associated with underlying inflammatory bowel disease; however, there are fewer than 50 case reports of such an association. Herein, we describe a young woman with Crohn's disease who presented with abrupt onset of a painful, tender erythematous rash on the dorsal hands and face. PMID: 30948979 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Silfvast-Kaiser A, Napoli E, Stockton L, Bautista I, Lopez L, Mirkes C Tags: Proc (Bayl Univ Med Cent) Source Type: research

Colonic stenting for a malignant large bowel obstruction with pneumatosis coli to reduce surgical risk.
Abstract Patients with a malignant large bowel obstruction are often late in seeking medical attention and are usually in poor health by the time a complete blockage is apparent. Emergency surgery in this setting, particularly in a patient with significant comorbidities, often requires the creation of an ostomy and can result in postoperative complications that delay the administration of adjuvant chemotherapy. This recent case at our center illustrates how the use of a colon stent, as a bridge to surgery, can help patients avoid the need for a stoma and reduce surgical complications. PMID: 30948980 [PubMed] ...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Stadler RF, Hughes MR, Hurley JB, Crim RW Tags: Proc (Bayl Univ Med Cent) Source Type: research

Nonoperative management of pneumoperitoneum after colonoscopy.
Abstract Pneumoperitoneum is often a sign of a perforated viscus and is considered a surgical emergency, as it can lead to enteric contamination within the peritoneal cavity with subsequent peritonitis and sepsis. Management of asymptomatic pneumoperitoneum can pose a dilemma to physicians. Here, we present and discuss a rare case of a 60-year-old man who developed a pneumoperitoneum after a colonoscopy. PMID: 30948981 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Joudeh LA, Newman MG Tags: Proc (Bayl Univ Med Cent) Source Type: research

Single-balloon enteroscopic retrograde cholangiopancreatography in the setting of altered upper gastrointestinal anatomy.
Abstract Endoscopic retrograde cholangiopancreatography in the setting of altered upper gastrointestinal anatomy presents several procedural challenges. Use of a standard side-viewing duodenoscope is often precluded by the patient's anatomy, thus rendering a limited examination of the ampulla and difficult cannulation of the bile duct. The authors present a case of single-balloon enteroscopy with successful endoscopic retrograde cholangiopancreatography, direct cholangioscopy, and cystic duct stone extraction using only an enteroscope. PMID: 30948982 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Smith S, Stagg J, Naumann C Tags: Proc (Bayl Univ Med Cent) Source Type: research

Iron pill pneumonitis with reactive lymph nodes.
We report a case of an elderly woman with chronic cough, infiltrates, and lymphadenopathy on imaging alongside nonnecrotizing granulomas on biopsy diagnosed with iron pill pneumonitis. PMID: 30948983 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Tlhabano L, Mankikar R, Odigwe C, Owens W, Grant L, Arya R Tags: Proc (Bayl Univ Med Cent) Source Type: research

Asthmatic granulomatosis as a rare variant of uncontrolled severe asthma.
We describe a 5-year course of a patient with AG that has shown no improvement with immunosuppression or other standards of therapy. PMID: 30948984 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Choudhury RH, Hashemi H, Tran T, Zhang H, Millard MW Tags: Proc (Bayl Univ Med Cent) Source Type: research

Left upper lobe torsion in pneumothorax.
We report a case of left upper lobe torsion in a patient who had a pneumothorax as a complication of subclavian venous access for an elective neurosurgical operation. Despite appropriate management of the pneumothorax, the patient's chest radiograph did not improve. Computed tomography of the chest was concerning for left upper lobe torsion. Fiberoptic bronchoscopy revealed near complete obstruction of the left upper lobe bronchus. Review of computed tomography imaging before and after bronchoscopy and subsequent thoracotomy confirmed lobar torsion. Consideration of lobar torsion in the differential diagnosis of patients w...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Pan T, Choudhury RH, Alias T, Felter D, Mora A Tags: Proc (Bayl Univ Med Cent) Source Type: research

Massive hemoptysis managed by rescue extracorporeal membrane oxygenation.
Abstract Massive hemoptysis can have a rapid and potentially fatal clinical course. A 68-year-old woman presented with recurrent hemoptysis complicated by refractory hypoxemia and shock despite aggressive intervention. The use of veno-venous extracorporeal membrane oxygenation was a nontraditional intervention that ultimately proved to be lifesaving, but is by no means recommended for routine use in this setting. PMID: 30948986 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Endicott-Yazdani TR, Wood C, Trinh AD, Mora A Tags: Proc (Bayl Univ Med Cent) Source Type: research

Salvage of severe primary graft dysfunction following heart transplantation using extracorporeal life support.
In conclusion, ECMO proved to be a viable option for early hemodynamic support in patients with severe PGD and has become our preferred modality for mechanical circulatory support in these patients. PMID: 30948987 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Martits-Chalangari K, Hernandez O, Jamil AK, Qin H, Felius J, Lima B, Rafael A, Gonzalez-Stawinski GV, Sherwood MJ, Hall SA Tags: Proc (Bayl Univ Med Cent) Source Type: research

Dengue fever as a cause of perimyocarditis and low-pressure cardiac tamponade.
We describe a case of dengue shock syndrome, perimyocarditis, and low-pressure cardiac tamponade following a trip to the Caribbean. The case was managed in the critical care unit and 6 weeks after discharge the patient was asymptomatic with a normal ejection fraction. Dengue fever presenting as cardiac tamponade is exceedingly rare and emphasizes the importance of taking a thorough travel history as well as being aware of atypical manifestations of rare diseases to make a correct diagnosis. PMID: 30948988 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Shah AB, Parmar YJ, Mangla A, Lasic Z, Coplan N Tags: Proc (Bayl Univ Med Cent) Source Type: research

Acute stroke intervention after transcatheter aortic valve replacement.
Abstract Stroke is a devastating complication in patients undergoing transcatheter aortic valve replacement (TAVR). We sought to determine whether early stroke intervention after TAVR would improve the neurological outcomes. Two patients experienced stroke immediately after TAVR, one treated with mechanical thrombectomy and localized lytic therapy and one treated with systemic lytic therapy. Our limited experience showed that early stroke intervention with either treatment option may reduce the risk of complications and improve neurological outcomes. PMID: 30948989 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Hamandi M, Farber AJ, Tatum JK, Brinkman WT, Brown DL, Lawrence ME, Mack MJ Tags: Proc (Bayl Univ Med Cent) Source Type: research

Effectiveness of treatment of innominate artery stenosis with retrograde supra-aortic stent using a flow reversal stent system.
We present the case of a 71-year-old man with critical stenosis of the innominate artery after previously undergoing bilateral carotid artery endarterectomies. We used an open retrograde approach of the right carotid artery to stent the innominate artery lesion employing the new ENROUTE Transcarotid Stent System with flow reversal. PMID: 30948990 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Beteck B, Corn R, Grimsley BR Tags: Proc (Bayl Univ Med Cent) Source Type: research

Management of bioprosthetic cardiac valve thrombosis.
Abstract Valvular thrombosis is a known complication of bioprosthetic valve replacement that usually occurs within a year of implantation. Four-dimensional computed tomography is quickly becoming the gold standard to directly visualize thrombus. Current guidelines for prophylaxis include aspirin for all bioprosthetic valve replacements, dual antiplatelet therapy for aortic valves, and anticoagulation for mitral valves. However, new trials have suggested single-agent antiplatelet therapy or anticoagulation for treatment of bioprosthetic valve thrombosis. Three cases are presented that illustrate the use of anticoag...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Fan J, Lipatov K, Lane W, Mixon T Tags: Proc (Bayl Univ Med Cent) Source Type: research

Retrograde venography and three-dimensional mapping of a great cardiac vein with separate drainage into the high right atrium in a patient with Wolf-Parkinson-White syndrome.
Abstract A 13-year-old boy presenting with palpitations was diagnosed with Wolf-Parkinson-White syndrome. We elected to bring him to the electrophysiology lab for evaluation of the accessory pathway and potential ablation. Structural assessment of the coronary sinus with electro-anatomical mapping and retrograde venography led to the discovery of a great cardiac vein having a separate insertion from the coronary sinus into the high right atrium. The accessory pathway was localized to the left lateral portion of the mitral annulus and treated successfully with radiofrequency ablation. Such venous anatomical variant...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Suarez K, Banchs JE, Lazol JP, Black JN Tags: Proc (Bayl Univ Med Cent) Source Type: research

Takotsubo cardiomyopathy in the setting of complete heart block.
Abstract Few cases of coincident takotsubo cardiomyopathy and complete heart block (CHB) have been reported. A 62-year-old woman presented with typical chest pain and was found to have CHB with a left ventricular ejection fraction of 35% and apical ballooning on ventriculogram. The patient was transvenously paced and a permanent biventricular pacemaker was placed when the CHB did not resolve. Repeat echocardiography 15 days after the event showed the ejection fraction to be 50%. This case highlights management strategies in this unique situation. PMID: 30948993 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Afzal A, Watson J, Choi JW, Schussler JM, Assar MD Tags: Proc (Bayl Univ Med Cent) Source Type: research

Acute myocardial infarction and renal dysfunction due to chronic extreme anemia (hemoglobin 2.5  g/dL) in immune thrombocytopenia.
Acute myocardial infarction and renal dysfunction due to chronic extreme anemia (hemoglobin 2.5 g/dL) in immune thrombocytopenia. Proc (Bayl Univ Med Cent). 2018 Oct;31(4):508-510 Authors: Muenchrath M, Aribindi K, Farnie M, DaSilva-DeAbreu A Abstract Immune thrombocytopenic purpura (ITP) is an acquired thrombocytopenia where autoantibodies are generated against platelet antigens. Primary ITP is often idiopathic, whereas secondary ITP has many potential causes, including drug induced, infection related (human immunodeficiency virus, hepatitis C), leukemias, or autoimmune such as systemic lupus ...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Muenchrath M, Aribindi K, Farnie M, DaSilva-DeAbreu A Tags: Proc (Bayl Univ Med Cent) Source Type: research

Early T-cell precursor acute lymphoblastic leukemia with KRAS and DNMT3A mutations and unexpected monosomy 7.
We report a case of ETP-ALL with KRAS and DNMT3A mutations and monosomy of chromosome 7 that did not initially respond to conventional ALL therapy but eventually responded to acute myeloid leukemia-type therapy, underscoring the interesting characteristics of this leukemia. Little information is available regarding monosomy 7 in this entity for the adult population. PMID: 30948995 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Tran T, Krause J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Simultaneous presentation of two distinct plasma cell neoplasms.
We report the simultaneous presentation of two distinct plasma cell neoplasms, a very uncommon situation. PMID: 30948996 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Metter DM, Maisel C, Krause JR Tags: Proc (Bayl Univ Med Cent) Source Type: research

Glioblastoma multiforme presenting as cryptogenic intracerebral hemorrhage.
We report a case of glioblastoma multiforme that presented as a large, spontaneous intracerebral hemorrhage (ICH). A 52-year-old woman developed headaches associated with photophobia and nausea. Computed tomography scan revealed a large ICH in the right temporal lobe. Further imaging, including magnetic resonance imaging and catheter-based arteriography, did not demonstrate an underlying lesion. She had 2-month follow-up imaging that was consistent with resolution of her hematoma and, again, no evidence of an associated mass. Six months after the initial ICH, she presented with worsening headaches. Magnetic resonance imagi...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Soto JM, Lyon KA, Benardete EA Tags: Proc (Bayl Univ Med Cent) Source Type: research

Skin involvement as the presenting sign of anorectal adenocarcinoma.
Abstract Cutaneous involvement as the presenting sign of internal carcinoma is rare and is associated with poor prognosis. Here we present the case of a 66-year-old woman with anorectal adenocarcinoma who presented with tumor involvement of the skin. PMID: 30948998 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Leiker AJ, Beg M, McIlwee B, Law R, Khosama L, Meyer J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Radiofrequency ablation of isolated liver metastasis from facial Merkel cell carcinoma.
This report describes an isolated metastasis to the liver from Merkel cell carcinoma of the left frontotemporal area and an effective treatment that may meaningfully prolong life. PMID: 30948999 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Huskic A, Goldstein R Tags: Proc (Bayl Univ Med Cent) Source Type: research

Successful treatment of atopic dermatitis with the JAK1 inhibitor oclacitinib.
We report the first case of atopic dermatitis successfully treated with the oral Janus kinase-1 (JAK1) inhibitor oclacitinib. A man in his 70s, with a 6-year history of skin disease refractory to topical and biologic therapies, self-prescribed this veterinary medication with rapid remission of symptoms. He has remained in remission for 7 months with no reported adverse side effects or infections. JAK1 plays a central role in expression of proinflammatory cytokines IL-4, IL-5, and IL-13, which play an important role in the pathogenesis of atopic dermatitis. Ruxolitinib and tofacitinib are JAK inhibitors currently app...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Haugh IM, Watson IT, Alan Menter M Tags: Proc (Bayl Univ Med Cent) Source Type: research

Yellow nail syndrome.
We present the case of a patient with yellow nail syndrome who had yellow, thickened nails unresponsive to antifungal treatment with concomitant lower-extremity lymphedema and a negative pulmonary workup despite chronic cough. His nails responded well to treatment with vitamin E and pulsed fluconazole. PMID: 30949001 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Preston A, Altman K, Walker G Tags: Proc (Bayl Univ Med Cent) Source Type: research

Ecthyma gangrenosum associated with Proteus bacteremia.
We present a case of ecthyma gangrenosum with atypical organisms and risk factors resulting in delayed diagnosis of both the condition and the underlying infectious process that caused it. Despite the atypical findings, the diagnosis was confirmed by biopsy and tissue culture. PMID: 30949002 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Hawrylak A, Seago S, Stroberg E, Hunt R, Greene Newman M Tags: Proc (Bayl Univ Med Cent) Source Type: research

Anesthetic management for cesarean section and tubal ligation in a patient with Marfan syndrome, multiple sclerosis, and multiple postdural puncture headaches.
We report a 29-year-old woman with Marfan syndrome, multiple sclerosis, and multiple postdural puncture headaches who presented for a scheduled repeat cesarean delivery with bilateral tubal ligation at 37 weeks gestation. During an outpatient preoperative visit, a general anesthetic plan was ultimately selected through a shared decision-making process. The patient had an uneventful general anesthetic that included a rapid sequence induction with direct laryngoscopy. Neonatal Apgar scores were 8 at 1 minute and 9 at 5 minutes. Prior to emergence, fentanyl, acetaminophen, and ketorolac were administered intravenously and a t...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Hofkamp MP, Galvan JM Tags: Proc (Bayl Univ Med Cent) Source Type: research

Dorsal root ganglion stimulator for avascular necrosis of the hip.
We describe a 24-year-old woman with severe left hip pain secondary to avascular necrosis in whom multiple treatments failed, including oral analgesics and radiofrequency ablation. A dorsal root ganglion stimulator was implanted with significant pain relief. PMID: 30949004 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Victor S, Burnett C, Lange R, Pohler K Tags: Proc (Bayl Univ Med Cent) Source Type: research

Acute neurological syndrome complicating secondary hyperparathyroidism.
We present the case of a young woman with end-stage renal disease on hemodialysis with uncontrolled secondary hyperparathyroidism. The patient presented with progressive lower extremity weakness and back pain. Imaging showed multiple lytic bone lesions, the most impressive being a T3 spinal lesion causing cord compression. She underwent urgent neurosurgical resection of the tumor at T3 followed by subtotal parathyroidectomy. Our case touches upon the pathophysiology, consequences, and treatment of secondary hyperparathyroidism in patients with end-stage renal disease. PMID: 30949005 [PubMed] (Source: Baylor University...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Patel R, Wiederkehr M Tags: Proc (Bayl Univ Med Cent) Source Type: research

Isolated intraparenchymal tension pneumocephalus.
We describe a 35-year-old man who presented with urinary incontinence, left eye vision loss, and nasal discharge/cerebrospinal fluid rhinorrhea 2 months after recovering from bifrontal hemorrhagic contusions following a road traffic accident. Intraparenchymal/intracerebral tension pneumocephalus was diagnosed with computed tomography and the patient was taken for an urgent decompressive surgery along with repair of the skull base defect. PMID: 30949006 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Soin P, Sharma P, Goyal P, Kochar PS Tags: Proc (Bayl Univ Med Cent) Source Type: research

Osteochondrosis of the tarsal navicular and medial cuneiform in a child.
Abstract A 6-year-old boy presented to his primary care physician with complaints of left foot pain after minor recent trauma. Left foot radiographs demonstrated osteochondrosis of the tarsal navicular (also known as Kohler's disease) and medial cuneiform-benign self-limiting processes, though likely the source of the patient's pain. PMID: 30949007 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Duncan B, Hurst D Tags: Proc (Bayl Univ Med Cent) Source Type: research

Vascular lakes after doxorubicin drug-eluting bead chemoembolization with histologic analysis.
We present a case of vascular lakes seen at the time of chemoembolization, with associated histologic findings after liver explantation. To the authors' knowledge, this case represents the first histological correlative analysis of this imaging pattern. PMID: 30949008 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Sacks JD, Heithaus E, Ghazi A, Cura M Tags: Proc (Bayl Univ Med Cent) Source Type: research

Baylor Scott & White Health news.
Baylor Scott & White Health news. Proc (Bayl Univ Med Cent). 2018 Oct;31(4):546-549 Authors: PMID: 30949009 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Tags: Proc (Bayl Univ Med Cent) Source Type: research

Osler goes viral: "The Fixed Period" revisited.
Osler goes viral: "The Fixed Period" revisited. Proc (Bayl Univ Med Cent). 2018 Oct;31(4):550-553 Authors: Bryan CS Abstract William Osler's parting address to faculty at the Johns Hopkins University, given on February 22, 1905, and published as "The Fixed Period," clouded his departure from North America after reporters sensationalized a playful suggestion that aging professors be chloroformed. A newly available collection of newspaper clippings affords a semiquantitative analysis of the press reaction. Only 40% of the writers openly criticized Osler. Some (about 15%) defended him...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Bryan CS Tags: Proc (Bayl Univ Med Cent) Source Type: research

Dwight Emary Harken, MD, an all-American surgical giant: Pioneer cardiac surgeon, teacher, mentor.
PMID: 30949011 [PubMed] (Source: Baylor University Medical Center Proceedings)
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Alivizatos PA Tags: Proc (Bayl Univ Med Cent) Source Type: research

Medical liability in the electronic medical records era.
Abstract Physicians encounter new medical liability risks in a medical milieu subjugated to electronic health information exchange. The budding electronic medical record systems have revolutionized how health care is dispensed. They alter the doctor-patient relationship in many uncertain and evolving ways. The shifting landscape of electronic information and medical liability risk is important for every practicing physician to understand. We review the historical changes of the electronic medical record, the emerging changes of the maturing electronic medical record, and the medical liability risk for physicians u...
Source: Baylor University Medical Center Proceedings - October 1, 2018 Category: Universities & Medical Training Authors: Paterick ZR, Patel NJ, Ngo E, Chandrasekaran K, Jamil Tajik A, Paterick TE Tags: Proc (Bayl Univ Med Cent) Source Type: research