Severe aortic root dilatation in infantile Marfan syndrome.

Cardiovascular manifestations of Marfan syndrome are associated with increased mortality, especially in the pediatric population. Early recognition is critical to long-term management. We present two cases of genetically defined "classical" Marfan syndrome presenting with severe infantile aortic root dilatation among siblings and discuss options for therapy.

Chronic peripheral nerve hyperalgesia in the thoracolumbar region.

Chronic neuropathic pain presents a significant burden to health care worldwide. Its complexity and variation in presentation make therapeutic targeting a challenge in clinical practice. We present a case of chronic idiopathic peripheral neuropathy localized to a specific region in the back to highlight current understandings and available treatment options for neuropathic pain.

Delayed Splenic Rupture Resulting in Massive Intraperitoneal Hemorrhage Post Ambulatory-Related Injury.

Delayed splenic rupture, once thought to be unusual, but now growing in incidence, is an issue that could potentiate severe morbidity and mortality to patients, regardless of the severity of the trauma. This case report presents one instance of delayed splenic rupture following minor trauma and discusses the need for further investigation in the management of this condition. A middle-aged, hypotensive male presented to the emergency department (ED) with signs of an acute abdomen following a syncopal episode, with successful resuscitation upon arrival. Computed tomography (CT) revealed fluid in the gastrohepatic ligament, as well as the right pericolic gutter, along with findings suggestive of a perforated peptic ulcer. General surgery was consulted, and an exploratory laparotomy was performed. However, during exploration, no such perforation was found. A large amount of blood was visualized in the left upper quadrant. The spleen was mobilized, and inspection revealed a posterior rupture, resulting in a splenectomy and subsequent hemostasis by the surgical team. The post-operative period was uneventful, with the patient revealing a previous fall onto a concrete floor two weeks prior to presentation to the ED. A pathological examination of the spleen revealed capsular tear with focal congestion and hemorrhage. It is the goal of this report to highlight the morbidity and mortality that occur after delayed splenic rupture, even with minor traumatic events. Current guidelines suggest nonoperative management of splenic injury in stable patients with low-grade splenic injuries after blunt abdominal trauma. However, with the varied presentation and difficulty in the assessment of delayed splenic rupture, patients may be exposed to undue risks with current recommendations on the management of splenic injuries. Further research is needed to find the best practice in managing, and possibly preventing, delayed splenic rupture in patients presenting with an acute abdomen or abdominal trauma.