ABSTRACT
Antibiotic prophylaxis prior to dental work in bicuspid aortic valve (BAV) patients is currently a matter of debate. The American Dental Association does not require those with native BAV to receive antibiotic prophylaxis prior to dental work as BAV is considered an "intermediate" risk for infective endocarditis (IE). We present the case of a 63-year-old male, with a medical history of BAV, who acquired Streptococcus sanguinis IE after a routine dental cleaning four months prior to initial onset of symptoms. He exhibited new-onset and severe aortic regurgitation at presentation, requiring urgent aortic valve replacement to restore valve function. BAV patients are at high risk of IE, emphasizing the need for prophylactic antibiotics in dental cleaning as well as invasive dental procedures in those with BAV.
ABSTRACT
Morel-Lavallée lesions (MLL) occur following closed degloving injuries in trauma and appear as subcutaneous fluid collections. These lesions provide a diagnostic dilemma due to their resemblance to other subcutaneous lesions, including post-traumatic or post-procedural hematomas, and malignant entities such as soft tissue sarcomas. Magnetic resonance imaging (MRI) remains the diagnostic test of choice to diagnose MLL. Here we present a single case of MLL in a 40-year-old female who sustained an injury to her left thigh months earlier after falling through a pier as well as a review of literature on the diagnostic findings typically seen in this type of injury.
ABSTRACT
Perioperative change to the autonomic nervous system (ANS) in spine surgery is an uncommon occurrence but has a wide range of possible presentations including blood pressure, heart rate, and heart rate variability changes collectively referred to as dysreflexia. Increased sympathetic tone and decreased vagal output are believed to be the underlying causes of these autonomic manifestations and pose an important question as to effective treatment of these dysfunctions. Spinal nerve root decompression has shown to be a valuable tool in normalizing autonomic tone by increasing parasympathetic output, most notably to the cardiovascular system, leading to the resolution of the aforementioned cardiovascular complications. Here we report a patient with elevated blood pressure with complaints of upper extremity paresthesias. MRI showed nerve root compression, and anterior cervical discectomy was performed. Post-operatively the patient had a decrease in both systolic and diastolic blood pressure which was maintained two months after surgery and allowed for discontinuation of one anti-hypertensive medication.
ABSTRACT
Genu varum is a common finding in the pediatric population with a large differential, including but not limited to Blount's disease, rickets, and physiologic bowing of the legs. Here we report a case of a 12-year-old Caucasian male who presented for an atraumatic stress fracture of the fifth metatarsal after an athletic event. Further evaluation showed significant genu varum with a Q angle of 9 degrees and medial knee joint space narrowing. The patient was unable to undergo conservative management due to early completion of puberty with relatively premature skeletal maturity. A bilateral tibial and fibular osteotomy with external spatial frame placement was performed successfully followed by six months of minor activity complicated by subclinical enoxaparin-induced purpura. The unique presentation of a stress fracture caused by compensatory mechanisms for the severe varus deformity, as well as the rarity of this procedure being performed on both legs simultaneously with good outcomes was the primary reason for the publication of this paper.
ABSTRACT
Multiple myeloma (MM) is an uncommon hematologic malignancy in the general population and extremely rare in pregnant and peripartum women. Here we report a rare case of multiple myeloma in a 43-year-old African American woman at 24 weeks gestation who presented for severe flank pain and difficulty breathing. An elevated D-dimer was present on initial presentation and diagnoses of deep vein thrombosis and pulmonary embolism were ruled out via bilateral Doppler ultrasounds and CT scan. Lytic bone lesions, anemia, and elevated total protein were also noted and an iliac crest biopsy demonstrating monoclonal plasma cells confirmed the diagnosis of MM. She was started on steroids at 27 weeks gestation and delivered via c-section at 30 weeks gestation. Postpartum, a treatment regimen to allow for breastfeeding was discussed but was unable to be accommodated, and she was started on a multi-drug chemotherapy regimen. There have only been about 30 cases of multiple myeloma in pregnant women reported in the literature. The rarity and lack of information on the effects of multiple myeloma in pregnancy was the primary indication for publication of this case.
