Molar pregnancy presenting in the emergency department.

A 27-year-old female grava1 para 0 presented to the emergency department with complaints of intractable nausea and vomiting associated with fatigue and shortness of breath for the past 2 weeks with concerns for pregnancy. Physical exam was benign. Labs were significant for a ß-hcg level of 348,260 mIU/mL. Ultrasonography showed a 12.4 pelvic mass possibly arriving from the anterior uterus concerning for fibroid. US also showed an anechoic focus suggestive of a gestational sac measuring 2.09 cm. The presentation was concerning for hyperemesis gravidarum due to molar pregnancy.

Emergency department point-of-care ultrasound diagnosis of active bleeding into the intraluminal thrombus of an abdominal aortic aneurysm.

Rupture of an abdominal aortic aneurysm (AAA) is an immediately life-threatening phenomenon with substantial mortality. Although most AAAs are asymptomatic, an impending AAA rupture can be heralded by nonspecific symptoms and imaging findings on CT and point-of-care ultrasound (POCUS). In this report, we present a case of an 81-year-old male with an atypical presentation of an AAA with novel sonographic findings of imminent rupture on POCUS with Doppler that prompted successful emergent intervention. In the emergency department, imaging findings on aortic POCUS and CT imaging with angiography can facilitate assessment for impending aortic rupture, which can expedite appropriate disposition and potentially life-saving intervention.

Life-Threatening Sublingual Hematoma in the Setting of Anticoagulation and Neck Trauma.

Sublingual hematoma is a rare and life-threatening emergency department presentation. The rich vascular supply of the tongue results in a predisposition for rapid hemorrhage secondary to lingual trauma and developing lethal upper airway obstruction. In the setting of a patient with neck trauma, assessment of risk factors, such as the use of anticoagulation, and clinical signs of vascular injury are essential for rapid diagnosis and mobilization of resources for airway protection.

Greenstick Fractures of the mid- Radial and Ulnar Diaphysis with Volar Angulation.

The authors present the case of a patient who was brought to the emergency department (ED) with severe left forearm pain following a classroom fall. This incident exacerbated the fractures that the patient experienced three months earlier in an accident. He had partial fractures of the middle radial and ulnar diaphyses. A review of the various presentations of forearm fractures and the nonoperative and surgical treatment options are discussed.

Oral lipoic acid as a treatment for acute optic neuritis: a blinded, placebo controlled randomized trial.

BACKGROUND: Lipoic acid, an antioxidant, has beneficial effects in experimental acute optic neuritis and autoimmune encephalomyelitis. Optical coherence tomography can detect retinal nerve fiber layer thinning, representing axonal degeneration, approximately 3-6 months after acute optic neuritis. OBJECTIVE: To determine whether lipoic acid is neuroprotective in acute optic neuritis. METHODS: A single-center, double-blind, randomized, placebo controlled, 24-week trial. Intervention included 6 weeks of once daily lipoic acid (1200 mg) or placebo within 14 days of acute optic neuritis diagnosis. The primary outcome was the mean difference in affected eye retinal nerve fiber layer (RNFL) thickness from baseline to 24 weeks. RESULTS: We enrolled 31 subjects (placebo n=16; lipoic acid n=15; average age 38.6 years (standard deviation (SD) 10.3)). Affected eye mean global RNFL thickness (µm) in the lipoic acid group decreased from 108.47 (SD 26.11) at baseline to 79.31 (SD 19.26) at 24 weeks. The affected eye RNFL in the placebo group decreased from 103.67 (SD 18.04) at baseline to 84.43 (SD 20.94) at 24 weeks. Unaffected eye RNFL thickness did not significantly change in either group over 24 weeks. CONCLUSION: Six weeks of oral lipoic acid supplementation after acute optic neuritis is safe and well tolerated; however, because of insufficient recruitment, we could not conclude that lipoic acid treatment was neuroprotective in acute optic neuritis.

Differential effects of caveolin-1 and -2 knockdown on aqueous outflow and altered extracellular matrix turnover in caveolin-silenced trabecular meshwork cells.

PURPOSE: A single nucleotide polymorphism (SNP) identified between caveolin-1 (CAV1) and caveolin-2 (CAV2) on chromosome 7 is associated with glaucoma. One function of CAVs is endocytosis and recycling of extracellular matrix (ECM) components. Here, we generated CAV-silencing lentivirus to evaluate the effects on ECM turnover by trabecular meshwork (TM) cells and to measure the effect on outflow facility in anterior segment perfusion culture. METHODS: Short hairpin CAV1 and CAV2 silencing and control lentivirus were generated, characterized, and applied to anterior segments in perfusion culture. Colocalization of CAVs with various ECM molecules in TM cells was investigated using immunofluorescence and confocal microscopy. Western immunoblotting and fluorogenic-based enzyme activity assays were used to investigate ECM protein levels and degradation, respectively. RESULTS: Endogenous CAVs colocalized with cortactin at podosome- or invadopodia-like structures (PILS), which are areas of focal ECM degradation. In perfusion culture, outflow rates increased significantly in CAV1-silenced anterior segments, whereas outflow significantly decreased in CAV2-silenced anterior segments. Matrix metalloproteinase (MMP)2 and MMP14, and a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS4) colocalized with both CAVs in TM cells. Protein levels and enzyme activities of MMP/ADAMTS4, fibronectin protein levels, actin stress fibers, and α-smooth muscle actin were all increased in CAV-silenced cells. CONCLUSIONS: Caveolin-mediated endocytosis is one mechanism by which TM cells can alter the physiological catabolism of ECM in order to change the composition of the outflow channels in the TM to regulate aqueous outflow resistance. Dysregulation of CAV function could contribute to the pathological changes in ECM that are observed in glaucoma.