RESUMEN
Non-ketotic hyperglycemia is an uncommon cause of hemichorea-hemiballismus syndrome that has been associated with high levels of glucose that are not well controlled. Lesions typically occur in the globus pallidus and putamen, which can be identified via computed tomography (CT) or magnetic resonance imaging (MRI). These lesions generally correspond with ballistic and choreiform movements on the contralateral side of the observed imaging findings. Additionally, amelioration of hyperglycemia is the first-line treatment and usually reduces and resolves these hyperkinetic movement symptoms. This case report demonstrates a case of non-ketotic hyperglycemia hemichorea-hemiballismus syndrome in an individual with a history of poorly controlled type 2 diabetes mellitus and a highly elevated hemoglobin A1C (HbA1C), who subsequently improved with insulin therapy.
RESUMEN
A 49-year-old male was brought to the Emergency Department after being found unresponsive. The patient had multiple seizures and was intubated in the prehospital setting. A computed tomography scan showed bilateral paranasal sinus disease, and magnetic resonance imaging showed a right frontal abscess and subdural empyema. Neurosurgery took the patient to the operating room, performed a craniotomy, and drained a large amount of purulent fluid. He was subsequently discharged for acute rehabilitation. Clinicians should consider complicated frontal sinusitis, especially in the undifferentiated patient presenting with neurologic deficits and signs or symptoms of sinus disease.
RESUMEN
Accidental hypothermia can lead to untoward cardiac manifestations and arrest. This report presents a case series of severe accidental hypothermia with cardiac complications in three emergency patients who were treated with extracorporeal membrane oxygenation (ECMO) and survived after re-warming. The aim of this discussion was to encourage more clinicians to consider ECMO as a re-warming therapy for severe hypothermia with circulatory collapse and to prompt discussion about decreasing the barriers to its use. Niehaus MT , Pechulis RM , Wu JK , Frei S , Hong JJ , Sandhu RS , Greenberg MR . Extracorporeal membrane oxygenation (ECMO) for hypothermic cardiac deterioration: a case series. Prehosp Disaster Med. 2016;31(5):570-571.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Paro Cardíaco/terapia , Hipotermia/terapia , Adulto , Femenino , Humanos , Masculino , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Absceso/complicaciones , Manejo de la Vía Aérea/métodos , Oxigenación por Membrana Extracorpórea , Enfermedades Faríngeas/complicaciones , Supraglotitis/complicaciones , Absceso/cirugía , Servicio de Urgencia en Hospital , Femenino , Humanos , Intubación Intratraqueal , Persona de Mediana Edad , Planificación de Atención al Paciente , Enfermedades Faríngeas/cirugía , TraqueostomíaRESUMEN
The following unique case demonstrates an episode of acute dyskinesia secondary to oral baclofen toxicity. We discuss an 80-year-old man with a history of Stage III chronic kidney disease, coronary artery disease, diabetes and stroke who presented to the Emergency Department with new onset of behavioral changes and irregular jerking movements. The patient had been recently prescribed baclofen 10mg twice daily for a back strain he suffered; he subsequently was admitted to the hospital, and his symptoms resolved within 48 hours of admission and discontinuance of baclofen.
Asunto(s)
Dolor de Espalda/tratamiento farmacológico , Baclofeno/toxicidad , Discinesia Inducida por Medicamentos/etiología , Relajantes Musculares Centrales/toxicidad , Polifarmacia , Anciano de 80 o más Años , Dolor de Espalda/complicaciones , Baclofeno/sangre , Baclofeno/uso terapéutico , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Diabetes Mellitus/tratamiento farmacológico , Interacciones Farmacológicas , Tasa de Filtración Glomerular , Humanos , Tiempo de Internación , Masculino , Relajantes Musculares Centrales/uso terapéutico , Insuficiencia Renal Crónica/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológicoAsunto(s)
Asma/complicaciones , Gripe Humana/complicaciones , Enfisema Mediastínico/complicaciones , Enfisema Mediastínico/etiología , Enfisema Mediastínico/terapia , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/terapia , Adulto , Servicio de Urgencia en Hospital , Femenino , Humanos , Virus de la Influenza A , Enfisema Mediastínico/diagnóstico por imagen , Cuello , Enfisema Subcutáneo/diagnóstico por imagen , Tomografía Computarizada por Rayos XAsunto(s)
Dolor Abdominal/etiología , Infarto/complicaciones , Infarto/diagnóstico , Epiplón , Enfermedades Peritoneales/complicaciones , Enfermedades Peritoneales/diagnóstico , Complicaciones del Embarazo/etiología , Dolor Abdominal/diagnóstico por imagen , Adulto , Femenino , Humanos , Infarto/diagnóstico por imagen , Infarto/cirugía , Laparotomía , Hígado/diagnóstico por imagen , Hígado/patología , Epiplón/irrigación sanguínea , Epiplón/diagnóstico por imagen , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/patología , Embarazo , Complicaciones del Embarazo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The vitamin D(3) receptor (VDR) is present in all microenvironments of the breast, yet it is hypothesized to signal through the epithelium to regulate hormone induced growth and differentiation. However, the influence or contribution of the other microenvironments within the breast that express VDR, like the breast adipose tissue, are yet to be investigated. We hypothesized that the breast adipocytes express the signaling components necessary to participate in vitamin D(3) synthesis and signaling via VDR, modulating ductal epithelial cell growth and differentiation. We utilized human primary breast adipocytes and VDR wild type (WT) and knockout (KO) mice to address whether breast adipocytes participate in vitamin D(3) -induced growth regulation of the ductal epithelium. We report in this study that breast primary adipocytes express VDR, CYP27B1 (1α-hydroxylase, 1α-OHase), the enzyme that generates the biologically active VDR ligand, 1α,25-dihydroxyvitamin D(3) (1,25D(3) ), and CYP24 (24-hydroxylase, 24-OHase), a VDR-1,25D(3) induced target gene. Furthermore, the breast adipocytes participate in bioactivating 25-hydroxyvitamin D(3) (25D(3) ) to the active ligand, 1,25D(3) , and secreting it to the surrounding microenvironment. In support of this concept, we report that purified mammary ductal epithelial fragments (organoids) from VDR KO mice, co-cultured with WT breast adipocytes, were growth inhibited upon treatment with 25D(3) or 1,25D(3) compared to vehicle alone. Collectively, these results demonstrate that breast adipocytes bioactivate 25D(3) to 1,25D(3) , signal via VDR within the adipocytes, and release an inhibitory factor that regulates ductal epithelial cell growth, suggesting that breast adipose tissue contributes to vitamin D(3) -induced growth regulation of ductal epithelium.