Adult-onset multifocal kaposiform hemangioendothelioma in the bone marrow, lung, liver, and brain: a case report.

Kaposiform hemangioendothelioma (KHE), a rare form of vascular neoplasm, is typically seen in children. In this paper, we report a unique case of KHE replacing bone marrow tissue mimicking myeloproliferative neoplasm with additional involvement in the lung, liver, and brain in a 60-year-old Caucasian woman. The patient was initially seen in the hematology department for the chief complaint of epigastric pain and anemia. Abdominal magnetic resonance imaging (MRI) revealed mild splenomegaly with iron deposition secondary to extramedullary hematopoiesis. Additional workup was inconclusive. Subsequent bone marrow and lung biopsies eventually revealed bone marrow with extensive grade 3 fibrosis and multiple foci of low-grade vasoformative neoplasm in the lung suggestive of KHE. Although rare, KHE can present as an aggressive disease with indolent behavior in adults and can be distinguished from other vascular malignancies based on histopathology and imaging findings.

Aeromedical helicopter transport of prisoners: The Mexico City experience.

INTRODUCTION: Helicopter medical transport of prisoner patients has unique logistical and medical challenges, as well as potential risks to healthcare providers. Prisoners have specific requirements for safe transport, and it is of paramount importance to know the variables related to transport related mortality since most prisoners that need air evacuation are critically ill. Because we understand that there is a potentially dangerous nature of transport of this population, and because of the unique nature of them, we aimed to provide a detailed insight on predictors of outcome in prisoners who were injured as a result of trauma and that needed to be transported via air medical transport in Mexico City. METHODS: A retrospective chart analysis was conducted using data from the Mexico City Police Helicopter Emergency Medical Service (HEMS) for air medical transport of felons that occurred between January 1, 2000 and December 31, 2013. Subject demographics, injury, procedures performed, transport time, Glasgow Coma Scale (GCS), and mortality were collected. Exploratory data analysis, Chi-square, and T-test were performed. Statistical significance was assumed to be p ≤ 0.05 for two-sided hypothesis. RESULTS: Fifty-three patients were included in this study. Forty-two were men and 11 were women. Median age of the patients was 30 ± 8 years. Total transport time was 23 ± 5 min. Gunshot wounds accounted for 39.6% of patients, stabbing wounds 28.3%, head trauma 7.5%, motor vehicle accidents 5.7%, blunt trauma (i.e., fist assaults) 5.6%, falls 5.7%, motorcycle accidents 3.8%, and prisoner-motor vehicle collisions 3.8%. Median heart rate was 114 ± 41 beats per minute (BPM), median systolic blood pressure (SBP) was 103 ± 14 mmHg, median diastolic blood pressure (DBP) was 70 ± 12 mmHg, and median GCS was 10 ± 5. Mortality rate was 16.9% (n = 9). The variables that were statistically significant, and therefore related to mortality were: heart rate > 130 bpm (p < 0.001), SBP <95 mmHg (p = 0.039), GCS <7 (p = 0.040), age > 42 years (range, 17-47 years) p < 0.001, and need for cardiopulmonary resuscitation (CPR) (p < 0.001). CONCLUSIONS: As dangerous and challenging as it may seem, air medical transport of prisoners by a police crew physician, may be safe and reliable, since no complications or safety events were observed.

Aortic Valve Replacement in Severe Factor V Deficiency and Inhibitor: Diagnostic and Management Challenges.

Factor V (FV) deficiency (F5D) is a rare hematological disorder with a variable spectrum of bleeding manifestations. Until now, no specific protocols for the management of these patients have been established. However, available literature suggests that perioperative infusion of fresh frozen plasma (FFP) may help maintain FV levels to prevent bleeding. We present the case of a 64-year-old man with previously undiagnosed severe FV deficiency and mild FV inhibitor, who underwent aortic valve replacement with no bleeding complications.

Hypertrophic Cardiomyopathy and the Brockenbrough-Braunwald-Morrow Phenomenon: A Case Report.

The Brockenbrough-Braunwald-Morrow phenomenon provides objective evidence of the existence and degree of left ventricular outflow tract (LVOT) obstruction, which can be improved with pharmacological therapy, surgical myectomy, or interventional alcohol septal ablation (ASA). This article incorporates contemporary research findings that are useful for the diagnosis and management of this entity. We present the case of a 67-year-old lady with a past medical history significant for hypertension, hyperlipidemia, and coronary artery disease. The patient presented with a complaint of functional class-3 dyspnea on exertion with associated substernal chest tightness radiating to her back that had been worsening for two days prior to admission. An echocardiogram showed left ventricular hypertrophy with septal predominance measuring 17.5 mm in end-diastole and a left ventricular ejection fraction greater than 65%. The LVOT peak gradient was elevated and a positive Brockenbrough-Braunwald-Morrow phenomenon was observed for which a septal myectomy and coronary bypass of the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery were performed. The patient had an uneventful postoperative course and her symptoms improved significantly. The Brockenbrough-Braunwald-Morrow phenomenon is useful to determine the degree of LVOT and to confirm the resolution of obstruction after treatment.

Capnocytophaga Induced Acute Necrotizing and Exudative Pericarditis with Abscess Formation.

We present the case of a 55-year-old gentleman, with bilateral pulmonary embolism and a large pericardial effusion that lead to a pericardial window with evacuation of creamy pus. Gram stains were negative, with culture growing Capnocytophaga. Pathology revealed acute necrotizing and exudative changes, including frank abscess formation. In developed countries, pericardial abscess and acute pericarditis are uncommon due to availability of broad-spectrum antibiotics. Pericardial abscess due to Capnocytophaga is even more uncommon.