Nonsurgical Management of an Embedded Metal Clip in Sigmoid Colon Causing Perforation and Abscess.

Intentional ingestion of foreign objects is common in incarcerated individuals. Ingested foreign objects can lead to serious complications. Surgical treatment is considered mandatory once complications such as bowel perforation and abscess develop. We report an incarcerated individual with sigmoid perforation and pelvic abscess related to an ingested foreign object that was managed nonsurgically.

Hemobilia Leading to a Diagnosis of Hepatocellular Carcinoma.

Hemobilia from hepatocellular carcinoma (HCC) is rare and is usually noted in established cases of HCC after invasive procedures. Hemobilia can present with serious complications including acute pancreatitis and cholangitis. We describe an unusual case of hemobilia causing obstructive jaundice with suspected cholangitis and acute pancreatitis with subsequent workup revealing HCC.

Gemella Species Bacteremia and Stroke in an Elderly Patient with Respiratory Tract Infection.

Gemella species are part of normal human flora. They are rarely associated with infections. As opportunistic pathogens, they can cause life-threatening infection in individuals with risk factors. We present an unusual case of an elderly patient, with no predisposing risk factors, who presented with respiratory tract infection and Gemella species bacteremia and suffered a stroke in the absence of features of endocarditis.

Successful Biopsy and Removal of a Tricuspid Valve Papillary Fibroelastoma in Cardiac Catheterization Laboratory: A Case Report.

Papillary fibroelastomas are rare benign cardiac tumours with a predilection for cardiac valves. Because of the rarity of these tumours, management is individualized, but some recommend surgical removal of all papillary fibroelastomas due to the increased risk of embolization. We report a case of a 71-year-old man who presented with a sessile mass on the tricuspid valve. The mass, a papillary fibroelastoma, was successfully biopsied and removed in the cardiac catheterization laboratory. This report demonstrates a unique minimally invasive way of approaching a cardiac tumour wherein a major surgery was avoided.

Contrast induced neurotoxicity following coronary angiogram with Iohexol in an end stage renal disease patient.

Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol (Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.

Apical hypertrophic cardiomyopathy mimicking acute coronary syndrome: a case report and review of the literature.

Apical hypertrophic cardiomyopathy is a form of hypertrophic cardiomyopathy localized to the left ventricular apex. It is common in Japanese and other Asian populations, where it is generally considered relatively benign. However, its presence has also been recognized, though less commonly, in non-Asian patients. In these patients, the electrocardiographic changes and symptoms associated with apical hypertrophic cardiomyopathy often mimic acute coronary syndromes. Invasive or noninvasive evaluation of the left ventricular cavity confirms the diagnosis, with the "ace-of-spades" sign on left ventriculography being pathognomonic. Its prognosis is relatively benign in terms of cardiovascular mortality; however, morbid sequelae, such as diastolic dysfunction, left atrial enlargement, apical thrombi, ventricular aneurysms, and myocardial infarction, are not uncommon. The authors present a case of apical hypertrophic cardiomyopathy in a Caucasian patient who presented with findings suggestive of acute coronary syndrome and review the literature on apical hypertrophic cardiomyopathy.

Pseudo-pseudoaneurysm: a rare and unexplored mechanical complication of myocardial infarction.

The mechanical complications of myocardial infarction are less frequently encountered in the current era of early revascularization. Complete myocardial rupture, although infrequent, is a potentially lethal complication. The pathology, prognosis, and treatment of complete myocardial rupture are well described in the medical literature. Incomplete cardiac rupture has been less well described, and its prognosis and treatment are less clear. Pseudoaneurysms, subepicardial aneurysms, and pseudo-pseudoaneurysms form the pathologic spectrum of incomplete cardiac rupture. Pseudoaneurysms involve complete myocardial rupture with containment by overlying pericardium, whereas subepicardial aneurysms involve aneurysmal outpouchings contained by epicardium. Pseudo-pseudoaneurysms are a subtype of subepicardial aneurysm consisting of diverticula contained by myocardial elements. Pseudo-pseudoaneurysms follow a variable course. Fibrous tissue may be deposited in the wall of the aneurysm allowing the patient to remain asymptomatic, or the myocardium may progressively dissect with resultant complete ventricular rupture. We describe a case of postinfarction pseudo-pseudoaneurysm that was diagnosed by echocardiography and managed conservatively.

Status of mobile computing in health care: an evidence study.

Information technology (IT) has played an impacting role in helping healthcare professionals increasingly recognize the value of IT in clinical medicine, disease management, treatment strategies and other related areas. Of the numerous IT applications currently pursued, the use of telemedicine is a major force in addressing the healthcare delivery issues. As evidenced by a number of studies, telemedicine has come to play a significant mode of delivery and treatment, especially in the remote rural areas. Despite the growing interest, the R&D advances and the vast number of telemedicine applications currently ongoing, there still seem to be only a few quantitative studies characterizing the economic aspects of telemedicine and how cost-effective such solutions are. Of particular interest to the healthcare community is the effectiveness of the emerging mobile communications in telemedicine especially in home healthcare environment. In this paper we report on a profile of the current status of the use of mobile devices based on an extensive literature search of 213 articles. In particular we have focused our research on reports of the cost effectiveness of mobile telemedicine applications with respect to improved quality of care and medical error reduction. Preliminary results are reported in the paper, with an extended discussion to be provided in the final conference presentation, based on outcomes obtained from a more robust data analysis.