Spontaneous Pneumomediastinum in a Healthy Pediatric Patient.

Spontaneous pneumomediastinum (SPM) is a rare condition, especially in children with no predisposing factors. In the vast majority of patients, this condition is benign and self-limiting; however, there is always the possibility that serious and potentially life-threatening complications such as mediastinitis or cardiac tamponade could arise. Early recognition, prompt diagnosis, and appropriate management allow for ideal care and prevent unnecessary and excessive investigations in these patients. An eight-year-old female was admitted to the emergency department with SPM after swimming and no known predisposing lung conditions. The probable causative event was likely to be pressure changes in the alveoli during swimming. This is notable because the patient's SPM occurred in the absence of an underlying cause such as asthma. The patient was admitted overnight for monitoring and pain control. The symptoms resolved the following day, along with a decrease in the size of the SPM on the chest X-ray. Physicians should be aware of the signs of SPM in young patients who present with chest pain in the absence of trauma or pulmonic disease. A review of literature highlighted the pathophysiology and recommended treatment course for similar cases.

Scalp Leiomyosarcoma: Diagnosis and Treatment During a Global Pandemic With COVID-19.

Leiomyosarcoma is an aggressive, uncommon sarcoma effecting smooth muscle tissue. Prompt tissue diagnosis and staging workup are keys to preventing distant metastasis. Identification of this rare sarcoma has become increasingly difficult with decreased ability to seek out non-coronavirus disease 2019 (COVID-19) medical care. The pandemic has caused a widespread healthcare demand with providers reaching their full capacity causing care and resources to be shifted to the pandemic. We have experienced an 83-year-old male who significantly delayed to seek any medical attention for his scalp lesion for several months due to a combination of fear and decreased available appointments. Since the patient presented with a delayed scalp leiomyosarcoma, he required an extensive excision and flap reconstruction for the lesion. This case sheds light on the importance of weighing the risks and benefits associated with cancer management during the pandemic for both patients and healthcare providers. The healthcare system's response to the pandemic also played a role in this case as well, with shorter appointment times and decreased frequency of follow-up. As a result, the pandemic has had a catastrophic impact on the diagnostic pathway for cancer. This case report discusses the difficulties in diagnosing and treating a rare cancer such as scalp leiomyosarcoma amidst the global pandemic and the importance of telemedicine in improving future outcomes.

Novel beta-blocker pretreatment prevents alcohol-induced atrial fibrillation in a rat model.

BACKGROUND: A case report published in 2019 described a patient who presented with difficult-to-manage atrial fibrillation (AF) that consistently was associated with alcohol consumption. After the patient did not respond to drug therapy, a novel beta-blocker (BB) pretreatment regimen initiated immediately before alcohol consumption successfully prevented AF occurrence. OBJECTIVE: The purpose of this study was to test the hypothesis that a novel prophylactic BB therapy given before alcohol consumption could prevent AF in a rat model. METHODS: An alcohol-induced AF model was developed in adult Sprague-Dawley rats of both sexes by administering alcohol (2 g/kg intraperitoneal [IP]) once every other day for a total of 4 times. Three groups were enrolled: alcohol (EtOH; n = 10); alcohol plus BB (metoprolol 50 mg/kg IP) pretreatment (EtOH+BB; n = 10); and control (n = 9). Cardiac function (assessed by echocardiography and left ventricular hemodynamics) and in vivo atrial electrophysiology and AF inducibility tests were performed 24 hours after the last injection. RESULTS: All but 1 rat completed the study. Alcohol exposure did not significantly impact cardiac function and the atrial effective refractory period. However, alcohol exposure significantly increased AF inducibility [median (first and third quartile [Q1-Q3]) 0% (0%-0%) in control vs 60% (25%-100%) in the EtOH group; P <.05] and AF duration [0 second (0-0 second) in control vs 0.81 second (0.24-3.67 seconds) in the EtOH group; P <.05]. Compared to the EtOH group, the EtOH+BB group had significantly reduced AF inducibility [0% (0%-22.5%); P <.05] and duration [0 second (0-0.2 second); P <.05]. CONCLUSION: Metoprolol pretreatment before alcohol administration significantly decreased AF induction in rats. These findings suggest that BB pretreatment is a promising prophylaxis regimen for alcohol-induced AF.

Assessment of Left Ventricular Volume and Function Using Real-Time 3D Echocardiography versus Angiocardiography in Children with Tetralogy of Fallot.

BACKGROUND: Evaluation of left ventricular (LV) size and function is one of the important reasons for performing echocardiography. Real time three dimensional echocardiography (RT3DE) is now available for a precise non-invasive ventricular volumetry. Aim of work was to validate RT3DE as a non-invasive cardiac imaging method for measurement of LV volumes using cardiac angiography as the reference technique. METHODS: Prospective study on 40 consecutive patients with tetralogy of Fallot (TOF) referred for cardiac catheterization for preoperative assessment. Biplane cineangiography, conventional 2 dimensional echocardiography (2DE) and RT3DE were performed for the patients. A control group of 18 age and sex matched children was included and 2DE and RT3DE were performed for them. RESULTS: The mean LV end diastolic volume (LVEDV) and LVEDV index (LVEDVI) measured by RT3DE of patients were lower than controls (p value = 0.004, 0.01, respectively). There was strong correlation between the mean value of the LVEDV and the LVEDVI measured by RT3DE and angiography (r = 0.97, p < 0.001). The mean value of LV ejection fraction measured by RT3DE was lower than that assessed by 2DE (50 ± 6.2%, 65 ± 4.6%, respectively, p value < 0.001) in the studied TOF cases. There was good intra- and inter-observer reliability for all measurements. CONCLUSION: RT3DE is a noninvasive and feasible tool for measurement of LV volumes that strongly correlates with LV volumetry done by angiography in very young infants and children, and further studies needed.