Carotid Web as an Embolic Source of Acute Ischemic Stroke.

INTRODUCTION: Carotid webs are shelf-like projections of the carotid bulb lumen associated with ipsilateral ischemic stroke in young patients. Given its rarity, a limited number of studies have evaluated the optimal management of symptomatic carotid webs to prevent further ischemic stroke. CASE REPORT: A 40-year-old Caucasian man presented with a sudden onset of left-sided facial droop, hemiparesis, and dysarthria. Computed tomography angiography revealed occlusion of the distal M1 and proximal M2 segments of the right middle cerebral artery and a small intimal flap at the right internal carotid artery origin. Intravenous alteplase was administered without clinical improvement. The patient underwent successful mechanical thrombectomy with complete revascularization of the middle cerebral artery and no residual neurologic deficits. Magnetic resonance angiography confirmed a curvilinear, shelf-like projection from the right carotid bulb posterior wall, consistent with a carotid web. The patient underwent carotid endarterectomy with no complications and was discharged home with no residual deficits or recurrence of stroke. CONCLUSION: No randomized, controlled prospective studies have compared the efficacy of endarterectomy to carotid artery stenting in patients with symptomatic carotid web. This case emphasizes the importance of considering carotid web as an embolic source of stroke in the young and provides support for revascularization as a safe and effective mean of secondary stroke prevention.

Large cholelithiasis with cholecystoduodenal fistula.

Cholelithiasis is a common gastrointestinal pathology that can lead to rare complications including cholecystoduodenal fistulas and GI hemorrhage. Diagnosing cholelithiasis and cholecystoduodenal fistulas in the emergency department (ED) using computed tomography (CT) imaging despite nonspecific and variable symptoms is critical in determining management strategies for medically complex patients. An 87-year-old medically complex female presented to the ED in hemorrhagic shock after several episodes of hematemesis, hematochezia, and other nonspecific gastrointestinal symptoms. A CT of the abdomen/pelvis was performed revealing cholecystitis with a large 6-cm stone; additionally, a biliary enteric fistula was noted with blood products in the gallbladder. This case highlights the importance of CT imaging in the setting of gastrointestinal bleeding with cholelithiasis and biliary enteric fistula diagnosis, and discusses potential management strategies of these diagnoses in medically complex patients.

Patient emulator: a tool for testing mechanical ventilation therapies.

Several modes of mechanical ventilation are clinically available. The differences among them in terms of efficacy and patient outcomes are not clear yet. Testing and comparison of mechanical ventilation modes via human or animal trials is a very challenging and costly process. In this paper, we present the patient emulator (PE), a novel system that can be used as a platform for in-silico testing of mechanical ventilation therapies. The system is based on a large-scale integrated mathematical model of the human cardiopulmonary system interfaced with a physical ventilator via a controlled piston-cylinder actuator. The performance of the proposed PE is demonstrated by simulating a realistic pressure support ventilation step protocol. The PE-simulated patient's response is then compared against averaged data from 33 human subjects. The agreement between the simulated data and their experimental counterparts shows the potential of the proposed PE to be used as a substitute for or in addition to conventional animal and human trials.

Brucellosis acquired by eating imported cheese.

Pyrexia of unknown origin is an important clinical presentation in both paediatric and adult medicine. We present a case of pyrexia of unknown origin in a 14 year-old boy which turned out to be due to infection with Brucella melitensis, despite the patient not having left Great Britain - an officially brucellosis-free country - in six years. Repeated history-taking provided a clue to the diagnosis.

Maternal vitamin D deficiency associated with neonatal hypocalcaemic convulsions.

Maternal vitamin D insufficiency is not uncommon. Infants born to mothers who are deficient in vitamin D and or calcium, usually due to cultural modifications in their diets or clothing habits, and in addition are breastfed, are at risk of developing vitamin D deficiency and hypocalcaemia. We present a case of neonatal hypocalcaemic seizures secondary to vitamin D deficiency. Rickets in children resulting from vitamin D deficiency is well documented. It is also becoming clear that there is a positive correlation between maternal vitamin D status during pregnancy and lactation and the development of rickets both in infancy and childhood. The correlation between maternal vitamin D, neonatal vitamin D and hypocalcaemia is not well documented.