Successful Resolution of a Large Left Ventricular Thrombus with Rivaroxaban Therapy after Acute Myocardial Infarction.

Left ventricular (LV) thrombus is a major complication of acute systolic cardiomyopathy especially after a large anterior myocardial infarction (AMI), and it poses a significant embolic risk, up to five times higher than the general population. Current guidelines for LV thrombi recommend vitamin K antagonist for anticoagulation in contrast to novel oral anticoagulants (NOACs) which have not been studied well in cases of LV thrombus. We present a case of patient with AMI, who was noted to have severe systolic dysfunction and a large LV thrombus which was successfully treated with rivaroxaban therapy with complete resolution of LV thrombus on two months follow-up.

A Masquerader of Disease: An Incomplete Presentation of Kawasaki Disease.

Kawasaki disease (KD) is a systemic pediatric vasculitis that most commonly affects children between the ages of 6 months and 4 years. The diagnosis of KD requires a high degree of clinical suspicion. In younger patients (less than 6 months) the diagnosis is exceedingly difficult as these patients typically do not meet the criteria to diagnosis KD clinically. Oftentimes, these younger patients do not meet enough of the criteria to warrant ordering an echocardiogram. We report a case of a 6-month-old Caucasian female who presented with high fevers originally thought to be due to a urinary tract infection. The patient required multiple echocardiograms in order to be diagnosed with incomplete KD. The patient was treated with IVIG and aspirin per standard of care, and experienced resolution of fevers and illness.

An Analysis of the Financial Burden Associated with the Residency Match at the University of South Dakota Sanford School of Medicine.

OBJECTIVE: The application process for residency positions is a costly endeavor. This study aims to quantify the financial expenses incurred by University of South Dakota Sanford School of Medicine (USD SSOM) class of 2016. Our hope is that this study will prepare future students of USD and other smaller programs for the financial burdens associated with the match. This data should be used to guide financial decision making by medical students from USD or by regional students from medical programs that desire to apply to residency programs not offered at their home institution. METHODS: A 10-item online survey was administered in April of 2016 via the USD Sanford School of Medicine email listserv to the graduating MD class of 2016. The survey asked respondents about the number and cost of away-rotations completed, interviews attended, second-look days attended after the interview, preferences for interviewing during an away-rotation, the specialty the applicant matched into, and number on each applicant's rank list that he/she matched. RESULTS: The survey had a 68.3 percent response rate. The mean number of away-rotations completed, interviews attended, and second-look days attended were 1.3, 12.1, and 0.1 per applicant respectively. The mean costs of attendance to away-rotations, interviews, and second-look days were $1,690.63, $4,881.88, and $24 per applicant, respectively. The total mean collective cost of away-rotations, interviews, and second-look days was $6,596.51 per applicant. CONCLUSIONS: The process of applying to residencies among the graduating MD class of 2016 is a costly endeavor. Attendance of interviews for residency positions is the most costly part of the residency application process. Although the financial burden associated with applying to residency programs is high, increasing competition for graduate medical education positions may only drive the cost further.

Recurrent In-stent Restenosis in the Area of Previous Stent Fracture: A Management Dilemma.

Drug eluting stents (DES) have been increasingly being used for treatment of coronary artery disease (CAD) and have been shown to be very effective in prevention of primary in-stent restenosis (ISR). However DES have been increasingly associated with acute to subacute risk of stent fractures (SF). There is also a paucity of data about different management strategies for SF, especially in the long term. We present a case of recurrent ISR in an area of previous acute SF at the touchdown of saphenous venous graft (SVG) to first diagonal artery (D1). In our knowledge this is the first case reported of recurrent ISR due to prior acute stent fracture in a saphenous venous graft. It presents an interesting management dilemma with multiple layers of stent in the area of recurrent ISR which was managed with balloon angioplasty with good results.

A Rare Case of Lymphadenopathy: Kikuchi-Fujimoto Disease.

A relatively unknown cause of cervical lymphadenopathy is Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis. This is a rare and benign condition that presents with painful cervical lymphadenopathy, fevers, night sweats, and weight loss. This disease is most prevalent in Asian women between the age of 20-35 years. The diagnosis of Kikuchi Disease is made histologically and is characterized by paracortical areas of necrosis and a notable complete absence of neutrophils. The painful lymphadenopathy can be simply treated with antipyretics, but due to its presenting symptoms of Kikuchi disease, it is often mistaken for malignant lymphoma. As such, accurate diagnosis is required to avoid unnecessary testing. The evaluation of lymphadenopathy without an obvious cause can be quite challenging. When patients present with relapsing remitting lymphadenopathy, Kikuchi disease may warrant consideration.