Vulvar and perineal verrucous changes complicating hidradenitis suppurativa after wide excision: a case and literature review.

Poorly controlled and long-standing hidradenitis suppurativa (HS) increases the risk of squamous cell carcinoma (SCC). We report a 54-year-old woman with an over 20-year history of HS, who had previously undergone wide perineal excision with secondary intention healing and presented with a painful verrucous vulvar plaque and proximal non-healing perineal wound. The patient had four perineal scouting biopsies performed and excisional biopsy with no evidence of high-grade dysplasia or carcinoma on histology. Chromogenic in situ hybridization was negative for HPV 16 and 18 mRNA; the patient's HIV and HSV PCR were also negative. Our patient was treated with interferon alfa-2b with notable clinical improvement. There is currently no standardized stepwise approach to monitoring verrucous lesions in HS patients with significant risk factors for SCC. Our report highlights a vigilant approach to monitoring. If scouting biopsies are negative, complete testing for high risk HPV strains (HPV 16 and 18) is warranted. If negative, we recommend follow up every 6 months with no further biopsies except if overt clinical changes are observed. We also recommend treatment of verrucous changes to decrease risk of possible malignant conversion. Interferon alfa-2b was effective in decreasing the verrucous lesion burden in our patient and may be considered.

A case of periostomy intestinal metaplasia without adenomatous or dysplastic changes in an ulcerative colitis patient.

We strive to educate medical providers of the possibility of cellular transformation occurring as a parastomal complication and to emphasize the importance of close monitoring, as there is a risk, although low, of subsequent malignant transformation.

Computed tomography diagnosis of omental infarction presenting as an acute abdomen.

Omental infarction is a rare cause of acute abdominal pain. Without the support of radiological evidence, diagnosis is difficult to attain owing to its infrequent incidence, low awareness among clinicians, and its nonspecific presentation that mimics other causes of acute abdomen, namely, acute appendicitis and cholecystitis. Incorrect diagnosis may lead to unnecessary invasive surgery in patients with omental infarction, a disorder that is typically managed conservatively without exposing the patient to intraoperative risks and postoperative morbidity. We report a case of a 61-year-old man who presented to the emergency department with signs of peritonitis. He was eventually diagnosed with omental infarction through computed tomography of the abdomen. He was successfully managed medically with nonsteroidal anti-inflammatory and antiemetic medications, with complete resolution of his symptoms within 2 weeks.

Wellens' syndrome: a close call.

We describe a case of a middle-aged man who presented to the emergency department with typical anginal chest pains and found to have new, deeply inverted T-waves on ECG consistent with Wellens' syndrome. Similar to the description by Wellens et al, a critical 99% stenosis of the proximal left anterior descending artery was indeed confirmed by coronary angiography and successfully treated with drug-eluting stent. It is very important that physicians recognise this ECG finding as a harbinger of a serious cardiovascular condition and the necessity for an early invasive cardiac catheterisation.

Trauma-induced adiposis dolorosa (Dercum's disease).

We present a case of a 39-year-old man who presented with chronic bilateral upper extremity pain associated with innumerable angiomyolipomas that developed 5 years after a motor vehicle accident involving his upper extremities. Our case notes the rare nature of painful adipose tissue deposits and the diagnostic challenges.

Higher Risk of Care for Hidradenitis Suppurativa in African American and Non-Hispanic Patients in the United States.

Hidradenitis suppurativa (HS) is a chronic cutaneous inflammatory disease. Few reports have been published on the influence of race, ethnicity, and other patient demographic factors as determinants of care for HS. Data from the 2005 to 2011 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for to assess factors that were predictive of outpatient visits for HS. Logistic regression controlling for demographic and other factors showed several disparities. African Americans are more likely to experience clinic visits for HS than Whites (Odds Ratio (OR) 2.00, p = 0.047). Moreover, non-Hispanic, non-Latino patients are more likely to visit the clinic for HS than Hispanic, Latino patients (OR 5.49, p = 0.002). Additionally, with increasing patient age, there is less likelihood of a clinic visit for HS (OR 0.99; p = 0.03). Although obese patients were 3.5 times more likely to have an HS office visit than normal weight individuals, this difference was not significant (p = 0.07). Since weight was not collected in this survey until 2005 and data collection continues, further years of data may refine these estimates. These results suggest there may be either increased risk of HS among specific groups, disparities in health access for care of HS, or both.

Prostate brachytherapy seed migration to the heart seen on cardiovascular computed tomographic angiography.

Brachytherapy consists of placing radioactive sources into or adjacent to tumors, to deliver conformal radiation treatment. The technique is used for treatment of primary malignancies and for salvage in recurrent disease. Permanent prostate brachytherapy seeds are small metal implants containing radioactive sources of I-125, Pd-103, or Cs-131 encased in a titanium shell. They can embolize through the venous system to the lungs or heart and subsequently be detected by cardiovascular computed tomography. Cardiovascular imagers should be aware of the appearance of migrated seeds, as their presence in the chest is generally benign, so that unnecessary worry and testing are avoided. We report a case of a patient who underwent brachytherapy for prostate cancer and developed a therapeutic seeds embolus to the right ventricle.