A case report with Fitz-Hugh-Curtis syndrome, what does it mean?

Fitz-Hugh-Curtis (FHC) syndrome, also known as acute perihepatitis, was discovered in 1930 and is a rare disorder characterised by inflammation of the peritoneum and the tissues surrounding the liver. This syndrome can arise as a potential complication from a pelvic inflammatory disease caused by Neisseria gonorrhoeae or Chlamydia trachomatis. This syndrome is not well known in the medical community and is often underdiagnosed. In this case report, we revisit FHC syndrome, particularly its noninvasive diagnosis and complications

Seeks, finds, threats: Lyme disease!

Lyme borreliosis is a disease commonly found in humans. Here we report the case of a young, healthy girl presenting with symptomatic first- and second-degree atrioventricular blocks secondary to cardiac myocarditis. The disappearance of the conduction anomaly after antibiotic treatment confirmed Lyme disease before the results from the serology. Therefore, when a healthy, young person suddenly presents with an atrioventricular conduction block, physicians should consider a diagnosis of Lyme disease

Syncope Secondary to Obesity?

The frequency of obesity is increasing worldwide. The relationship between obesity and mortality is known. Bariatric surgery is well established in the treatment of morbid obesity to reduce weight permanently. Bariatric procedures are effective and influencing associated comorbidities. Adjustable gastric banding is a popular and effective bariatric operation in Europe for more than 10 years. Classic complications of gastric banding are known, but here we describe one more example. In this study, we report the case of a patient with gastric banding who presented with syncope after a meal

Mechanisms of periprocedural myocardial necrosis following Rotablator® and saphenous vein graft PCI

Objective: Rotational atherectomy device (Rotablator®) or saphenous vein graft (SVG) percutaneous coronary intervention (PCI) commonly results in elevated creatinine kinase-MB (CK-MB) levels and is associated with worse outcome. We have assessed the prevalence and mechanistic causes of procedural myocardial necrosis (PMN) following Rotablator® or SVG PCI. Methods: We assessed 46 cases of Rotablator® and 230 cases involving SVG PCI among the 7,700 total PCIs observed during a 12-year period (1996-2007). Following analysis of angiogram results, procedural data, and the delay between PCI and necrosis, we mechanistically classified PMN as follows: cryptogenic, immediate failure, side branch occlusion, stent thrombosis, prolonged ischemia, delayed failure, or none to communicate. Results: The incidence of elevated CK-MB greater than the upper limit of normal (ULN) after Rotablator® and SVG PCI was 19% and 7%, respectively. Important periprocedural myocardial infarction (important PMI; CK-MB >5 times ULN) was significant for both Rotablator® (56%) and SVG (70%) PCI. Also, we found that the mechanisms contributing to PMN in Rotablator® (n=9) were most often cryptogenic (56%), followed by immediate failure (22%) and prolonged ischemia (22%). For SVG PCI (n=17), cryptogenic (47%) was also the most common mechanism, followed by prolonged ischemia (29%), immediate failure (12%), stent thrombosis (6%), and none to communicate (6%). Conclusions: Rotablator® and SVG PCI led to increased risk for PMN and important PMI in comparison to the standard population. Also, we observed that the main mechanism of PMN for both Rotablator® and SVG PCI was cryptogenic, with micro-embolization likely acting as the primary etiology

A case of transient lymphangiectasis of the penis.

OBJECTIVE AND IMPORTANCE: Physicians are likely to encounter patients with penis disorders and can be caught off guard by these uncommon pathologies, especially because they occur in a sensitive anatomical location. CLINICAL PRESENTATION: Here, we report the case of a patient presenting with benign transient lymphangiectasis of the penis (BTLP), including its differential diagnosis and treatment. Conclusion headings: BTLP is not an uncommon pathology and diagnosis is based only on medical history and clinical examination. The differentiation between Mondor's disease and BTLP is not necessary for treatment

Assessing clinical reasoning using a script concordance test with electrocardiogram in an emergency medicine clerkship rotation

OBJECTIVES: Script concordance tests (SCTs) can be used to assess clinical reasoning, especially in situations of uncertainty, by comparing the responses of examinees with those of emergency physicians. The examinee's answers are scored based on the level of agreement with responses provided by a panel of experts. Emergency physicians are frequently uncertain in the interpretation of ECGs. Thus, the aim of this study was to validate an SCT combined with an ECG. METHODS: An SCT-ECG was developed. The test was administered to medical students, residents and emergency physicians. Scoring was based on data from a panel of 12 emergency physicians. The statistical analyses assessed the internal reliability of the SCT (Cronbach's α) and its ability to discriminate between the different groups (ANOVA followed by Tukey's post hoc test). RESULTS: The SCT-ECG was administered to 21 medical students, 19 residents and 12 emergency physicians. The internal reliability was satisfactory (Cronbach's α=0.80). Statistically significant differences were found between the groups (F0.271=21.07; p<0.0001). Moreover, significant differences (post hoc test) were detected between students and residents (p<0.001), students and experts (p<0.001), and residents and experts (p=0.017). CONCLUSIONS: This SCT-ECG is a valid tool to assess clinical reasoning in a context of uncertainty due to its high internal reliability and its ability to discriminate between different levels of expertise