RESUMEN
Nipple discharge presents as either physiological, which is green, white, or yellow, or is considered pathological, which is typically unilateral, spontaneous, and bloody. Bloody nipple discharge (BND) can be due to underlying malignancy or premalignant lesions. Mammogram (MMG), ultrasound (US), MRI, and ductography are all used to evaluate BND, but different modalities offer greater value in the diagnostic process. Here, we present a case that demonstrates the ability of MRI to detect abnormalities not seen on MMG and US in the setting of BND due to underlying malignancy. The use of MRI earlier in the diagnostic process allows for the use of breast-conserving measures and decreases the possibility of metastasis. This would result in less of a need for more aggressive treatments.
RESUMEN
BACKGROUND: Dual airbags are required to be installed and available for use in all motor vehicles since 1997. The National Highway Traffic Safety Administration reported that 50,457 lives were saved by airbags from 1987 to 2017; however, airbag deployment can cause injuries, including thermal and chemical burns, hyperpigmentation, and dysaesthesia. There is little information available in the literature regarding differences in outcomes between promptly visiting a plastic surgeon and waiting for treatment, especially as an injury may not be immediately apparent or patients may not know that airbag burn injuries may be delayed in presenting. METHODS: This is a retrospective cohort pilot study conducted among 14 patients who presented to a plastic surgeon between January 1, 2019 and June 30, 2022 owing to injuries from airbag deployment. An early visit was considered ≤30 days, and a late visit was >30 days. Other variables collected included age, sex, Fitzpatrick skin type, smoking status, comorbidities, type of injury, injury site, pain status, hyper/hypopigmentation, dysaesthesia, epithelialization, and improvements in pain, pigmentation, and dysaesthesia from treatment. RESULTS: The mean age was 36.0 years (standard deviation (SD) 17.9). The majority were female (85.7%), non-smokers (87.5%), and not diabetic (75.0%). Only six patients (42.9%) visited their doctor within one month of injury. Most patients experienced dysaesthesia (85.7%) and pain (71.4%). Thirteen of the 14 patients had hyperpigmentation or hyperemia, and one had hypopigmentation. Full or slight epithelialization was seen in 35.7%, and nine of the 14 patients had no epithelialization. Ongoing issues were a factor for 64.3% of these patients; 42.9% had ongoing issues with hyperpigmentation. A full recovery was seen in 28.6% of the patients. The patients who saw the plastic surgeon by day 30 or less (early) from the time of injury had a 66.7% improvement in pigmentation and 33.3% resolution in pain. Of those who went to the surgeon beyond 30 days (late), 25% had improvement in pigmentation and 37.5% had resolution of pain. Improvement in dysaesthesia occurred in both groups, but those who saw the plastic surgeon early had 33.3% resolution, while 37.5% of those who went late improved. Of those who went late to the surgeon, only 12.5% had epithelialization, while 66.7% of those who went within 30 days showed signs of (full or slight) epithelialization. CONCLUSION: Patients involved in motor vehicle collisions (MVCs) should be informed of the delayed fashion in which airbag burns can develop. An ostensibly mild burn may portend long-term consequences, especially if such injuries are not addressed in a prompt manner. Our study demonstrates how airbag burn injuries and their sequelae are best addressed with early care.
RESUMEN
Nephrotic syndrome is a known clinical syndrome in which there is increased permeability in the glomerular basement membrane leading to proteinuria, >3.5g/24h, and hypoalbuminemia. The primary causes of nephrotic syndrome include membranous nephropathy, focal segmental glomerulosclerosis, and minimal change disease. Secondary causes include lupus nephritis, diabetes mellitus, multiple myeloma, amyloidosis, and other systemic conditions. Clinically, nephrotic syndrome presents with edema, hyperlipidemia, and increased risk of thromboembolism, the primary focus of this paper. Nephrotic syndrome is often associated with thromboembolic events, especially in patients with membranous nephropathy. It has been shown that hypoalbuminemia is the most significant independent predictor of venous thromboembolic risk. We present the case of a 32-year-old male who first presented with pleuritic chest pain and was found to have multiple bilateral pulmonary emboli treated with oral anticoagulation. On subsequent visits, prompted by either chest pain or edema, he was found to have increasing pulmonary emboli, as well as downtrending serum albumin levels at each visit. Eventually, bilateral non-occlusive renal vein thrombi were discovered. Lab work indicated membranous nephropathy as the most likely etiology secondary to the patient's presentation. Serum anti-phospholipase A2 receptor antibody positivity confirmed the diagnosis, and the patient was treated appropriately.
RESUMEN
Central line-associated bloodstream infections (CLABSI) are a significant risk factor for poor patient outcomes. It is important to correctly diagnose and treat these infections to ensure the best chance of recovery. Kocuria rosea is a novel bacteria that is native to the human flora and has been on the rise as a culprit in recent nosocomial infections. However, due to its characteristics, it is often misclassified by commonly used hospital tests. We present a case of a 55-year-old female with sickle cell disease who developed a K. rosea infection during her hospital course and was effectively diagnosed and treated. This case report aims to bring awareness to this unusual bacteria as a possible cause of inpatient infection and CLABSI. Further research should be conducted to determine the incidence of this bacteria and the best testing to be done for its proper recognition.