A&A practice
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Case Reports
Advanced Progression of Scoliosis After Intrathecal Baclofen in an Adult With Stiff Person Syndrome: A Case Report.
Stiff person syndrome is a neuroimmunological disorder characterized by progressive muscular rigidity and spasms that affect axial/limb muscles, resulting in severe pain and functional limitations. When refractory to conservative treatments, intrathecal baclofen is a viable option to treat the increased tone. ⋯ This adverse effect has never been reported in adults with stiff person syndrome. We report a case of an adult with stiff person syndrome and underlying scoliosis who experienced accelerated progression of scoliosis after initiation of intrathecal baclofen, subsequently requiring neurosurgical intervention.
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Residency programs often struggle with strategies to formally teach leadership and communications skills. To provide a catalyst for professional development, Vanderbilt University Medical Center implemented a curriculum aimed at addressing this gap. ⋯ Outcomes were assessed using pre- and postrotation surveys. Sixty-nine residents completed the rotation over a 4-year period, and 82% (54 of 66) strongly agreed that nonclinical professional development should be a component of training.
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Case Reports
Münchhausen Syndrome: A Case Report of an Unusual Cause of Vitamin K Antagonist Intoxication.
Psychiatric disorders must be considered in the differential diagnosis of patients presenting to the emergency department with unexplainable somatic symptoms. Physicians should be aware of Münchhausen syndrome as a possible diagnosis. A 46-year-old female patient presented at the emergency department with signs of coagulopathy. ⋯ Urine toxicology revealed the presence of vitamin K antagonists (VKAs). After an extensive workup, she was diagnosed with Münchhausen syndrome. Intentional intoxication with VKA is rare.
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Preoperative cardiac risk stratification algorithms typically use a Bayesian approach to identify a low-risk category group for which the outcome is unlikely to be improved by further testing. This report suggests evaluating common carotid intima-media thickness (CCIMT) as measured by ultrasound to determine whether it strengthens and optimizes perioperative Bayesian risk indices. ⋯ A website (www.suhitam.com/vascularage) designed by one of the authors (S. M.) is a useful resource.).
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Case Reports
Anesthetic Management of Posterior Sternoclavicular Joint Dislocations: A Report of 2 Cases.
Posterior sternoclavicular joint (SCJ) dislocation is a rare cause of shoulder injury that can present with life-threatening mediastinal complications. This injury most commonly occurs in adolescents and young adults, and there is a lack of anesthesia literature addressing its anesthetic implications. We present 2 cases of posterior SCJ dislocations and discuss the anesthetic management and the potential for mediastinal injuries.