Curēus
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Current medical management of pulmonary embolism (PE) is driven by risk stratification, with thrombolytic treatment reserved for patients with hemodynamic instability. We describe a case of a man with acute submassive bilateral pulmonary emboli and a right popliteal deep vein thrombosis (DVT), who had persistent shortness of breath, tachycardia, and hypoxemia but remained normotensive and was therefore not treated with thrombolytics until he suffered a fatal cardiac arrest on hospital day six. We examine the indications, risks, and potential benefits of thrombolytic treatment in patients with submassive PE who exhibit signs of instability but do not meet current indications for thrombolytic treatment with persistent hypotension or shock.
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Background In the 1960s, less than 10% of medical school graduates were women. Today, almost half of all medical school graduates are women. Despite the significant rise in female medical school graduates, there continues to be a large gender gap in most subspecialties, particularly surgical subspecialties such as neurosurgery. ⋯ Likewise, only 7.45% of women hold first-in command leadership positions while 4.69% hold second-in-command positions within their institutions. Conclusions The existing data shows that women are significantly under-represented in academic neurosurgery. Lack of role models, experience, limited scientific output, and aspirations of a controlled lifestyle could be the potential contributing factors.
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Thoracic neuralgia (TN) is a chronic pain syndrome that can be refractory to pharmacologic intervention and management by pain specialists. Dorsal root ganglion (DRG) stimulation has shown promise as a targeted and effective modality compared to traditional therapies for several indications but has not yet been applied in the thoracic region. This study aims to report the outcomes of off-label thoracic DRG stimulation in patients with refractory TN. ⋯ DRG stimulation may be an effective therapy for patients experiencing chronic TN as a result of peripheral nerve injury; however, post-herpetic neuralgia may be unresponsive to this treatment. Future prospective studies are warranted to evaluate the feasibility of this procedure in patients with refractory TN.
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Case Reports
Shortness of Breath: An Unusual Presentation of Bladder Injury. A Case Report and Literature Review of Urinothorax.
Urinothorax is the presence of urine in the pleural space. It can occur at any age and is more common in males. It typically results from obstructive uropathy but can also be caused by malignancy or trauma. Urinothorax is a rare cause of transudative pleural effusion and the only cause of low pH (pH <7.4) transudative effusion. We present the case of a 51-year-old female patient who had recently undergone a urological procedure and came to the emergency department reporting shortness of breath. A chest X-ray revealed a newly developed, large, right-sided pleural effusion. Thoracentesis yielded a transudative yellow fluid of normal pH with a creatinine-to-serum creatinine ratio of 1.7. A computed tomography (CT) cystogram showed extravasated contrast material within the pelvis, from which a diagnosis of urinothorax was confirmed and treated. Urinothorax is a rare diagnosis that requires a multidisciplinary treatment approach, usually including a pulmonologist and a urologist. After the genitourinary disease is treated, the urinothorax usually resolves.
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Osteitis condensans ilii (OCI) is a benign cause of low back pain, which is self-limiting. Though OCI is still an orthopedic mystery, mechanical stress across the joint is a significant triggering factor according to the prevailing theories. The traditional location of involvement is around the ileum, and can be misinterpreted as sacroiliac joint (SIJ) involvement. We present a case of bilateral OCI with sclerosis based on radiological finding in a 30-year-old female presenting with chronic low back pain.