Hughes-Stovin Syndrome and the Acute Management of Recurrent Pulmonary Aneurysms.

Hughes-Stovin syndrome (HSS) is a rare autoimmune disease that is considered to be a variant of Behçet's disease. It typically presents with multiple venous thrombi, thrombophlebitis, as well as pulmonary and bronchial aneurysms. The disease is typically associated with high morbidity and mortality in those diagnosed. This case discusses a 28-year-old male with HSS complicated by venous cardiac emboli and a mechanical valve on chronic anticoagulation. Despite medical and surgical management, the patient experienced continued progression of his pulmonary aneurysms and excessive bleeding, eventually requiring lung transplantation.

AN ATYPICAL CASE OF OPTIC DISK PSEUDO-DUPLICATION WITH PROLIFERATIVE DIABETIC RETINOPATHY.

PURPOSE: To present a unique case of optic disk pseudo-duplication with proliferative diabetic retinopathy. METHODS: Case report. RESULTS: A 63-year-old white diabetic man presented with an apparent duplicated optic disk in the superonasal midperiphery of his left eye. A large flat frond of neovascularization fanned out from this structure. Optical coherence tomography scanning showed a noncolobomatous scar with a large plume of blood vessels sprouting from the choroid, thru the retina and branching out into the vitreous. Magnetic resonance imaging scanning revealed a normal left globe and orbit with a single optic nerve. The neovascularization regressed after panretinal photocoagulation and anti-vascular endothelial growth factor therapy. CONCLUSION: We describe a unique case of proliferative diabetic retinopathy associated with pseudo-duplication of the optic disk. This case is unique in the peripheral location of the pseudo-duplication, the presence of spontaneous choroidovitreal neovascularization in proliferative diabetic retinopathy, and the appearance of neovascularization elsewhere mimicking neovascularization of the duplicated disk.

Atypical Cystic Fibrosis: Diagnosis at the Age of 57 Years.

Cystic fibrosis (CF) is an autosomal recessive, multi-organ disorder found predominantly among Caucasians. It classically presents in childhood with chronic productive cough, malabsorption causing steatorrhea, and failure to thrive. We present a 75-year-old female diagnosed with CF at the age of 57 years, which highlights the natural history and challenges in the diagnosis of atypical CF, including broadening physicians' respiratory differential diagnosis, limited patient symptoms, and late age of symptom onset.

Impact of major bleeding on long-term mortality in anemic versus nonanemic patients undergoing percutaneous coronary intervention using bivalirudin.

Bleeding complications after percutaneous coronary intervention (PCI) have been associated with higher short and long-term mortality. Bivalirudin has been shown to reduce bleeding complications in patients who underwent PCI; however, the impact of anemia on bleeding complications and long-term mortality has not been studied. A total of 11,991 patients who underwent PCI over a period of 8 years with bivalirudin as the primary antithrombotic agent were included. Anemia was defined according to the World Health Organization definition. Bleeding complications were prospectively collected. Survival analysis was performed using multivariable Cox proportional hazards models. Of the 11,991 patients, 4,815 patients (40%) had baseline anemia. Major bleeding occurred in 3.3% of patients with anemia compared with 0.7% of patients without anemia (p <0.001) driven largely by transfusion events. In the overall study population, major bleeding was a significant predictor of mortality (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.04 to 1.8, p = 0.027) at a mean follow-up of 2.6 years (interquartile range 1.4 to 3.5). In patients with anemia, major bleeding remained an independent predictor of mortality (HR 1.5, 95% CI 1.1 to 2.0, p = 0.008); however, in patients without anemia, it did not (HR 1.25, 95% CI 0.52 to 3.03, p = 0.62). In patients who underwent PCI with bivalirudin therapy, major bleeding is associated with early and long-term mortality, which is more pronounced in patients with baseline anemia.

Correlation between preoperative endoscopic and intraoperative findings in localizing colorectal lesions.

BACKGROUND: Colonoscopy findings compared with findings at time of surgery have a discrepancy rate of 3-21%. The objective of our study was to investigate this discrepancy and provide potential resolutions. METHODS: In this retrospective study, we identified 400 patients who underwent colonoscopy followed by colon resection at our community hospitals in 1999-2006. Discrepancies between colonoscopy and intraoperative findings were noted. Each discrepancy was classified as major if the surgical procedure had to be altered, the lesion was missed, an unnecessary segment was removed, or the incision was extended. A discrepancy was classified as minor if there was no alteration in planned surgery. RESULTS: Of the 400 cases, 160 (40%) were located in the right colon, 13 (3%) were in the transverse colon, 185 (46%) were in the left colon, and 42 (11%) were in the rectum. A total of 48 (12%) discrepancies between colonoscopy and intraoperative findings were identified: 26 (54%) were major and 22 (46%) were minor. Thirteen (27%) were in the proximal colon (3 major and 10 minor discrepancies), 3 (6.3%) were in the transverse colon (all major), 22 (46%) were in the distal colon (17 major and 5 minor), and 10 (21%) were in the rectum (3 major, 7 minor). Major discrepancies were significantly higher in the left colon (17 of the 185 left-sided lesions; 9.1%) than in the right colon (3/160; 1.9%; P = 0.045). CONCLUSIONS: In our study, colonoscopy has an error rate of 12% when used to localize tumors; more than half of these patients require significant unanticipated changes in their surgery. The discrepancies are significantly higher in left side of colon.