Metastatic Disease Mimicking Osteomyelitis in the Foot.

Cervical cancer most commonly spreads hematogenously to the lungs, liver, and bone. However, it rarely metastasizes to the foot. There is only one other case of cervical cancer with metastasis to the foot. In addition, the initial imaging of metastatic disease has difficulty in differentiating from infectious or other inflammatory processes, particularly in a clinical setting highly suspicious of infectious sources. Here, we present a rare case of cervical cancer metastasizing to the calcaneus masquerading as osteomyelitis, highlighting the importance of diagnostic imaging in conjunction with histological confirmation.

Acquired Hemophilia A: A Case Report on a Rare Disease Manifesting as Persistent Hematuria.

Hemophilia A is most commonly a genetic clotting disorder that is caused by a decrease or lack of activity of clotting factor VIII. Acquired hemophilia, a rarer subset can occur later on in life. The incidence rate of the latter subtype is estimated to affect one per million cases a year. Given the rarity of the disease, the associated hemoglobin and hematocrit reduction seen from this can easily be missed and attributed to concomitant disorders such as hematuria. Our patient initially presented with persistent hematuria, was treated with multiple rounds of antibiotics, and underwent a plethora of urological studies with no resolution or explanation of her symptoms. It wasn't until her ICU admission that coagulation studies were reviewed in depth and workup for hemophilia A began. The American Urologic Association's hematuria workup is currently limited to the genitourinary system with no consideration for hematological disorders. We believe that the medical community may benefit from further research in this area in order to avoid mismanaging patients medically and thus minimize morbidity and mortality.

The Anterior Globus Pallidus Externus of Basal Ganglia as Primarily a Limbic and Associative Territory.

There have been an increasing number of functions attributed to the basal ganglia, such as cognitive, emotional, and motor functions. As a result, there is a growing interest to localize these functions to different subregions of the basal ganglia. Most research on localization has been conducted on animals. The experiments subdivide the basal ganglia regions into motor, limbic, and associative functioning areas. There are sparse reports on the localization of functions in humans. This paper attempts to provide such localization of function with a focus on the globus pallidus externus of the basal ganglia. We present the case of a young man who had impairment in mixed cognitive, perceptual, and mood disturbances. No significant motor symptoms were noted in the patient. Brain imaging demonstrated dense bilateral calcifications in the basal ganglia, bilaterally localizing to the anterior region of the globus pallidus externus. We discuss our findings in light of recent studies that imply that isolated pathology in the anterior region of the globus pallidus externus may be associated with behavioral, mood, and cognitive disturbance without motor symptoms.