Multiple Anomalous Coronary Arteries With Right Sinus of Valsalva Origin: A Case Report.

Coronary artery anomalies (CAA) define a wide array of congenital abnormalities that stem from the origin, course, and distribution of coronary arteries. CAAs can lead to severe complications such as arrhythmias, myocardial ischemia, and even sudden cardiac death. We describe the case of a 58-year-old female who presented to the emergency department with chest discomfort and shortness of breath and received a workup for acute coronary syndrome. She underwent a cardiac catheterization, which incidentally found an anomalous left anterior descending artery with a right sinus of Valsalva origin, an absent left circumflex coronary artery, and a dominant right coronary artery of unusually large caliber and distribution. There were no identified atherosclerotic plaques. This anomalous configuration of the coronary arteries is exceptionally rare. She required medical management with daily oral acetylsalicylic acid 81 mg, atorvastatin 80 mg, twice daily metoprolol tartrate 50 mg, and hydrocodone/acetaminophen 7.5mg/325 mg oral tablet to be taken every 4 h, as needed for severe pain. Despite optimal medical management, she continued to have chronic angina. A surgical evaluation by a cardiovascular surgeon deemed her anomaly to be inoperable.

Sigmoid Colon Angiomyolipoma as a Culprit for Intermittent Constipation and Hematochezia.

Colonic angiomyolipomas (CA) are very rare benign tumors arising from perivascular epithelioid cells. CA are most often found either during screening colonoscopies or as an incidental finding during abdominal imaging. However, some rare cases of CA are found to present with abdominal pain and hematochezia. In this article, we report a case of a 62-year-old man who presented with intermittent hematochezia and constipation who was found to have an angiomyolipoma in the sigmoid colon. The lesion was successfully removed endoscopically with no recurrence of bleeding and no complications within the first 30 days after the procedure.

Epidural abscess secondary to Streptococcus pneumoniae. A case report and review of the literature.

While spinal epidural abscess is a well described disease process, this condition is rarely caused by Streptococcus pneumoniae. This case describes a case of spinal epidural abscess secondary to S. pneumoniae in an otherwise healthy, immunocompetent 61-year-old female without a history of spinal procedures, obvious source of hematogenous seeding, or clear risk factors for invasive pneumococcal infection. She was treated with IV and oral antibiotic therapy and made a full recovery.

Unique Case of Severe Sepsis and Acute Respiratory Failure in the Setting of Aseptic Epiploic Appendagitis of the Descending Colon.

Epiploic appendagitis (EA) is an uncommon intraabdominal pathology resulting in transient, localized pain. The condition is caused by ischemia of one of the epiploic appendages, which are distributed axially along the length of the colon. EA is often mistaken for other more common etiologies of an acute abdomen. Generally, the patients experience focal abdominal pain with no further symptoms or laboratory abnormalities. The authors encountered a 79-year-old male with severe sepsis and acute respiratory failure requiring intubation. He recovered rapidly after the identification and removal of a single EA. This paper reports the first case of EA leading to the systemic dysregulation of sepsis.

Genotypic-specific heat shock response of vector susceptibility to Schistosoma mansoni.

Living organisms are vulnerable to thermal stress which causes a diversity of physiological outcomes. Previous work has shown that the snail vectors (Biomphalaria glabrata) of an important human pathogen, Schistosoma mansoni, revert from resistant to susceptible after short exposure to a heat stress as low as 31oC; however, due to lack of replicability among labs and genetic lines of snails, it has been hypothesized that this effect is genotype dependent. We examined the effects of heat shock on resistance of two species of snail vectors including B. glabrata and B. sudanica. We used 3 different inbred laboratory snail lines in addition to the F1 generation of field collected snails from Lake Victoria, Kenya, an area with high levels of schistosomiasis transmission. Our results showed marginal effects of heat shock on prevalence of infection in B. glabrata, and that this response was genotype specific. We found no evidence of a heat shock effect on prevalence of infection in B. sudanica or on intensity of infection (number of infectious stages shed) in either snail species. Such environmentally influenced defense responses stress the importance of considering this unique interaction between snail and parasite genotypes in determining infection dynamics under climate changes.