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  Teeth Extraction in a Patient with Left Ventricular Noncompaction Cardiomyopathy

  Cecilia Li, Dalton King, and Phillip Muellerleile

  Publication Date: 5-9-2025

  Left ventricular noncompaction (LVNC) cardiomyopathy is a congenital condition characterized by a non-compacted layer of abnormal trabeculation and a compacted layer of myocardium in the left ventricle. LVNC cardiomyopathy can lead to thromboembolic phenomena, left ventricular dysfunction, malignant arrhythmia, and sudden cardiac death. This specific type of cardiomyopathy is rare, and due to a potential lack of symptoms, true prevalence is unclear. The World Health Organization lists left ventricular noncompaction as an unclassified cardiomyopathy. As such, there is no clear definition or consensus on diagnostic criteria. The infrequency of LVNC cardiomyopathy, combined with unclear diagnostic criteria, make anesthesia management potentially challenging. This case report explores the anesthetic planning and changes in anesthesia management for a patient with this unique condition.

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  Hair-Raising Emergency: Managing a Minoxidil Overdose in a 17-Month-Old Infant

  Emma Lindemann, Brian Lewis, and Lindsey Ouellette

  Publication Date: 5-9-2025

  What begins as a standard treatment for hair loss or hypertension can quickly turn dangerous-minoxidil toxicity, though rare, may lead to severe hypotension, tachycardia, and multi-system complications, necessitating prompt medical intervention. Despite the widespread availability of minoxidil, reports of acute toxicity remain rare, and clinical management guidelines are not well established. This case highlights a severe presentation of minoxidil ingestion, emphasizing the pathophysiology, clinical manifestations, and critical interventions necessary for stabilization in a young child.

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  A Constellation of Common Emergency Department Presentations: BRASH Syndrome

  Kyle Lipa and Matthew Singh

  Publication Date: 5-9-2025

  In 2016, a rare phenomenon known as BRASH (bradycardia, renal failure, AV block, shock, hyperkalemia) syndrome was described. This is a synergistic process that can have a variety of presentations. We report an illustrative case of BRASH in an elderly woman who presented to the emergency department (ED) with bradycardia and hypoxia.

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  Diagnostic Yield of Exome Sequencing for Isolated, Non-Syndromic Autism Spectrum

  Anna Lively, Linda Rossetti, Elizabeth VanSickle, Georgina Brown-Steplitus, Tanya Pai, Ariel Breeden, and Sydney Sabanski

  Publication Date: 5-9-2025

  Autism spectrum disorder (ASD) is a neurodevelopmental disorder (NDD) affecting around 1 in 36 children in the U.S. in 2023, characterized by deficits in communication and social interactions. While molecular testing is useful for diagnosing NDDs, the broad scope and frequent co-occurrence of multiple NDDs complicate the diagnostic process. Current genetic testing provides an underlying diagnosis in 35% of children with ASD but does not distinguish between "syndromic" and "non-syndromic" ASD. This study aims to assess the diagnostic yield of exome sequencing (ES) in non-syndromic ASD and compare results to chromosomal microarray (CMA).

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  No Survival Benefit in Transplanting Stable LVAD Patients (Status 4)

  Renzo Loyaga-Rendon, Sangjin Lee, Nabin Manandhar-Shrestha, Deepak Acharya, and Marzia Leacche

  Publication Date: 5-9-2025

  The Heart Transplant (HT) allocation system prioritizes transplantation based on the likelihood of waitlist mortality (urgency) and doesn't incorporate post-transplant survival. Stable LVAD-supported patients have a low priority for HT. Currently, a new allocation system is being developed that would increase the chances of transplanting stable LVAD-supported patients. Our objective was to analyze the net benefit of receiving HT on LVAD patients according to their listing and transplant status.

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  Islanded Superficial Temporal Artery Fasciocutaneous Flap in Temporal Hairline Reconstruction Following Skin Cancer: A Novel Approach

  Beatrice Lucchesi and John Felder

  Publication Date: 5-9-2025

  Skin cancer defects spanning the temporal hairline present unique challenges. Current methods, although effective at achieving coverage, often fail to attain an aesthetically pleasing reconstruction, which should place scars in a natural position along the hairline and preserve the direction and location of hair growth. The islanded superficial temporal artery fasciocutaneous flap (ISTAFF) mobilized in V-Y fashion includes the galea and superficial temporal fascia and is supplied by the superficial temporal artery and vein (STA/V) pedicle. It is mainly utilized in the reconstruction of eyebrow or scalp-only defects. In this small three-case series, we demonstrate the utility of the ISTAFF for smaller temporal hairline defects and in a novel combination of multiple local flaps to achieve ideal reconstruction of larger defects spanning the temporal hairline.

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  Spontaneous Peroneal Pseudoaneurysm in the Young Athlete

  Nina Lund and Jennifer Hemberg

  Publication Date: 5-9-2025

  Atraumatic pseudoaneurysm is a rare cause of unilateral extremity pain particularly in the pediatric and young adult patient population, for whom genetic disorders with variable penetrance may not have yet reached clinical significance. We present an uncommon case of lower extremity pain and peroneal pseudoaneurysm complicated by compartment syndrome.

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  Real-World Adverse Events of Temporary Percutaneous Circulatory Support of the Right Ventricle - A Manufacturer and User Facility Device Experience (MAUDE) Analysis

  Joeita Macfield, Anjali Purohit, Ryan Grayburn, Jacob Gonzales, Nabin Manandhar-Shrestha, Scott Chicotka, Emily Seif, Brian Trethowan, Noah Jentzen, and Renzo Loyaga-Rendon

  Publication Date: 5-9-2025

  The Manufacturer and User Facility Device Experience (MAUDE), a mandatory FDA database was utilized for this study. Adverse events between September 2019 and January 2024 for Impella RP, Impella RP Flex and ProtekDuo systems were abstracted. The events were categorized as death, injury, malfunction, malfunction/injury.

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  Vacuum-Induced Hemorrhage Control versus Uterine Balloon Tamponade for Management of Postpartum Hemorrhage

  Courtney Makris and David Colombo

  Publication Date: 5-9-2025

  Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Despite the use of first- and second-line PPH treatment modalities, the incidence of PPH continues to increase. This has prompted the need for the development of novel treatment options. Intrauterine balloon tamponade devices (UBT) are a common treatment option for PPH not responsive to first-line treatment. The Bakri balloon is a commonly used intrauterine balloon tamponade device, and the recent introduction of the Jada device, a vacuum-induced hemorrhage control device (VHD) offers a novel, effective option. The purpose of this research study is to compare these two intrauterine devices for the treatment of PPH to determine the most effective strategy by comparing maternal outcomes.

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  A Case of a Traumatic Flank Hernia with Bowel Evisceration

  Claire McNary and Mario Zambino

  Publication Date: 5-9-2025

  Traumatic flank hernias are defined as a protrusion of bowel and abdominal organs through a defect in the posterior abdominal wall as a result of injury. Traumatic flank hernias are common following motor vehicle collisions with sudden and severe deceleration forces, particularly in individuals with weaker spigelian fascia. Traumatic flank hernias occur in less than 1% of all blunt abdominal traumas. Additionally, diagnosis of these types of hernias are typically delayed, with a mean of 1 year following the trauma. There have been few reports of traumatic flank hernias with bowel evisceration necessitating the need to undergo emergent repair in a step-wise approach.

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  Reverse Takotsubo Cardiomyopathy During Acute Bronchospasm

  Darian Mills and Thomas Peterson

  Publication Date: 5-9-2025

  Takotsubo cardiomyopathy is characterized by acute, left ventricular wall motion abnormalities associated with systolic dysfunction. A variant of Takotsubo cardiomyopathy has been described as, "reverse Takotsubo cardiomyopathy," involving ballooning and hypokinesis of the base of the left ventricle with preserved apical function or hyperkinesis of the apex. We report a case of reverse Takotsubo cardiomyopathy in a young female patient who presented to the emergency department (ED) with respiratory distress likely due to asthma exacerbation.

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  Intravascular Lithotripsy Followed by Angioplasty and Stenting for Severely Calcified Carotid Artery Stenosis: A Technical Note and Case Series

  Macy Mitchell, Leonard Verhey, Naveen Taylor, Andres Restrepo Orozco, Jake Haver, Andrea Sewell, Paul Mazaris, and Justin Singer

  Publication Date: 5-9-2025

  In patients with significant circumferential calcified carotid stenosis who are not endarterectomy candidates, carotid artery stenting (CAS) is challenged by the inability of stent radial forces to overcome the calcification. Intravascular lithotripsy fractures the plaque rendering it more amenable to angioplasty and stenting. This technique has only been reported on a single patient in neurosurgical literature.

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  Serendipitous X-Rays: Back-to-Back Incidental Findings of Congenital Diaphragmatic Hernia and Congenital Neuroblastoma on Routine Neonatal XR

  Geralyn Moody

  Publication Date: 5-9-2025

  Congenital diaphragmatic hernia (CDH) occurs in 2.3:10K births. CDH is a developmental defect of the diaphragm allowing abdominal contents to herniate into the thoracic cavity. About 50% of CDH cases are diagnosed antenatally. Clinical presentation varies from asymptomatic to severe respiratory failure at birth. Congenital neuroblastoma (CNB) occurs in 1:8K live births and is an embryonal neural crest tumor. About 20% of cases are diagnosed antenatally and 16% are diagnosed within the first month of life. Presentation of CNB is highly variable; about 20% present with spinal cord compression. The co-occurrence of these two rare diseases has been described in 1 other case report. Both diseases have proposed pathophysiologic mechanisms involving disturbance of the retinoic acid pathway. This case describes a baby girl incidentally diagnosed with both CDH and CNB.

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  Sestamibi as an Alternative to Mebrofenin for the Diagnosis of Acute Cholecystitis: An Alternative Option During Supply Chain Disruption

  Midhhath Afza Munavar Ali, Matthew S. Davenport, Daniel Wale, Bamidele Otemuyiwa, and Benjamin Viglianti

  Publication Date: 5-9-2025

  Acute cholecystitis affects approximately 200,000 patients in the United States every year and is the most common clinical indication for hepatobiliary scintigraphy. It can be diagnosed with CT, MRI, ultrasound, or composite clinical judgment, but hepatobiliary scintigraphy has been reported to have higher accuracy. Iminodiacetic agents are used in hepatobiliary imaging and have prompt hepatic uptake and excretion into the biliary system. Two agents currently approved by the FDA: Tc-99 m disofenin and Tc-99 m mebrofenin. During the COVID-19 pandemic from July to Sep 2021, there were supply chain disruptions which made sestamibi a potential substitute. This study is a retrospective analysis of those patients that used Tc-99 m sestamibi for hepatobiliary imaging and the diagnostic accuracy of those studies.

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  Bilateral Lower Cervical Facet Dislocation (CFD) Corrected with Reduction, Anterior Cervical Discectomy with Fusion (ACDF), and Posterior Fixation in a 19-Year-Old Male

  Kim Nguyen, Richard Nguyen, and Alexander Gomez

  Publication Date: 5-9-2025

  Cervical facet dislocation (CFD) is a well-established cause of traumatic spinal cord injury (TSCI).

  A previously healthy 19-year-old male presents to the emergency department with complete loss of motor function of bilateral lower extremities and hands following a traumatic spinal cord injury (TSCI). Radiographs demonstrated C6-C7 bilateral facet dislocation with anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), and ligamentum flavum (LF) at the same level.

  Following multiple unsuccessful attempts at closed reduction while awake, closed reduction was achieved under anesthesia of C6-C7 anterior cervical discectomy with fusion (ACDF) allograft and anterior plating along with posterior instrumentation and fusion.

  One year post-operatively, the patient regained near complete motor function in lower extremities with no assistive ambulatory device required but some continued ataxia.

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  Factors Associated with Microsurgical Outcomes for Cutaneous and Muscular Autologous Free Flaps in Pediatric Patients

  Crista Lee Oakley-Havens, Oscar Parker Martinez, Samuel Girian, Anna Carlson, and John Girotto

  Publication Date: 5-9-2025

  Autologous free flap (AFF) microsurgical outcomes have been well studied in adult populations, but have yet to be extensively studied in children, likely due to the relatively fewer number of microsurgical cases in this population. This study will investigate the relationship between pediatric health factors, demographics, insurance payor status, hospital characteristics and how they contribute to post surgical AFF transfer complications.

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  Gender Differences in Clinical Characteristics and Outcomes in Patients with Acute Pulmonary Embolism. An Analysis of 1000 PERT Activations.

  Maria Obeidat, Milena Jani, Dana Marsy, Glenn Vanotteren, Michael Knox, Wael Berjaoui, Joseph Pitcher, Trevor Cummings, Nabin K. Shrestha, and Renzo Loyaga-Rendon

  Publication Date: 5-9-2025

  Pulmonary embolism (PE) is ranked the third most common cause of cardiovascular death, after myocardial infarction and stroke. The management of acute PE requires a multidisciplinary team approach. Since the implementation of the Pulmonary Embolism Response Team (PERT) in 2019, one thousand patients have been evaluated. Our objective was to evaluate the clinical characteristics and outcomes in this population according to gender.

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  Differential Metabolomic Profile on End-Stage Ischemic and Non-Ischemic Cardiomyopathy

  Stephen Orey, Nadia Ashrafi, Romana Ashrafi Mimi, Vilija Lomeikaite, Migle Gabrielaite, Jouzas Gordevicius, Stewart Graham, and Renzo Loyaga-Rendon

  Publication Date: 5-9-2025

  Ischemic (ICMP) and non-ischemic cardiomyopathies (NICMP) can lead to end-stage heart failure (ESHF). Despite differing causes, treatment for ESHF is similar. We compared the metabolomic profiles of ESHF patients with ICMP and NICMP to identify potential metabolic differences or shared mechanisms.

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  A Case of SBO After Initiating Ozempic

  Elron Oscar and Monica Vandenbil

  Publication Date: 5-9-2025

  Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated significant clinical benefit in managing diabetes mellitus type 2 (DM2), facilitating chronic weight loss, and potentially improving obstructive sleep apnea. While generally well-tolerated, GLP-1 RAs can be associated with adverse events, including pancreatitis, acute kidney injury (AKI), gastroparesis, nausea, diarrhea, abdominal pain, and decreased appetite. Small bowel obstructions have been found in patients after initiating a GLP-1 RA, with limited case reports on this topic. In this case study, we describe a patient that experienced a small bowel obstruction (SBO) shortly after initiating treatment with Ozempic (a GLP-1 RA).

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  The Use of Medication for Addiction Treatment of Opioid Use Disorder in Pregnancy and Its Effects on Fetal Growth

  Bindi Patel

  Publication Date: 5-9-2025

  Pigmented villonodular synovitis (PVNS), also known as tenosynovial giant cell tumor (TGCT), is a rare proliferative disease of the synovial tissue that most commonly affects large joints such as the knee, hip, and shoulder in young individuals.1,2 PVNS can broadly be categorized into two types: localized PVNS (LPVNS) and diffuse PVNS (DPVNS), with the localized form being a mass within the synovium and the diffuse form involving the entire synovium.2,3 This rare condition has an incidence rate of 1.8 per million and is often misdiagnosed as arthritic disease. Early diagnosis is crucial as PVNS is often aggressive, and recurrence rates in the diffuse type have been reported to be as high as 46%.

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  Pulmonary Artery Pseudoaneurysm Following Right Heart Catheterization: Diagnostic and Interventional Considerations

  Alex Phillips and Samy Behairy

  Publication Date: 5-9-2025

  Pulmonary Artery Pseudoaneurysm (PAP) is a rare, life-threatening condition that requires prompt diagnosis and intervention due to its high risk of rupture and mortality. Pseudoaneurysms involve only the adventitia and media, making the vessel wall more prone to rupture. PAPs are primarily acquired, though can be congenital. The most commonly acquired PAPs are iatrogenic, occurring after procedures such as pulmonary artery catheterization or right heart catheterization. PAPs are typically diagnosed with CTA, although the gold standard remains pulmonary angiography. The nonspecific symptoms and variable progression of PAPs complicate their diagnosis. Additionally, no specific treatment guidelines exist. Endovascular interventions such as coil embolization, stents, plugs, or liquid embolization are the preferred treatment options due to lower invasiveness and mortality.

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  Langerhans Cell Histiocytosis of Vulva in a Pediatric Patient

  Sarah Pilarski, Kania McGhee, Kate Wiewiora, and Vyvian Borse-Hatchett

  Publication Date: 5-9-2025

  Langerhans Cell Histiocytosis (LCH) is a rare disorder characterized by proliferation of histiocytes in various tissues, most commonly affecting the bone and skin. Its clinical manifestations vary widely, ranging from local lesions to disseminated involvement. Patient presentations range from self-healing skin lesions to multi-organ dysfunction resistant to treatment. The unpredictable presentation of LCH can lead to diagnostic delay, particularly in pediatric patients with vulvar lesions at presentation. This case report highlights the significance of a proper gynecological evaluation in pediatric patients, including biopsy and specialist referral if the etiology remains unclear.

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  Acute Mastoiditis Complicated by Cerebral Venous Sinus Thrombosis in an Adolescent Male

  Gene Porter, Jennifer Bach, and Tiffany Fleeger

  Publication Date: 5-9-2025

  Diagnosis and management of complicated mastoiditis in adolescence is still controversial. We investigated clinical manifestations, evaluation, and management of a child with mastoiditis complicated with cerebral venous sinus thrombosis. Signs and symptoms are often atypical due to previous antibiotic treatment, and severe clinically "silent" intracranial complications may initially go unnoticed. We present the clinical presentation and management of an adolescent male with mastoiditis complicated with venous sinus thrombosis.

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  Case Study: Responsive Neurostimulation Treatment for a Case of X-linked NEXMIF Encephalopathy in a Female Patient

  Isabella Purosky, Jake Haver, and Marian Michael Bercu

  Publication Date: 5-9-2025

  Less than one in 100,000 people experience Neurite Extension and Migration Factor (NEXMIF) Encephalopathy, which is an X-linked condition that was discovered in 2004 and only became known between 2013-2016 clinically. Mutations in NEXMIF have a particular impact on dendrites and axon length that affects early brain development among other things. Its phenotype is seen to include primarily intellectual disabilities and drug-resistant epilepsy (DRE). Typically, males experience intellectual disability whereas females typically experience both with a less severe intellectual disability in comparison to males. A novel epilepsy surgery treatment for DRE is Responsive Neurostimulation (RNS, NeuroPace, Mountain View, California) which is a closed-loop cranial implant that can detect, learn, and abort individual epileptiform activity.

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  When Appearances Deceive: A Case of Papillary Endothelial Hyperplasia Mass in the Left Atrial Appendage in a Patient with Ischemic Stroke

  Mohamad Quilliams, Moiz Saeed, Mohammad Ahmed, Rafael Bernal, Amarinder Atal, and Richard McNamara

  Publication Date: 5-9-2025

  Papillary endothelial hyperplasia (PEH) is a benign condition of reactive endothelial cell proliferation, usually confined to the vasculature. Its occurrence in the left atrial appendage (LAA) is exceedingly rare.

  A 30-year-old male presented with a stab wound to the chest. He underwent a thoracotomy for repair of pulmonary lacerations and lobe resection. Post-extubation, he exhibited left arm weakness. Magnetic resonance imaging (MRI) revealed bilateral ischemic changes. Transesophageal echocardiogram (TEE) noted a hyperechoic structure in the LAA. Cardiac MRI findings were more consistent with a tumor. Patient underwent LAA resection. Pathological examination revealed PEH. No connection was noted between the left atrium and LAA, making air emboli through pulmonary veins during surgical repair the likely culprit for his strokes.