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Tele-Ultrasound to Guide Management of a Patient with Circulatory Shock

A 65-year-old man with a medical history of chronic obstructive pulmonary disease and ethanol abuse presented to the emergency department with tachypnea, tachycardia, and an altered mental status. He was hypotensive at 90/60 mm Hg. Examination of the patient showed confusion and decreased left-sided breath sounds. The serum laboratory values were significant for a urea […]

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Gastric Crohn’s Disease: A Rare Cause of Intermittent Abdominal Pain and Vomiting

Crohn’s disease is a chronic idiopathic inflammatory disease that may involve any part of the gastrointestinal tract from the mouth to the anus. It most commonly affects the terminal ileum and cecum, and less commonly is isolated to the colon. Crohn’s disease involving the stomach or duodenum is uncommon and described in only 0.5% to 4% of […]

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Immunotherapy in Squamous Cell Skin Carcinoma: A Game Changer?

  A 74-year-old white male was diagnosed with squamous cell carcinoma in 2013. Six months after Mohs surgery, he underwent a left superficial parotidectomy, left neck dissection, and excision of the left postauricular lymph node after confirmation of lymphatic spread. Pathology from the left parietal scalp lesion revealed multifocal invasive squamous cell carcinoma. Extranodal tumor […]

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Cerebral Fat Embolism in Hemoglobin SC Disease

A 63-year-old Caribbean man was admitted to the hospital for low back and pelvic pain. His medical history included sickle cell hemoglobin (Hb) C disease with no vaso-occlusive crisis within the last 20 years, and chronic obstructive pulmonary disease treated with inhaled corticosteroids for the last 4 years. A few hours after admission, respiratory distress […]

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What’s in a Mass?: Large Native Mitral Valve Mass

After an elective cystectomy, a 77-year-old man developed postoperative atrial fibrillation, resulting in a surprising new finding and a challenging diagnosis. He had no cardiovascular symptoms or cardiac history. The preoperative electrocardiogram was normal. Transthoracic echocardiogram identified a mass on the mitral valve (Figure 1A), new 3+ aortic valve regurgitation, and 2+ mitral valve regurgitation. Left ventricular […]

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