Christopher Sankey

Vanishing Lung Syndrome

A 41-year-old man with a smoking history of 30 pack-years presented with chronic chest pain, dyspnea, and cough. Physical examination revealed cachexia, with decreased apical breath sounds and hyperresonance to percussion in both lungs.

The Coffee Bean Sign and Sigmoid Volvulus in an Elderly Adult

antimicrobials, including macrolides (clarithromycin or azithromycin), ethambutol, and rifampin or rifabutin, is used in the treatment of pulmonary MAC disease and presumably might be used in the treatment of tenosynovitis. Initiating treatment for localized soft-tissue MAC infection with clarithromycin in combination with one or more of rifabutin, ethambutol, and ciprofloxacin has been suggested. The recommended duration of treatment for lung disease caused by MAC is 18 to 24 months. The optimal duration is unknown for extrapulmonary localized MAC disease involving the skin, soft tissue, tendons, and joints, but antimycobacterial treatment usually lasts 6 to 12 months. Geriatricians should be alert to the possibility of MAC tenosynovitis if an individual has a history of trauma or a poor response to the surgical release of carpal tunnel syndrome.

Incidental Discovery of Retained Triple Lumen Catheter Guidewire.

A 30-year-old male with type 1 diabetes mellitus presented with diabetic ketoacidosis, acute kidney injury, and respiratory failure requiring emergent venous access and intubation. A left femoral triple lumen catheter (TLC) was inserted by an internal medicine resident with attending supervision. There were no reported complications. Fourteen days later, interventional radiology retrieved an Bextra wire^ via the right internal jugular vein at the time of hemodialysis catheter insertion. This

Bacillus cereus Bacteremia and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry

AbstractBacillus cereus (B. cereus) is a rare cause of invasive infection. To our knowledge, we report the first case of a human immunodeficiency virus (HIV)-infected individual diagnosed with a B. cereus endovascular infection. We also present the largest literature review to date of reported B. cereus endovascular infections. A 65-year-old woman with well-controlled HIV and active injection drug use presented with an acute febrile illness. Blood cultures for multiple consecutive days after admission were positive for nonanthrax Bacillus species despite appropriate intravenous antibiotic therapy. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was used to identify B. cereus. Our analysis of previous cases reveals injection drug use and prosthetic heart valves as major risk factors for B. cereus endovascular infections, and we propose that HIV status does not play a significant role. In addition, the use of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for a rapid and accurate identification of this organism highlights the potential of this technology, and providers should be aware of its availability and utility.

Under the sheets.

Alice was in her 80s and appeared the quintessential grandmother: she had short, neatly-cropped gray hair and a pleasantly round face that gave her the appearance of being incapable of malediction. Her shoes were arranged neatly on the floor next to her bed; they were unmistakably non-athletic, beige “grandma shoes” with thick soles and Velcro. Her husband stood dutifully at her bedside, wearing a hat bearing a Naval emblem, identifying him as a proud veteran. I took a careful history.

The Third Dimension

With new home developers spending hundreds of thousands of pounds on branding activities each year you think that they might have something to show for it. This peace of research establishes just what if anything they have achieved. The three main sections of this dissertation are the literature review where branding is investigated that produced a set of principles that identified what a brand is and what are some of the key components. Branding was then investigated in two separate ways from the companies’ point of view and the consumers. Any consistencies were noted and a conclusion was drawn from this.

A Party Before Dying

At one point, Joe called me over to his wheelchair. We exchanged simple thanks: his for the care I had provided to him and his family over the last month; mine for the opportunity to know him, to k...