Axillobifemoral Bypass: A Brief Surgical and Historical Review

Peripheral artery disease (PAD) occurs when plaque accumulates in the arterial system and obstructs blood flow. Narrowing of the abdominal aorta and the common iliac arteries due to atherosclerotic plaques restricts blood supply to the lower limbs. Clinically, the lower limb symptoms of PAD are intermittent claudication, discoloration of the toes, and skin ulcers, all due to arterial insufficiency. Surgical revascularization is the primary mode of treatment for patients with severe limb ischemia. The objective of the surgical procedure is to bypass a blockage in an occluded major vessel by constructing an alternate route for blood flow using an artificial graft. This article presents information on aortoiliac reconstruction, with an emphasis on axillobifemoral bypass grafting.

Nonketotic Hyperglycemic Chorea-Ballism (NKHCB): An Atypical Case and a Review of Literature

Nonketotic hyperglycemic chorea-ballism (NKHCB) is a rare movement disorder characterized by hemichoreahemiballism, contralateral striatal abnormality, and rapid resolution following glycemic control. We describe an atypical case of NKHCB in a 71-year-old female with uncontrolled type 2 diabetes exhibiting hemichorea and hemiballism limited to the right upper extremity. While NKHCB patients typically show abnormalities on computed tomography (CT) imaging of the head, a CT scan of our patient during the acute phase was unremarkable. The movements subsided following glycemic control and fluid administration. The current literature on NKHCB is sparse and largely limited to case reports and series. We discuss several typical and atypical presentations and findings on imaging.

An Uncommon Cause of Acute Abdominal Pain: Primary Epiploic Appendagitis in the Emergency Setting

In the emergency setting, the diagnosis of benign causes of acute abdominal pain can prevent unnecessary medical interventions. To illustrate this point, we report the case of a 28-year-old man who presented to the emer- gency department with symptoms suggestive of acute diverticulitis. Abdominal computed tomography (CT) established, instead, a diagnosis of primary epiploic appendagitis (PEA), which was managed expectantly. The patient’s symptoms resolved within one week of hospital discharge and he remained free of pain at a five-month phone follow-up. Increased awareness of PEA and its self-limited course can help the emergency physician avoid unnecessary imaging studies and expectantly manage this cause of acute abdominal pain.

Autophagy and Schizophrenia: A Closer Look at How Dysregulation of Neuronal Cell Homeostasis Influences the Pathogenesis of Schizophrenia

Autophagy, the process of degrading intracellular components in lysosomes, plays an important role in the central nervous system by contributing to neuronal homeostasis. Autophagic failure has been linked to neurologic dysfunction and a variety of neurodegenerative diseases. Recent investigation has revealed a novel role for autophagy in the context of mental illness, namely in schizophrenia. This article summarizes the phenomenology, genetics, and structural/histopathological brain abnormalities associated with schizophrenia. We review studies that demonstrate for the first time a connection between autophagy malfunction and schizophrenia. Transcriptional profiling in schizophrenia patients uncovered a dysregulation of autophagy-related genes spatially confined to a specific area of the cortex, Brodmann Area 22, which has been previously implicated in the positive symptoms of schizophrenia. We also discuss the role of autophagy activators in schizophrenia and whether they may be useful adjuvants to the traditional antipsychotic medications currently used as the standard of care. In summary, the field has progressed beyond the basic concept that autophagy impairment predisposes to neurodegeneration, to a mechanistic understanding that loss of autophagy can disrupt neuronal cell biology and predispose to mood disorders, psychotic symptoms, and behavioral change.

Acute Obstructive Suppuration of the Pancreatic Duct Causing Sepsis

Objective: We report a rare case of acute obstructive suppuration of the pancreatic duct causing sepsis, which was successfully treated with emergent endoscopic retrograde cholangiopancreatography (ERCP). Methods: We describe the patient’s clinical presentation, laboratory test results, and imaging used for diagnosis and treatment. Results: A 33-year-old female with a history of recurrent acute pancreatitis was admitted during an episode of acute pancreatitis. Computed tomography (CT) scan of the abdomen revealed acute pancreatitis, diffuse pancreatic atrophy and pancreatic ductal dilatation with obstruction due to a soft tissue lesion within the distal duct. Shortly after admission she developed symptoms and signs of sepsis. Urgent ERCP was performed to further assess the suspected cholangitis. “Clean” bile emanated from the common bile duct, while copious purulent fluid was detected at the dilated pancreatic duct orifice, confirming suppuration of the pancreatic duct. A plastic single pigtail stent was placed traversing the ampulla and pancreatic duct stones that were causing the obstruction, which were later removed. After endoscopic decompression, the patient rapidly improved over the following 24 hours and had no subsequent admissions for pancreatitis.Conclusion: Acute suppuration of the pancreatic duct (ASPD) is a rare and potentially fatal infectious complication of pancreatic ductal obstruction with few cases reported in the English literature. It would be of interest to further investigate the exact pathophysiology leading to development of ASPD. The endoscopic methods of urgent ERCP and pancreatic duct decompression utilized in our case proved effective in successfully treating ASPD. This unusual condition should be considered in patients with acute pancreatitis who develop early clinical decompensation.

Molecular and Cellular Foundations of Medicine

After six years and six medical school classes, the course leader of Molecular and Cellular Foundations of Medicine reflects on how the course began and where it is going

Trends in the Financing of United States Medical Schools: 1970-1999

We examined 30-year trends in the financing of allopathic medical schools in the United States using data from the Annual Medical School Questionnaire administered to United States medical schools. We calculated relative proportions for total revenues derived from different sources. Federal support for teaching/training/public service represented 18.8% of total revenues in 1970-1971, but only 0.3% of total revenues in 1998-1999. The proportion of revenues derived from state/localgovernment appropriations also declined across this period. In contrast, the proportion of revenues derived from medical services increased substantially. The proportion of revenues derived from tuition/fees, gifts, and endowments remained constant