William Edwards Ladd, M.D. (1880-1967): the description of his bands.

In the early 20th century, an established surgical specialty catering to pediatric surgery did not exist, and pediatric surgical ailments were operated on by general surgeons. With his devotion to childhood diseases and his unique thinking in surgical development, William E. Ladd would become a leading figure in America by pioneering the field of pediatric surgery

The Rare Case of Streptococcus Pyogenes Pneumonia and Its Sequelae

Introduction Group A Streptococcus (GAS) or Streptococcus pyogenes is an aerobic gram-positive coccus that causes a multitude of infections that range in severity. GAS most commonly infects the soft tissues, which results in infections such as cellulitis, erysipelas, necrotizing fasciitis and myositis. These deep soft tissue infections are also the most common source of GAS bacteremia. Other common infections caused by GAS include pharyngitis, rheumatic fever and glomerulonephritis.1 The lower respiratory tract is an uncommon site for GAS infection and it is the least common source of GAS bacteremia; however, in adults with GAS pneumonia, the incidence of bacteremia is 80 percent.2 Patients with a severe GAS infection can develop streptococcal toxic shock syndrome, which consists of GAS bacteremia in conjunction with shock and organ failure. Here we present a case of severe GAS pneumonia complicated by toxic shock syndrome and purpura fulminans, a rare complication of disseminated GAS infection. Case Presentation A 57-year-old male with a history of gastric adenocarcinoma status post partial gastrectomy presented with a two-day history of shortness of breath and chest tightness. He denied any associated fevers, cough, sputum production, pharyngitis, diarrhea or dysuria. In the emergency room, he was afebrile (although he had been taking acetaminophenoxycodone tablets every 4 to 6 hours for his chest pain) with a heart rate of 123 bpm, blood pressure 78/49 mmHg, respiratory rate 21-27 bpm, and pulse oximetry of 94% on a non-rebreather. Physical exam revealed right upper lobe rales, as well as egophony and sinus tachycardia. There was no evidence of pharyngeal erythema, exudates, or ulcers. Pertinent lab work on admission included a creatinine of 2.3 mg/dL and a lactate of 9.0 mmol/L. Computed tomography (CT) of his chest was consistent with pneumonia in the right upper lobe with patchy areas of consolidation in the right middle and lower lobes. The patient received ceftriaxone, azithromycin and five liters of normal saline. He was admitted to the medical intensive care unit (MICU) for severe sepsis secondary to communityacquired pneumonia

Life under Scrutiny

ON KISSING, TICKLING, AND BEING BORED: PSYCHOANALYTIC ESSAYS ON THE UNEXAMINED LIFE Adam Phillips Harvard University Press Cambridge, Massachusettes 1993, Hardcover, 138 pages, $ 19.9

Guadecitabine, in combination with Cyclophosphamide, promotes anti- cancer immunity in BALB/c mice bearing 4T1 mouse mammary carcinoma

Background: The extremely high mortality rate of patients diagnosed with triple negative breast cancer makes it one of the deadliest forms of cancer. Due to the heterogenous nature of tumors, complete clearance is not achieved and clonal selection occurs resulting in tumor cells evading the immune system. I aim to design a therapeutic intervention that is able to elicit an effective immune response against the tumor and instill immunological memory to eradicate primary and metastatic lesions. I hypothesize that the combination of Guad and Cyp will synergize and promote anticancer immunity via increased expression of neo-tumor antigens and depletion of MDSCs and T-regs. Methods: Guadecitabine (Guad), is a second-generation DNA methyltransferase inhibitor (DMNTi) that has been reported to increase antigenicity and deplete myeloid-derived suppressor cells (MDSC’s). Cyclophosphamide (Cyp) is a chemotherapy that has been shown to deplete regulatory T-cells (T-regs). Both MDSD’s and T-regs suppress antitumor immunity. BALB/c mice were challenged with 4T1 tumor cells subcutaneously in the mammary fat pad region. 4T1-bearing mice were administered low-dose Guad and Cyp for ten consecutive days. Tumor growth curves, tumor-infiltrating lymphocytes (TILs) were measured and MDSC’s and T- regs levels were assessed by flow cytometry. Results: Results from this experiment showed significant synergy between Guad and Cyp with both drugs reducing the tumor size over monotherapy. Conclusions: Further analysis of the data along with future experiments will elucidate if this synergy is driven by the depletion of MDSC’s and T-regs alone or the increase in tumor antigenicity inducing increased numbers of TILs.https://scholarscompass.vcu.edu/gradposters/1078/thumbnail.jp

End-Stage Chronic Intestinal Pseudo-Obstruction Resulting in Intestinal Pneumatosis

Chronic intestinal pseudo-obstruction (CIPO) is a rare gastrointestinal motility disorder that presents with symptoms, physical exam, and imaging findings of mechanical bowel obstruction without an anatomical obstruction. Multiple etiologies, including enteric or extrinsic neuropathic dysfunction, myopathic dysfunction, or dysfunction of the interstitial cells of Cajal, cause CIPO’s pathogenesis. The presentation of CIPO may be idiopathic or caused by underlying diseases. The most common presentation is abdominal pain, bloating, and distension. Here, we present a patient with an end-stage case of CIPO who failed medical therapy. Her distension progressed over a decade, requiring emergency surgery due to intestinal pneumatosis

The Use of Maintenance Electroconvulsive Therapy for Relapsing Depression

It is generally accepted that electroconvulsive therapy (ECT) is an effective treatment of major depressive episodes in patients with both unipolar and bipolar affective disorders (1). Yet, repeated relapse of depression occurs in some patients, even with vigorous maintenance therapy on antidepressant drugs (2-4). This often necessitates rehospitalization for ECT. In past decades, several authors suggested that periodic outpatient ECT was efficacious as a maintenance therapy (5-7). Recently, maintenance ECT was recommended by Fink (8), and Maletzky (9), but barely mentioned in two reviews (10,11), and discouraged in another (12) . However, a recent nationwide survey has disclosed that such therapy is widely practiced (13)

A Novel Treatment of Postpartum Depression and Review of Literature.

Early-onset postpartum depression has been shown to have a unique neurobiological basis compared to major depressive disorder, implying a need for targeted treatments such as the recent Food and Drug Administration (FDA)-approved brexanolone. In this case report, a woman with a past medical history of major depressive disorder was diagnosed with postpartum depression due to worsening mood with suicidal and homicidal ideations. She was treated with vilazodone and aripiprazole with good effect after consideration of her past medication trials. Her regimen is unique in clinical practice and not reported in current literature for the treatment of postpartum depression. It may represent a safe and effective medication choice, especially in the context of current first-line treatments that have a high treatment failure rate. More research is needed to find treatments that address the unique challenges of postpartum women