Reversible Cerebral Vasoconstriction Disorder in a Patient with a Chief Complaint of Headache.

As emergency medicine physicians, we have formulated an approach to managing patients with a chief complaint of headache that starts with considering the story the patient relays in the context of a wide differential. Here we will describe a case that presented to our emergency department in hopes to broaden your differential. Reversible cerebral vasoconstriction syndrome (RCVS), well described in the neurology literature, is characterized by severe headaches that may or may not be accompanied by neurological symptoms and is definitively diagnosed by diffuse constriction of cerebral arteries on cerebral angiogram. Here we present a case of a patient who presented to the emergency department with intermittent severe persistant headaches and was diagnosed with reversible cerebral vasoconstriction syndrome

Peritoneal Dialysis-Related Peritonitis With <i>Acinetobacter Pittii</i>: A Case Report

We demonstrate the first reported case of peritoneal dialysis (PD)–related peritonitis with Acinetobacter pittii. Although previous reports have reported the uncommon similar infection in the larger Acinetobacter calcoaceticus-baumannii complex group of organisms, none have particularly focused on A pittii. Furthermore, we present a case of a young man with end-stage renal disease on PD who had a severe infection with A pittii. Although the organism was sensitive to ceftazidime, and despite a 4-week extended course of intraperitoneal antibiotics, the patient had a worsening infection leading to the removal of the PD catheter. Furthermore, the case illustrates the importance of proper sterile technique and hand hygiene, as this may have been the nidus of infection for this case

Malignant prolactinoma: A rare case report

Pituitary carcinomas are rare adenohypophyseal tumors with cerebrospinal or extracranial metastasis. None of the histologic findings distinguish pituitary adenoma from carcinoma. We describe clinico-pathological and immunohistological features of malignant prolactinoma. The patient initially presented with a prolactin-secreting pituitary adenoma. The tumor showed aggressive clinical course presenting with repeated recurrences and eventually metastasized to multiple bones. MIB-1 and p53 labeling indices were also compared in primary adenoma, recurrent invasive adenoma and metastatic tumor

Osteoid differentiation in mesodermal (mullerian) adenosarcoma of ovary

A 55-year-old female presented with abdominal pain and 10 cm mass per abdominal examination. Computerized tomography scan of abdomen and pelvis revealed a heterogeneously enhancing solid cystic mass right ovarian mass and mild ascites. Surgery was performed. Specimens were sent for examination. Microscopic examination revealed an admixture of benign but occasionally atypical appearing mullerian type glands with sarcomatous stroma. Solid area showed undifferentiated tumour cells. Atypical mitoses and necrosis were also seen. Areas with extensive benign osteoid surrounded by fibroblastic stroma were also present. Glandular component showed positivity for CK-7, AE-1 and EMA while sarcomatous areas showed positivity for vimentin only. Mullerian adenosarcoma of ovary with sarcomatous overgrowth (SO) having heterologous component was confirmed. Postoperative 3 cycles of chemotherapy was given and the patient was well till date (three months after surgery)