BackgroundChylous ascites is considered to be an intra-abdominal collection of creamy colored fluid with triglyceride content of > 110 mg/dL. Chylous ascites is an uncommon but serious complication of numerous surgical interventions. However, it is a rare complication of LRYGB. An internal hernia limb defect is thought to be the underlying etiology, where the hernia will cause lymphatic vessel engorgement and lymphatic extravasation.Case presentationWe report a case of a 29 years old male with a 9 year history of laparoscopic Roux en y gastric bypass (LRGYB), presenting with recurrent abdominal pain for 2 months radiating to the right shoulder. Ultrasound examination revealed gallstones and the patient was subsequently admitted for laparoscopic cholecystectomy. Intraoperatively, whitish colored fluid, high in triglycerides content was aspirated. During exploration, an internal hernia limb defect was found and corrected.ConclusionPost LRGYB patients with symptoms of recurrent abdominal pain should be suspected for chylous ascites reflecting an internal hernia.

BackgroundPrevious studies have demonstrated that induction of heme oxygenase-1 results in weight loss in several rodent models of obesity. However, the specific role of the heme oxygenase-1 metabolite, carbon monoxide (CO), in this response has yet to be established. We recently reported that chronic treatment with CO releasing molecules results in prevention of weight gain in mice fed a high fat diet. In the present study, we sought to determine the effect of chronic CO inhalation on the development and reversal of high fat diet induced obesity.ResultsCO inhalation at both levels initially resulted in a prevention and reversal of body weight and fat mass over the first 10 weeks of treatment, however, this effect was not sustained. CO inhalation in the prevention groups also had an early effect to lower fasting blood glucose but this effect also was not sustained.ConclusionsOur results demonstrate that CO inhalation has a transient effect to prevent and reduce body weight which is not sustained chronically in mice fed a high fat diet. These results suggest that chronic CO inhalation therapy is not an effective treatment to induce long term weight loss.

Patient: Male, 43Final Diagnosis: ST-elevation myocardial infarctionSymptoms: Dyspnea • ear painMedication: —Clinical Procedure: Percutaneous coronary interventionSpecialty: CardiologyObjective:Unknown ethiologyBackground:Myocardial infarction (MI) is one of the most serious conditions presenting to the Emergency Department. Typical/classical symptoms of MI include chest pain and tightness that is referred to the left arm.Case Report:We present a case of ST-elevation myocardial infarction (STEMI) with a primary atypical presentation of right ear pain. The patient was diagnosed with STEMI based on electrocardiogram (ECG) and cardiac markers. As a result, the patient underwent percutaneous intervention (PCI), which showed an occluded left anterior descending artery (LAD) compared to the previous reported studies with similar presentation in which the right coronary artery (RCA) was affected.Conclusions:While MI is known for its typical presentation, being vigilant to patients who present atypically especially when they possess risk factors is extremely important and doing so can be critical to the outcome because MI treatment is dependent on fast and prompt management.

In 1673, the first case of lung agenesis was reported during an autopsy. Since then many more similar cases were reported and a classification of these cases developed for better medical management. Those cases ranged from hypoplasia to aplasia or agenesis of the lung tissue, with a survival rate of less than 50% by the age of 5 years in cases of agenesis. More commonly affecting the left side than the right, here we present a case of a late presentation of right lung agenesis in a young 24-year-old female. Who presented with multiple episodes of shortness of breath over a year. When examined she had an asymmetric chest and dull right sided auscultation. The x-ray done showed a homogeneous opacity in the right upper, middle and lower zone with shift of the mediastinum to the right side, making the heart in dextroposition. Watchfulness need to be maintained when encountering patients with simple complaint, as sometimes, it is not just the normal anatomy.