Raynaud's phenomenon (RP) is a relatively common syndrome occurring alone or in combination with autoimmune and inflammatory diseases. It is characterized by pain and ulceration due to vasospasm in response to cold and stress, most often affecting the digits. Although pharmacologic treatment for this condition exists, it is not always efficacious. Our case series demonstrates the use of abobotulinum toxin A in the treatment of RP. We report the cases of four patients who received injections of abobotulinum toxin A to treat their mild to severe RP symptoms. They experienced clinical improvement for up to one year after treatment.
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Medical professionals engage in an enormous and ever-increasing amount of reading in Electronic Health Records (EHRs), which may have adverse impacts on patient care. Personalized readability formats (PRFs) may help to accelerate reading these records, without training, and without adversely affecting comprehension in this critical task. Using History of Present Illness (HPI) reports written by physicians, we investigated how personalized fonts impacted medical text reading speed and comprehension. Crowd-workers without medical training read a set of eighth-grade level passages in six common fonts to determine their fastest and slowest fonts, which were then used to display a set of HPI reports and accompanying comprehension questions. Results showed that PRFs accelerated reading of medical passages by 15% while maintaining comprehension. This finding suggests that individualized information design like PRFs, and specifically font optimization, may be a straightforward way to optimize EHRs through readability. We see a future in which PRFs may help physicians in reading medical information, and look toward future studies investigating PRF impacts on medical professionals’ EHR reading.
INTRODUCTION: Nerve sheath tumors are rarely found in the gastrointestinal tract andhave been seen only in association with inherited syndromes such as neurofibromatosis type I (NF-1), multiple endocrine neoplasia type 2B (MEN 2B) and Cowden syndrome. Mucosal Schwann cell hamartoma (MSCH) is a new entity described by Gibson et al. in 2009 and has mostly been described in the colorectal area. CASE DESCRIPTION/METHODS: A 59-year-old man with no pertinent past medical history visited the gastroenterology clinic as a scheduled appointment for a long-standing history of GERD. He denied any nausea, vomiting, early satiety, abdominal pain or unintentional weight loss. His diagnosis was made on a clinical basis, and for this reason, an EGD was recommended. The EGD showed no abnormalities and esophageal mucosa was not erythematous (Figure 1). Multiple biopsies were taken. Pathology results showed mucosal Schwann cell hamartoma features in the antral biopsies (Figure 2). DISCUSSION: The exact incidence of MSCH is not known but it is mostly seen in female patients. MSCH has specific histological characteristics: lack of circumscription, absence of peripheral lymphoid cuff, crypt entrapment and strong positive stain for S-100. It is important to differentiate it from other spindle cell tumors since this will affect the management, prognostication and monitoring of possible associated complications. Differential diagnosis includes gastrointestinal stromal tumors (GISTs), carcinoid tumor, leiomyoma, schwannoma, mucosal neuroma, neurofibroma and ganglioneuroma. GISTs are the most common spindle cell tumors in the GI tract, however they have immunoreactivity to C-KIT and CD 117. GI schwannomas are mostly found in the stomach, but these have peripheral lymphoid cuffs and Antoni-A and Antoni –B regions. MSCH presents as a polypoid lesion in the colon and patients are typically asymptomatic. However, they can also present with rectal bleeding when the tumor is located in the colorectal area. This tumor follows a benign course and there is no need for treatment or extraction. Given its recent discovery and rarity, there is only one case report in the literature describing gastric affectation of the MSCH tumors. We describe this case due its unusual location as this is the 2nd case in the literature describing gastric affectation. Furthermore, a correct histological characterization is recommended since it will be crucial for the management and prognostication of these patients.
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