In this unusual case, this pituitary carcinoma metastasized twice in 6 years to virtually the same intradural extramedullary lumbar region. Surgical resection of these masses aided in relieving neurological symptoms and prolonging life.

The aim of the study was to identify oral baclofen dosing variability at steady state based on weight and Gross Motor Function Classification System level using a retrospective cross-sectional study design. The medical records of 500 pediatric aged patients (age 1–21 yrs) were reviewed to obtain 144 pediatric patients who met inclusion criteria. One-way analysis of variance tests revealed increasing mean doses in baclofen (in milligram per kilogram) with higher Gross Motor Function Classification System levels (P = 0.001). Post hoc Tukey analysis showed patients with higher ambulatory ability (Gross Motor Function Classification System I–II) received a lower total daily dosage than did patients with less ambulatory ability (Gross Motor Function Classification System III–V). A moderate correlation was observed with increasing oral baclofen dose as weight increased (r = 0.43, P < 0.0001). Because of the variability in dosing between Gross Motor Function Classification System levels, prescribing oral baclofen for pediatric patients with cerebral palsy may not follow the traditional model of weight-based dosing seen in other pediatric conditions.

Head injuries vary in severity and traumatic brain injuries can be extremely serious leading to bleeding, loss of consciousness, and can affect verbal responses, muscles movement in motor responses, and responses with eye movement. Traumatic brain injuries require medical care to assess the severity and treat the injury. In this case report, we discuss a patient's very severe closed head injury while rollerblading without a helmet from which he was not expected to make a full recovery, but did so following intensive medical treatment, rehabilitation, and intercessory prayer to Saint Don Guanella to combat the initial injury and subsequent issues.

Background: Over half of the ischemic strokes in the US are "mild" by NIHSS scores at presentation.The most common reason for witholding tPA in patients who arrive in time is that the stroke is "too mild."Based on mounting evidence that mild strokes may cause significant disability, the stroke team at Saint Luke’s Neuroscience Institute (SLNI) began to consider mild strokes (NIHSS 0-5) eligible for treatment with intravenous tissue plasminogen activator (IVtPA) in 2009.This analysis evaluated whether more aggressive treatment of mild strokes with IVtPA resulted in better overall outcomes measured by a greater percentage of patients being discharged home with fewer discharges to skilled nursing (SNF) and lower mortality. Methods: We retrospectively reviewed strokes in the SLNI database with presenting NIHSS scores of 0-5 in 2007/2008, and in 2010/2011 by treatment status and discharge disposition. Results: In 2007/2008, there were 342 mild strokes; 11(3.2 %)received tPA.In 2010,2011 there were 432 mild strokes; 62(15.7%)received tPA (p=0.001).Overall discharge to home: 218/342(63.7%) in 07/08 and 310/432(71.8%) in 10/11 (p=0.017). Discharge to SNF: 45/342(13.2%)in 07/08; 42/432(9.7%) in 10/11 p=0.133. In cases treated with IVtPA in both cohorts, discharge to SNF=5/79(6.3%); no IVtPA=82/695(11.8%)p=0.108. Mortality: 9/342 (2.6%) in 07/08 and 3/342(0.7%) in 10/11 (p=0.030).Of the 12 total mortalities, 2 were treated with IVtPA.There were no statistically significant differences in the percentage of discharges to rehabilitation in the two cohorts. Conclusions: It is safe to administer IVtPA to patients with mild strokes.There is a trend toward more aggressive treatment of mild strokes with tPA being associated with a higher likelihood of being discharged to home, fewer discharges to SNF, and lower mortality in the group as a whole.A randomized prospective trial would be useful to further direct decision making in this group of patients.

INTRODUCTION: Food bolus impactions are commonly encountered GI emergencies, often from impacted meat. We report two patients with esophageal eggshell impaction who presented predominantly with chest pain and odynophagia. CASE DESCRIPTION/METHODS: Case 1: An 88-year-old female with a history of gastroesophageal reflux disease, prior hiatal hernia repair, and intermittent dysphagia to solid food presented to the emergency department with intermittent severe, sharp chest and epigastric pain that occurred with swallowing 30 minutes after eating a hard-boiled egg. The patient could not handle secretions due to dysphagia and had several episodes of non-bloody emesis. Chest x-ray was unremarkable. Gastroenterology was consulted, and she underwent EGD. A rectangular piece of eggshell was found in the middle third of the esophagus. The eggshell was grasped with standard forceps and pushed into the stomach without difficulty. No esophageal lesions or erosions were noted in the esophagus. Case 2: A 26-year-old female with a history of chronic intermittent reflux symptoms presented to the emergency department with sharp midsternal chest pain upon swallowing that started after she drank egg whites. She was found to have an elevated D-dimer, and a CT Angiogram Chest was obtained in the emergency department which revealed a calcified foreign body within the mid-esophagus at the level of the carina. The patient denied any history of dysphagia. Her physical exam was unremarkable. Gastroenterology was consulted, and EGD was performed, showing a piece of eggshell, which was extracted using rat tooth foreign body forceps. The patient had a healthy mucosal appearance of the esophagus. DISCUSSION: Eggshell food impaction is rarely documented in the literature. In both cases, we describe, chest pain/odynophagia as a predominant symptom, although one patient did describe concomitant dysphagia. The eggshell foreign body was visible on a CT scan, perhaps due to the calcified nature of the shell. Thus, this calcified eggshell could potentially be mistaken for an impacted bone fragment in the esophagus on imaging studies. However, the eggshell was not seen on a routine chest x-ray in the other case. Endoscopic management was achieved by grasping the eggshell with standard forceps and pushing the eggshell into the stomach by extraction of the eggshell using foreign body forceps. Neither patients exhibited erosions caused by the impacted eggshell, despite the presence of sharp edges.