Localized hypertrichosis of intermammary cleft in monozygotic twins

Hypertrichosis is a condition in which hair is longer and denser than what is considered normal for an individual based on age, sex, ethnicity, and location on the body and can be classified based on its distribution (generalized vs localized), age of onset (congenital vs acquired), and type of hair (lanugo or vellus vs terminal). We describe a rare case of monozygotic female twins who presented for localized hypertrichosis of the intermammary cleft that developed during puberty. Endocrine examination was unremarkable. Discussion of various treatment modalities should be considered, because localized hypertrichosis may have a considerable psychosocial effect.     

Are Risks From Medical Imaging Still too Small to Be Observed or Nonexistent?

Several radiation-related professional societies have concluded that carcinogenic risks associated with doses below 50-100 mSv are either too small to be detected, or are nonexistent. This is especially important in the context of doses from medical imaging. Radiation exposure to the public from medical imaging procedures is rising around the world, primarily due to increased utilization of computed tomography. Professional societies and advisory bodies consistently recommend against multiplying small doses by large populations to predict excess radiation-induced cancers, in large part because of the potential for sensational claims of health impacts which do not adequately take the associated uncertainties into account. Nonetheless, numerous articles have predicted thousands of future cancers as a result of CT scanning, and this has generated considerable concern among patients and parents. In addition, some authors claim that we now have direct epidemiological evidence of carcinogenic risks from medical imaging. This paper critically examines such claims, and concludes that the evidence cited does not provide direct evidence of low-dose carcinogenicity. These claims themselves have adverse public health impacts by frightening the public away from medically justified exams. It is time for the medical and scientific communities to be more assertive in responding to sensational claims of health risks.     

Near‐complete aortic mechanical valve dehiscence due to endocarditis reinfection

Prosthetic valve infective endocarditis (IE) is one of the most serious postimplantation complications. Prosthetic aortic valve IE constitutes 1%–6% of all prosthetic valve IE cases. We present a dramatic echocardiographic case of prosthetic aortic valve IE leading to near‐complete valve dehiscence. Echocardiographic evidence of prosthetic aortic valve rocking motion is indicative of significant dehiscence. Aside from IE, other causes and risk factors for prosthetic aortic valve dehiscence include inflammatory and autoimmune vasculitides, concomitant ascending aorta aneurysm, and aortic root calcification.     

Injury Due to Mechanical Falls: Future Directions in Gender‐specific Surveillance,Screening, and Interventions in Emergency Department Patients

The Centers for Disease Control and Prevention report that among older adults (≥65 years), falls are the leading cause of injury‐related death. Fall‐related fractures among older women are more than twice as frequent as those for men. Gender‐specific evidence‐based fall prevention strategy and intervention studies show that improved patient‐centered outcomes are elusive. There is a paucity of emergency medicine literature on the topic. As part of the 2014 Academic Emergency Medicine (AEM) consensus conference on “Gender‐Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes,” a breakout group convened to generate a research agenda on priority questions to be answered on this topic. The consensus‐based priority research agenda is presented in this article.