Browsing by Author "Nguyen, Antoine"
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Item Pseudopheochromocytoma: A Case of Benign Endothelial Cyst of the Adrenal Gland(2024-03-21) Nguyen, Antoine; Tamayo, Jesus; Mohammad, Moath; Paluru, SwethaBackground: Benign endothelial cyst of the adrenal gland (ECAG) with pheochromocytoma-like symptoms, or pseudopheochromocytoma (pseudoPHEO), is an extremely rare condition. Adrenal cysts seldomly occur with an incidence of 0.06% in the general population. Most cases are asymptomatic and discovered incidentally on imaging. ECAG predominately affect females and represent approximately 45% of all cystic tumors involving adrenal glands with two subtypes: angiomatous and lymphangiomatous. The association of adrenal cysts with pseudopheochromocytoma is a rare but well-documented relationship. Occasionally, these cysts can increase pressure in the adrenal medulla leading to elevated metanephrine levels. PseudoPHEO is a diagnosis of exclusion with pheochromocytoma being an important differential diagnosis. Patients may present with pheochromocytoma-like features such as symptomatic paroxysmal hypertension. If adrenal cortical tumors are involved, elevated catecholamines can be found on evaluation, although catecholamine-secreting tumors are diagnosed in less than 0.5% of patients with hypertension. Case Information: A 63-year-old female with a past medical history of an adrenal nodule discovered in 2017 during colon resection and poorly-controlled hypertension presented for adrenalectomy for suspected pheochromocytoma. Her normetanephrine level was 342 (normal: <148pg/mL) and metanephrine was 50 (normal: <57pg/mL). CT of the abdomen demonstrated an adrenal lesion with some features of benign etiology. She underwent robotic-assisted laparoscopic right adrenalectomy during which a 3 cm cyst in the adrenal medulla was found abutting the adrenal cortex. Microscopically, a multilocular cyst associated with hemorrhage involving the adrenal medulla was present. Conclusion: To diagnose pseudoPHEO, pheochromocytoma must be excluded especially when symptomatic paroxysmal hypertension is present with or without elevated catecholamines. The cells were positive for CD31 and negative for calretinin on immunohistochemistry staining which support an endothelial cell origin consistent with benign ECAG, not pheochromocytoma. These cysts may occupy space in the adrenal gland, increasing pressure in the adrenal medulla to cause elevated metanephrines, as seen in this patient. While the prognosis for ECAG is good, ECAG with associated pseudopheochromocytoma can cause life threatening complications. Treatment of pseudoPHEO is dependent on severity and etiology of disease process. Medical management can be complicated by unpredictable episodes of hypotension as patients can be normotensive between symptomatic episodes. In cases of pseudopheochromocytoma caused by ECAG, adrenalectomy is often indicated.Item Using the Model Aquatic Health Code to Grade the Safety of Swimming Pools in Houston, Texas(2023) Nguyen, Antoine; Arroyo, Miguel; Jones, Jennifer; Shenoi, RohitPurpose: Drowning and submersion injuries in the pediatric population are responsible for many unintentional deaths. Moreover, there are other associated injuries in young children such as water-borne diseases, falling, and diving injuries. The Model Aquatic Health Code (MAHC) developed by the CDC issues guidelines aimed to decrease disease, injury, and drowning events at aquatic facilities. Since no federal regulatory authority currently exists, there is wide variation in the inspection of aquatic facilities and implementation of the MAHC guidelines across state and local authorities. The aim of this study was to devise a grading system for swimming pools across the city of Houston by applying the MAHC guidelines to pool inspection data. The results may then inform measures to strategically provide pool operators and the public with safety information regarding swimming pools. Methods: A cross-sectional study of commercial swimming pools and spas in Houston was conducted in 2016 using routine inspection reports. Each public pool in Houston is required to undergo annual inspections. Private residential pools are not required to be inspected annually and such reports were excluded. The MAHC was used to develop a grading system that assigned points to commercial swimming pools and spas based on violations as detailed in inspection reports. Letter grades were assigned 95-100% (A); 85-94% (B); 75-84% (C); <75% (F-Fail) based on overall percentage of compliance with MAHC and projected onto a map of the city of Houston. Results: A total of 3107 commercial aquatic venues were inspected in Houston during 2016 with 3100 of these being located within the city of Houston. Each venue was graded for safety and had the following grade distribution: (A): 40.2%; (B): 0.5%; (C): 0%; and (F): 59.3%. The most frequent violations were related to swimming pool enclosures (18%) followed by self-closing gates (13.8%). The majority of swimming pools inspected were concentrated in southwest Houston. Conclusions: The MAHC guidelines may be used to appropriately assess and grade swimming pool safety in jurisdictions in which they have not yet been endorsed. Many jurisdictions vary in their regulation and implementation of policies regarding swimming pool safety. There may be a need for more jurisdictions to update their pool inspection criteria using MAHC guidelines. Further, injury prevention measures can be used to devise injury prevention measures based on the spatial distribution of safety violations.