San Joaquin General Hospital is a 196-bed public teaching hospital located within the San Joaquin County area of French Camp, California, United States. San Joaquin General Hospital, funded by San Joaquin County, originally established in 1857, is a general acute care facility providing a full range of inpatient services including General Medical/Surgical Care, High-Risk Obstetrics and Neonatal Intensive Care, Pediatrics and Acute Physical Medicine and Rehabilitation. The hospital is the only trauma center serving the 700,000 residents of San Joaquin County. San Joaquin General Hospital is also a primary stroke center and the county's EMS base station. The county's EMS administrative and education facility is immediately adjacent to the hospital.The hospital offers physician residencies in family medicine, internal medicine, and general surgery. The physician residencies are affiliated with the University of California, Davis School of Medicine. The hospital also has a pharmacy residency program, and is a teaching site for the University of the Pacific School of Pharmacy..
Abstract Glucocorticoid-induced adrenal insufficiency (GIAI) is a very common cause of adrenal insufficiency, resulting from exogenous glucocorticoid exposure leading to suppression of the hypothalamic–pituitary–adrenal axis. While typically due to prescribed glucocorticoids, hidden ingredients in supplements may also contribute to this exposure. We describe a case of a 52-year-old male who presented with recurrent gastrointestinal symptoms of nausea and vomiting. Clinical features included persistent sinus tachycardia, hyponatremia, hypokalemia, and hypomagnesemia. The initial work-up was unrevealing; additional testing revealed a low random cortisol level, an inadequate response to cosyntropin stimulation, and an inappropriately normal adrenocorticotropic hormone level, confirming secondary adrenal insufficiency. Treatment with hydrocortisone resulted in improvement of the patient's clinical symptoms. Further history uncovered that the patient had abruptly discontinued a daily supplement named “Force Forever,” which, according to the US Food and Drug Administration (FDA), contains undisclosed ingredients, including diclofenac and dexamethasone. Although the FDA has issued a warning regarding this supplement, there have been no reported cases of GIAI from its use in the United States. This case emphasizes the importance of comprehensive history taking and considering adrenal insufficiency in the differential diagnosis for patients presenting with refractory, unexplained gastrointestinal symptoms like nausea and vomiting.
Chylothorax, the accumulation of lymphatic fluid within the pleural cavity, is rarely caused by blunt trauma. We present the case of a 26-year-old male involved in a high-speed motor vehicle collision who sustained a T8 chance fracture and developed progressive right-sided pleural effusion. The patient was managed conservatively with drainage and dietary modification. His clinical history of congenital cardiac surgery, abnormal facies, and prior pleural effusion raised suspicion for Noonan syndrome, which has been associated with lymphatic maldevelopment and predisposition to chylothorax. This case underscores the importance of including chylothorax in the differential diagnosis of pleural effusion following blunt thoracic trauma, particularly in patients with underlying lymphatic abnormalities, and highlights the effectiveness of conservative management in low-output cases.
Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare liver tumor that typically affects young adults without underlying liver disease. This case describes an incidental diagnosis of FL-HCC in a healthy 25-year-old male who presented to the Emergency Department with left flank pain. Imaging revealed a ureteropelvic junction stone with moderate hydronephrosis, as well as an unexpectedly large right hepatic mass. Further evaluation confirmed the diagnosis of FL-HCC. The patient underwent a successful right hepatectomy utilizing the anterior approach with hanging maneuver and extra-Glissonian right pedicle control. Postoperatively, the patient experienced an uneventful recovery. This case highlights the importance of thorough evaluation of incidental findings, even in asymptomatic and healthy individuals, and demonstrates the advantages of advanced surgical techniques in managing large liver tumors.
