Recognizing and treating cutaneous signs of liver disease.

Cutaneous changes may be the first clue that a patient has liver disease. Recognizing these signs is crucial to diagnosing liver conditions early. Here we describe the spectrum of skin manifestations that may be found in various liver diseases.

Agrypnia excitata: current concepts and future prospects in management.

Agrypnia excitata is an extremely rare, life-threatening syndrome characterized by autonomic activation, persistent insomnia, and generalized overactivity. Agrypnia excitata describes a triad of three separate conditions: delirium tremens, Morvan's chorea, and familial fatal insomnia (FFI). Each of the aforementioned three conditions have sleep disturbances as a unifying theme and results in distinct neurophysiological findings. The following is an overview of agrypnia excitata with a particular emphasis placed upon each of the three individual conditions that constitute the syndrome with recommendations on appropriate management.

Chilaiditi syndrome complicated by cecal perforation.

Chilaiditi sign is a radiological finding which describes the interposition of a part of the bowel between the diaphragm and the liver, a finding that can be misinterpreted as pneumoperitonium. Chilaiditi syndrome refers to a clinically symptomatic patient in the presence of the classical radiographic findings. It is a very rare syndrome which usually follows a benign course. Here we report the first documented case of Chiliaditi syndrome complicated by cecal perforation.

Derm diagnoses you can't afford to miss.

Management of hereditary angioedema should include fresh frozen plasma containing C1 inhibitor (C1-INH), whenever possible; if C1-INH-containing plasma is unavailable, fresh frozen plasma can be used instead. Do not give neomycin to patients with suspected cellulitis; the drug may promote antibiotic resistance in Staphylococcus aureus, a pathogen often associated with this condition. Whenever a patient presents with erythematous skin lesions and a recent history of receiving penicillin or a cephalosporin antibiotic, a sulfa derivative, or an anticonvulsant, the suspected medication should be stopped until Stevens-Johnson syndrome is ruled out.

Ocular complications of cancer therapy: a primer for the ophthalmologist treating cancer patients.

PURPOSE OF REVIEW: Cancer patients may develop ocular complications secondary to direct or metastatic involvement with cancer, radiation exposure, or chemotherapy. As many as 1.4 million new cancer cases arise in the United States annually. RECENT FINDINGS: Chemotherapy administration remains a critical aspect of treating many cancers and offers improved prognosis and prolonged survival in many cases; however, these therapies are known to cause a wide range of toxicities. SUMMARY: Ocular side effects such as photophobia, cataracts, glaucoma, retinopathy, and other ocular toxicities have been reported following chemotherapy administration. To effectively treat cancer patients, oncologists, primary care clinicians, and ophthalmologists should be aware of the potential ophthalmic toxicities certain widely used chemotherapeutic agents and radiation therapy may pose to their patients, particularly in the setting of preexisting ocular conditions.

The Stanford V regimen is effective in patients with good risk Hodgkin lymphoma but radiotherapy is a necessary component.

One-hundred and thirteen patients between the ages of 15 and 88 years with biopsy proven, untreated Hodgkin lymphoma were treated by physicians in the Nebraska Lymphoma Study Group using the Stanford V regimen (bleomycin, doxorubicin, etoposide, mechlorethamine, prednisone, vinblastine and vincristine) between January 1997 and January 2006. With a median follow-up of all surviving patients of 63 months, the 5-year overall survival (OS) was 84% and the 5-year progression-free survival (PFS) was 74%. Age >60 years, other than nodular sclerosing histological subtype, Ann Arbor Stage III/IV, and the presence of B-symptoms significantly predicted treatment outcome. Patients with 0-2 of these factors had a 5-year PFS and OS of 80% and 89% vs. 20% and 40% for patients with 3 or 4 factors. Patients who received radiotherapy had a superior 5-year PFS (86% vs. 42%) and OS (96% vs. 53%). Patients with 0-2 adverse risk factors who received radiotherapy had an excellent treatment outcome with 5-year PFS of 88% and a 5-year OS of 97%. The Stanford V chemotherapy regimen has an excellent treatment outcome for good prognosis patients with Hodgkin lymphoma. The results are compromised when radiotherapy is not utilized.

A case of aortic dissection in a cocaine abuser: a case report and review of literature.

BACKGROUND: Prompt diagnosis and management of aortic dissection are key to reduce patient morbidity and mortality; hence the need to a have a high index of suspicion for this condition. We believe it's important to report this case because it underscores the relationship between cocaine abuse and aortic dissection. In addition it strongly emphasizes basic principles in medicine: patients should not be profiled, and chronic complaints may need reassessment. CASE PRESENTATION: We are presenting a case of Stanford type A aortic dissection in a 46 year old patient with history of cocaine abuse. The aortic dissection presented as worsening of chronic upper abdominal pains he has had for years. He presented to us hours after using crack cocaine. CONCLUSION: Aortic dissection associated with cocaine abuse develops at a younger age. Therefore it's crucial to have high index of suspicion for aortic dissection in this subset of patients. Furthermore as this case illustrates, serious diseases can masquerade in old complaints. Patients should never be profiled, and chronic complaints should always be revisited.

Primary squamous cell carcinoma of the lung with bony metastasis in a 13-year-old boy: case report and review of literature.

Primary bronchogenic carcinoma of the lung is extremely rare in children, particularly the squamous cell type. Only 6 cases have been reported in the literature. We are reporting a case of metastatic squamous cell carcinoma in a 13-year-old boy who presented with left shoulder pain secondary to bone metastasis. Given the lack of specific symptoms associated with such malignancies, many children are at risk of delayed diagnosis and, as a result, associated metastases. Diagnostic evaluation hinges on biopsy of suspected lesion and histopathologic evaluation. Treatment regimens are rather ill defined, though the mainstay is surgical resection of the lesion along with chemotherapy and palliative radiotherapy for bone metastasis.

Rhabdomyolysis induced by simvastatin-fluconazole combination.

Rhabdomyolysis is a potential adverse consequence of statin therapy. Here, we report a patient with prostate cancer being treated with simvastatin who developed rhabdomyolysis after coadministration with fluconazole. The rhabdomyolysis promptly resolved after discontinuation of fluconazole, suggesting the possible role of drug interaction in the development of rhabdomyolysis with coadministration of the two medications. Both simvastatin and fluconazole were promptly discontinued, and the patient was admitted to the intensive care unit, where vigorous hydration along with urine alkalinization led to resolution of rhabdomyolysis. Since statins are commonly prescribed treatments for individuals with hyperlipidemia, caution is advised in coadministration with azoles such as fluconazole. Although supportive treatment remains the mainstay of therapy for patients with rhabdomyolysis, fatal consequences can arise from hyperkalemia, cardiac arrhythmia, renal failure and disseminated intravascular coagulation.

A rare case of hemochromatosis and Wilson's disease coexisting in the same patient.

Wilson's disease and hereditary hemochromatosis are two inherited diseases with life-threatening complications. Early recognition and prompt treatment may be instrumental in reducing such complications associated with these disorders. Although both Wilson's disease and hereditary hemochromatosis are genetic in nature, the two conditions have distinct, unrelated genetic etiologies. Two distinct, separate mutations are required for simultaneous existence of the two diseases. As such, the likelihood of the two conditions coexisting is exceedingly rare. Here we report a case of a 23-year-old male with hereditary hemochromatosis with coexistent Wilson's disease. Only two reported cases exist in which this dual diagnosis was present simultaneously. In our patient, laboratory evaluation demonstrated elevated ferritin, transferrin saturation >90%, and subsequent liver biopsy demonstrated diffuse fibrotic changes. Confirmatory genetic analysis revealed the patient to be a compound heterozygous for C282Y and H63D gene mutations. Given the patient's young age and the improbability of hemochromatosis-induced hepatic damage at that age, an alternative diagnosis was sought. Further analysis revealed reduced serum ceruloplasmin along with elevated urinary copper excretion. Subsequent ophthalmologic exam revealed bilateral Kaiser Fleischer rings. In conclusion, Wilson's disease and genetic hemochromatosis both involve inherent flaws in the transportation of heavy metals and their accumulation in hepatocytes. Although both diseases arise from distinctly different genetic mutations, the coincidence of the two disorders can, in rare cases, occur.

Transient midventricular ballooning: a case report and review of the literature.

BACKGROUND: We describe a case of transient left midventricular ballooning in 68-year-old male patient presented with picture of acute coronary syndrome. CASE PRESENTATION: The left ventriculogram showed mid ventricular akinesis and dilatation along with hypercontractile apex and basal segments. Follow up echocardiogram after one month showed resolution of wall motions abnormalities and normalization of the left ventricular function. CONCLUSION: This is considered as a new variant of previously reported transient left ventricular apical ballooning; the only difference in our case is the location of wall motions abnormalities.