Hepatocellular Carcinoma With Cardiac Metastasis Presenting as Presyncope.

Hepatocellular carcinoma (HCC) is a common primary tumor of the liver that is highly invasive and can even invade the portal and hepatic veins in later stages. In this report, we present one such rare case of HCC invading the right atrium. A 69-year-old male patient recently diagnosed with HCC secondary to hepatitis C presented to the hospital after experiencing an episode of near syncope. On examination, he had a distended abdomen consistent with ascites with positive fluid shift, elevated jugular vein distention (JVD), and bilateral pitting lower extremity edema. He had an elevated alkaline phosphatase of 298 U/L (34-104) with a total bilirubin of 2.7mg/dL (0.3-1) and a D-dimer of 1.67ugFEU/mL (<0.5). On admission, CT scan of the chest and abdomen showed extensive invasion of the liver by neoplasm and a large 7 cm mass extending from the intrahepatic inferior vena cava to the right atrium. A transthoracic echocardiogram confirmed this, which also better visualized the cardiac anatomy. Due to the extent of the disease, the patient ultimately opted for palliative care. The prognosis for patients with HCC who have an invasion of the right atrium remains dismal, with a median survival of only five months. Surgical extraction of the thrombus with resection of the tumor, liver transplantation, and systemic chemotherapy are some of the treatment modalities employed in such patients; however, historically, the median survival has remained only a few months. With the advent of new techniques and a better understanding of the disease, this seems to be changing and a curative approach can now be considered.

Prostate Cancer Presenting With an Unusual Presentation of Rectal Pain and Bleeding.

We report an atypical case of prostate cancer with rectal involvement presenting with gastrointestinal symptoms predominately and a rectal mass. A 51-year-old male patient came to the hospital with abdominal pain and rectal bleeding. Imaging revealed prostate enlargement, perirectal lymphadenopathy, and multiple hepatic and pulmonary nodules. The patient also had an elevated prostate-specific antigen (PSA) of 502 ng/mL (against normal range 0.6-0.7 ng/mL). Biopsies were performed on tissue samples taken from the rectum and prostate gland, which confirmed the diagnosis of prostate adenocarcinoma. The lack of urinary symptoms and close clinical similarity to colorectal cancer presented a diagnostic challenge for us. Familiarity with this specific presentation of prostate cancer is necessary to avoid misdiagnoses and guide correct treatment.

Follicular Lymphoma Presenting as Intussusception in an Adult.

A 61-year-old male with no past medical history presented with intense abdominal pain for three days, associated with hematochezia, nausea, and non-bloody vomiting. CT scan of the abdomen showed distended small bowel, diffuse lymphadenopathy, and intussusception of the distal ileum into the cecum with obstruction. Ileocolic resection and histopathological staining confirmed the diagnosis of follicular lymphoma and appropriate treatment was initiated. Intussusception is a condition that involves the invagination of the proximal segment of a bowel tract into its contiguous distal segment as a result of enthusiastic or impaired peristalsis. Only 5% of the total intussusception cases are found in adults. Most cases in adults are caused by pathological lead points which can be benign or malignant. Lymphomas rarely present with intussusception and follicular lymphomas are even less common. To the best of our knowledge, there have only been a few such cases of follicular lymphomas with the initial presentation of intussusception. In this article, we present a rare case of follicular lymphoma presenting as intussusception. Considering lymphomas as a cause of intussusception in adults can decrease diagnostic delays and guide treatment.

Frequency and Predictors of Pacifier Use in the Low Socioeconomic Group of Karachi, Pakistan: A Cross-Sectional Study.

Background Pacifier use has been popular for ages. They are prevalent all over the world because of their various perceived benefits. On the other hand, there is a common belief that they do carry health risks as well. Due to these contradicting belief systems, the frequency of their use, and the factors that determine them, need to be thoroughly evaluated. Since Pakistan is a developing country with a low literacy rate, it can be implied that a vast majority of the country's population may lack awareness regarding the advantages and disadvantages of pacifier use, making them incapable of weighing associated risks versus benefits. The data evaluating these factors in this region are however scarce in the published literature. We, therefore, aimed to highlight the frequency and predictors of pacifier use in the low socioeconomic group of Karachi, Pakistan. Materials and methods A descriptive, cross-sectional study was conducted on a sample of 300 mothers visiting a tertiary care hospital in Karachi, Pakistan. We included mothers who had at least one child under the age of two years, and whose child did not have any oro-nasal anomaly that could prevent them from sucking a pacifier. Data were collected using pre-tested questionnaires and analyzed using the Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US). Frequencies were calculated and presented in the form of tables. The chi-square test was used to determine the significance of all categorical variables. A P-value of <0.05 was considered to be statistically significant. Results Almost half of our respondents (49%) gave pacifiers to their children. A significant number (59%) of these mothers were uneducated. Almost all (97%) of the users had annual household income less than 15,000 Pakistani rupees (PKR); 34% were primiparous and more than two-thirds (71%) had a normal vaginal delivery. Out of all the factors, maternal age less than 20, annual household income less than 15,000 PKR, and primiparity were significantly associated with pacifier use in mothers (P<0.05). Only a half of the users (51%) cleaned the pacifiers by boiling; one-fourth (25%) washed it with water only; while 18% washed it with soap and water. The majority (84%) of the mothers used the pacifier to soothe the baby when upset. Among mothers who did not use a pacifier, about a third (30%) did not do so as they believed it's a bad practice. About one-fourth (27%) believed it was unhygienic. Conclusions Our study highlights the gap in the awareness of mothers regarding pacifier use. Using this data, we can target to disseminate specific information to this population to integrate safe and healthy child care habits in society.