Emerging Multiorgan Klebsiella pneumoniae Invasive Syndrome Leading to Septic Shock: A Case Report and Review of the Literature.

Klebsiella pneumoniae (K. pneumoniae) is a community-acquired pathogen that typically causes pneumonia and urinary tract infections. Rarely, it can affect other organ systems such as the gastrointestinal tract, as well as the meninges, ears, eyes, and spine. We present the case of a 62-year-old male admitted with septic shock secondary to necrotizing pneumonia and multiple hepatic liver abscesses, which to the best of our knowledge, is the first reported case of multiorgan invasive K. pneumoniae infection, including the presence of a newly recognized syndrome referred as Invasive Liver Abscess Syndrome (ILAS). It is important to maintain both ILAS and K. pneumoniae invasive syndrome (KPIS) in the differential diagnosis, especially in areas of the world with a large number of tourists and immigrants, such as New York City, where the presented case took place.

Chemopreventive effects of dietary canola oil on colon cancer development.

Fatty acid composition of dietary fat plays a vital role in colon tumor development in animal models. Fats containing ω-6 fatty acids (e.g., corn oil) enhanced and ω-3 fatty acids (e.g., flaxseed oil) reduced chemically induced colon tumor development in rats. The objective of the present investigation was to study the effects of dietary canola oil, a source of ω-3 fatty acid on azoxymethane-induced colon cancer development in Fischer rats and compare with dietary corn oil. Dietary canola oil significantly (P<0.05) decreased colonic tumor incidence and tumor multiplicity as compared to dietary corn oil in rats. Fatty acid analysis showed that corn oil group had higher levels of ω-6 fatty acid levels, whereas the canola oil groups exhibited higher levels of ω-3 fatty acids from the colon and serum samples of rats. For the mechanistic study, COX-2 expression in the colon samples from the canola oil group was significantly lower (P<0.05) as compared to the corn oil group. Taken together, dietary canola oil may be chemopreventive for colon tumor development in Fischer rats as compared to possibly by increasing ω-3 fatty acid levels and decreasing COX-2 levels.

Hypercalcemia-leukocytosis syndrome in a patient with cavitating squamous cell carcinoma of the lung.

INTRODUCTION: Lung cancer is the leading cause of death among the cancers seen in the United States. Hypercalcemia and leukocytosis are two common paraneoplastic syndromes associated with lung cancer. Unfortunately patients presenting with Hypercalcemia- leukocytosis syndrome has a worse prognosis than patients presenting with lung cancer alone. CASE PRESENTATION: We present a 67 yr old Caucasian male with a history of active smoking presenting as pneumonia being diagnosed as cavitating squamous cell carcinoma of the lung with hypercalcemia-leukocytosis syndrome CONCLUSION: There should be a high degree of suspicion to diagnose lung cancer in patients presenting with symptoms of paraneoplastic syndrome.

The use of vasopressin in the setting of recalcitrant hypotension due to calcium channel blocker overdose.

Treatment of hypotension caused by calcium channel blocker overdose (CCB) remains a challenge. We describe the successful use of vasopressin in two patients with massive CCB overdoses in whom hypotension was unresponsive to calcium, glucagon, insulin, and conventional vasopressor therapies. While various modes of treatments have been used to treat the hypotension of CCB overdose, this is the first report to our knowledge of the successful use of vasopressin in this clinical setting.

Venous dilatation seen on routine mammography: a clue to superior vena cava obstruction.

A diagnosis of superior vena cava obstruction (SVCO) generally is made on clinical grounds and can be confirmed by SVCO-specific diagnostic tests. When the obstruction is long-standing, clinical recognition may be compromised as venous drainage of the head, neck, chest, and upper extremity is diverted via collateral venous channels that bypass the obstructed superior vena cava. In such situations, only the visualization of this collateral flow will suggest the presence of SVCO. We describe a patient in whom the unanticipated diagnosis of SVCO was first suggested when routine mammography revealed grossly dilated superficial veins of both breasts, which were the result of collateral flow.

Diffuse panbronchiolitis: a treatable sinobronchial disease in need of recognition in the United States.

Diffuse panbronchiolitis (DPB) is a progressive inflammatory disease, well recognized in Japan, characterized by sinusitis and obstructive small airway disease; if left untreated, it progresses to bronchiectasis, respiratory failure, and death. Treatment using low-dose erythromycin has proven to be highly efficacious. Lack of familiarity with DPB in the United States may result in the failure to correctly diagnose and treat this disorder. We describe a Cambodian man in whom the characteristic imaging and histologic features of DPB were elicited but not recognized in spite of evaluation at a referral center. When DPB was diagnosed 6 years later, he was in respiratory failure, but made an excellent recovery once erythromycin therapy was instituted. We report this case to increase physician awareness of DPB as a cause of sinobronchial disease and discuss its diagnostic features so that the disease is recognized and treated without delay.