Bleeding Isolated Gastric Varices as a Rare Presentation of Pancreatic Neuroendocrine Tumor: Case Report and Literature Review.

Isolated gastric varices (IGV) are gastric varices in the absence of esophageal varices. IGV is one of the rare causes of gastrointestinal bleeding and an uncommon complication of pancreatic neuroendocrine tumors (PNET). The gold standard diagnostic tool of varices is esophagogastroduodenoscopy (EGD). IGV tend to bleed with lesser portal pressure compared to esophageal varices. Initial treatment is similar to the gastroesophageal varices. The intervention options include endoscopic, radiological, and surgical approach.

A Rare Case Presentation of Apixaban-induced Nontraumatic Spinal Subdural Hematoma.

A spinal subdural hematoma is a rare clinical entity and an uncommon urgent complication that can be associated with the use of vitamin K and less commonly nonvitamin K oral anticoagulants. It is considered a neurological emergency requiring prompt diagnosis and surgical intervention in the majority of the cases. Herein, we present an 84-year-old male patient with a history of nonvalvular atrial fibrillation on apixaban who presented with complaints of bilateral lower extremity weakness, severe back pain, and urinary retention. His lumbar and thoracic spine images showed a diffuse spinal subdural hematoma. Urgent neurosurgical intervention was performed with minimal improvement in his symptoms postoperatively. We report a case of spontaneous spinal subdural hematoma related to apixaban use with relevant literature review.

Telomere Length and Risk of Major Adverse Cardiac Events and Cancer in Obstructive Sleep Apnea Patients.

Telomere length (TL) is associated with cardiovascular disease (CVD) and cancer. Obstructive sleep apnea (OSA) is also linked to higher risk of CVD and cancer, and to TL. We investigated the association between TL and risk of major adverse cardiac events (MACE) and cancer in OSA patients. We studied 210 individuals undergoing sleep-related studies between 2000 and 2007. Baseline characteristics and follow-up data (available in 164 subjects) were obtained from clinic records. Incidence rates were calculated for the entire group and by OSA status. Hazard ratios were calculated to estimate effects of OSA and TL on risk of MACE and cancer. In total, 32 individuals (20%) developed MACE and/or cancer during 12.7-year follow-up. The OSA group had a higher likelihood of cancer (16.0 vs. 4.9 events per 1000 person-years, P = 0.044) but no clear evidence of an elevated incidence of MACE (10.8 vs. 4.8 events per 1000 person-years, P = 0.293) compared to the non-OSA group. There was no association between TL and MACE- (HR = 1.01, 95% CI 0.78-1.28), or cancer-risk (HR = 1.18, 95% CI 0.96-1.43). Our study warrants further investigation of any modulating effect of OSA on TL and the risk of MACE and cancer.

Primary Pulmonary Epithelioid Angiosarcoma: A Rare Case Presentation of Bilateral Pneumothoraces.

Angiosarcoma is a rare malignant neoplasm with a very poor prognosis that originates from the vascular endothelium and accounts for only 1%-2% of all sarcomatous malignancies. It is most commonly present in the deep soft tissues. Still, a wide range of primary sites, including the adrenals, thyroid, skin, and bone, are encountered. Here, we report a 52-year-old female with a past medical history of hypertension who presented with chest pain. Her chest images showed bilateral pneumothoraces with diffuse cystic lung disease. She underwent bilateral video-assisted thoracoscopy with a tissue biopsy, which was consistent with epithelioid angiosarcoma.