Esophageal Cancer With Cardiac Metastasis: Approach to Cardiac Masses in Patients With a Known Malignancy.

Cardiac metastases occur in a significant proportion of cancer patients and profoundly affect clinical outcomes and management strategies, especially in esophageal cancer, where the metastasis typically targets the left heart due to its unique lymphatic spread. Diagnostic imaging is crucial for patients with cardiac symptoms or electrocardiogram (EKG) changes, as it significantly influences treatment decisions, including the operability of the primary tumor and the risks associated with left-sided metastasis, such as the potential for embolization leading to stroke. This case report provides a detailed analysis of esophageal cancer metastasizing to the left atrium, highlighting diagnostic challenges and discussing the appearance of cardiac metastasis across various imaging modalities. The report examines the advantages and limitations of each imaging technique, offering insights into their roles in accurate diagnosis and effective management in complex clinical scenarios.

Alternative Dosing of Eltrombopag for the Treatment of Chronic, Steroid-Refractory Immune Thrombocytopenia.

Idiopathic thrombocytopenic purpura (ITP) presents challenges in management, particularly in cases refractory to corticosteroids. Thrombopoietin receptor (TPO-R) agonists, such as eltrombopag, offer alternative therapeutic options. We report a case of a 72-year-old South Asian male with steroid-refractory chronic ITP who achieved a favorable response with biweekly eltrombopag dosing. Platelet response was comparable to daily dosing, suggesting the efficacy of less frequent administration schedules. This approach may enhance patient adherence and reduce treatment-related financial burdens. Biweekly eltrombopag dosing presents a promising alternative for chronic ITP management, warranting further investigation.

Occam's razor and Hickam's dictum: a dermatologic perspective.

Diagnostic heuristics help ease the cognitive load in our day-to-day work. Occam's razor or the rule of diagnostic parsimony is a diagnostic heuristic often applied in dermatology. Occam's razor dictates that all things being equal, one diagnosis (as opposed to several diagnoses) should be sought to explain a patient's presentation. While this can often be helpful, it can also obscure the full picture. Hickam's dictum is an aphorism expressing the opposite opinion: "patients can have as many diseases as they damn (or darn) well please." This acknowledges that multiple simultaneous processes can be at play. This article delves into the implications of use of these approaches and offers tips through cases illustrating the limitations of Occam's razor and when Hickam's Dictum should be invoked.