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Background: Neuroendocrine neoplasms (NENs) comprise a wide-ranging group of abnormal neoplasms with atypical presentations, from primary localized disease to extensive metastasis, reaching the bone and brain. The NENs are divided into two major groups: neuroendocrine tumors (NETs), which are well-differentiated tumors of any grade, and neuroendocrine carcinomas (NECs), which are poorly differentiated, high-grade cancers with a high risk of morbidity and mortality. The challenge of diagnosing NENs early, particularly prior to metastasis, highlights the importance of further studying these diseases. We present a case of aggressive metastatic neuroendocrine carcinoma of a gastrointestinal/pancreaticobiliary origin. Case summary: A 54-year-old male with a past medical history of hypertension and left total hip replacement presented with generalized weakness, dyspnea on exertion, decreased appetite, and fatigue for one month. Initial laboratory findings noted a hemoglobin level of 3.1 g/dL and a platelet count of 9 × 109/L. CT scan findings revealed a splenic infarct, lytic bone lesions, and small bilateral occipital hemorrhages. Bone marrow biopsy was consistent with metastatic, high-grade, poorly differentiated neuroendocrine carcinoma favoring a gastrointestinal/pancreaticobiliary origin. The patient expired shortly after starting chemotherapy due to the extensive disease. Conclusion: Neuroendocrine neoplasms may be discovered late in their course with distant metastatic spread and thus have a poor prognosis. This case report and literature review describes the presentation of metastatic high-grade neuroendocrine carcinoma in a patient presenting to a community hospital, and reviews the current literature and guidelines on neuroendocrine carcinomas.
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Amyloidosis involves the deposition of abnormal proteins in various tissues and results in progressive organ dysfunction, commonly affecting multiple organs. Two types of systemic amyloidosis are AA and AL; the former is associated with acute phase reactions and the latter is composed of light chain immunoglobulins. This disease commonly affects the kidneys and is evidenced by massive proteinuria. A biopsy is the gold standard of diagnosis, with Congo Red staining revealing an apple-green birefringence under polarized light. Although the kidneys are frequently affected in this disease, it is rare that amyloidosis is limited to the kidneys without involvement of other organs. We present an 83-year-old female with bilateral lower extremity swelling for several months who was found to have 12.374 grams of protein in a 24-hour urine sample and a large amount of free lambda chains. A renal biopsy demonstrated renal amyloidosis of the AL type. Serum immunofixation and flow cytometry were unremarkable for any plasma dyscrasia; a bone marrow biopsy did not reveal systemic amyloidosis and imaging with PET/CT scan did not show evidence of other organ involvement. She was diagnosed with renal-limited amyloidosis and started on bortezomib, melphalan, and steroids. Clinicians should be aware of the signs and symptoms of amyloidosis, specifically its ability to present with unusual involvement of individual organs.
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Kwashiorkor syndrome is a form of severe protein-energy malnutrition characterized by protein deficiency and bilateral extremity swelling. Worldwide, most affected regions include Southeast Asia, South Africa and Central America; it is rare in developed countries such as the USA. We report a case of profound kwashiorkor in a 38-year-old male with an underlying psychiatric disorder and restricted diet who presented with extensive abdominal distention and systemic findings indicative of protein malnutrition.
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Work stress has extremely significant consequences to the individual and to the organization (Barling, Kelloway, & Frone, 2005). This study examined the relationship between perceived work stress, burnout, satisfaction at work, and turnover intentions. We hypothesized that a positive relationship would be found between work stress and burnout, and negative relationships would be found between burnout and satisfaction, and between satisfaction and turnover intentions. The sample included 124 hospital physicians. As expected, all our hypotheses were corroborated. Structural Equation Modeling (SEM) found that beyond the assumed direct relationships, burnout partially mediated between work stress and work satisfaction, and work satisfaction partially mediated the relationship between burnout and turnover intentions. The paper reviews the theoretical consequences and suggests ideas for future research (AU)
El estrés laboral tiene consecuencias muy importantes para la persona y para la organización (Barling, Kelloway y Frone, 2005). Este estudio analiza la relación entre estrés laboral percibido, agotamiento (burnout), satisfacción laboral e intención de abandono. Planteamos las hipótesis de que habría una relación positiva entre estrés laboral y agotamiento y negativa entre este último y satisfacción y entre esta y la intención de abandono. La muestra estaba compuesta por 124 médicos de hospital. Según lo esperado, se corroboraron todas las hipótesis. El modelo de ecuaciones estructurales demostró que más allá de las supuestas relaciones directas, el agotamiento mediaba parcialmente entre el estrés laboral y la satisfacción laboral y esta mediaba parcialmente la relación entre agotamiento e intención de abandono. El trabajo revisa las consecuencias teóricas y propone ideas para la futura investigación (AU)
