Pulmonary Lymphangitic Carcinomatosis: An Atypical Presentation Leading to Discovery of Multi-Organ Metastasis With Unknown Occult Primary Malignancy.

Pulmonary lymphangitic carcinomatosis is the spread of malignant cells to the lymphatic system in the lungs, which results in inflammation and lymphatic dilation. It is often found to coexist in patients with prior history of malignancy. The clinical presentation is usually related to respiratory symptoms, but atypical presentation can occur. Chest x-ray imaging can be non-revealing at initial stages, and abnormalities may only be appreciated when the disease gets to more advanced stages. Computed tomography imaging can reveal radiological abnormalities that were found to be associated with pulmonary lymphangitic carcinomatosis. More advanced imaging modalities and pathological tissue confirmation may be required for the diagnosis. However, once the diagnosis is made, prognosis remains poor and treatment efforts are geared towards the underlying malignancy. Here, we report on a rare case of pulmonary lymphangitic carcinomatosis in an adult male with no prior history of cancer, for whom his hospitalization led to the discovery of malignancy involving multiple organs.

A Case Report of Successful Medical Management of Emphysematous Gastritis With Portal Venous Air.

Emphysematous gastritis is an uncommon yet life-threatening condition characterized by air in the gastric wall. It requires clinical and radiological findings for its diagnosis. Management is done either medically or surgically and requires early intervention with bowel rest, proton pump inhibitors, and antibiotics with or without gastrectomy secondary to the high mortality associated with the condition. We present a case of a 55-year-old male who responded well to medical therapy without the need for surgical intervention.

Lower gastrointestinal bleeding due to rectal Dieulafoy's lesion.

Dieulafoy's lesion is a relatively rare but serious cause of gastrointestinal bleeding. It usually involves the upper gastrointestinal tract. However, it has recently been reported in different regions of the gastrointestinal tract, including the rectum. Here, we report the case of a female patient who presented with fresh bleeding per rectum for 1 day with low hemoglobin level. Colonoscopy revealed an actively bleeding rectal Dieulafoy's lesion which was successfully treated with a clip. To our knowledge, there have been few reported cases of lower gastrointestinal bleeding caused by Dieulafoy's lesion in the rectum.

Vitamin D status in children with cystic fibrosis. Associations with inflammation and bacterial colonization.

RATIONALE: Patients with cystic fibrosis (CF) have high rates of vitamin D insufficiency. The relation between vitamin D status and inflammation in patients with CF is poorly understood. OBJECTIVES: To determine the prevalence of vitamin D deficiency and insufficiency in a young CF population and to examine correlations between vitamin D status, disease severity, and inflammatory markers. METHODS: This was a retrospective chart review of patients with CF under the age of 12 years. Serum laboratory parameters, growth indices, pancreatic status, CFTR genetics, medications, microbiology, and presence of CF-related comorbidities were collected for patients who had fat-soluble vitamin levels measured between January 1, 2009 and December 31, 2011. Vitamin D deficiency was defined as a serum 25(OH)D less than 20 ng/ml and insufficiency as serum 25(OH)D 20 to 29.9 ng/ml. Associations between serum vitamin D concentration and clinical/inflammatory markers were assessed using Chi-square and t tests. MEASUREMENTS AND MAIN RESULTS: Data were collected for 148 children. The mean serum 25(OH)D concentration was 32.4 ng/ml (SD, 8.9). Seven percent (10 of 148) were vitamin D deficient, and 36% (53 of 148) were vitamin D insufficient. Among the pancreatic-sufficient patients, 50% (14 of 28) were vitamin D insufficient/deficient, whereas among pancreatic-insufficient patients, 41% (49 of 120) were vitamin D insufficient/deficient. Pseudomonas aeruginosa was a more common pathogen in the patients who were vitamin D insufficient/deficient (18 of 63 vs. 11 of 85, P = 0.018). There was no difference between vitamin D-sufficient versus -insufficient groups in terms of other bacterial colonization or inflammatory markers. CONCLUSIONS: Overall, vitamin D insufficiency is common among young children with CF. Vitamin D insufficiency is prevalent even in children who are pancreatic sufficient. In this population, vitamin D insufficiency is associated with a history of Pseudomonas colonization but not with classic markers of systemic inflammation.