Mixed Adenocarcinoid Tumor Presenting as Acute Appendicitis.

Mixed adenocarcinoid tumors are not uncommon neoplasms of appendix. The clinical presentation of these tumors is often similar to that of acute appendicitis or may present as asymptomatic. These tumors are found incidentally during histopathological examination of the resected appendix following appendectomy or other abdominal procedures. Mixed adenocarcinoids usually behave as adenocarcinomas with rapid metastasis, so prognosis depends upon how aggressive the tumor behaves. The present study reports a case of a 53-year-old male who presented with abdominal pain and fever for 1 day and underwent successful appendectomy and recovered later. Subsequently, a mixed adenocarcinoma with carcinoid features of the appendix was diagnosed by histopathological examination. Follow-up examination of the patient in 3 months revealed metastasis of carcinoma to the peritoneum with adenocarcinoma features.

Normal Pressure Hydrocephalus in a Human Immunodeficiency Virus Type 1 Patient.

Normal pressure hydrocephalus (NPH) is a relatively common disease of adulthood characterized by a typical combination of clinical and radiological findings. In this report, we discuss a 54-year-old female presenting with symptoms suggestive of NPH and found to have a history of human immunodeficiency virus (HIV) type 1. She was not treated as she was in denial state and developed NPH as a possible complication. In the literature, there has only been one reported case of HIV type 2 causing NPH; however, no relationship has been properly documented with HIV type 1. These findings bring about a question on whether NPH is associated or a complication of HIV with awareness of this association. Earlier screening of HIV can be done in patients presenting with such symptoms, thus to prevent further progression of its complications.

Convulsive Syncope Induced by Ventricular Arrhythmia Masquerading as Epileptic Seizures: Case Report and Literature Review.

It is important but difficult to distinguish convulsive syncope from epileptic seizure in many patients. We report a case of a man who presented to emergency department after several witnessed seizure-like episodes. He had a previous medical history of systolic heart failure and automated implantable converter defibrillator (AICD) in situ. The differential diagnoses raised were epileptic seizures and convulsive syncope secondary to cardiac arrhythmia. Subsequent AICD interrogation revealed ventricular tachycardia and fibrillation (v-tach/fib). Since convulsive syncope and epileptic seizure share many similar clinical features, early diagnosis is critical for choosing the appropriate management and preventing sudden cardiac death in patients with presumed epileptic seizure.

Hypertriglyceridemia-Induced Pancreatitis: Choice of Treatment.

Severe hypertriglyceridemia is one of the many yet rare risk factors associated with acute pancreatitis. The level of triglycerides plays a crucial role in determining the method and duration of treatment. As with the treatment of other causes of acute pancreatitis, bowel rest, intravenous fluids, and supportive care play a crucial role. However, depending on the degree of hypertriglyceridemia, the role of other treatment options may need to be implemented. There are no set established guidelines for the management of hypertriglyceridemia-induced pancreatitis, but the role of insulin, heparin, and plasmapheresis has been studied and successfully used in its management. We report the case a 44-year-old female with clinical acute pancreatitis secondary to hypertriglyceridemia who was successfully managed with the addition of intravenous insulin.

Severe Hypothyroidism-Induced Volvulus.

Thyroid disorders have been found to be associated with multiple organ systems and thus have a broad spectrum of presenting symptoms and clinical conditions. Certain aspects of the gastrointestinal (GI) system have yet to be fully understood and documented. Hypothyroidism and even hyperthyroidism have been identified in patients with motility symptoms involving the GI tract. These symptoms can vary and can be a complication of undertreated or undiagnosed condition involving the thyroid. Unfortunately, the mechanism in which these hormones can impact intestinal motility remains poorly understood and not well documented. In this case report, we discuss the presentation of a 71-year-old female with poorly managed hypothyroidism presenting with significant abdominal distention and pain secondary to underlying volvulus formation. By better understanding the complications induced by hypothyroidism, physicians may be able to prevent further life-threatening outcomes with early management and intervention.

Elevated Troponin I in the Absence of Coronary Artery Disease: A Case Report With Review of Literature.

Cardiac troponins are the most sensitive and specific markers of myocardial injury. In fact, the Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction (MI) states that troponins are the preferred cardiac marker for detecting myocardial injury. For the aforementioned reasons, troponin levels are routinely ordered for patients presenting to the emergency department with chest pain, dyspnea, syncope, or any other possible presentations of MI. While troponin levels do reflect the extent of myocardial damage, they do not necessarily indicate myocardial ischemia in a subset of patients. Elevated troponin levels can be due to a wide array of mechanisms in the absence of myocardial ischemia and injury. Thus, relying solely on troponin levels, in the presence of a normal electrocardiogram (ECG), to diagnose myocardial ischemia can lead to unnecessary and expensive invasive testing. It is therefore important for the clinician to keep in mind the varying causes of troponin elevations in order to provide the highest value care to the patient. We present a case and review of literature regarding patients who present with elevated troponin levels in the absence of any coronary artery disease.

Elevated erythropoietin and multicystic neoplasm of the pancreas.

Cystic lesions of the pancreas are more frequently recognized due to the widespread use of improved imaging techniques. There are a variety of pancreatic cystic lesions with different clinical presentations and malignant potentials, and their management depends on the type of the cysts. Although the early recognition of a cystic neoplasm with malignant potential provides an opportunity of early surgical treatment, the precise diagnosis of the cystic neoplasm can be a challenge, largely due to the lack of reliable biomarkers of malignant transformation. We report a case of a large, multicystic neoplasm within the body and tail of the pancreas complicated by elevated erythropoietin, which is likely related to the malignant transformation of the pancreatic neoplasm.