Meals ready to eat: a brief history and clinical vignette with discussion on civilian applications.

Meals ready to eat (MRE) have undergone many revisions of their origins in the trench ration from World War I. The MRE was implemented in 1980. Its design allows extended storage and easy, safe meal preparation. MRE sodium content varies by meal and may range from 1.6 g/meal to 2.3 g/meal. The average MRE contains 1,200 kcal. When consumed as intended, MREs are adequate for maintaining a soldier's physical parameters without undesirable consequences. The average soldier has a healthy cardiovascular system, has the ability to excrete high sodium loads, and has high insensible losses. The American Heart Association recommends limiting sodium to 2.3 g/day for the general population. Additionally, those with heart failure should limit sodium to 2 g/day. Excess intake of calories and electrolytes may lead to adverse outcomes in certain populations. We describe a case of heart failure exacerbated by regular MRE consumption and the "perfect storm" of risk factors encountered with postdisaster distribution of MREs to a civilian population.

Interstitial pneumonitis in the transplant patient: consider sirolimus-associated pulmonary toxicity.

Interstitial pneumonia in a transplant patient can have a varied etiology. Sirolimus (Rapamycin; Rapamune) is a popularly used immunosuppressant in solid organ transplantation that has anecdotally been associated with pulmonary toxicity. Sirolimus-induced pulmonary toxicity consists of a range of syndromes that is characterized by the presence of organizing pneumonia, interstitial pneumonitis, pulmonary alveolar proteinosis, focal fibrosis, or by the presence of alveolar hemorrhage. Diagnosis can be challenging and is usually made by exclusion of other etiologies. In this report we present two cases of sirolimus-associated pulmonary toxicity with a review of the literature.

Crohn disease of the esophagus: a review of the literature.

Esophageal Crohn disease is a difficult disease both to diagnose and treat. The diagnosis is made in patients with other extraintestinal manifestations of Crohn disease in whom other esophageal pathology has been ruled out. This often requires integration of clinical, endoscopic, radiographic, and histologic findings. Despite its relative rarity, it does cause severe symptoms that are difficult to treat. Treatment requires careful integration of medical, endoscopic, and surgical techniques. This review aims to discuss the significant literature regarding diagnosis and treatment of this important manifestation of inflammatory bowel disease. There is additional discussion of the literature regarding the efficacy of newer medical and endoscopic therapies, including biologic agents and removable polymer stents.

Calcium multimineral complex induced esophageal stricture.

Pill-induced esophageal injury remains an under-recognized event despite its potentially devastating consequences. Most cases are due to nonsteroidal anti-inflammatory drugs, antibiotics, or bisphosphonates, and symptoms usually resolve upon discontinuation of the medication. Reported herein is the case of an elderly woman who experienced prolonged impaction of a calcium tablet in the upper esophagus. She reported breaking the nonprescription pill in half prior to ingestion due to its large size. Subsequently, a severe esophageal stricture developed. We are unaware of any previous cases of esophageal stricture due to an impacted tablet containing primarily calcium, among other minerals. This is relevant, as patients are being advised by both their physicians and the lay press to increase calcium intake. It also highlights the importance of proper instruction and cautions for taking both prescription and over-the-counter preparations. Management of patients with suspected pill impaction is discussed.