Hepatic Kaposi sarcoma: A case report and review of the literature.

Kaposi sarcoma (KS) is an aggressive cancer caused by human herpesvirus-8, primarily seen in immunocompromised patients. As opposed to the well-described cutaneous manifestations and pulmonary complications of KS, hepatic KS is rarely reported before death as most patients with hepatic KS do not manifest symptoms or evidence of liver injury. In patients with acquired immune deficiency syndrome, hepatic involvement of KS is present in 12%-24% of the population on incidental imaging and in approximately 35% of patients with cutaneous KS if an autopsy was completed after their death. Patients with clinically significant hepatic injury due to hepatic KS usually have an aggressive course of disease with hepatic failure often progressing to multi-organ failure and death. Here we report an unusual presentation of acute liver injury due to hepatic KS and briefly review the published literature on hepatic KS.

The Five Senses of Haiti.

The Five Senses of Haiti discusses a series of medical mission trips by physicians and medical students to the Central Plateau of Haiti delivering care in the outpatient setting. Practitioners describe their experiences through the use of their five senses to draw contrast between modern health care and medical practice in the developing world. Physicians in a resource poor setting are left without the usual diagnostic armamentarium and the safeguards and distractions of the modern hospital setting. This deficit creates an opportunity to devote time and focus to individual patients. Practicing medicine in this context clinicians use a heightened sense of awareness and increase their reliance on physical exam findings. Global medicine creates an opportunity for medical students to learn and physicians out of training to practice overlooked physical exam skills in the modern era. Physical exam findings and patient care yield diagnoses and fosters the bonds of the doctor-patient relationship.

Multimodality image guidance with Dyna-CT for transcatheter treatment of paravalvular leak of a stentless valve.

The transcatheter treatment of paravalvular leaks (PVL) are technically challenging procedures; they pose increasing difficulty in cases where there is a stentless valve, without the usual fluoroscopic landmarks. Hence, there is limited experience in treating this defect percutaneously. We present a case of a patient with an aortic PVL of a stentless valve and how the integrated use of multi-imaging modalities (transesophageal echocardiography, computed tomography and rotational angiography) allowed the demarcation of landmarks onto live fluoroscopy and guided the transcatheter occlusion of the PVL.