Liver infarct masquerading as intrahepatic cholangiocarcinoma.

Cholangiocarcinoma is one of the most lethal tumors because of its complex location and lack of good chemoradiotherapy options. When it is diagnosed, urgent intervention is needed, often involving radical surgical resection. It generally presents as a liver mass with biliary obstruction.

A Case to Overcome the Stigma of Testicular Cancer.

Testicular cancer is seen commonly in young males and has a high cure rate if diagnosed and treated early. It clinically presents with painless testicular swelling. We discuss the case of a young previously healthy male with an aggressive testicular cancer which started with a testicular swelling but the primary site underwent necrosis secondary to its own vascular demand thus giving the false impression of resolution, but not before metastasizing to the rest of the body.

Young patient with pneumonia complicated by bronchopleural fistula.

We present the case of a 19 year old female presenting to the Emergency Department with signs of pneumonia and sepsis, with her clinical status deteriorating rapidly to septic shock and respiratory failure. Her pneumonia was complicated by formation of an empyema and a bronchopleural fistula. Bronchopleural fistula (BPF) is a fistula between pleural space and a bronchus.

Gemcitabine associated pseudocellulitis: A missed diagnosis.

We report a case of a 51-year-old male with past medical history significant for cholangiocarcinoma presented with two weeks of worsening bilateral lower extremity swelling and erythema. Patient has been on active chemotherapy for his cholangiocarcinoma with Gemcitabine weekly infusions. Physical exam was significant for bilaterally petechial rash coalescing into ecchymoses over the dorsum of the feet, sparing soles and toes, which dissipated into thinning petechiae more proximally.

Bowel Ischemia from Heat Stroke: A Rare Presentation of an Uncommon Complication.

A healthy 27-year-old female presented to the hospital after she collapsed an hour into her first marathon run on a hot humid day. On presentation, she was hyperthermic, encephalopathic, tachycardic, and hypotensive. On admission, she was found to have lactic acidosis, rhabdomyolysis, and acute kidney injury and was treated with cold normal saline and cooling blankets.

Oral anticoagulants to reduce the risk of stroke in atrial fibrillation: how should a clinician choose?

Atrial fibrillation (AF), a common arrhythmia that occurs with increasing frequency in the aging population, is associated with increased mortality and morbidity. To ensure that patients receive adequate anticoagulant prophylaxis, clinical guidelines for anticoagulation advocate use of validated scoring systems to stratify patients by cardiovascular risk and predict the individual patient's risk of adverse effects of therapy. Recently approved oral anticoagulants-a direct thrombin inhibitor and the factor Xa inhibitors-may offer advantages over the 50-year standard, warfarin, for efficacy, safety, and ease of administration.

Endothelial microparticles: sophisticated vesicles modulating vascular function.

Endothelial microparticles (EMPs) belong to a family of extracellular vesicles that are dynamic, mobile, biological effectors capable of mediating vascular physiology and function. The release of EMPs can impart autocrine and paracrine effects on target cells through surface interaction, cellular fusion, and, possibly, the delivery of intra-vesicular cargo. A greater understanding of the formation, composition, and function of EMPs will broaden our understanding of endothelial communication and may expose new pathways amenable for therapeutic manipulation.