Diagnosis and treatment of malignant-appearing arteriovenous malformation.

Arteriovenous malformations (AVM) are most commonly found in the gastrointestinal tract, and presentation can range from asymptomatic to massive gastrointestinal hemorrhage. This case highlights a unique presentation of AVMs. During a screening colonoscopy, a 5-cm mass was discovered in the transverse colon encompassing 25% to 50% of the circumference of the lumen.

Spontaneous sphenoid meningoencephalocele with sepsis.

Streptococci bacteremia is an unusual source of sepsis from spontaneous cerebrospinal fluid (CSF) rhinorrhea due to sphenoid meningoencephalocele. A spontaneous cause of CSF rhinorrhea should be on the differential along with trauma and congenital and neoplastic lesions. Moxifloxacin 400 mg daily for 2 weeks has a satisfactory CSF penetration to treat bacteremia due to CSF rhinorrhea.

Malignant melanoma of the cecum and small intestine.

Malignant melanoma is the most lethal skin cancer. While it represents about 5% of all cutaneous malignancies for men and women, melanoma accounts for the most skin cancer deaths Symptomatic gastrointestinal involvement from primary malignant cutaneous melanoma is uncommon and represents only 1% to 4% of melanoma cases but is found in 60% of autopsies in patients who have had a primary cutaneous melanoma. We present a case of metastatic melanoma in a 61-year-old man with initial symptomatic cecal melanoma and subsequent jejunal involvement discovered during endoscopy.

Advanced heart failure with reduced ejection fraction.

Patients suffering advanced heart failure with reduced ejection fraction (HFrEF) account for a large portion of patients admitted to hospitals worldwide. Mortality and 30-day readmission rates for HFrEF are now a focus of value-based payment models, making management of this disease a priority for hospitals, physicians, and payers alike. Angiotensin-converting enzyme inhibitors have been the cornerstone of therapy for decades.