Said Chaaban

Chronic Eosinophilic Pneumonia in a Breast Cancer Patient Post-Radiation Therapy: A Case Report

Chronic eosinophilic pneumonia (CEP) is a syndrome associated with nonspecific pulmonary and atopic manifestations, chest imaging findings suggestive of peripheral alveolar opacities, and alveolar and blood eosinophilia.[1][1] Onset is insidious, with symptoms lasting up to 2–4 weeks. It is

Colon cancer metastasis to mediastinal lymph nodes without liver or lung involvement: A case report

Colon cancer is the second most common type of cancer in females and the third in males, worldwide. The most common sites of colon cancer metastasis are the regional lymph nodes, liver, lung, bone and brain. In this study, an extremely rare case of colon adenocarcinoma with extensive metastasis to the mediastinal lymph nodes without any other organ involvement is presented. A 44-year-old Caucasian male presented with abdominal pain, a change in bowel habits, melena and weight loss. Colonoscopy revealed a large friable, ulcerated, circumferential mass in the ascending colon. Biopsies were consistent with the diagnosis of invasive moderately differentiated adenocarcinoma. Subsequently, right colon resection was performed, and pathological analysis revealed moderately differentiated adenocarcinoma of the right colon with extensive regional lymph node involvement. Computed tomography (CT) scans of the chest, abdomen and pelvis were performed preoperatively as part of routine staging for colon cancer. No liver or lung pathology was identified; however, multiple pathologically enlarged mediastinal lymph nodes were observed. Endoscopic ultrasound with fine needle aspiration of the largest mediastinal lymph node, which measured 5.2×3.5 cm on CT scans, was performed. The pathology was again consistent with the diagnosis of metastatic colorectal primary adenocarcinoma. At present, no optimum treatment has been identified for metastatic colon cancer to the mediastinal lymph nodes. The patient in the current case received chemotherapy with folinic acid, fluorouracil and oxaliplatin (FOLFOX), as well as with bevacizumab. Initial follow-up CT scans of the chest revealed a positive response to treatment. Physicians, in particular, radiologists, must consider the mediastinum during the first evaluation and further follow-up of patients with colorectal carcinoma even in the absence of metastasis.

Mo1963 Under-Diagnosing and Under-Treating Iron-Deficiency in Hospitalized Patients With Acute Gastrointestinal Bleeding: Retrospective Cohort Preliminary Results

Background and aim: Gastrointestinal (GI) bleeding is the major cause of iron deficiency in men and post-menopausal women. The aim of this study is to determine whether patients admitted to the hospital with acute gastrointestinal blood loss anemia are being worked up for concomitant highly prevalent iron deficiency and adequately treated for it. Methods: Retrospective chart review of all patients admitted to a single tertiary care hospital between 11/1/2011 and 11/1/2012 for any type of gastrointestinal bleeding. The primary endpoint was the percentage of patients with iron studies performed during a hospitalization for GI blood loss anemia. Secondary outcomes included prevalence of iron deficiency in acute GI bleeders, percentage of anemic patients hospitalized for GI bleeding who had adequate documentation of anemia and iron deficiency, and those who were treated for their iron deficiency. Secondary outcomes also included identifying possible predictors of checking iron studies. Results: 126 charts of patients hospitalized for GI bleeding have been reviewed so far. 100 patients (79.4%) had anemia on admission, while 119 (94.4%) had anemia at some point during their hospitalization. 62 were transfused at least 1 unit of packed red blood cells. Out of 126 patients, only 34 (27%) had iron studies performed during hospitalization. 19 out of 34 had iron deficiency (55.9%) defined as serum Ferritin <45 ng/mL or transferrin iron saturation <15%. None of the 126 patients were discharged with recommendations to their primary care physicians to check iron studies as an outpatient. Out of 126 patients included so far in this cohort, 16 (12.7%), 27 (21.4%), and 23 (18.3%) were on iron supplements prior to their current hospitalization, received iron therapy during hospitalization, and were discharged on iron supplements, respectively. Out of the 19 patients with proven iron deficiency, only 12 (63.2%) received iron therapy during hospitalization while only 9 (47.4%) got discharged on iron supplements. 41 patients (32.5%) were admitted to a residency teaching service and 85 (67.5%) to a hospitalist non-teaching service. There were no significant differences between the 2 services in any patient characteristics or outcomes. Out of 119 patients that had anemia during hospitalization, 17 (14.3%) had no documented anemia in their chart, 10 (8.4%) had a documented iron deficiency anemia, and 92 (77.3%) had a documented anemia diagnosis in their chart without specification whether iron deficient or not. On multivariable analysis, the only predictors of checking iron studies were a lower hemoglobin (p=0.01; OR=1.6 (1.1-2.2)) and occult bleeding (p= 0.001; OR=7.1 (2.3-25.0)) Conclusion: Iron deficiency is under-diagnosed, under-recognized even when iron studies were checked, and finally under-treated in hospitalized patients with gastrointestinal bleeding.