History Of Recent Weight Loss Research Articles

OGBN P46 Megaoesophagus in a patient with achalasia treated with laparoscopic Heller cardiomyotomy

Abstract Background Achalasia is an oesophageal motility disorder that is a rare but important differential diagnosis in patients with dysphagia. Surgical treatment with laparoscopic Heller myotomy (LHM) and fundoplication is the gold standard; other options include peroral endoscopic myotomy (POEM), dilatation in cases that are unsuitable for surgery, and esophagectomy as a last resort. Methods We describe a case reported at our institution and the relevant workup, findings and management. Results A 41-year-old woman presented with persistent cough and shortness of breath on exertion. Chest x-ray showed right basal consolidation and a dense structure along the right mediastinum. CT revealed megaoesophagus with an oesophageal diameter of 7cm. Detailed history revealed long-standing history of progressive dysphagia and acid reflux and more recent history of weight loss, retrosternal pain and shortness of breath when eating solid foods. Workup included gastroscopy, oesophageal manometry and Chagas disease testing due to potential exposure to T. cruzi. A diagnosis of idiopathic achalasia was made, and she underwent laparoscopic Heller’s cardiomyotomy and Dor fundoplication. Conclusions Achalasia is an important differential in patients presenting with symptoms of dysphagia. This case reveals an atypical presentation of the disorder, suggesting a need to consider it in a wider range of presentations. Successful treatment of achalasia depends on timely diagnosis prior to oesophageal failure when it is still possible to intervene effectively.

Severe mandibular osteomyelitis and exfoliation of a mandibular canine tooth in a Vietnamese potbellied pig

A 10-year-old male castrated Vietnamese potbellied pig presented for evaluation of a dermal mass present on the left cervico-mandibular region. The patient had a mass removed 6 years earlier from the same region, which was diagnosed as squamous cell carcinoma on histopathology. On physical examination, all vital parameters, including heart rate, respiratory rate and temperature, were within normal reference ranges, and the owner reported a normal appetite with no recent history of weight loss. Upon intubation for the dermal mass removal, a large heterogeneous mass of material was observed in the rostral aspect of the left mandible (Figure 1). Once removed, the mass appeared to be grossly composed of foodstuffs, hair, and a firm, mineralized segment of unknown material (Figure 2a). Within the contents of this debris, the left mandibular canine tooth (304) or tusk was identified. For the size of the mass of material, there was minimal inflammation associated with the gingiva and the mucosa (Figure 2b). There did not appear to be any evidence of displacement of the remaining teeth in the area. The periodontal attachment appeared to be normal in the remaining teeth. Computed tomography (CT) of the head was performed with the patient anaesthetized as previously described1 and positioned in sternal recumbency. Findings included severe, multifocal, chronic periodontal disease. The left mandibular canine tooth (304) or tusk was absent, and there was a large bony defect associated with the left mandibular body along the alveolar margin. The bony defect continued to affect the buccal aspect of the mandibular body (Figure 3). There was also extensive periapical lysis and evidence of external tooth resorption of the right mandibular canine tooth (404). The radiographic dental abnormalities were consistent with severe diffuse mandibular osteomyelitis characterized by multifocal moth-eaten bone lysis and irregular periosteal new bone formation, and multiple draining tracts from the right ventral mandible. Additional radiographic findings included absence of all premolar and molar teeth except the right first maxillary premolar (105), multifocal periapical lysis of the remaining teeth, bilateral medial retropharyngeal lymphadenopathy, and evidence of bilateral otitis externa and right otitis media. Miniature companion pigs (MCPs) are increasing in popularity as companion animal pets in North America.2 While data for exact numbers are limited, MCPs first appeared in the United States in the 1980s, with a dramatic increase in popularity over the past 17 years.3 With the increase in numbers, preventive care strategies are essential to improve animal health and welfare. Commonly reported dental pathologies in MCPs include missing teeth (most commonly the first mandibular premolar), periodontal disease, and tooth resorption.4 Early diagnosis of dental disease and mandibular osteomyelitis is important for companion animal pigs, considering their potentially long life span. Extraction of an infected tusk can be quite challenging. In cases of severe infection and disease, the integrity of the mandible can be affected to the point where it can be unstable after the extraction.5 Osteomyelitis can be managed with long-term antimicrobial therapy, including oral, injectable, and regional infusion of antibiotic-impregnated compounds, depending on lesion location.6 Removal of the infected nidus, in many cases the tooth, is critical for a positive long-term outcome. A complete oral assessment with inclusion of dental radiographs in MCPs should be considered for proper preventative dental care.4 As evidenced by our case, CT is also beneficial for a thorough oral evaluation and dental assessment. The authors declare no conflict of interest. This case represents a retrospective clinical case report and not a prospective study that requires institutional approval. The authors received no specific funding for this work. Open access funding provided by the Iowa State University Library.

Wilkie’s Weight Loss Wonder: A Case Series

INTRODUCTIONWilkie’s Syndrome, also known as Superior Mesenteric Artery Syndrome (SMAS), is a rare cause of bowel obstruction that can contribute to vague abdominal symptoms on clinical presentation. This syndrome occurs when the aortomesenteric angle decreases, compressing the third portion of the duodenum between the aorta and the superior mesenteric artery. An acute decrease in the mesenteric fat pad cushion between these two blood vessels is the primary etiology, although other causes (e.g., anatomical, postoperative, functional, and pubescent etiologies) have also been described.CASE PRESENTATIONIn the present cases, 2 females with a common history of recent weight loss presented to our institution with similar symptoms of abdominal pain, nausea and vomiting. Each patient was subsequently diagnosed with SMAS following imaging studies. Both patients experienced successful resolution of symptoms with conservative nutritional management.DISCUSSIONCommon presenting complaints of SMAS include nausea, vomiting, early satiety and postprandial pain. These symptoms overlap with other gastrointestinal disorders (i.e., mesenteric ischemia, intestinal volvulus, peptic ulcer disease) making diagnosis difficult. SMAS can be identified through imaging modalities including barium studies and computer tomography. First line therapies typically include conservative nutritional support and promotion of weight gain. If conservative therapies fail, various surgical procedures can be pursued. Delayed diagnosis can lead to further pathological sequelae, including duodenal compromise, ischemia and necrosis. As the syndrome progresses, success of conservative nutritional support is less likely, and surgical correction becomes increasingly necessary.CONCLUSIONTherefore, a clinical goal for SMAS should include as swift a recognition and diagnosis as possible.

Superior mesenteric artery syndrome.

Superior mesenteric artery (SMA) syndrome, though rare, should be considered in patients with duodenal obstruction with no other causes. History of recent weight loss and imaging modalities help in the diagnosis. Conservative management can be tried before going for surgery.

Atypical hyperglycemia presentation suggests considering a diagnostic of other types of diabetes: first reported GCK-MODY in Per\xfa

BackgroundPrevalence of maturity-onset diabetes of the young (MODY) is estimated between 1 and 2% of all diabetes cases. In Latin-America little information has been described about the frequency of the disease, perhaps due to limited access to genetic studies.Case presentationWe present the case of a male patient with a history of two years of fatigue, mild hyperglycemia and intermittent polyuria, accompanied by a recent history of weight loss. He was diagnosed initially as type 2 diabetes, but in the follow-up as a patient with type 1 diabetes. He required relatively low doses of insulin and was evaluated in the endocrinology service at a hospital in Lima. The results of glucose, insulin and C-peptide in the oral glucose tolerance test (OGTT) performed were not consistent with a type 1 diabetes. Moreover, the age of the patient and the clinical characteristics did not strongly suggest a diagnosis of type 2 diabetes either. These clinical features had prompted us to carry out the genetic study. The genetic test performed with a genetic MODY panel through a massive sequencing. Heterozygous pathogenic for a variant in GCK gene was found c.629C>T p.(Thr210Met). His parents were negative for this variant after performed the genetic test.ConclusionsThis is the first case of MODY for a pathogenic variant in the GCK gene reported in Perú. The genetic evaluation of a clinical suspicion of MODY is important to confirm the diagnosis and establish an adequate treatment in patients.

Recurrent visual loss in a 64-year-old man

A 64-year-old Indian man presented to the emergency department with a 3-day history of worsening blurred vision in his right eye. This was accompanied by dull right periocular pain exacerbated...

Assessing Cachexia Acutely after Autologous Stem Cell Transplant.

Autologous hematopoietic stem cell transplantation (AHCT) is an accepted strategy for various hematologic malignancies that can lead to functional impairment, fatigue, muscle wasting, and reduced quality of life (QOL). In cancer cachexia, these symptoms are associated with inflammation, hypermetabolism, and decreased anabolic hormones. The relative significance of these factors soon after AHCT setting is unclear. The purpose of this study was to characterize the acute effects of AHCT on physical function, body composition, QOL, energy expenditure, cytokines, and testosterone. Outcomes were assessed before (PRE) and 30 ± 10 days after (FU) AHCT in patients with multiple myeloma (n = 15) and non-Hodgkin lymphoma (n = 6). Six-minute walk test (6MWT; p = 0.014), lean mass (p = 0.002), and fat mass (p = 0.02) decreased; nausea and fatigue increased at FU (both p = 0.039). Recent weight change and steroid exposure were predictors of reduced aerobic capacity (p < 0.001). There were no significant changes in interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF), energy expenditure, or bioavailable testosterone. Alterations in cytokines, energy expenditure, and testosterone were not associated with functional impairment acutely following AHCT. Recent history of weight loss and steroid exposure were predictors of worse physical function after AHCT, suggesting that targeting nutritional status and myopathy may be viable strategies to mitigate these effects.

Giant leiomyoma of the renal capsule: CT and MR imaging features with pathologic correlations

Renal leiomyoma (RL) is a rare benign tumor, usually presenting as a small asymptomatic lesion, frequently found during autopsy with a higher incidence in women (2:1). However, larger RL can become symptomatic and show structural changes (such as hemorrhagic and cystic degeneration), thus posing a diagnostic challenge. A 49-year-old woman with a recent history of weight loss and left flank pain was referred to our institution. An ultrasound exam revealed the presence of a complex mass at the left kidney. Both CT and MRI scans were performed to characterize the renal mass, which appeared well circumscribed with no signs of local invasion. Moreover, CT and MRI provided valuable additional information such as the absence of both macroscopic and microscopic fat and the presence of calcifications, hemorrhagic areas, multiple cysts and delayed enhancement. A left nephrectomy was performed via laparoscopy. Histopathological evaluation confirmed the diagnosis of RL. Imaging techniques can aid in the identification of large RL and guide the differential diagnosis; however, histopathologic analysis is required for a definitive diagnosis.

Life after 90: Predictors of mortality and performance of the ACS-NSQIP risk calculator in 4,724 nonagenarian patients undergoing emergency general surgery

The decision to emergently operate on nonagenarian patients (NONAs) can be complex due to the uncertainty about outcomes and goals of care at this advanced age. We sought to study: (1) the outcomes and predictors of mortality for NONAs undergoing emergency general surgery (EGS) and (2) the accuracy of ACS-NSQIP mortality risk calculator in this special population. Using the 2007 to 2015 ACS-NSQIP database, we included all patients older than 90 years of age who underwent an emergent operation with a Current Procedural Terminology (CPT) code for "digestive system." Multivariable logistic regression analyses were performed to identify independent predictors of 30-day mortality. NONAs' mortality rates for different combinations of risk factors were also studied and compared to the ACS-NSQIP calculator-predicted mortality rates. Out of a total of 4,456,809 patients, 4,724 NONAs were included. The overall 30-day patient mortality and morbidity rates were 21% and 45%, respectively. In multivariable analyses, several independent predictors of 30-day mortality were identified, including recent history of weight loss, history of steroid use, smoking, functional dependence, hypoalbuminemia and sepsis or septic shock. The mortality among NONAs with a history of steroid use and a recent history of weight loss was 100%. Similarly, the mortality of NONAs with recent history of weight loss who presented with preoperative septic shock was 93%. The ACS-NSQIP calculator significantly and consistently underestimated the risk of mortality in all NONAs undergoing EGS. Most NONAs undergoing EGS survive the hospital stay and the first 30 postoperative days, even in the presence of significant preexisting comorbidities. However, the combination of recent weight loss with either steroid use or septic shock nearly ensures mortality and should be used in the discussions with patients and families before a decision to operate is made. The ACS-NSQIP surgical risk calculator should be used with caution in these high-risk patients. Prognostic study, level III.

Regorafenib Is Associated With Increased Skeletal Muscle Loss Compared to TAS-102 in Metastatic Colorectal Cancer

BackgroundCurrent guidelines of the National Comprehensive Cancer Network and the European Society of Medical Oncology recommend regorafenib or trifluridine/tipiracil (TAS-102) for third-line therapy of metastatic colorectal cancer (mCRC). We evaluated the impact of regorafenib and TAS-102 treatment on skeletal muscle dynamics and sarcopenia. Patients and MethodsThis retrospective analysis was based on unselected, consecutive mCRC patients treated with regorafenib and/or TAS-102 during third or later line of therapy at our tertiary-care cancer center in Salzburg, Austria. The skeletal muscle index (SMI, cm2/m2) and sarcopenia were evaluated from cross-sectional computed tomographic images at the level of the third lumbar vertebra. ResultsBetween January 2013 and April 2018, a total of 45 patients had received regorafenib and/or TAS-102. At initial mCRC diagnosis and at initiation of third-line therapy, 24% and 54% of patients presented with sarcopenia. A statistically significant skeletal muscle loss was observed during regorafenib treatment (median SMI change: −2.75 cm2/m2 [−6.3%]; P < .0001), which was not the case during TAS-102 therapy (−1.5 cm2/m2 [−3.5%]; P = .575). Furthermore, subclassification of patients into 3 groups—normal muscle mass, stable sarcopenia, and new-onset sarcopenia—at initiation of third-line therapy permitted discrimination of overall survival, with 1-year overall survival rates of 61%, 29%, and 16%, respectively (P = .04). ConclusionThe frequency of sarcopenia increases during the course of mCRC and negatively affects survival. In contrast to TAS-102, regorafenib is associated with increased skeletal muscle loss during mCRC treatment and should therefore be used with caution in mCRC patients with preexisting sarcopenia or a history of recent weight loss.

Case for diagnosis. Ulcerated intradermal nevus simulating Sister Mary Joseph’s nodule

We report a case of a 76-year-old patient with a history of recent weight loss and ulcerated umbilical nodular lesion. Initially, we considered the diagnostic hypothesis of Sister Mary Joseph’s nodule. However, histopathological evaluation revealed that it was an ulcerated intradermal nevus. We perform a brief review of umbilical nodules.

Short-term postoperative functional outcomes in older women undergoing prolapse surgery.

To evaluate whether preoperative markers of functional status predict postoperative functional outcomes in older women undergoing surgery for pelvic organ prolapse (POP). Prospective cohort study of women aged 60 years or older who underwent surgery for prolapse. Preoperative functional status was measured using number of functional limitations (such as difficulty walking or climbing), American Society of Anesthesiologists class, anemia, and history of recent weight loss. Our primary outcome was the number of postoperative functional limitations and secondary outcomes were failure to return to baseline functional status and length of stay after surgery. We determined the association of preoperative functional status markers with postoperative outcomes using univariable and multivariable regression. In 127 women, presence of a preoperative functional limitation was a significant predictor of a 0.55 (95% confidence interval [CI] 0.36-0.74) increase in the number of postoperative functional limitations after controlling for age, number of preoperative functional limitations, comorbidities, depression, surgeon, type of procedure, and complications (P<.001). History of recent weight loss and anemia increased risk for failure to return to baseline functional status after controlling for surgeon, type of surgery, and complications (relative risk 2.44, 95% CI 1.26-4.71 and relative risk 2.72, 95% CI 1.29-5.75), respectively). Preoperative markers associated with longer length of stay after surgery were American Society of Anesthesiologists class III (0.83 days, 95% CI 0.20-1.46) and history of weight loss (0.84 days, 95% CI 0.13-1.54). Preoperative markers of functional status are useful in predicting short-term postoperative functional outcomes in older women undergoing surgery for POP. : II.

6. A case of human immunodeficiency virus presenting with alk-negative anaplastic large cell lymphoma, with positive epstein-barr virus expression

Background Anaplastic large cell lymphoma (ALCL) is a mature T-cell lymphoma which is sub-classified into ALK-positive and ALK-negative primary systemic variants, and thirdly primary cutaneous anaplastic lymphoma. In the current WHO classification, ALK-negative ALCL is included as a provisional separate entity, occurring most commonly in elderly men and carrying a poor prognosis. Both ALK-positive and negative ALCL in the general population have been reported to be consistently negative for Epstein-Barr virus (EBV) expression. Case A 40 year-old woman presented to a regional Queensland hospital with a recent history of weight loss, sweats, cough and right neck swelling. An axillary lymph node biopsy was performed as a part of a broad work-up. Histology revealed a lymphoproliferative tumour consisting of sheets of non-cohesive large atypical cells, with multi-lobate nuclei, and frequent mitoses. Immunohistochemical staining was positive for CD45, CD30, CD4, CD43 and EBER-ish; and negative for S100, pan-cytokeratin (AE1/AE3), CD20, CD79a, CD138, CD2, CD3, CD5, CD8, CD15, PAX5 and ALK1. Concurrent pathology investigations subsequently revealed that the patient was in fact HIV positive, and thus these findings were in keeping with a HIV-associated ALK-negative anaplastic large cell lymphoma. Discussion Despite a paucity of reported cases, there is growing recognition of a unique HIV-associated ALCL which arises in the setting of immunosuppression. A small case series published in 2010 analysed 37 cases and found: an average age of 38 years; a male to female predominance of 4:1; a majority of cases were ALK-negative; one third showed positive EBV expression; and there was a variable loss of T-cell markers. This case represents another extremely rare example of HIV-associated ALCL, with positive EBV expression.

The tuberculin skin test in school going adolescents in South India: associations of socio-demographic and clinical characteristics with TST positivity and non-response.

BackgroundIndia has generally used 1 TU purified protein derivative (PPD) as opposed to 2 TU PPD globally, limiting comparisons. It is important to assess latent TB infection in adolescents given that they may be a target group for new post-exposure TB vaccines.The aim of this study is to describe the pattern and associations of tuberculin skin test (TST) responses (0.1 ml 2 TU) in adolescents in South India.Methods6643 school-going adolescents (11 to <18 years) underwent TST. Trained tuberculin reader made the reading visit between 48 and 96 hours after the skin testResultsOf 6608 available TST results, 9% had 0 mm, and 12% ≥10 mm responses. The proportion of TST positive (≥10 mm) was higher among older children, boys, those with a history of TB contact and reported BCG immunization Those with no TST response (0 mm) included younger participants (<14 years), those whose mothers were illiterate and those with a recent history of weight loss. Those of a higher socio-economic status (houses with brick walls, LPG gas as cooking fuel) and those with a visible BCG scar were less likely to be non-responders.ConclusionProportion of non-responders was lower than elsewhere in the world. Proportion of TST positivity was higher in those already exposed to TB and in children who had been BCG immunized, with a zero response more likely in younger adolescents and those with recent weight loss.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0571-7) contains supplementary material, which is available to authorized users.

Lymphangioma of the Small Bowel Mesentery: A Rare Intra-abdominal Tumor Causing Anemia

A 46-year-old woman was referred for a 1-year history of symptomatic persistent anemia requiring repeated blood transfusion. Her medical history was only remarkable for acquired hypothyroidism. She denied any recent history of weight loss or hematochezia. She previously underwent esophagogastroduodenoscopy and colonoscopy, which revealed no source of bleeding. She received a transfusion every 2 months before admission and again 2 weeks before. A computed tomography scan of the abdomen was performed approximately 1 year before presentation, which was negative.

An Uncommon Malignancy of the Esophagus

Question: A previously healthy, 56-year-old man visited our hospital with a 2-month history of dysphagia. The patient's past medical history was unremarkable. He denied a recent history of weight loss, reflux symptoms, or food impaction. Laboratory and physical test results revealed no abnormalities. Barium swallow esophagogram showed dilatation of the esophagus with a filling defect, approximately 7 cm long, in the intrathoracic esophagus (Figure 1A). Endoscopy also revealed an elastic and large polypoid tumor occupying the almost whole lumen in the mid-esophagus (Figure B).

Investigation of nutritional risk factors using anthropometric indicators in hospitalized surgery patients

The investigation of risk factors associated with nutritional status could contribute for better knowledge of the malnutrition. To investigate the incidence of malnutrition and its possible association with many parameters that assess nutritional status and to identify the associated risk factors. The nutritional status was assessed in 235 hospitalized patients. Malnutrition was defined as present when the patient presented at least two anthropometric criteria below the normal range and habitual energy intake below 75% of the energy requirement (HEI/ER<75%). Gender, age, type of disease, recent weight change and dental problems were investigated as possible associated risk factors. The chi-square and Mann-Whitney tests were used to compare the data and univariate and multiple logistic regressions were used to identify the factors associated with malnutrition. The odds ratio (OR) and confidence interval (CI) of 95% were calculated with the significance level set at 5% (P<0.05). One-fifth (20%) of the patients were malnourished on admission to the hospital and 27.5% reported recent weight loss. Malnutrition (P<0.0001) was greater in patients with malignant diseases. The only variables significantly associated with malnutrition according to univariate logistic regression were recent weight loss (P = 0.0058; OR = 2.909; IC95% = 1.362; 6.212) and malignant disease (P = 0.0001; OR = 3.847; IC95% = 1.948; 7.597). When multiple regression was used in the model which included type of disease, malignant disease was shown to increase the chance of malnutrition fourfold (P = 0.0002; OR = 3.855; IC95% = 1.914; 7.766). When disease was excluded, recent weight loss also increased malnutrition fourfold (P = 0.0012; OR = 3.716; IC95% = 1.677; 8.236). Patients with a history of recent weight loss and those with malignant diseases are more susceptible to malnutrition.

Eating attitudes and food intakes of elite adolescent female figure skaters: a cross sectional study.

BackgroundElite adolescent female figure skaters compete in an aesthetic-based sport that values thin builds and lithe figures. To conform to the sport’s physical requirements, skaters may alter their eating patterns in unhealthful directions. This study assesses the eating attitudes and dietary intakes of elite adolescent female figure skaters to assess the potential nutritional risks among them.MethodsThirty-six elite competitive adolescent female figure skaters (mean age 16 ± 2.5 SD years) completed self-administered three-day records of dietary intake and simultaneous physical activity records during training season. Two months later, they attended a national training camp during which they completed the Eating Attitudes Test (EAT-40), provided fasting blood samples, and had heights and weights measured.ResultsParticipants’ mean body mass index (BMI) was 19.8 ± 2.1 SD. Their BMIs were within the normal range, and the majority (70%) did not report a history of recent weight loss. The mean EAT-40 score was normal (19.5 ± 13.5 SD) and below the cut-off score of 30 that indicates clinically significant eating pathology. However, one-quarter of the skaters had EAT-40 scores above 30. The skaters reported a mean energy intake of 1491 ± 471 SD kcal/day (31 ± 10 SD kcal/kg), with 61.6% of calories from carbohydrate, 14.6% from protein, and 23.7% from fat. Their reported dietary intakes were high in carbohydrates but low in total energy, fat, and bone-building nutrients.ConclusionsAlthough these highly active young women compete in a sport that prizes leanness, they had appropriate weights. The athletes reported dietary intakes that were far below estimated energy needs and were at moderate risk of disordered eating. Anticipatory guidance is warranted to improve their dietary intakes, particularly of bone-building nutrients.

An Unusual Case of Intraluminally Growing Esophageal Tumor

Question: A 78-year-old man presented with a 2-month history of progressive dysphagia to solids. His past medical history revealed heavy tobacco use and chronic obstructive pulmonary disease. He denied any recent history of weight loss or a history of food impaction. On presentation, there were no palpable lymph nodes or liver enlargement. Laboratory data were not pertinent except for slight elevation of SCC to 3.6 ng/mL. A barium esophagogram revealed a 5-cm filling defect in the esophagus 20 cm distal to the incisors. Upper GI endoscopy demonstrated a large, elastic, circumferential mass almost entirely occupying the lumen in the upper esophagus, but the endoscope easily passed the lesion (Figure A). What is your diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Pathologic findings obtained from biopsy specimens revealed spindle-shaped cells as well as moderately differentiated squamous cell carcinomas in the same view, and there was a transitional zone (Figure B, arrow) between the sarcomatous (above the arrow) and the carcinomatous components (below the arrow). Computed tomography showed regional lymph node metastasis, but no distant metastasis. Immunohistochemical staining for cytokeratin AE1/AE3 antibodies were positive in the spindle-shaped cells (Figure C), which confirmed the diagnosis of carcinosarcoma of the esophagus (cT3N1M0, stage III). This patient was not a candidate for esophagectomy because of his age and advanced lung disease, so he was treated with chemoradiation with remarkable response (Figure D).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Carcinosarcoma of the esophagus is an uncommon malignancy of the esophagus with both carcinomatous and sarcomatous components, and it represents only 1%–2% of all esophageal neoplasms. There were 2 major proposed explanations for the pathogenesis of carcinosarcomas: The metaplastic and the collision concepts. The metaplastic concept is that individual elements might be derived from a single common ancestor cell (so-called carcinosarcoma), whereas the collision concept is that 2 individual stem cells may independently and simultaneously undergo malignant transformation (true carcinosarcoma).1Iwaya T. Maesawa C. Uesugi N. et al.True carcinosarcoma of the esophagus.Dis Esophagus. 2006; 19: 48-52Crossref PubMed Scopus (17) Google Scholar Recent studies have supported the metaplastic concept of carcinosarcoma. Therefore, most esophageal carcinosarcomas are diagnosed as a so-called carcinosarcoma. This tumor often presents as a bulky intraluminal polypoid lesion, and thus often causes symptoms of dysphagia.2Madan A.K. Long A.E. Weldon C.B. et al.Esophageal carcinosarcoma.J Gastrointest Surg. 2001; 5: 414-417Crossref PubMed Scopus (48) Google Scholar Esophageal carcinosarcomas are usually treated according to same protocol as other esophageal cancers. This case highlights that esophageal carcinosarcoma should be considered in the differential diagnosis of esophageal tumors growing intraluminally.

Case-Control Study of Risk Factors Associated with Feline and Canine Chronic Kidney Disease

An age-matched case-control study was initiated to determine the major risk factors associated with CKD in cats and dogs and to determine what clinical signs cat and dog owners observed before their veterinarian diagnosed their pet with CKD. When compared to controls, the feline cases were more likely to have had polydipsia and polyuria in the year before the owners' cats were diagnosed with CKD. In the dogs, increased water intake, increased urination, small size and a recent history of weight loss and bad breath were noticed by the dog owners before veterinary CKD diagnosis. Dog owners recognized abnormal drinking and urination behavior over half a year before their pet's veterinary diagnosis with CKD, and they recognized weight loss almost 4 months before CKD diagnosis. Bad breath was noticed 1.2 years before recognition of CKD by a veterinarian. Given that earlier CKD diagnosis should have been possible in most cases, clinical trials should proceed to measure the efficacy of early interventions.