Hemoptysis as a Presenting Symptom for Metastatic Pancreatic Cancer

Introduction Approximately 32,000 pancreatic neoplasms are diagnosed in theUnited States annually. Currently, carcinoma of the pancreas isthe fourth most common cause of cancer death in both menand women in this country, after cancers of the lung, breast/prostate, and colon. The most common presenting symptomsof pancreatic cancers are epigastric pain, obstructive jaundice,and weight loss. However, since pancreatic cancer is frequentlymetastatic when diagnosed, it may uncommonly present withfindings characteristic of the site of spread

Comparison of Disease Phenotypes and Clinical Characteristics among South Asian and White Patients with Inflammatory Bowel Disease at a Tertiary Referral Center

Background: The prevalence and clinical features of inflammatory bowel disease (IBD) vary among different racial and ethnic groups. The aim of this study was to compare the clinical and phenotypic features of Crohn\u27s disease (CD) and ulcerative colitis (UC) in South Asian patients living in the United States with those of a white cohort. Methods: The demographic, clinical, and phenotypic characteristics of 73 South Asian patients (31 CD and 42 UC) who presented initially to our tertiary referral center from 2012 to 2016 and had subsequent follow-up were retrospectively compared with those of 408 consecutive white patients (245 CD and 163 UC). Results: South Asian IBD patients were significantly more likely to have UC (58.0% vs 40.0%; P = 0.005) than white patients. South Asians with CD were less likely to have a family history of IBD (9.7% vs 26.9%; P = 0.037) and required fewer CD-related surgeries (22.5% vs 46.1; P = 0.012). South Asians were also less likely to be active or former smokers in both the CD (P = 0.004) and UC (P = 0.020) groups. South Asians with UC had a higher incidence of Clostridium difficile infection compared with white patients (19.0% vs 8.6%; P = 0.050). Conclusions: A cohort of South Asian patients with IBD were more likely to have UC and had differing family and tobacco risk factors, requirements for surgery, and Clostridium difficile infection rates as compared with white patients

65-Year-Old Man with Weight Loss, Anorexia, and Distal Extremity Numbness

Case Report A 65-year-old Caucasian male with no significant pastmedical history presented to the emergency department with an unintentional 44-pound weight loss over a four-month period. The weight loss was preceded by fatigue and anorexia,which had been increasing for approximately eight months.In addition, he noted numbness and tingling of his hands and feet that began over the same time period. The patient was initially treated for depression with sertraline by his primarycare physician. However, his symptoms persisted without significant improvement. An initial workup at outside hospital one month prior to presentation included an abdominal CTscan, which revealed a mass in the pancreatic head suggestive of a pseudocyst. He was also treated for Lyme disease with a course of doxycycline based on a rash finding on his left thigh.Lyme serologies were negative. He denied fever, chills, nightsweats, changes in bowel habits or stool character, dysphagia,odynophagia, abdominal pain, cough, or shortness of breath.He also denied focal weakness, changes in speech, or changes invision. He has no known drug allergies. Medications included sertraline for depression, zolpidem and diphenhydraminefor sleep. He denied tobacco or illicit drug use. He drinks alcohol occasionally. Family history was non contributory, with no history of malignancy, neurodegenerative or endocrine disorders