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Acute esophageal necrosis (AEN) is a rare and often fatal pathology of unclear etiology affecting the distal two-thirds of the esophagus. Typically, elderly patients with multiple comorbidities present with signs of upper gastrointestinal (GI) hemorrhage. On endoscopy, the mucosa is black due to ischemic necrosis, resulting in the commonly used term “black esophagus.” We present a rare case of a 61-year-old male presenting with shortness of breath and hematemesis diagnosed as AEN through endoscopy. This case illustrates the importance of considering AEN as part of differential diagnoses in a rising elderly population with multiple comorbidities that present with upper GI hemorrhage. Treatment should be aimed at maintaining hemodynamic stability with high-dose proton pump inhibitors. [ABSTRACT FROM AUTHOR]

The treatment for melanoma is challenging because of its nature of being refractory particularly in metastatic stages. Treatment options include surgical resection of the lesion, radiation therapy, chemotherapy, and immunotherapy. Immunotherapy such as anti-cytotoxic T-lymphocyte antigen-4 and anti-programmed cell death protein 1 (PD-1) are increasingly being used in the treatment of metastatic malignant melanoma. Nivolumab is a PD-1 inhibitor used for the treatment of malignant melanoma. In our case, an 83-year-old patient presented with enlarged inguinal lymphadenopathy 2 years after curative surgical resection of her toes secondary to melanoma. She was started on nivolumab therapy after positron emission tomography (PET) -computed tomography scan and biopsy confirmed metastatic melanoma. She was responding well to the treatment as evidenced by repeated PET scan. Unfortunately thereafter, she was hospitalized with severe lethargy and generalized weakness attributed to immune-related adverse effects of thyroiditis and hypophysitis. Therefore, nivolumab was discontinued, and she was treated with high dose steroids and thyroid supplementation. The most common side effects of nivolumab therapy are immune-mediated colitis, immune-mediated hypothyroidism, immune-mediated hyperthyroidism, and immune-mediated adrenal insufficiency. It is important for clinicians to monitor patients closely with appropriate laboratories and regular follow-ups to identify side effects early so that they can be treated appropriately. [ABSTRACT FROM AUTHOR]

Study Objectives: Lung carcinoma is leading cause of death from cancer, thus an important subject for review. Lung carcinoma is associated with various prognostic factors including both clinical and objective findings; therefore, a review of thrombocytosis regarding predicting stage at initial diagnosis was prompted. Materials and Methods: A retrospective chart review of 180 patients diagnosed with lung carcinoma at Saint Michael's Medical Center between 2009 and 2013 and comparison with platelet level at time of diagnosis. The pathological diagnosis of lung cancer was made by either trans-bronchial or CT guided biopsy. Design: A retrospective chart review of 180 patients diagnosed with lung carcinoma at Saint Michael's Medical Center between 2009 and 2013 and comparison with platelet level at time of diagnosis. Results: No statistical significance was determined between advanced (including advanced staging of small cell lung cancer [SCLC] and Stage IIIb-IV of non-SCLC [NSCLC]) lung cancer staging and elevated platelet level (P = 0.078 and confidence interval [CI] of -89.103-4.774). However, on a subgroup analysis of cases including only NSCLC showed a statistically significant difference between limited and advanced stages (P = 0.0.18 and CI of -95.756-9.104). Conclusions: Thrombocytosis is associated with various neoplasms, included lung cancer as indicated in this retrospective study. In fact, thrombocytosis has been implicated with advanced staging of both SCLC and NSCLC, therefore indicating poor outcomes and mortality. [ABSTRACT FROM AUTHOR]