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Thyroid Metastasis to the Colon [Case Report]

Lewine, Eliza B; Patel, Zinal; Forman, Jacqueline; Manvar, Amar; Hanna, Iman
Approximately 1% of colorectal cancers can be attributed to metastatic neoplasms originating from other primary sources typically the lung, ovary, breast, prostate, kidney, or skin. Metastasis to the colon from the thyroid however is exceedingly rare. We present a 76-year-old man with a history of papillary thyroid carcinoma WHO presented with colon polyps consistent with carcinoma from his papillary thyroid carcinoma. The findings in this report suggest prompt colorectal cancer screening after thyroid cancer diagnosis and regular screening thereafter.
PMID: 37954929
ISSN: 2326-3253
CID: 5611012

Thirty-Day Readmissions After Upper and Lower Gastrointestinal Hemorrhage: A National Perspective in the United States

Patel, Smit D; Desai, Rupak; Patel, Upenkumar; Singh, Sandeep; Patel, Zinal; Patel, Neel; Zhang, Allan; Panwala, Amruta H; Khan, Vinshi N; Singh, Gagandeep; Shah, Nihar
BACKGROUND:Upper gastrointestinal hemorrhage (UGIH) and lower gastrointestinal hemorrhage (LGIH) are 2 of the most common reasons for hospital admissions across the United States. The 30-day readmission after index admission poses a major burden on the health care infrastructure, and thus, it is important to assess the causes of 30-day readmission for patients with UGIH and LGIH. METHODS:The study cohort was derived from the 2013 National Readmission Database. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volume 3 diagnosis codes were utilized to identify UGIH and LGIH patients from this data set. Patients who were readmitted to the hospital within 30 days within the same calendar year were further analyzed. Categorical variables and continuous variables were assessed by the χ test and the student t test, respectively. The independent predictors of unplanned 30-day readmissions were recognized by multivariate logistic regression, adjusting for stratified cluster design of National Readmission Database. SAS 9.4 (SAS Institute Inc., Cary, NC) was used for data analysis. RESULTS:The number of index admissions identified from the National Readmission Data 2013 were 82,290 for UGIH and 133,114 for LGIH. All-cause 30-day readmission rate for UGIH versus LGIH was 14.6% (readmitted N=12,046; 56.64% age 65 y and above) versus 14.4% (readmitted N=19,128; 70.21% age 65 y and above and 49.61% men). Gastrointestinal causes were most common (33.9% vs. 39.6%), followed by cardiac (13.3% vs. 15.3%), infectious (10.4% vs. 9.1%), and respiratory causes (7.8% vs. 7.1%) for 30-day readmission for UGIH and LGIH. Significant predictors of increased 30-day readmission (odds ratio, 95% confidence interval, P-value) included metastatic disease (2.15, 1.75-2.64, P<0.001), discharge against medical advice (1.85, 1.55-2.22, P<0.001), and length of stay >3 days (1.50, 1.38-1.63, P<0.001). Predictors for 30-day readmission for LGIH included metastatic disease (1.75, 1.48-2.06, P<0.001), liver disease (1.59, 1.49-1.71, P<0.001), and drug abuse (1.38, 1.21-1.58, P<0.001). CONCLUSIONS:Most common reason for UGIH and LGIH readmission was related to gastrointestinal disease, followed by cardiac, infectious, and respiratory etiologies. By addressing these etiologies for readmission, it may be possible to reduce adverse outcomes.
PMID: 29561353
ISSN: 1539-2031
CID: 5052802

Association of Antibiotic and Proton Pump Inhibitor Usage in Patients with Hospital Acquired Clostridium difficile Infection: A Single Center Experience [Meeting Abstract]

Ballecer, Eric; Ali, Mohammad; Patel, Zinal; Shen, Mark; Islam, Shahidul; Vrabie, Raluca; Grendell, James H.
ISSN: 0002-9270
CID: 3897692

ANCA-Associated Vasculitis (AAV) in Younger Vs Older Patients: Comparison of Clinical, Serologic and Outcome Differences and Their Implications for Management [Meeting Abstract]

Chokshi, Priya; Aina, Olufemi; Masani, Naveed; Fazzari, Melissa; Belilos, Elise; Belostocki, Kristina; Rosenblum, Gary; Abraham, Tobin; Shimonov, Daniil; Patel, Zinal; Carsons, Steven E.
ISSN: 2326-5191
CID: 3519862

A Giant Adrenal Mass in a Super Obese Patient [Case Report]

Ologun, Gabriel O; Patel, Zinal M; Adeboye, Adeolu; Guduru, Mounika; Trostle, Douglas; Vandermeer, Thomas; Bertsch, David
Giant pheochromocytomas (Pheo) are rare entities requiring clinical suspicion coupled with strategic diagnostic evaluation to confirm the diagnosis. The majority of cases are discovered incidentally. The diagnosis consists of biochemical evaluation and imaging study to localize the mass. Pathological examination confirms the diagnosis. The female patient in this case report presented with chest pain, palpitation of three weeks duration and was found on evaluation to have an abdominal mass concerning for pheochromocytoma. She was treated with surgical resection. The pheo measured 20.5 x 18 x 10 cm and weighed 2,582 grams. Pathological examination confirmed the diagnosis of pheochromocytoma.
PMID: 29057184
ISSN: 2168-8184
CID: 5052792

Large Unilateral Adrenal Mass with Surrounding Brown Fat: A Case Report [Case Report]

Ologun, Gabriel O; Patel, Zinal M; Rana, Navpreet K; Trecartin, Andrew; Shen, Alice; Trostle, Douglas; Bertsch, David
Pheochromocytomas are rare tumors derived from chromaffin cells located in the adrenal and extra adrenal tissues. Pheochromocytomas are diagnosed biochemically and localized using different imaging modalities. The definitive management is surgical resection. Brown adipose tissues are normally present during fetal development, with regression over time. Brown adipose tissues are thermogenic and usually located in the neck, mediastinum, and retroperitoneum. Here, we report a case of a unilateral pheochromocytoma surrounded by brown fat. The abnormal stimulation of brown fat noted on positive emission tomography scan (PET) resolved after the pheochromocytoma was resected.
PMID: 29021924
ISSN: 2168-8184
CID: 5052782

Type 2 autoimmune pancreatitis: case report of a 9-year-old female and a review of the literature [Case Report]

Patel, Zinal; Patel, Suril; Grendell, James; Marciano, Tuvia
We report a case of autoimmune pancreatitis in a 9-year-old female who presented with persistent epigastric pain for 3 weeks. Magnetic resonance cholangiopancreatography (MRCP) showed both intrahepatic and extrahepatic biliary ductal dilatation. The common bile duct, along with the pancreatic duct, was noted to be dilated. Labs showed normal IgG and IgG4 levels and negative for autoimmune antibodies. Endoscopic ultrasound revealed the pancreatic head to be enlarged and surrounded by hypoechoic and lobulated lymph nodes. Biopsy of the pancreatic head showed chronic mildly active inflammation with fibrosis, acinar atrophy, and lymphocytic infiltrate. A diagnosis of autoimmune pancreatitis (AIP) was made, and she was treated with prednisone. The patient's symptoms improved quickly, and follow-up MRCP showed resolution of inflammatory changes and intrahepatic and pancreatic ductal dilatation.
PMID: 26590828
ISSN: 1865-7265
CID: 3411982

Autoimmune Pancreatitis: Case Report of a 9-Year-Old Female and Review of Literature [Meeting Abstract]

Patel, Zinal; Patel, Suril; Chapalamadugu, Prateek; Marciano, Tuvia; Husain, Sohil; Grendell, James
ISSN: 0002-9270
CID: 3537922