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Foreign body aspiration can be a life-threatening emergency. An aspirated solid or semi-solid object may lodge in the larynx, trachea or other breathing airways. If the object is large enough to cause nearly complete obstruction of the airway, asphyxia may rapidly cause death. We report a 19-year old man admitted with right lower lobe pneumonia who spontaneously expelled a foreign body, one day after admission and glucocorticoids administration. Glucocorticoids should be considered in foreign body aspiration management because improvement of the inflammatory reaction may facilitate expontaneous expulsion or foreign body extraction

Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints affecting multiple organs in the body. Pericardial disease is a relative common systemic manifestation of RA. A small number of cases are described in the literature related to pericardial involvement in RA. We described a case of a 69 year-old-male with chronic RA who presented with progressively worsening shortness of breath at exertion. Previous echocardiogram performed one year ago had normal ejection fraction and no structural abnormalities. Laboratories showed no significant abnormalities. The echocardiogram and MRI performed at the time of evaluation, revealed a mass in the right ventricle free wall pericardia. On the pathology report the pericardial mass resection showed mild chronic inflammation, extensive fibrosis, fat necrosis and branchial cyst surrounded with mild chronic inflammation. After surgical resection the patient improved clinically.

Unlabelled: Emotional stress has been linked to acute coronary events. We examined whether the emotional response to elections in Puerto Rico induced a similar response., Methods: We reviewed records at HIMA San Pablo Hospital (HIMASP) and Ramon Ruiz Arnau University Hospital (HURRA) in Bayamon and identified patients admitted with ICD-9 codes 410, 411, and 413 or corresponding diagnoses during a period surrounding the general elections and compared them with the same time period in non-election years., Results: Cardiovascular events accounted for 3.24% of election-year admissions vs. 5.51% during non-election years in HURRA (p=0.036, N=37), while accounting for 2.86% of election-year admissions in HIMASP vs. 3.27% during non-election years (non-significant)., Discussion: There was a trend towards a lower rate of admission for cardiovascular events during general elections in both hospitals, reaching statistical significance at HURRA. Further study may elucidate reasons for this behavior and determine whether similar trends hold true in other populations.

Leptospirosis is a rare and potentially fatal infection that requires a high index of suspicion for timely diagnosis and treatment. Diagnosis of leptospirosis can be particularly difficult in context of coexistent viral hepatitis. We present a case of Weil's syndrome, in which a concurrent resolving Hepatitis A virus infection was concomitantly diagnosed. Assessment of epidemiologic risk factors and serial serology testing were key in making this diagnosis. The immunologic consequence of the coexistence of these two infections is also discussed. It is likely that hepatitis A infection predisposed our patient's leptospirosis infection to progress to Weil's syndrome.

Amyloidosis is a process were an abnormal protein deposits in tissues. This deposit accumulates and may eventually cause a variety of nonspecific symptoms. Primary amyloidosis refers to amyloidosis caused by an underlying plasma cell disorder. Protein electrophoresis showing a monoclonal band is suggestive of the disease but in order to make the diagnosis, the presence of amyloid deposition on tissues must be shown by biopsy. We present a woman in whom primary amyloid is manifested as a rectal stricture. She came to the gastroenterology clinics complaining of hematochezia, weight loss, decreased appetite and abdominal pain. Her only sign of organ damage was mild to moderate proteinuria (80mg per day). The patient also had an unusual retroperitoneal infiltration with encasement of the abdominal aorta.