Gamil Kostandy, MD

September 14, 2005

An 80-year-old woman presented with recurrent abdominal pain for 1 month, constipation, and vomiting. She had no diarrhea, rectal bleeding, or weight loss.

September 14, 2005

A 24-year-old woman was concerned about a protruding epigastrium mass that had grown since it was first noted 4 months earlier. She had no abdominal pain, nausea, or vomiting.

September 14, 2005

A 28-year-old woman reported that she was in good health before experiencing generalized weakness; exhaustion; and pain in her legs, shoulders, and back for the past 3 months. She also complained of shortness of breath with minimal activity, irregular menstrual periods, and occasional episodes of nose and gum bleeding.

September 14, 2005

Back pain and weakness of both legs had bothered this 60-year-old woman for 1 week. Left breast cancer, stage 2, had been diagnosed 2 years before, and subsequently she underwent a lumpectomy followed by chemotherapy and radiation therapy.

September 14, 2005

An 82-year-old woman was admitted to the hospital with severe dilated cardiomyopathy. The condition was alcohol-induced and had been diagnosed about 12 years earlier. The patient was taking angiotensin-converting enzyme inhibitors and diuretics.

September 14, 2005

A 55-year-old woman with no significant medical history reported that diffuse erythematous, patchy, purpuric skin lesions over most of her body had been present for the past year. Applications of an over-the-counter corticosteroid cream helped control the pruritus but did not clear the skin lesions.

September 14, 2005

A 66-year-old man presented to the emergency department complaining of vomiting “coffee ground” emesis for 3 days. His history revealed chronic alcoholism for the last 30 years.

September 14, 2005

A 20-year-old woman, who had been confused and delirious for 2 days, was brought to the emergency department (ED). She had no significant past medical history and was taking no medication but had recently returned from a trip to Southeast Asia. In the ED, the patient had several convulsions and rapidly became comatose. She was unresponsive; her temperature was 37.9°C (100.3°F), and her blood pressure measured 80/50 mm Hg. The neurologic examination showed no signs of meningeal irritation. Cranial nerve examination was normal and showed mild, bilateral, symmetric increase in deep tendon reflexes. All other physical examination findings were normal.

September 14, 2005

While evaluating this 26-year-old man for suspected sinusitis, skull films revealed the fragments of a 32-caliber gunshot embedded in his brain. The anteroposterior and lateral radiographs show three metallic bullet fragments; the largest remnant is on the left side of the occipitoparietal region. The patient reported being shot at age 11 but denied any residual neurologic signs.

September 14, 2005

A 47-year-old woman complained of pain and swelling of the right knee of 3 days' duration. Positive fullness of the popliteal area with no pulsations was discerned. Doppler ultrasound showed a 2.5 cm × 1.5 cm cystic structure in the right popliteal region; this confirmed the diagnosis of a Baker's cyst.