Clinical concept of Kaposi sarcoma Case Scenario: 28 y/o Caucasian female presented to the ED with main c/o a mouth

sore that occurred about two weeks ago, associated with pain, unable to eat or drink for the last three days. As well, complaints of abdominal upset stomach and poor appetite. Does report nausea, vomiting, and denies diarrhea. Patient complaints as well of SOB at rest and with exertion not relieve by any measures with occasional chest pain. States that pain is located at center of the chest wall with no radiation, pain 8/10. More concern with a rash that developed a couple days ago bluish red in color with elevated papules along her back and arms. States that she was diagnosed with HIV + about eight months ago. Has not taken any prescribed medications or followed up with physician recently. Continues with unhealthy habits such as smoking and drug abuse. Upon examination lab results reveal a CD4 count of 150/mm3, CXR images revealed pleural effusion and vascular congestion, WBC 20,000, and physician has given a diagnosis of r/o Kaposis sarcoma-associated herpes virus (KSHV). Diane: A Case of Physician Assisted Suicide Diane was a patient of Dr. Timothy Quill, who was diagnosed with acute myelomonocytic leukemia. Diane overcame alcoholism and had vaginal cancer in her youth. She had been under his care for a period of 8 years, during which an intimate doctor-patient bond had been established. It was Dr. Quill's observation that "she was an incredibly clear, at times brutally honest, thinker and communicator." This observation became especially cogent after Diane heard of her diagnosis. Dr. Quill informed her of the diagnosis, and of the possible treatments. This series of treatments entailed multiple chemotherapy sessions, followed by a bone marrow transplant, accompanied by an array of ancillary treatments. At the end of this series of treatments, the survival rate was 25%, and it was further complicated in Diane's case by the absence of a closely matched bone-marrow donor. Diane chose not to receive treatment, desiring to spend whatever time she had left outside of the hospital. Dr. Quill met with her several times to ensure that she didn't change her mind, and he had Diane meet with a psychologist with whom she had met before. Then Diane complicated the case by informing Dr. Quill that she be able to control the time of her death, avoiding the loss of dignity and discomfort which would precede her death. Dr. Quinn informed her of the Hemlock Society, and shortly afterwards, Diane called Dr. Quinn with a request for barbiturates, complaining of insomnia. Dr. Quinn gave her the prescription and informed her how to use them to sleep, and the amount necessary to commit suicide. Diane called all of her friends to say goodbye, including Dr. Quinn, and took her life two days after they met. PROSTATE CANCER
Carlos Aquino, a 63 year old Filipino male with hormone-refractory prostate cancer is your clinic patient. Mr. Aquino was diagnosed with benign prostatic hypertrophy (BPH) several years ago and was taking alpha blockers for this condition. A year ago, his BPH symptoms worsened despite maximal therapy. At that time you performed a digital rectal exam and noted that he had a new hard nodule (1cm x 1cm) in the right lobe of his prostate and a PSA of 2.4 (PSA in the year prior to that was 2.2). A prostate biopsy revealed highgrade adenocarcinoma in 5/5 R lobe biopsy specimens with Gleason's score of 4+5, and 2/5 of L lobe biopsies. A bone scan showed a small focal abnormality in the lumbar spine at the level of the L2 vertebra. The prostate cancer was staged as T2b.