Primary lung sarcoma with gastric metastasis and morphological divergence presenting as melena

A 61-year-old man was admitted to the medical intensive care unit following a 2-week history of weakness, lightheadedness and melena resulting in an acute anaemia. Upper endoscopy revealed multiple large gastric masses without evidence of active bleeding. CT of the chest revealed a large right upper lobe mass with bony destruction of the third rib and invasion into the anterior chest wall and mediastinum, as well as a soft-tissue density in the left kidney. Biopsy and histopathological review of both pulmonary and gastric masses revealed two distinct sarcomatous malignancies that, while both from a primary lung source, differed in their morphology. Natural history and behaviour are not well understood in sarcomas due to their rarity, but abdominal metastasis is considered an uncommon event in the progression of the disease. Gastrointestinal bleeding as the presenting symptom of a primary lung sarcoma is an atypical finding with no previously reported cases.

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Enteral baclofen withdrawal managed with intravenous dexmedetomidine: A case report

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz332 ◽

2020 ◽

Vol 77 (5) ◽

pp. 352-355 ◽

Cited By ~ 2

Author(s):

Aubrey Defayette ◽

Anna Perrello ◽

Thomas Brewer ◽

John Picano ◽

Saman Ahmed

Keyword(s):

Chronic Back Pain ◽

Medical Intensive Care Unit ◽

High Dose ◽

Respiratory Drive ◽

Visual Hallucinations ◽

Pharmacy Records ◽

Minimal Improvement ◽

Baclofen Withdrawal ◽

History Of ◽

Medical Intensive Care

Abstract Purpose Acute enteral baclofen withdrawal can be clinically severe if not identified and managed appropriately. Treatment of baclofen withdrawal includes supportive care and reinitiation of baclofen. There are limited pharmacotherapeutic interventions available to manage symptoms of acute enteral baclofen withdrawal, especially in nonintubated patients. Summary We describe a 61-year-old Caucasian male with a past medical history of chronic back pain and spinal stenosis who was admitted to the medical intensive care unit with confusion, insomnia, agitation, delirium, and auditory and visual hallucinations. For control of agitation, the patient was administered 10 mg of i.v. haloperidol, 1 mg of i.v. lorazepam, and 14 mg of i.v. midazolam, with minimal improvement noted; therefore, dexmedetomidine was initiated, which led to clinical resolution of his symptoms. Upon further investigation it was determined that the patient was taking approximately 10 baclofen 20-mg tablets a day. According to his pharmacy records, he had filled prescriptions for a total of 738 baclofen tablets in the previous 12 weeks. The patient’s presentation and sudden discontinuation of high-dose baclofen led to a diagnosis of baclofen withdrawal. Baclofen was subsequently restarted, and dexmedetomidine was weaned over 36 hours. Conclusion Dexmedetomidine controlled this patient’s agitation and delirium without suppressing his respiratory drive and should be considered for management of acute enteral baclofen withdrawal.

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Oropharyngeal flora in patients admitted to the medical intensive care unit: clinical factors and acid suppressive therapy

Journal of Medical Microbiology ◽

10.1099/jmm.0.053066-0 ◽

2013 ◽

Vol 62 (5) ◽

pp. 778-784 ◽

Cited By ~ 8

Author(s):

Wesam Frandah ◽

Jane Colmer-Hamood ◽

Hoda Mojazi Amiri ◽

Rishi Raj ◽

Kenneth Nugent

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill Patients ◽

Medical Intensive Care Unit ◽

Upper Airway ◽

Suppressive Therapy ◽

Oral Flora ◽

History Of ◽

Medical Intensive Care ◽

The Mean

Acid suppression therapy in critically ill patients significantly reduces the incidence of stress ulceration and gastrointestinal (GI) bleeding; however, recent studies suggest that proton pump inhibitors (PPIs) increase the risk of pneumonia. We wanted to test the hypothesis that acid suppressive therapy promotes alteration in the bacterial flora in the GI tract and leads to colonization of the upper airway tract with pathogenic species, potentially forming the biological basis for the observed increased incidence of pneumonia in these patients. This was a prospective observational study on patients (adults 18 years or older) admitted to the medical intensive care unit (MICU) at a tertiary care centre. Exclusion criteria included all patients with a diagnosis of pneumonia at admission, with infection in the upper airway, or with a history of significant dysphagia. Oropharyngeal cultures were obtained on day 1 and days 3 or 4 of admission. We collected data on demographics, clinical information, and severity of the underlying disease using APACHE II scores. There were 110 patients enrolled in the study. The mean age was 49±16 years, 50 were women, and the mean APACHE II score was 9.8±6.5. Twenty per cent of the patients had used a PPI in the month preceding admission. The first oropharyngeal specimen was available in 110 cases; a second specimen at 72–96 h was available in 68 cases. Seventy-five per cent of the patients admitted to the MICU had abnormal flora. In multivariate logistic regression, diabetes mellitus and PPI use were associated with abnormal oral flora on admission. Chronic renal failure and a higher body mass index reduced the frequency of abnormal oral flora on admission. Most critically ill patients admitted to our MICU have abnormal oral flora. Patients with diabetes and a history of recent PPI use are more likely to have abnormal oral flora on admission.

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A PILOT STUDY OF PENICILLIN SKIN TESTING IN PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY ADMITTED TO A MEDICAL INTENSIVE CARE UNIT (MICU)

Critical Care Medicine ◽

10.1097/00003246-199912001-00234 ◽

1999 ◽

Vol 27 (Supplement) ◽

pp. A91

Author(s):

Mercedes E Arroliga ◽

Mary Beth Bobek ◽

Lori Hogg-Hoffman ◽

William Wagner ◽

Steven M Gordon ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pilot Study ◽

Medical Intensive Care Unit ◽

Skin Testing ◽

Penicillin Allergy ◽

History Of ◽

Medical Intensive Care

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Myasthenia gravis crisis coinciding with asthma exacerbation in a patient with recent heroin use: three causes of acute hypercarbic respiratory failure

BMJ Case Reports ◽

10.1136/bcr-2018-224176 ◽

2018 ◽

pp. bcr-2018-224176

Author(s):

Adem Aktas ◽

Edward Rojas ◽

Hardik A Parikh ◽

Kathleen Pergament

Keyword(s):

Respiratory Failure ◽

Myasthenia Gravis ◽

Asthma Exacerbation ◽

Mediastinal Mass ◽

Medical Intensive Care Unit ◽

Simultaneous Occurrence ◽

Heroin Use ◽

History Of ◽

Medical Intensive Care ◽

Flexion And Extension

A 57-year-old woman with a history of asthma, hypertension and substance abuse disorder was admitted to the medical intensive care unit with hypercapnic respiratory failure. After the history was obtained, patient admitted heroin use earlier that day. The initial physical examination revealed right eye ptosis, diplopia, fatigability of neck flexion and extension. She also presented with wheezing and a prolonged expiratory phase. Pupils were 4 mm, with sluggish response to light bilaterally. CT chest with contrast showed a large mediastinal mass. Three different processes coexisted in this patient: simultaneous occurrence of a myasthenia gravis crisis, asthma exacerbation and a component of heroin use. This case highlights a series of overlapping clinical features that could lead to potential confounding and misdiagnosis. Respiratory symptoms improved after initial treatment for asthma exacerbation, but ptosis, diplopia and fatigability of neck muscles persisted.

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