Oxycodone-induced neurotoxicity secondary to concurrent voriconazole use in a patient with cancer.

Chronic pain is common in patients with underlying malignancy with prevalence of up to 70 percent in those with advanced disease. Opioids are often used for those with both active disease and chronic cancer-related pain. In high-risk patients with hematologic malignancies and pneumonia, the Infectious Diseases Society of America recommends empiric antifungal therapy, often with voriconazole or another similar azole agent. Thus, patients with cancer are commonly on medications, such as antifungals, that have the potential to interact with opioids, causing adverse effects. Our case demonstrates severe neurotoxicity due to the concurrent use of voriconazole and oxycodone.

Transbronchial Lung Cryobiopsy and Video-assisted Thoracoscopic Lung Biopsy in the Diagnosis of Diffuse Parenchymal Lung Disease. A Meta-analysis of Diagnostic Test Accuracy.

RATIONALE: Transbronchial lung cryobiopsy is increasingly being used for the assessment of diffuse parenchymal lung diseases. Several studies have shown larger biopsy samples and higher yields compared with conventional transbronchial biopsies. However, the higher risk of bleeding and other complications has raised concerns for widespread use of this modality. OBJECTIVES: To study the diagnostic accuracy and safety profile of transbronchial lung cryobiopsy and compare with video-assisted thoracoscopic surgery (VATS) by reviewing available evidence from the literature. METHODS: Medline and PubMed were searched from inception until December 2016. Data on diagnostic performance were abstracted by constructing two-by-two contingency tables for each study. Data on a priori selected safety outcomes were collected. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool. Random effects meta-analyses were performed to obtain summary estimates of the diagnostic accuracy. RESULTS: The pooled diagnostic yield, pooled sensitivity, and pooled specificity of transbronchial lung cryobiopsy were 83.7% (76.9-88.8%), 87% (85-89%), and 57% (40-73%), respectively. The pooled diagnostic yield, pooled sensitivity, and pooled specificity of VATS were 92.7% (87.6-95.8%), 91.0% (89-92%), and 58% (31-81%), respectively. The incidence of grade 2 (moderate to severe) endobronchial bleeding after transbronchial lung cryobiopsy and of post-procedural pneumothorax was 4.9% (2.2-10.7%) and 9.5% (5.9-14.9%), respectively. CONCLUSIONS: Although the diagnostic test accuracy measures of transbronchial lung cryobiopsy lag behind those of VATS, with an acceptable safety profile and potential cost savings, the former could be considered as an alternative in the evaluation of patients with diffuse parenchymal lung diseases.

Mucin-producing Malignant Tumor of Lower Eyelid Presenting in a 14-year-old Patient.

Malignancies of the ocular adnexa are rare, aggressive tumors with significant potential for local recurrence and metastases. Although basal cell carcinoma remains the most common malignancy of the eyelid, encompassing more than 90 percent of all periocular cancers, several other malignant neoplasms have been reported. Malignant ocular adnexal neoplasms are most commonly of sweat gland origin and include hidradenocarcinoma, mucinous eccrine adenocarcinoma, and apocrine adenocarcinoma of the glands of Moll. The different ocular adnexal adenocarcinomas share many of the same characteristics with regard to incidence, primary location, and rates of recurrence and metastases. As a result, these tumors are difficult to distinguish clinically and true diagnosis depends on histological findings. The highest incidence of the reported cases occurred during the sixth decade of life. The head, neck, and trunk are the most frequently reported primary locations. Ocular adnexal adenocarcinomas have a significant rate of metastasis to regional lymph nodes as well as distant sites. Standard treatment of care includes surgical excision of the tumor; however, these malignancies have a tendency to recur locally. The authors present a 14-year-old Caucasian girl with no significant past medical history who presented with a recurrent right lower eyelid tumor. She previously had multiple resections at an outside hospital; however, the margins could not be cleared. The patient was taken to the operating room for Mohs-type resection of the primary site as well as a right parotidectomy with facial nerve preservation and right modified radical neck dissection. The final pathology was consistent with a mucin-producing malignant tumor of ocular adnexa. Due to the great potential for local recurrence and metastases, the prognosis for ocular adnexal adenocarcinoma remains poor even with aggressive surgical management. The use of Mohs surgery for resection has increased as it has been linked to prolonged intervals of metastatic-free disease.

Neurotic excoriations: a diagnosis of exclusion.

Patients with psychiatric disease may use the skin as a means of communication during times of increased emotional distress. Furthermore, a high incidence of skin disorders among patients with a primary psychiatric condition, including depression, schizophrenia, and anxiety, has been demonstrated, with neurotic excoriation being one of the most commonly diagnosed. Despite the strong association and incidence of psychogenic excoriation in patients with a primary psychiatric disorder, it is important for primary care physicians and dermatologists alike to realize that these patients may have true dermatological disease. The authors present a 53-year-old woman with past medical history significant for schizophrenia, depression, hepatitis C, and diabetes mellitus type II, who was transferred from an outside hospital secondary to anemia in association with diffuse skin lesions. Although she adamantly denied self-inducing the skin lesions, she was diagnosed with neurotic excoriations by primary care and specialty care physicians on three different occasions. After a thorough workup during this admission, the patient was diagnosed with bullous pemphigoid.