Dronabinol treatment of refractory nausea and vomiting related to peritoneal carcinomatosis.

Nausea and vomiting are common and often highly distressing symptoms in advanced cancer and in hospice and palliative medicine practice. Nausea and vomiting generally respond well to correction of the underlying etiology (when possible) and appropriate selection of antiemetic medication, but up to 7% of patients will have refractory symptoms. Dronabinol is extensively studied for chemotherapy-related nausea and vomiting, but there are only a few case reports of its use in nausea and vomiting unrelated to chemotherapy. We report a patient with end-stage ovarian cancer with peritoneal carcinomatosis and refractory nausea and vomiting who responded dramatically to addition of dronabinol. Dronabinol is usually well tolerated and may have several novel mechanisms of antiemetic action; further study of its scope of efficacy is warranted.

Ischemic fasciitis in an 85-year-old debilitated female.

Ischemic fasciitis is a rare reactive, non-neoplastic proliferation of atypical fibroblasts typically seen in older debilitated patients at pressure points. We describe the case of an 85-year-old female nursing home resident with a past medical history of advanced dementia and immobility who developed an enlarging nodule on the posterior aspect of her right shoulder. A needle biopsy was performed under ultrasound guidance, and the histology was consistent with ischemic fasciitis. Surgical resection of the lesion was performed and anatomical pathology was consistent with ischemic fasciitis. Ischemic fasciitis has been described in association with immobility and debilitation in elderly patients. It is usually located over a bony prominence and should be recognized and differentiated from other skin conditions, such as pressure ulcers or soft tissue sarcoma. It is diagnosed by biopsy and treated by surgical resection. A high degree of clinical suspicion and appropriate management will help to avoid delay in care and medical complications.