From Dyspepsia to Diagnosis: A Rare Gastric Subepithelial Lesion Definitively Diagnosed via Endoscopic Submucosal Dissection and Immunohistochemistry.

INTRODUCTION: Peripheral nerve sheath tumors, known as perineuriomas, are typically found on the trunk and extremities. They are less commonly described in the gastrointestinal tract (GI), and extremely rarely are described in the stomach. CASE PRESENTATION: We present a case of a 2-cm gastric perineurioma in a 42-year-old patient with nonspecific GI complaints of chronic dyspepsia and epigastric discomfort. Esophagogastroduodenoscopy, followed by endoscopic ultrasound, revealed a 2-cm umbilicated lesion in the stomach, which was subsequently removed with endoscopic submucosal dissection and sent for pathology. Immunohistochemical staining revealed a rare entity known as a gastric perineurioma. CONCLUSION: Since the first case of gastric perineurioma was first described in 2004, there have only been 4 reported cases in the English literature. This case highlights the crucial interdisciplinary multidisciplinary effort between pathologists and GI specialists required to reach this diagnosis and showcases endoscopic diagnosis using endoscopic dissection, which allows for complete lesion resection and complete resolution of the patient's symptoms.

Effects of Length of Vasopressors Infusion on Mortality.

Background There has been a myriad of studies into the physiology of vasopressors and the survival benefit of vasopressor initiation in cases of septic shock. The aim of the Effects of Length of Vasopressors Infusion on Mortality (ELVI-Mortality) study is to observe a relationship between the length of vasopressor infusion and mortality in the intensive care unit. Methods This was a single-center, retrospective, matched-cohort study that collected data from Arrowhead Regional Medical Center's electronic medical records (EMR; MediTech, MA, US) using International Classification of Diseases, Tenth Revision (ICD-10) coding and a chart reviewing the past five years. Patients were on norepinephrine, phenylephrine, or epinephrine. Two patient groups were compared. The first group encompassed those with vasopressor infusion less than 48 hours in duration, whereas the second group included those with vasopressor infusion greater than 48 hours. Results A total of 193 patients were diagnosed as having septic shock. Participant data were obtained for 163 patients (84.4%). Of the 106 patients who had a vasopressor duration of less than 48 hours, 32 patients (30.2%) expired. Of the 57 patients that had more than 48 hours of vasopressor infusion, 18 patients (31.6%) expired. Conclusions There was no statistically significant increase in mortality in patients with vasopressor infusion greater than 48 hours as compared to less than 48 hours.