A Rare Case of Acute Liver Failure Secondary to Miliary Liver Metastasis.

Acute liver failure (ALF) is a potentially fatal condition that adversely affects multiple organs and has a high mortality rate. ALF due to hepatic infiltration is rare even though it is a common place for cancer to metastasize. Patients with ALF usually present with abdominal pain and elevated liver function tests. We report a case of a 65-year-old male that developed ALF due to miliary liver metastasis of non-small cell carcinoma from an unknown primary origin. The patient initially presented with a couple of episodes of coffee-ground emesis and epigastric pain. Upon further evaluation, along with computed tomography (CT) scans and liver biopsy, the diagnosis was established. The patient passed away on the 12th day of hospitalization.

Feasibility of a virtual reality intervention in the intensive care unit.

BACKGROUND: Delirium prevention requires optimal management of pain and anxiety. Given the limitations of current pharmacologic interventions, evaluation of novel non-pharmacological interventions is required. Virtual reality (VR) stimulation may be a promising intervention because of its capability to reduce psychophysiological stress, pain, and anxiety and to restore cognitive and attentional capacities. OBJECTIVE: To ascertain patients' and providers' perceptions of acceptability and safety of VR intervention in the intensive care unit (ICU). METHODS: We enrolled a cohort of 15 ICU patients and 21 health care providers to administer a 15-minute session showing a relaxing beach scene with VR headsets and nature sound effects. Participants were then asked to rate their experiences on a Likert scale survey. RESULTS: The majority of patients (86%, 12 of 14) rated the headsets as moderately to very comfortable. All had moderate or greater sense of presence in the virtual environment, and 79% (11 of 14) rated their overall experience at 3 or greater (5 indicating that they enjoyed it very much). Seventy-one percent (10 of 14) of the patients felt that their anxiety was better with VR, and 57% (8 of 14) did not notice a change in their pain or discomfort. All health care providers found the headset to be at least moderately comfortable and felt a moderate or greater sense of presence. All providers concluded that VR therapy should be available for their patients. Both groups experienced minimal side effects. CONCLUSION: In this prospective study of perceptions of VR therapy for ICU patients and health care providers, there was a high level of acceptance, with minimal side effects, for both groups despite their low levels of prior experience with virtual reality and video gaming.

Multiple myeloma causing interstitial pulmonary infiltrates and soft-tissue plasmacytoma.

Multiple Myeloma (MM) is a relatively rare disease and MM presenting outside the bone marrow, known as extramedullary myeloma (EMM), is rarer still. While the liver and CNS are most commonly affected in EMM, the lung parenchyma is an especially unusual site of involvement. We present the case of a 64-year-old male with known history of MM admitted with acute respiratory failure and a chest wall mass. Chest CT revealed patchy interstitial and alveolar opacities with no pulmonary masses or nodules. Bronchoalveolar lavage (BAL) was performed, with flow cytometry demonstrating monoclonal plasma cells expressing CD38, CD138 and CD56 with lambda light chain restriction. Fine Needle Aspiration of chest wall mass revealed CD138-positive cells as well. Review of the literature revealed only one other documented case of a patient presenting with both interstitial lung parenchymal involvement with MM as well as soft tissue plasmacytoma, with this occurring in a patient who had previously underwent stem cell transplant. To our knowledge, we report the first recorded case of this presentation in a patient without a history of stem cell transplantation. Furthermore, it demonstrates the utility of using BAL, rather than lung biopsy, to establish the diagnosis through less invasive means.

Effects of music intervention on inflammatory markers in critically ill and post-operative patients: A systematic review of the literature.

BACKGROUND: Music listening has been shown to reduce anxiety, stress, and patient tolerance of procedures. Music may also have beneficial effects on inflammatory biomarkers in intensive care and post-operative patients, but the quality of evidence is not clear. OBJECTIVES: We conducted a systematic review to evaluate the effects of music on inflammatory biomarkers in intensive care, and post-operative patients. METHODS: A comprehensive search of the literature was performed. After screening 1570 references, full text review of 26 studies was performed. Fourteen studies were selected for inclusion. RESULTS: Seven studies showed a significant decrease in cortisol levels, but the level of evidence was low. Three studies had low risk of methodological bias, while 11 studies had high risk of bias. CONCLUSIONS: Music intervention may decrease cortisol levels, but other biomarkers remain unchanged. Given the low level of evidence, further research on music effects on inflammatory biomarkers is needed.

Prevention and treatment of influenza in the primary care office.

Influenza, a common respiratory infection, is a source of significant rates of illness, death, and loss of productivity. Annual vaccination is safe and effective in preventing disease and in reducing its severity. Yet a majority of eligible US adults do not receive the annual vaccine, at least in part because of misunderstandings about adverse reactions and clinical effectiveness.