Congenital cystic adenomatoid malformation is a rare pulmonary lesion that can be diagnosed prenatally by ultrasonography. This hamartomatous pulmonary mass is typically unilateral and usually involves one lobe or segment of the lung. Hamartomas are rare tumors of variable physical appearance, whose sonographic appearance is usually that of a predominantly cystic or solid mass. Typically slow growing, it is not uncommon for focal calcifications to develop. On rare occasion, hamartomas may be bilateral or involve the entire lung. Pulmonary sequestrations probably represent bronchopulmonary foregut abnormalities. Extralobar lesions are the least common overall, but are the most common form found in neonates and nearly the only form that has been detected prenatally. Sequestrations occur most commonly on the left (90%) in the posterior and basal segments. Subdiaphragmatic lesions (which account for 2.5% of bronchopulmonary foregut malformations) have been observed prenatally associated with other anomalies, including foregut abnormalities and congenital diaphragmatic hernia in 58% of cases. This form of sequestration has rarely been diagnosed prenatally. The following case report illustrates cystic adenomatoid malformation in extralobar pulmonary sequestration.
Post-traumatic stress disorder is a debilitating chronic illness that affects 6 out of 100 adults after a severe trauma. The alpha-adrenergic antagonist prazosin, which is prescribed off-label for flashbacks and nightmares due to trauma, is often continued indefinitely due to reports of symptoms returning upon discontinuation. There is no standard guidance for a trial of discontinuation of prazosin due to intolerance or side effects. In this case series, three patients are started on prazosin leading to remission of trauma-related symptoms, and symptoms continue to remit after treatment for an average of about 2 years followed by discontinuation of the medication. There are many similarities in these case reports which serve to provide guidance as to when a trial of prazosin discontinuation may be warranted.
Prazosin is an alpha-1 adrenergic receptor antagonist widely known by mental health providers for its off-label use for nightmares in patients with PTSD. Prazosin is lipophilic and crosses the blood-brain barrier to antagonize alpha-1 receptors in the central nervous system, potentially reducing autonomic arousal caused by PTSD. There have been numerous case reports describing the reduction of nightmares and daytime flashbacks due to PTSD with prazosin dosed at night and during the day, respectively. This case report illustrates the resolution of flashbacks related to chronic PTSD with prazosin dosed 3 times a day. As the half-life of prazosin is only 2 to 3 hours, even a twice daily dosing regimen may lead to breakthrough symptoms between doses. This case proposes a unique dosing strategy for prazosin and need for further research utilizing multiple daily doses of prazosin in the treatment of PTSD.
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