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.
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.
A 61-year-old man was admitted to an outside medical facility with left leg deep vein thrombosis and bilateral pulmonary emboli. His clinical course was complicated by hypotension, azotemia and declining mental status. Positive blood cultures for gram-positive cocci prompted transfer to our institution. Despite broad-spectrum antibiotics (vancomycin, cefepime, and ciprofloxacin), the patient remained febrile (temperature 39.4°C) with persistent leukocytosis. An echocardiogram revealed no valvular vegetations. Bacteremia persisted with methicillin-sensitive Staphylococcus aureus despite antimicrobial therapy. In the absence of a clear source of infection, an indium-111labeled white blood cell (WBC) scan was performed, revealing radiotracer enhancement of the left popliteal, femoral, and common femoral veins (Panels A and B) corresponding to thrombus location as assessed by ultrasound (Panels C and D). Radiotracer uptake within these
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.
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