Fentanyl is a potent opioid analgesic used in the treatment of pain. Transdermal fentanyl patches are now widely utilized as an acceptable and efficacious method of medication delivery. Unfortunately, the potential for their abuse is well recognized. Previous case reports have documented deaths after intravenous (IV) misuse of fentanyl which had been extracted from Duragesic (liquid reservoir type) patches. We present a case of IV fentanyl abuse after the extraction from a Mylan (matrix type) patch. This method of abuse has not previously been described in the literature.

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We present the case of a 67-year-old man who presented to our hospital with acute shortness of breath. He was initially treated for a presumed infective exacerbation of chronic obstructive pulmonary disease (COPD) but did not respond to standard therapy. Further investigations were performed and revealed a large pulmonary vein thrombus. Clinical, laboratory, and radiological investigation did not identify an underlying cause for his thrombus. Idiopathic pulmonary vein thrombosis is much rarer than the more well-known pulmonary embolism and is worthy of consideration as an uncommon cause of pulmonary decline. To our knowledge, this is the first case report in the English literature of idiopathic pulmonary vein thrombus occurring in the setting of known COPD.

BackgroundPhaeochromocytomas (PCC) and paragangliomas (PGL; together PPGL) are rare tumours of the adrenal medulla or extra‐adrenal paraganglia. They may secrete catecholamines with significant cardiovascular effects. Management of PPGL is predominantly surgical, despite the anaesthetic risks related to potential haemodynamic instability. Meticulous pre‐treatment and intra‐operative management are required to improve cardiovascular outcomes.AimsThere are limited local data regarding the incidence of PPGL and the clinical characteristics of individuals diagnosed with these tumours in New Zealand. We undertook a retrospective study investigating the local practice and patient characteristics with an additional focus on intra‐operative haemodynamic stability and post‐operative outcomes.MethodsElectronic patient records were searched for individuals with a diagnosis of PPGL. Clinical records and electronic databases were interrogated for pre‐operative, intra‐operative and post‐operative data points. Particular attention was paid to rates and types of germline mutations, intra‐operative haemodynamic stability and post‐operative renal and cardiovascular outcomes.ResultsWe identified 49 individuals with PPGL, of whom 34 were from the local area. This gave a local incidence of PPGL of around five cases per million people per year. Māori were significantly over‐represented in our cohort, with this being in part due to high rates of the SDHB R46Q mutation.Over 95% of our cohort met pre‐specified pre‐operative blood pressure parameters. Intra‐operative monitoring revealed a tendency to hypotension, but this did not translate into adverse post‐operative outcomes, which were infrequent.ConclusionsMāori were over‐represented due to high rates of germline SDHB R46Q mutations. There were few post‐operative adverse outcomes in this contemporary cohort.

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