Reducing inappropriate inpatient thrombophilia testing through an electronic health record intervention.

Current literature does not support routine testing for hereditary and acquired thrombophilia disorders in the inpatient setting. Testing in the acute setting rarely changes patient management or could lead to patient mismanagement. Despite prior educational interventions, continued overuse of inpatient testing warrants further quality improvement measures.

Locally Advanced Inflammatory Myofibroblastic Tumor Treated With Targeted Therapy: A Case Report and Literature Review.

Inflammatory myofibroblastic tumors (IMTs) are known to be associated with anaplastic lymphoma kinase (ALK) gene rearrangements. Other molecular alterations such as ROS proto-oncogene 1, receptor tyrosine kinase (ROS1), neurotrophic tyrosine receptor kinase (NTRK), and platelet-derived growth factor receptor (PDGFR) have also been identified in IMTs. Although there are no randomized controlled clinical trials comparing chemotherapy, tyrosine kinase inhibitors (TKIs), or other systemic therapies, the literature demonstrates the use of ALK-targeted TKIs as an effective strategy for the treatment of locally advanced or metastatic ALK-rearranged IMTs.

Effect of repeat manual blood pressure measurement on blood pressure and stage of hypertension.

Hypertension management guidelines are influenced by clinical trials that utilize automated office blood pressure (BP) to measure BP. Many primary care clinics still use manual office BP, which has been shown to produce significantly higher BP values than automated office BP. In a primary care office, a manual BP was obtained by nursing staff using an aneroid sphygmomanometer.

Cetirizine versus diphenhydramine in the prevention of chemotherapy-related hypersensitivity reactions.

Objective: This study evaluated the role of cetirizine compared to diphenhydramine as premedications for patients receiving paclitaxel, cetuximab, and rituximab infusions. Historically, diphenhydramine has been linked with more sedation in comparison to cetirizine; however, it is unknown if cetirizine can replace diphenhydramine in the prevention of hypersensitivity reactions in patients receiving chemotherapy.

Methods: This is a retrospective study designed to assess infusion reactions occurring in patients receiving diphenhydramine or cetirizine premedication for rituximab, paclitaxel, or cetuximab therapies.

From skin to spontaneous lysis: A case of spontaneous tumor lysis syndrome in metastatic melanoma.

Tumor lysis syndrome is a life-threatening complication that often occurs after administration of cytotoxic therapy, but rarely occurs spontaneously without chemotherapy. This vignette describes a 59-year-old male with known extensive metastatic melanoma who presented to the hospital with spontaneous tumor lysis syndrome. Most spontaneous tumor lysis cases occur in patients with acute leukemias and aggressive lymphomas; however, this rare case depicts a patient with melanoma developing tumor lysis before the administration of chemotherapy.

Bile duct lymphoma disguised as cholangiocarcinoma.

We present a case of intrabiliary primary B-cell lymphoma masked as a cholangiocarcinoma in an HIV-positive patient. The two entities have similar symptoms, laboratory findings, and imaging findings but require very different treatments. The case highlights the need to confirm the diagnosis by biopsy.

Melanoma to the heart.

Malignant melanoma is the third most common skin cancer yet has the highest mortality rate due to its predilection for metastasis. While the diagnosis of antemortem melanoma with cardiac metastasis is relatively uncommon, diagnosing malignant melanoma itself by first identifying a cardiac metastasis is even more rare. This vignette describes an antemortem diagnosis of melanoma in a 50-year-old woman through identification of metastasis to multiple sites, including the tricuspid valve.