An unusual recurrence of adenosquamous carcinoma of the lung

Adenosquamous carcinoma of the lung is an uncommon histological variant of non-small cell lung carcinoma (NSCLC) associated with a poorer prognosis than either adenocarcinoma or squamous cell carcinoma (SCC) histological subtypes. Most adenosquamous carcinomas of the lung present with advanced disease, often with the central nervous system as a common site of metastasis. We present a case of a patient with recurrent adenosquamous carcinoma who presents with multiple cerebral metastases, with two metastatic sites composed of separate distinct histological subtypes, one adenocarcinoma and one SCC. Interestingly, both metastatic deposits were also found to harbor an L858R epithelial growth factor receptor (EGFR) point mutation in exon 21. Upon progression after craniotomy and whole brain radiotherapy, the patient achieved a radiological response with the EGFR inhibitor, erlotinib

Successful treatment of telomeropathy‐related interstitial lung disease with immunosuppression and danazol

We report the case of a 42‐year‐old female with a history of finger clubbing which improved during pregnancy, a history of unexplained hepatosplenomegaly, and subsequent non‐specific interstitial pneumonia with respiratory failure. Given a personal and family history of early greying of the hair, the peripheral blood monocyte telomere length was measured and was confirmed to b

Prevelance, types and correlates of sleep problems in head injury patients during the rehabilitation period

<i>Objectives:</i> The prevalence of sleep difficulties is high after head injury (HI). Previous research suggests that HI patients with sleep problems require longer stays in rehabilitation units and that disturbance of arousal disrupts engagement in rehabilitation activities. The present study explored the prevalence and types of sleep disorders in patients with severe HI undergoing inpatient rehabilitation and whether the presence of sleep problems affects their rehabilitation.<p></p> <i>Methods:</i> Twenty-three (n = 23) severe HI patients responded to a semi-structured clinical screening interview about their sleep–wake patterns and wore an actiwatch (an activity monitor that is associated with sleep and wakefulness) for 7 days. Participants also completed self-report measures on sleep, mood, fatigue, pain and daytime sleepiness. Information on rehabilitation variables, including frequency of aggressive behaviour, engagement in rehabilitation and level of disability was collected retrospectively from staff and rehabilitation notes.<p></p> <i>Results:</i> Fifteen participants (65.2%) had sleep problems. Of these, 10 (43.8%) met formal diagnostic criteria for a sleep disorder and in five (21.7%) no underlying cause for sleep problems was identified. Diagnosed sleep disorders in the sample comprised insomnia (21.7%), post-traumatic hypersomnia (8.7%), circadian rhythm disorder (8.7%), sleep apnoea (4.3%), periodic limb movement disorder (4.3%) and rhythmic movement disorder (4.3%). Senior rehabilitation therapists estimated sleep disturbance as interfering with the rehabilitation process in 26% of the overall research sample (n = 23). Sleep quality, assessed by self-report measures (Pittsburgh Sleep Quality Index; PSQI) was not significantly associated with rehabilitation variables (Hopkins Rehabilitation Engagement Rating Scale). Poor sleep quality (PSQI) was associated with greater anxiety (r = 0.611), fatigue (r = 0.683) and daytime sleepiness (r = 0.529).<p></p> <i>Conclusions:</i> Consistent with previous studies, sleep disorder and disturbed sleep was common in HI patients undergoing rehabilitation and was associated with anxiety, fatigue and daytime sleepiness. These findings highlight the importance of assessing and treating sleep problems in HI patients undergoing rehabilitation