RESUMEN
We report a rare case of a lung adenocarcinoma presenting with chylothorax and metastases to the common bile duct and the rectum. From the radiological and endoscopic appearance of the tumors, the main differential diagnoses were metastatic lung cancer to multiple rare extra-thoracic sites and multiple synchronous primary oncological malignancies. Pathological examination of the biopsies with positive immunohistochemical staining for thyroid transcription factor-1 (TTF-1) played an important role in confirming metastatic pulmonary adenocarcinoma.
Asunto(s)
Adenoma/diagnóstico por imagen , Adenoma/patología , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/patología , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/patología , Adenoma/cirugía , Anciano , Humanos , Hipercalcemia/etiología , Hiperparatiroidismo/etiología , Masculino , Neoplasias del Mediastino/cirugía , Neoplasias de las Paratiroides/cirugía , Tomografía de Emisión de Positrones , Radiofármacos , Tecnecio Tc 99m Sestamibi , Timectomía , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Polypharmacy is very common in the psychiatric setting despite the lack of evidence to justify its use. The objective of this study was to review the prescription patterns in a tertiary mental health institute in Asia and evaluate the impact of a treatment algorithm for patients with first-episode psychosis (FEP) on the use of polypharmacy. MATERIALS AND METHODS: A treatment algorithm was implemented for patients accepted into an Early Psychosis Intervention Programme (EPIP) and the prescription patterns of these patients were compared with a comparator group (pre-EPIP) before the use of the algorithm. The prescribing pattern was established at 2 points: at baseline after the diagnosis was made, and 3 months later. RESULTS: There were 68 subjects in the comparator group and 483 EPIP patients; the latter were on the average younger. None in the comparator group was diagnosed to have an affective psychosis. There was a significant reduction in the rate of antipsychotic polypharmacy, prolonged use of benzodiazepines and anticholinergic medication in EPIP patients. This group also had an increase in the use of second-generation antipsychotics and received lower doses of antipsychotics. CONCLUSION: The implementation of a treatment algorithm coupled with audit has changed the trend towards polypharmacy among patients with FEP.