Spontaneous Tumor Lysis Syndrome Secondary to Metastatic Pancreatic Adenocarcinoma

Spontaneous tumor lysis syndrome (STLS) secondary to metastatic pancreatic adenocarcinoma is a rare clinical phenomenon. An 86-year-old woman with a history of pancreatic cysts presented to the emergency department with progressive fatigue, transaminitis, elevated lactate dehydrogenase, and acute kidney injury of unclear etiology. Abdominal imaging and celiac lymph node biopsy were consistent with metastatic pancreatic adenocarcinoma. Her clinical status deteriorated requiring intensive care unit transfer, and her laboratory results were found to be consistent with STLS. Despite treatment, she entered multisystem organ failure and died shortly after. This case adds to the literature of STLS in pancreatic adenocarcinomas.

Health in occupants of energy efficient new homes

A prospective telephone-administered questionnaire study in new home occupants compared general and respiratory health at occupancy and 1 year later in two groups. The test group or cases, was 52 R-2000(TM) homes (128 occupants) built to preset and certified criteria for energy efficient ventilation and construction practices. The control group were 53 new homes (149 occupants) built in the same year in the same geographic area and price range. Analyzed by household, case occupants' summative symptom scores improved significantly over the year of occupancy (Wilcoxon rank sum test, P < 0.006). Analysis of variance of individuals' total symptom scores showed a significant effect of the type of house (P < 0.0001), with lower change of scores in case buildings, but not of age or sex. In comparison with control homes, occupants of case homes reported more improvement in throat irritation (P < 0.004), cough (P < 0.002), fatigue (P < 0.009) and irritability (P < 0.002) with the main change in symptom category being from 'sometimes' to 'never'. Further extension of this pilot study is required to determine if these perceived health benefits are reproducible and/or relate to objective indoor air quality measures.

PRACTICAL IMPLICATIONS

New occupants of energy efficient homes with heat recovery ventilators report improvement over 1 year in the symptoms of throat irritation, cough, fatigue, and irritability in comparison with control new home occupants. If this pilot study is reproducible and shown to relate to indoor air quality, prospective new home buyers may be interested in obtaining this health information prior to decision making.