resistant beta-lactamantibiotic such as ampicillin-sulbactam or piperacillin-tazobactam. Tailored intravenous antibiotic therapy should be given for at least two weeks, followed by oral therapy for two weeks or until resolution of pulmonary abscesses on CT scan. Anticoagulation is controversial and typically reserved for cases with significant thrombus exten- sion. Given the significant mortality risk and urgent need for intravenous, an increased awareness of LS is warranted. Colitis Therapeutics (6-MP, Sulfasalazine, Budesonide) Suppress Intestinal Lymphatic Smooth Muscle Tonic Contractility Implications For IBD Therapy? H. Galous, M. Al-Kofahi, D.C. Zawaieja, M. Muthuchanny, P. Von der Weid, P. Jordan, A. Sheth, F. Becker, Y. Wang, and J.S. Alexander LSU-Health Sciences Center, Shreveport Background: The lymphatic systemplays a central role in drainage of tissue inflammatory mediators. Lymphatic contractility is an important mechanism that facilitates clearance of inflammatory mediators. In IBD, depression of lymphatic contractility may intensify inflammatory responses. It is unclear how drugs used to treat IBD may influence this phenomenon, which may influence therapy for this condition. Methods: The effects of different IBD therapeutics on intestinal lymphatic smooth muscle (ILSM) tonic contrac- tion was studied using 1% collagen gel contraction system in vitro. 6-mercaptopurine (6MP), sulfasalazine (5-ASA), and budesonide were added to ILSM gels at concentra- tions similar to those used in IBD therapy. Tonic intestinal muscle contraction was monitored over four days. Percent contraction was compared between untreated cultures and drug treated gels after four days. Budesonide was used at final concentrations of 5 and 25 nM. 6-mercaptopurine was used at concentrations of 0.5, 2, and 5 ng/ml; sulfasalazine was used at a concentration of 0.2, 1.0, and 5.0ng/ml. Results: High-dose 6-MP 5 ng/ml showed a significant (37±5.6%, **p<0.01, avg/SE) suppression in contractility (day four), compared to controls (49±5.6%); 2 ng/ml 6-MP also suppressed tissue contractility (43±2.5%) but this did not reach statistical significance; 0.5 ng/ml did not suppress contraction (48±4.1%). Budesonide at low and high doses (5, 25 ng/ml) significantly suppressed contractility (43±4.2% and 42±3.6, both *p<0.05, respectively) compared to control group (50±5.2%). 5-ASA was tested at 0.2, 1.0, and 5.0 ng/ ml; we found that only 1 ng/ml significantly suppressed contractility (45±3.1%, *p<0.05) compared to control group (50±3.1%). Conclusions: While IBD therapeutics are currently used to reduce inflammation, at higher doses some may also depress lymphatic smooth muscle contractile function, which could negatively influence the export of interstitial fluid and its complement of inflammatory mediators from the IBD-inflamed intestine. This work is supported by a Department of Defense Grant Lymphatic Vascular Based Therapy in IBD (W81X-
WH-11-1-0577).
Extragonadal Germ Cell Tumor: A Rapid Grower G. Anazia, N. Jones, M. Yu, C. Billeaud, and D. Englert LSU-Health Sciences Center, New Orleans Introduction: Extragonadal germ cell tumors (EGCT), which are defined as germ cell tumors without a primary tumor in the testes, are very rare. Of the 8,000 annual cases of germ cell tumors (GCT), only 2%-5% are of extragonadal origin. Case: A 22-year-old man presented to the emergency room after acute onset of cough three days prior associated with severe weakness. On initial physical exam, he was afebrile, normotensive, in mild respiratory distress, and mildly tachypneic at 32 respirations per minute. His oxygen saturation was 98% on room air. He had decreased breath sounds and dullness to percussion on the right. Testicular examwas unremarkable. Labs were remarkable for a slight leukocytosis, mild normocytic anemia, and hypoalbumin- emia. Alpha fetoprotein (AFP) drawn on initial presentation was elevated at 860. B-hCG and CEA were within normal limits. Chest X-ray revealed complete opacification of the right hemithorax. CT of the chest with IV contrast demon- strated a large right-sided pleural effusion with right-to-left mediastinal shift and numerous heterogeneously-enhancing pleural based lesions, highly concerning for neoplasm. An ultrasound of the scrotum and testicles was obtained and showed a small left-sided hydrocele, but no masses. Tho- racentesis was performed and revealed 1,800 cc of bloody fluid, and biopsy was suggestive of either a synovial sar- coma or a poorly-differentiated germ cell tumor. One week following discharge, the patient developed increasing pain and shortness of breath. Repeat CT of the chest showed that the tumor had grown to occupy the entire right hemithorax, with shift of the mediastinal structures to the left. Due to his rapid clinical deterioration, he was intubated and started on empiric chemotherapy with etoposide, ifosfamide, and cisplatin, even before a final diagnosis was made. His tu- mor responded well to chemotherapy. Repeat biopsy was obtained and was consistent with a germ cell tumor most compatible with yolk sac origin. Discussion: Mediastinal germ cell tumors are aggres- sive, rapidly growing tumors, typically found in younger men. Standard treatment consists of platinum-based chemo- therapy, usually followed by surgical resection of residual disease. Due to their rapidity of cell growth, these tumors are typically very responsive to chemotherapy. Mojo-Induced Critical Illness (MICI): A Syndrome of Pseudo-Seizures and Multi-Organ Failure T. Eady and A. Afshinnik Ochsner Clinic Foundation, New Orleans Introduction: Synthetic cannabinoids have gained popularity for producing intoxicationwhile avoiding detec- tion on drug screens. They have undergone minimal scien-
J La State Med Soc VOL 166 March/April 2014 85
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