Bilateral adrenal haematoma complicated by adrenal insufficiency in a patient treated with bevacizumab

2021 ◽  
Vol 14 (2) ◽  
pp. e239689
Author(s):  
Cristina Smolenschi ◽  
Melodie Tazdait ◽  
Emanuelle Kuhn ◽  
Valerie Boige
Keyword(s):  
Adrenal Insufficiency ◽  
Blood Test ◽  
Adrenocorticotropic Hormone ◽  
Concurrent Chemotherapy ◽  
Favourable Outcome ◽  
Test Results ◽  
Acth Level ◽  
Dramatic Decrease ◽  
Diffuse Abdominal Pain ◽  
First Time

Bevacizumab (bev) significantly improves outcomes of patients with metastatic colorectal cancer (mCRC). However, the addition of bev to concurrent chemotherapy significantly increased the risk of haemorrhage. We describe the case of a patient with mCRC who presented with acute diffuse abdominal pain following four cycles of bev-containing systemic chemotherapy. A CT revealed the appearance of bilateral adrenal enlargement suggestive of acute adrenal haematoma. Blood test results showed a dramatic decrease in cortisol level and highly elevated Adrenocorticotropic Hormone (ACTH) level suggesting an adrenal insufficiency. After differential diagnosis, we hypothesised that bev may have contributed to the development of a bilateral adrenal haematoma complicated by adrenal insufficiency. Bev was immediately withdrawn and the patient was subsequently treated with hydrocortisone substitution with favourable outcome. This case highlights for the first time the possibility of adrenal bleeding with bev-containing chemotherapy.

scholarly journals COT-13 Current situation and problems of cancer genomic profiling test in Kyoto University Hospital

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii22-ii22
Author(s):  
Yoshiki Arakawa ◽  
Junko Suga ◽  
Yukinori Terada ◽  
Kohei Nakajima ◽  
Masahiro Tanji ◽  
...  
Keyword(s):  
Treatment Options ◽  
Insurance Coverage ◽  
Germline Mutations ◽  
University Hospital ◽  
Genomic Profiling ◽  
Test Results ◽  
Final Test ◽  
First Time ◽  
To Receive ◽  
Secondary Finding

Abstract Objective: Kyoto University Hospital has introduced the cancer genomic profiling tests, Oncoprime in 2015, Guardant360 in 2018, which are not under insurance coverage, FoundationOne CDx(F1CDx) and OncoGuide NCC Oncopanel system(NCC OP) in 2019, which received approval for insurance coverage for the first time in Japan. We investigated the results of cancer genomic profiling test under insurance coverage in our hospital. Methods: A special facility for the cancer genomic profiling tests was produced. To perform the cancer genomic profiling test, an outpatient must visit the facility three times (learning, ordering of the test, and getting the results). The expert panels decide the final test results and treatment options with the all information of the patients. Results: From November 2019 to March 2020, 51 and 9 patients were tested with F1CDx and NCC OP, respectively. 16 patients (31%) of F1CDX and 2 patients (22%) of NCC OP got treatment recommendations from the expert panels. However, only 5 patients (9.8%) of F1CDX and 1 patient (11%) of NCC OP received the treatments. The secondary finding suspecting germline mutations was found in 8 patients of F1CDX. Conclusion: After the approval the cancer genomic profiling tests with insurance coverage in Japan, it becomes easy for the patients to perform the test and get the genetic information of the tumor. However, it remains not easy to receive the recommended drugs because of several limitations of their usages.

scholarly journals Abdominal pain as an initial symptom of isolated ACTH deficiency induced by nivolumab in a patient with malignant mesothelioma

2021 ◽  
Vol 14 (7) ◽  
pp. e243093
Author(s):  
Koichi Hata ◽  
Chikara Sakaguchi ◽  
Michiko Tsuchiya ◽  
Yukio Nagasaka
Keyword(s):  
Abdominal Pain ◽  
Adverse Events ◽  
Adrenal Insufficiency ◽  
Malignant Mesothelioma ◽  
Adrenocorticotropic Hormone ◽  
Hormone Deficiency ◽  
Initial Symptom ◽  
Isolated Acth Deficiency ◽  
Wide Range ◽  
Isolated Adrenocorticotropic Hormone Deficiency

Used for a wide range of cancers, nivolumab has been reported to cause immune-related adverse events, including isolated adrenocorticotropic hormone deficiency (IAD). We report an 81-year-old woman with malignant mesothelioma who presented with abdominal pain after eight courses of nivolumab therapy, leading to the diagnosis of nivolumab-induced IAD. We should consider adrenal insufficiency (AI) when a patient on nivolumab complains of abdominal pain and has no other explanatory findings. Infusion-resistant hypotension and hyponatraemia can further suggest AI.

Improving the Strength of Abrasive Wheels and Optimizing the Control over the Strength of Composite Abrasive Materials

2019 ◽  
Vol 946 ◽  
pp. 380-385
Author(s):  
Boris A. Chaplygin ◽  
Viacheslav V. Shirokov ◽  
Tat'yana A. Lisovskaya ◽  
Roman A. Lisovskiy
Keyword(s):  
Mechanical Properties ◽  
Test Results ◽  
Key Factors ◽  
Special Equipment ◽  
Material Density ◽  
Factors Affecting ◽  
Control Factors ◽  
Reinforcing Material ◽  
Special Studies ◽  
First Time

The strength of abrasive wheels is one of the key factors affecting the performance of abrasive machining. The paper discusses ways to improve the strength of abrasive wheels. The stress-state mathematical model presented herein is a generalization of the existing models. It is used herein to find for the first time that there are numerous optimal combinations of the elastic modulus and reinforcing material density, which result in the same minimum value of the objective function. It is found out that increasing the radius of the reinforcing component while also optimizing the mechanical properties of its material may increase the permissible breaking speed of the wheel several times. We herein present a regression equation and a nomogram for finding the optimal combination of control factors. Conventional methods for testing the mechanical properties of materials, which have been proven reliable for testing metals and alloys, are not as reliable for testing abrasive materials, as the test results they generate are not sufficiently stable or accurate. We therefore propose an alternative method that does not require any special equipment or special studies.

scholarly journals The use of routine blood tests to assist the diagnosis of COVID-19 in symptomatic hospitalized patients

2021 ◽  
pp. 000456322199907
Author(s):  
IT Parsons ◽  
AT Parsons ◽  
E Balme ◽  
G Hazell ◽  
R Gifford ◽  
...  
Keyword(s):  
Cell Count ◽  
Retrospective Review ◽  
Blood Test ◽  
Patient Flow ◽  
White Cell Count ◽  
Area Under The Curve ◽  
White Cell ◽  
Test Results ◽  
Rt Pcr ◽  
Blood Tests

Introduction Specific patterns of blood test results are associated with COVID-19 infection. The aim of this study was to identify which blood tests could be used to assist in diagnosing COVID-19. Method A retrospective review was performed on consecutive patients referred to hospital with a clinical suspicion of COVID-19 over a period of four weeks. The patient’s clinical presentation and severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction (SARS-CoV-2 RT-PCR) were recorded. The patients were divided by diagnosis into COVID (COVID-19 infection) or CONTROL (an alternate diagnosis). A retrospective review of consecutive patients over a further two-week period was used for the purposes of validation. Results Overall, 399 patients (53% COVID, 47% CONTROL) were analysed. White cell count, neutrophils and lymphocytes were significantly lower, while lactate dehydrogenase and ferritin were significantly higher, in the COVID group in comparison to CONTROL. Combining the white cell count, lymphocytes and ferritin results into a COVID Combined Blood Test (CCBT) had an area under the curve of 0.79. Using a threshold CCBT of –0.8 resulted in a sensitivity of 0.85 and a specificity of 0.63. Analysing this against a further retrospective review of 181 suspected COVID-19 patients, using the same CCBT threshold, resulted in a sensitivity of 0.73 and a specificity of 0.75. The sensitivity was comparable to the SARS-CoV-2 RT PCR. Discussion Mathematically combining the blood tests has the potential to assist clinical acumen allowing for rapid streaming and more accurate patient flow pending definitive diagnosis. This may be of particular use in low-resource settings.

Predicting abnormal laboratory blood test results in the intensive care unit using novel features based on information theory and historical conditional probability (Preprint)

2021 ◽  
Author(s):  
Camilo E. Valderrama ◽  
Daniel J. Niven ◽  
Henry T. Stelfox ◽  
Joon Lee
Keyword(s):  
Machine Learning ◽  
Intensive Care ◽  
Conditional Probability ◽  
Blood Test ◽  
Laboratory Tests ◽  
Conditional Entropy ◽  
Admission Diagnosis ◽  
Test Results ◽  
Abnormal Laboratory ◽  
Blood Tests

BACKGROUND Redundancy in laboratory blood tests is common in intensive care units (ICU), affecting patients' health and increasing healthcare expenses. Medical communities have made recommendations to order laboratory tests more judiciously. Wise selection can rely on modern data-driven approaches that have been shown to help identify redundant laboratory blood tests in ICUs. However, most of these works have been developed for highly selected clinical conditions such as gastrointestinal bleeding. Moreover, features based on conditional entropy and conditional probability distribution have not been used to inform the need for performing a new test. OBJECTIVE We aimed to address the limitations of previous works by adapting conditional entropy and conditional probability to extract features to predict abnormal laboratory blood test results. METHODS We used an ICU dataset collected across Alberta, Canada which included 55,689 ICU admissions from 48,672 patients with different diagnoses. We investigated conditional entropy and conditional probability-based features by comparing the performances of two machine learning approaches to predict normal and abnormal results for 18 blood laboratory tests. Approach 1 used patients' vitals, age, sex, admission diagnosis, and other laboratory blood test results as features. Approach 2 used the same features plus the new conditional entropy and conditional probability-based features. RESULTS Across the 18 blood laboratory tests, both Approach 1 and Approach 2 achieved a median F1-score, AUC, precision-recall AUC, and Gmean above 80%. We found that the inclusion of the new features statistically significantly improved the capacity to predict abnormal laboratory blood test results in between ten and fifteen laboratory blood tests depending on the machine learning model. CONCLUSIONS Our novel approach with promising prediction results can help reduce over-testing in ICUs, as well as risks for patients and healthcare systems. CLINICALTRIAL N/A

Ambient vibration test results of the Imperial County Services Building

1983 ◽  
Vol 73 (6A) ◽  
pp. 1895-1902
Author(s):  
Gerard C. Pardoen
Keyword(s):  
Strong Motion ◽  
Ambient Vibration ◽  
Vibration Test ◽  
Test Results ◽  
Structural Failure ◽  
Imperial Valley ◽  
Ambient Vibration Test ◽  
Significant Interest ◽  
First Time ◽  
County Services

Abstract The ambient vibration test results conducted on the Imperial County Services Building prior to the 15 October 1979 Imperial Valley earthquake are summarized. These results are of significant interest because the Imperial County Services Building has been the source of many postearthquake investigations due to the fact that the 1979 earthquake represented the first time a building instrumented with strong motion recorders suffered and recorded the major structural failure.

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