scholarly journals 123 Gemcitabine-related radiation recall as a cause of focal myositis and muscle necrosis

2019 ◽  
Vol 90 (e7) ◽  
pp. A40.1-A40
Author(s):  
Sean Byrnes
Keyword(s):  
Palliative Radiotherapy ◽  
Radiation Recall ◽  
Post Contrast ◽  
Immune Mediated ◽  
Cutaneous Tissue ◽  
Muscle Necrosis ◽  
History Of ◽  
Contrast Ct ◽  
Ct And Mri

IntroductionRadiation recall is a phenomenon in which chemotherapy triggers an inflammatory response in tissue previously subjected to radiation therapy. A wide variety of agents have been implicated. Cutaneous tissue is most frequently affected but other tissue can be involved; myositis has been associated with administration of gemcitabine in particular. Incidence has been estimated at less than 6% and the pathophysiology is not understood. We present a case report from Gosford Hospital, with the additional feature of positive SRP antibodies.CaseA 74 year old female presented with a one day history of left hip pain and inability to weight bear. She had been diagnosed with metastatic squamous cell carcinoma of the lung five months earlier and underwent palliative radiotherapy to a left acetabular metastasis. 12 days prior to presentation she completed her second cycle of chemotherapy with carboplatin and gemcitabine. Pre- and post-contrast CT and MRI demonstrated necrosis in left sartorius, with foci of myositis in other muscles of the thigh, and surrounding soft tissue oedema. Symptoms improved after chemotherapy was ceased. Myositis antibody studies subsequently revealed low level positive Ku and SRP antibodies.ConclusionRadiation recall should be considered in the differential diagnosis of myositis in oncology patients. The serum of our patient contained SRP antibodies, which are associated with immune mediated necrotising myopathy. A previous case study reported gemcitabine-induced radiation recall muscle necrosis associated with dermatomyositis. These findings hint that radiation recall myositis may occur in the setting of a predisposition to immune mediated myopathy.

scholarly journals SUN-192 Spontaneous Adrenal Hemorrhage in a Patient with Antiphospholipid Syndrome on Rivaroxaban: A Potentially Fatal Complication

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Daniela Maria DiCenso ◽  
Carlos A Penaherrera ◽  
Alejandro Ayala
Keyword(s):  
Antiphospholipid Syndrome ◽  
Adrenal Glands ◽  
Oral Anticoagulants ◽  
Adrenal Hemorrhage ◽  
Post Contrast ◽  
Severe Fatigue ◽  
Bilateral Adrenal Hemorrhage ◽  
Intravenous Hydration ◽  
History Of ◽  
Contrast Ct

Abstract Introduction: Primary Adrenal insufficiency is an uncommon complication of antiphospholipid syndrome, with an incidence of 0.4% [2]. It is often secondary to bilateral adrenal hemorrhage. We present a case of bilateral adrenal hemorrhage in a patient with APLS on anticoagulation with rivaroxaban. Case: 46-year-old m with a history of antiphospholipid syndrome, recently transitioned from warfarin to rivaroxaban for anticoagulation, who presented to the ED after a syncopal episode following a prior episode of abdominal pain with an unremarkable work-up. He subsequently developed severe fatigue, dizziness, headaches, nausea and 15 lbs weight loss. On presentation, the patient was hypotensive(72/45 mmHg) and tachycardic. Intravenous hydration was started with minimal response. Initial laboratory testing showed serum sodium of 121mmol/L, potassium of 5.5mmol/L and random cortisol of 0.8mcg/dL. The patient was admitted to the intensive care unit where he was started on vasopressors and hydrocortisone 50 mg IV every 8 hours. A non-contrast CT of the abdomen and pelvis showed thickening of the adrenal glands with decreased attenuation. MRI of the abdomen showed hyper-intensity of the adrenal glands bilaterally (T1 images), without post-contrast enhancement suggestive of bilateral adrenal hemorrhage. His electrolytes normalized, and he was successfully discharged home on hydrocortisone and fludrocortisone replacement with outpatient follow-up. Discussion: Atraumatic bilateral adrenal hemorrhage is rare, but remains one of the most common endocrine-related complications of antiphospholipid syndrome (APLS). The venous anatomical configuration of the adrenal gland increases risk of thrombotic hemorrhagic infarction[1]. Patients with APLS are commonly anticoagulated to prevent thrombosis. The ideal anticoagulation regimen remains controversial. Only three other cases of spontaneous bilateral adrenal hemorrhage on patients with APLS using new oral anticoagulants (NOACs) were reported. The use of NOACs seem to increase the already-elevated risk of adrenal hemorrhage seen in patients with APLS. References: 1. Aldaajani, H. et al. Bilateral adrenal hemorrhage in antiphospholipid syndrome: Anticoagulation for the treatment of hemorrhage. Saudi Med J. 2018; 39(8): 829-833. 2. Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome: Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002;46:1019-27.

scholarly journals Statin-induced anti-HMGCR antibody-related immune-mediated necrotising myositis achieving complete remission with rituximab

2019 ◽  
Vol 12 (11) ◽  
pp. e232406 ◽  
Author(s):  
Wenwen Zhang ◽  
Henry Miles Prince ◽  
Katrina Reardon
Keyword(s):  
Creatine Kinase ◽  
Complete Remission ◽  
Antibody Level ◽  
Immunosuppressive Agents ◽  
Immunosuppressive Treatment ◽  
Current Treatment ◽  
Immune Mediated ◽  
Immunosuppressive Medications ◽  
Muscle Necrosis ◽  
History Of

Statin-induced immune-mediated necrotising myopathy (IMNM) is a rare but increasingly recognised myositis. Many cases have positive antibodies to 3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR). The current treatment is ceasing the statin, but often immunosuppressive therapy is required as the antibodies persist, causing muscle necrosis. Despite the use of immunosuppressive medications, most commonly prednisolone, methotrexate, plasma exchange and/or intravenous immunoglobulin, some patients do not respond. We report the successful treatment with rituximab therapy for three patients with IMNM with positive anti-HMGCR antibodies. All three patients with statin-induced IMNM were elderly, with a disease history of 7–9 years, and had failed several immunosuppressive agents. They responded well to rituximab (induction and maintenance) therapy. They remain in remission with no symptoms and normal creatine kinase. One patient had normalisation of anti-HMGCR antibody level, and one patient’s antibody level reduced significantly. Rituximab is an effective immunosuppressive treatment for patients with refractory IMNM.

Press Propaganda and Subaltern Agents of Pan-Islamic Networks in the Muslim Mediterranean World prior to World War I

2018 ◽  
Author(s):  
Odile Moreau
Keyword(s):  
Middle East ◽  
World War I ◽  
North Africa ◽  
World War ◽  
Subaltern Studies ◽  
Resistance Movements ◽  
The Press ◽  
Mediterranean World ◽  
History Of

This chapter explores movement and circulation across the Mediterranean and seeks to contribute to a history of proto-nationalism in the Maghrib and the Middle East at a particular moment prior to World War I. The discussion is particularly concerned with the interface of two Mediterranean spaces: the Middle East (Egypt, Ottoman Empire) and North Africa (Morocco), where the latter is viewed as a case study where resistance movements sought external allies as a way of compensating for their internal weakness. Applying methods developed by Subaltern Studies, and linking macro-historical approaches, namely of a translocal movement in the Muslim Mediterranean, it explores how the Egypt-based society, al-Ittihad al-Maghribi, through its agent, Aref Taher, used the press as an instrument for political propaganda, promoting its Pan-Islamic programme and its goal of uniting North Africa.

Turning Aliens into Socialists

2010 ◽  
Vol 1 (1) ◽  
pp. 75-93
Author(s):  
Jessica Moberg
Keyword(s):  
Outer Space ◽  
The United States ◽  
Second World War ◽  
World War ◽  
History Of ◽  
Swedish History ◽  
Second World ◽  
The Universe ◽  
Highly Evolved

Immediately after the Second World War Sweden was struck by a wave of sightings of strange flying objects. In some cases these mass sightings resulted in panic, particularly after authorities failed to identify them. Decades later, these phenomena were interpreted by two members of the Swedish UFO movement, Erland Sandqvist and Gösta Rehn, as alien spaceships, or UFOs. Rehn argued that ‘[t]here is nothing so dramatic in the Swedish history of UFOs as this invasion of alien fly-things’ (Rehn 1969: 50). In this article the interpretation of such sightings proposed by these authors, namely that we are visited by extraterrestrials from outer space, is approached from the perspective of myth theory. According to this mythical theme, not only are we are not alone in the universe, but also the history of humankind has been shaped by encounters with more highly-evolved alien beings. In their modern day form, these kinds of ideas about aliens and UFOs originated in the United States. The reasoning of Sandqvist and Rehn exemplifies the localization process that took place as members of the Swedish UFO movement began to produce their own narratives about aliens and UFOs. The question I will address is: in what ways do these stories change in new contexts? Texts produced by the Swedish UFO movement are analyzed as a case study of this process.

Paranasal Sinus Mucocele Clinical, imagistic and biochemical aspects

2018 ◽  
Vol 69 (8) ◽  
Author(s):  
Doina Vesa ◽  
Cristian Martu ◽  
Razvan Leata ◽  
Ludmila Lozneanu ◽  
luminita Radulescu ◽  
...  
Keyword(s):  
Facial Asymmetry ◽  
Retrospective Case ◽  
Mri Scans ◽  
The One ◽  
Ethmoid Sinuses ◽  
Retrospective Case Study ◽  
Cellular Components ◽  
Ct And Mri

Paranasal mucoceles are a type of cysts that evolve slowly and are asymptomatic; this poses a difficulty in diagnosing the patient because the symptoms can go unnoticed. The mucocele evolves unpredictably. On the one hand, it can become infected turning into pyoceles and on the other hand, it can invade important regions such as the orbital, cranial or genian regions, creating facial asymmetry. This is a retrospective case study of 37 patients diagnosed with sinus mucoceles, followed up by clinical examination and paraclinical tests such as CT and MRI scans. The biochemical components of the liquid from within the mucocele were analyzed and the following criteria were recorded: NaCl-, Cl-, Na+ and cholesterine as well as cellular components such as mastocytes, macrophages, hematocytes and leucocytes. In all cases, the treatment option was surgery with favorable post-operative and follow-up evaluation. The mucoceles that appeared post-operatively (maxillary and ethmoid sinuses) evolved more rapidly than the mucoceles that were induced byan external injury. Longer follow-up of operated patients permitted a more timely diagnosis of recurrences.

A Case Study on the Process of Creating Interests in History of History-Deokhu

2019 ◽  
Vol 58 (1) ◽  
pp. 147-159
Author(s):  
Young-Seok Seo ◽  
Bong-Seok Kim
Keyword(s):  
History Of

Scales and Units

2018 ◽  
Author(s):  
Kathryn M. de Luna
Keyword(s):  
Language Change ◽  
Historical Linguistics ◽  
Bantu Languages ◽  
The North ◽  
First Case ◽  
Linguistic Evidence ◽  
River Region ◽  
History Of ◽  
Alternative Approaches

This chapter uses two case studies to explore how historians study language movement and change through comparative historical linguistics. The first case study stands as a short chapter in the larger history of the expansion of Bantu languages across eastern, central, and southern Africa. It focuses on the expansion of proto-Kafue, ca. 950–1250, from a linguistic homeland in the middle Kafue River region to lands beyond the Lukanga swamps to the north and the Zambezi River to the south. This expansion was made possible by a dramatic reconfiguration of ties of kinship. The second case study explores linguistic evidence for ridicule along the Lozi-Botatwe frontier in the mid- to late 19th century. Significantly, the units and scales of language movement and change in precolonial periods rendered visible through comparative historical linguistics bring to our attention alternative approaches to language change and movement in contemporary Africa.

Case Study: Rome's House of Memory and History: The Politics of Memory and Public Institutions

2012 ◽  
Author(s):  
Alessandro Portelli
Keyword(s):  
Oral History ◽  
Cultural Policy ◽  
Public Institutions ◽  
Politics Of Memory ◽  
Political Events ◽  
History Of ◽  
Ambitious Program ◽  
The City

This article centers around the case study of Rome's House of Memory and History to understand the politics of memory and public institutions. This case study is about the organization and politics of public memory: the House of Memory and History, established by the city of Rome in 2006, in the framework of an ambitious program of cultural policy. It summarizes the history of the House's conception and founding, describes its activities and the role of oral history in them, and discusses some of the problems it faces. The idea of a House of Memory and History grew in this cultural and political context. This article traces several political events that led to the culmination of the politics of memory and its effect on public institutions. It says that the House of Memory and History can be considered a success. A discussion on a cultural future winds up this article.

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