scholarly journals The Intrinsic Differences Between Immune Checkpoint Inhibitor Induced Myocarditis: A Retrospective Analysis of Real-World Data

2022 ◽  
Author(s):  
Yanna Lei ◽  
Xiufeng Zheng ◽  
Qian Huang ◽  
Xiaoying Li ◽  
Meng Qiu ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Medical Records ◽  
Immune Checkpoint Inhibitor ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Real World Data ◽  
West China Hospital ◽  
West China ◽  
Life Threatening ◽  
The Relationship

Abstract Immune-related myocarditis is a severe and even life-threatening immune-related adverse event (irAE) which may also be under-estimated due to the challenge in diagnosis. There have been few reports about the intrinsic difference between patients with immune-associated myocarditis. A retrospective analysis was conducted between March 2019 to June 2020 in West China Hospital and 18 patients with immune-related myocarditis were studied. Cases were classified as mild (n=12) or severe myocarditis (n=6) according to the clinical manifestations and haemodynamic complications. Covariates extracted from medical records were compared in different groups, and factors associated with severe myocarditis were identified. In this retrospective analysis, the median age of the 18 patients was 60 years old. Most cases occur early and approximately after the first or second ICI infusion. The severity of myocarditis may be correlated with lactate dehydrogenase (LDH) (P=0.04) and troponin (P=0.0057). The relationship between troponin and myocarditis was further confirmed in another cohort which including 30 patients. In addition, patients are more likely to develop multi-irAEs, and myositis was the most common second irAE. Those who experience multi-irAEs had significantly higher LDH (P=0.02) as well as myoglobin levels (P=0.02) than did not experience. All patients were treated with steroids timely and the mortality rate was 5.6% in our study. In this study, we explore risk factors for severe myocarditis and we emphasized the importance of a multidisciplinary team in assisting diagnosis and treatment options. It is critical to initiate corticosteroid therapy, regardless of the severity of the myocarditis.

scholarly journals Palmoplantar psoriasis: a comparative therapeutic study

2019 ◽  
Vol 5 (4) ◽  
pp. 779
Author(s):  
Sathya Narayanan Rajendran ◽  
Sukanya Mathupal Gurusamy
Keyword(s):  
Treatment Options ◽  
Clinical Manifestations ◽  
Simple Random Sampling ◽  
Inflammatory Dermatosis ◽  
Duration Of Illness ◽  
Erythrodermic Psoriasis ◽  
Life Threatening ◽  
Group A ◽  
Group B ◽  
Therapeutic Study

<p class="abstract"><strong>Background:</strong> Psoriasis is an immunologically mediated inflammatory dermatosis presenting with extremely variable clinical manifestations ranging from indolent lesions to life threatening forms of pustular and erythrodermic psoriasis. Palmoplantar psoriasis present as hyperkeratotic scaly plaques with fissures and can be managed with different treatment forms. This study was done to compare the efficacy between topical and systemic treatment options.</p><p class="abstract"><strong>Methods:</strong> The study was conducted in a tertiary level teaching hospital after ethical committee clearance. Fifty patients with palmoplantar psoriasis were allocated into the two groups using simple random sampling. PPPASI scoring was calculated to assess the extent of involvement. Patients in Group A were prescribed calcipotriol with clobetasol propionate ointment. Group B patients were given tablet methotrexate.<strong></strong></p><p class="abstract"><strong>Results:</strong> Twenty eight patients were males M: F of 1.27: 1. Mean age was 36. Mean duration of illness was eleven months. Most of these patients were manual laborers. 32 patients had lesions over both palms and soles, 9 over palms alone and 9 involving soles alone. Mean PASI reduction at 16 weeks was seen maximum with methotrexate. Compliance was comparatively good with methotrexate than topical. Though mean PASI reduction and compliance was good, relapse rates were higher with methotrexate in our study.</p><p class="abstract"><strong>Conclusions:</strong> There was no significant change in clinico-epidemiology and presentation of palmoplantar psoriasis. Methotrexate was observed to be the more efficacious modality in treating palmoplantar psoriasis.</p>

scholarly journals Updated Cutoff Values of Basal Serum Calcitonin to Discriminate True Medullary Thyroid Cancer from Other Conditions of Hypercalcitoninemia

2021 ◽  
Author(s):  
Qianhui Liu ◽  
Xin Nie ◽  
Yong He ◽  
Guixing Li
Keyword(s):  
Thyroid Carcinoma ◽  
Disease Burden ◽  
Chronic Renal Disease ◽  
Tumor Diameter ◽  
Serum Calcitonin ◽  
West China Hospital ◽  
West China ◽  
Medullary Thyroid ◽  
Cutoff Values ◽  
The Relationship

Abstract Background Calcitonin (Ctn) is a tumor marker of medullary thyroid carcinoma (MTC). However, serum Ctn cutoff values for MTC diagnosis are still under discussion. This study aimed to identify the cutoff values of Ctn and explore the relationship between two tumor markers (Ctn and carcinoembryonic antigen (CEA)) and disease burden. Methods This was a retrospective study conducted in West China Hospital of Sichuan University. We included 61 MTC patients and 235 non-MTC patients with nonspecific elevation of Ctn (> 9.52 pg/mL for males and > 6.40 pg/mL for females) and collected patients’ demographic information, essential serological indicators, cervical ultrasound and pathological reports. Results Unlike MTC, papillary thyroid carcinoma (40.85%), uremia (18.73%), chronic renal disease (10.21%) and inflammation (8.94%) commonly occurred with hypercalcitoninemia. The Ctn cutoff values were 38.24 pg/mL for males and 26.00 pg/mL for females. The Ctn level was found to be positively related to the largest tumor diameter (r = 0.702). Serum Ctn levels were significantly higher in patients with lymph node metastasis than in those without (P < 0.05), but CEA levels did not differ (P > 0.05). Conclusion The best Ctn cutoff values for Chinese people to discriminate MTC from other hypercalcitoninemia conditions are 38.24 pg/mL for males and 26.00 pg/mL for females.

scholarly journals Risk factors for malnutrition in refractory convulsive status epilepticus

2020 ◽  
Author(s):  
Yu Zhang ◽  
Deng Chen ◽  
Li-na Zhu ◽  
ling liu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Status Epilepticus ◽  
Logistic Regression Model ◽  
Adverse Outcomes ◽  
Convulsive Status Epilepticus ◽  
Common Complication ◽  
West China Hospital ◽  
West China ◽  
The Relationship

Abstract Purpose: To study the risk factors and prognosis of malnutrition in patients with refractory convulsive status epilepticus. Methods: A total of 73 patients with refractory convulsive epileptic status in West China Hospital from January 2017 to May 2019 were collected. All patients met the 2016 International Anti-epileptic Alliance diagnostic criteria for refractory convulsive status epilepticus. A logistic regression model was used to evaluate the risk factors of malnutrition in refractory convulsive status epilepticus. Results: Of the 73 patients with refractory convulsive status epilepticus, 33 (45.21%) suffered from malnutrition during hospitalization, and hospitalization days (OR =1.251; 95% CI: 1.067-1.384; P =0.007), nasal feeding (OR =22.623; 95% CI: 1.091-286.899; P =0.013), and malnutrition on admission (OR =30.760; 95% CI: 1.064-89.797; P =0.046) were risk factors for malnutrition in patients with refractory convulsive status epilepticus. Conclusion: Malnutrition is a common complication during hospitalization in patients with refractory convulsive status epilepticus. Hospitalization days, nasal feeding, and malnutrition at admission are risk factors for malnutrition in patients with refractory convulsive status epilepticus. Further longitudinal studies are needed to identify the relationship between refractory convulsive status epilepticus and adverse outcomes.

Intralesional Electrocoagulation With Insulated Microneedle for the Treatment of Periorbital Syringomas: A Retrospective Analysis

2019 ◽  
Author(s):  
Ga Ram Ahn ◽  
Guk Jin Jeong ◽  
Jae Min Kim ◽  
Ji Yeon Hong ◽  
Kapsok Li ◽  
...  
Keyword(s):  
Adverse Event ◽  
Retrospective Analysis ◽  
Medical Records ◽  
Conventional Treatment ◽  
Treatment Options ◽  
Surface Damage ◽  
Efficacy And Safety ◽  
Level Of Evidence ◽  
Safe Treatment Option ◽  
Lesion Severity

Abstract Background Conventional treatment options for periorbital syringomas are often unsatisfactory because of inevitable surface damage from the procedure and frequent recurrence rate of the tumors. Objectives The authors sought to ascertain the efficacy and safety of intralesional electrosurgery utilizing a monopolar radiofrequency device with a single insulated microneedle for the treatment of periorbital syringomas. Methods A retrospective analysis was performed employing data from medical records, routine questionnaires, and clinical photographs of 55 patients with periorbital syringoma who underwent intralesional electrosurgery. Results Approximately one-half of the patients (50.9%) experienced marked resolution after 1 treatment. The lesion clearance rate increased and lesion severity decreased each time the treatment was repeated. No persistent therapy-related adverse event was found except transient erythema or crusting. Conclusions Intralesional electrosurgery with insulated microneedle is an effective and safe treatment option for periorbital syringomas. Level of Evidence: 4

scholarly journals Prevalence of Gastroesophageal Reflux in Infants with Recurrent Brief Apneic Episodes

1999 ◽  
Vol 6 (5) ◽  
pp. 401-404 ◽  
Author(s):  
Shahid Sheikh ◽  
Thomas C Stephen ◽  
Barbara Sisson
Keyword(s):  
Risk Factor ◽  
Gastroesophageal Reflux ◽  
Medical Records ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Acid Reflux ◽  
Diagnostic Dilemma ◽  
Esophageal Ph ◽  
Life Threatening ◽  
The Relationship

BACKGROUND: Apnea in an infant can be a diagnostic dilemma for the treating pediatrician. It is suggested that in some infants, gastroesophageal reflux (GER) might be a factor in the pathogenesis of apnea, although its role as a cause of apnea is still controversial.OBJECTIVE: To evaluate the prevalence of GER in infants presenting with recurrent brief apneic periods.PATIENTS AND METHODS: A retrospective review of the medical records of all the infants who underwent prolonged esophageal pH studies for brief apneic episodes (n=105) at the Kosair Children’s Hospital in the six years from January 1992 to December 1997 was performed. Infants presenting with apparent life-threatening episodes were excluded.RESULTS: Of 105 infants, 72 (68.6%) were younger than two months of age and 22 (21%) were born preterm. Fifty of 105 infants (47.6%) had positive esophageal pH studies for acid reflux. Among infants with positive pH studies, only 21 (42%) had associated gastrointestinal or feeding complaints.CONCLUSION: GER is present in a large number of infants presenting with brief apneic episodes. Though the relationship between the two is still not fully established, GER may be a significant risk factor for such apneic episodes in infants.

scholarly journals Classifying Hydroceles of the Pelvis and Groin: An Overview of Etiology, Secondary Complications, Evaluation, and Management

2016 ◽  
Vol 10 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Gautam Dagur ◽  
Jason Gandhi ◽  
Yiji Suh ◽  
Steven Weissbart ◽  
Yefim R. Sheynkin ◽  
...  
Keyword(s):  
Treatment Options ◽  
Clinical Manifestations ◽  
Diagnostic Techniques ◽  
Current Treatment ◽  
Serous Fluid ◽  
Secondary Complications ◽  
Appropriate Treatment ◽  
Iatrogenic Trauma ◽  
Life Threatening

Introduction: A hydrocele is defined as the pathological buildup of serous fluid in the pelvis and groin due to various etiologies such as diseases or trauma. It has distinct clinical manifestations, particularly discomfort and psychosocial distress. Understanding the anatomy, embryology, and physiology associated with hydrocele formation is crucial to understand its onset and progression. Materials and Methods: A MEDLINE® search was conducted using keywords for the relevant classification of hydrocele and its etiology, complications, sexual barriers, evaluation, and management. Results: Appropriately classifying the hydrocele as primary, secondary communicating, secondary noncommunicating, microbe-induced, inflammatory, iatrogenic, trauma-induced, tumor-induced, canal of Nuck, congenital, and giant is important for identifying the underlying etiology. Often this process is overlooked when the classification or etiology is too rare. A focused evaluation is important for this, so that timely management can be provided. We comprehensively review the classifications, etiology, and secondary complications of hydrocele. Pitfalls of current diagnostic techniques are explored along with recommended methods for accurate diagnosis and current treatment options. Conclusion: Due to the range of classifications and etiologies of hydrocele in the pelvis and groin, a deliberate differential diagnosis is essential to avoiding imminent life-threatening complications as well as providing the appropriate treatment.

scholarly journals MORPHOLOGICAL CHARACTERISTICS ANd CLINICAL MANIFESTATIONSOF THE PANCREAS dISEASES IN PATIENTS WITH VIRAL HEPATITIS

2015 ◽  
Vol 7 (2) ◽  
pp. 78-85
Author(s):  
V P Zemlanoy ◽  
A B Syngaevskiy ◽  
R S Sidorov ◽  
U V Letina ◽  
V M Labazanov
Keyword(s):  
Acute Pancreatitis ◽  
Liver Failure ◽  
Viral Hepatitis ◽  
Retrospective Analysis ◽  
Clinical Picture ◽  
Medical Records ◽  
Clinical Manifestations ◽  
Morphological Characteristics ◽  
Chronic Viral Hepatitis ◽  
Pathological Changes

The study analyzed the protocols autopsies of patients with decompensated forms of viral hepatitis. According to the autopsy 60% of patients with decompensated forms of viral hepatitis had pathological changes in the pancreas of which 2/3 were morphologically classified as acute pancreatitis. We performed retrospective analysis of medical records of patients who was found to have changes of the pancreas at autopsy. The clinical picture typical for pancreas involvment was scanty and concealed by severe clinical manifestations of decompensated liver failure due to progression of chronic viral hepatitis.

Sacrococcygeal Teratoma in the Newborn: A Case Study of Prenatal Management and Clinical Intervention

2008 ◽  
Vol 27 (3) ◽  
pp. 185-191 ◽  
Author(s):  
Kara Fadler ◽  
Debbie Fraser Askin
Keyword(s):  
Treatment Options ◽  
Clinical Manifestations ◽  
Clinical Intervention ◽  
Primitive Streak ◽  
Sacrococcygeal Teratoma ◽  
Labor Dystocia ◽  
Life Threatening ◽  
Prenatal Management ◽  
The Impact

Sacrococcygeal teratomas (SCTs) are the most common germinal cell neoplasms of the fetus and neonate. They originate during embryonic development when the primitive streak fails to differentiate among mesodermal, ectodermal, and endodermal tissues in the embryonic disc. This article discusses the fetal pathophysiology of SCTs and the impact of the condition on the newborn. Fetal SCTs can have life-threatening physiologic effects— such as premature labor, dystocia, and high-output cardiac failure—if not managed appropriately. Clinical manifestations, prenatal diagnosis, therapeutic approaches and treatment options for the fetus and newborn, and current research related to SCTs are addressed to aid practitioners caring for a fetus or infant diagnosed with an SCT.

scholarly journals Case Report: Kaposiform Hemangioendothelioma With Spinal Involvement

2021 ◽  
Vol 9 ◽  
Author(s):  
Tong Qiu ◽  
Kaiying Yang ◽  
Shiyi Dai ◽  
Siyuan Chen ◽  
Yi Ji
Keyword(s):  
Age At Onset ◽  
Clinical Manifestations ◽  
Bone Destruction ◽  
Vascular Tumor ◽  
Imaging Features ◽  
Kaposiform Hemangioendothelioma ◽  
Tissue Mass ◽  
West China Hospital ◽  
West China ◽  
Spinal Involvement

Introduction: Kaposiform hemangioendothelioma (KHE) is a rare, locally invasive vascular tumor that mostly appears in infants and adolescents. KHE with spinal involvement is extremely rare. The aim of this study was to review the imaging features, clinical manifestations and treatment of KHE patients with spinal involvement.Materials and Methods: We reviewed patients with KHE who were admitted to Pediatric Surgery of West China Hospital of Sichuan University from April 2014 to August 2020, and the cases were evaluated.Results: Seven patients with spinal involvement were enrolled in the study, including four (57.1%) males and three (42.9%) females. The age at onset ranged from 1.0 day to 4.0 years, with an average of 1.6 years. Five (71.4%) had pain due to bone destruction, three patients (42.9%) had decreased range of motion (ROM), four (57.1%) patients had scoliosis, two (28.6%) patients developed claudication, and three patients (42.9%) presented with a soft tissue mass in the neck of the back. Five patients (71.4%) had the Kasabach-Merritt phenomenon (KMP), with a minimum platelet value of 8 × 109/L. All patients were treated with sirolimus, and showed regression of the lesion and/or normalization of the hematologic parameters.Conclusion: KHE with spinal involvement is difficult to diagnose due to its rarity and variable symptoms, which need to be recognized to start early treatment. The management of KHE with spinal involvement should be performed by a multidisciplinary team. Sirolimus can improve outcomes in patients with KHE with spinal involvement.

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