scholarly journals A rare case of pancreatic adenocarcinoma and subsequent metastatic insulinoma causing severe hypoglycemia

2016 ◽  
Vol 3 (4) ◽  
pp. 22
Author(s):  
Josephine H. Li ◽  
Catherine J. Tang ◽  
James V. Hennessey
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Pancreatic Head ◽  
Severe Hypoglycemia ◽  
Laboratory Evaluation ◽  
High Dose ◽  
Biochemical Studies ◽  
Hepatic Lesions ◽  
Octreotide Scan ◽  
The Right ◽  
Beta Hydroxybutyrate

Objective: To report an unusual case of concurrent pancreatic adenocarcinoma and metastatic insulinoma causing severehypoglycemia in a patient with diabetes.Methods: The clinical presentation, biochemical studies, and relevant imaging of this patient are presented and the pertinentliterature is reviewed.Results: A 59-year-old man with a history of unresectable pancreatic adenocarcinoma and diabetes was admitted for persistenthypoglycemia, meeting all criteria for Whipple’s triad and requiring high-dose dextrose infusion. Prior outpatient abdominalimaging had revealed hepatic lesions that were biopsied and found to be a high-grade neuroendocrine carcinoma. On admission, laboratory evaluation revealed inappropriately suppressed beta-hydroxybutyrate levels, and inappropriately elevated insulin, C-peptide, and proinsulin levels. An octreotide scan revealed uptake in the hepatic lesions but not in the pancreatic head mass. Immunohistochemistry staining of prior liver biopsy samples was negative for insulin. Diazoxide therapy was initiated, butdiscontinued after the onset of hypotension. The hypoglycemia resolved only after trans-arterial chemoembolization of lesionsboth in the left and the right liver lobes, in combination with continued octreotide. Unfortunately, he subsequently developedrecurrent hypoglycemia three weeks later and ultimately passed away after transitioning to hospice care.Conclusions: Insulinomas are rare neoplasms of the pancreas that are characterized by insulin hypersecretion, which can bedebilitating and potentially life-threatening. The diagnosis of metastatic insulinoma is difficult to make in the setting of multiplecomorbidities and requires precise biochemical studies. Multiple medical treatments are available but the overall prognosis ispoor.

scholarly journals MON-679 What’s in a Bottle? the Importance of Careful Medication Review to Prevent Life Threatening Hypoglycemia

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ela Banerjee ◽  
Sejal B Doshi ◽  
Jasmin Lebastchi ◽  
Amanda Fernandes
Keyword(s):  
Emergency Department ◽  
Blood Glucose ◽  
Medication Review ◽  
Diabetes Management ◽  
Severe Hypoglycemia ◽  
Insulin Level ◽  
Laboratory Evaluation ◽  
Oral Glucose ◽  
Free T4 ◽  
Beta Hydroxybutyrate

Abstract Background: Over 1 in 9 emergency department (ED) visits are due to drug-related adverse events (1) and careful medication review is essential for patient safety. Clinical Case: A 73-year-old male presented to the ED after his family found him to be tremulous with a blood glucometer reading of 30 mg/dL. He was given glucagon and oral glucose however this did not help his blood glucose and he was brought in for further evaluation. He had a history of chronic kidney disease, hepatocellular carcinoma (HCC) and diabetes mellitus type 2 for which he was on no medication at the time of presentation. He reported being on Glipizide nine months ago. In the ED, he had a temperature of 98.3°F; pulse of 76 beats/min; respiratory rate of 18 breaths/min and blood pressure of 166/71. On physical examination, he was in no acute distress with normal neurologic, cardiac and respiratory exam. Laboratory workup was notable for glucose 40 mg/dL, HbA1c 5.0%, Cr 2.55 mg/dL, eGFR 24, ALT 7 IU/L and AST 23 U/L. CT abdomen and pelvis was consistent with known diagnosis of HCC. The patient was given 4 boluses of D50W and started on a continuous dextrose infusion along with octreotide infusion due to persistent hypoglycemia. Patient’s blood glucose improved one day later and he remained stable off the dextrose and octreotide infusions. Further laboratory evaluation revealed ACTH 9 pg/mL (ref 6-50), Random Cortisol 16.1 at 1:36pm, TSH 1.40uIU/ml, Free T4 1.09 ng/dL, Cosyntropin stimulation test at baseline 15.4 ug/dL; at 30 min 22 ug/dL; at 60 min 28.3 ug/dL and Beta-Hydroxybutyrate 0.11 mmol/L. With a blood sugar level of 32 mg/dL, he was found to have Insulin level 35.9 (ref 3.0-25.0mU/L), Pro-insulin 55.6 (ref &lt 18.8pmol/L) and C-peptide 9.21 (ref 0.8-3.85ng/mL). The patient’s family brought his medications for review with no clear discrepancies noted. Closer inspection of the tablets inside each pill bottle revealed that the pills inside the Docusate-Senna container did not match the description for the same but instead matched the description for Glipizide. The patient disclosed that he had emptied the Glipizide tablets into the bowel regimen container for “safe keeping” when it was discontinued. He was inadvertently taking two Glipizide tablets twice a day as the VNA had mistakenly used these pills to fill his pill box. This serious error in confirming the patient’s medications resulted in his severe hypoglycemia. His Sulfonylurea screen returned positive for Glipizide. Conclusion: Sulfonylureas, an essential component of diabetes management, have a dangerous side effect of hypoglycemia and errors in its administration can be fatal. Therefore, thorough medication reconciliation and review of the actual pills is essential to prevent such errors. Reference: Zed PJ, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. Can Med Assoc J. 2008;178(12):1563-1569.

Eosinophilic vasculitis: an inhabitual and resistant manifestation of a vasculitis

VASA ◽  
2010 ◽  
Vol 39 (4) ◽  
pp. 344-348 ◽  
Author(s):  
Jandus ◽  
Bianda ◽  
Alerci ◽  
Gallino ◽  
Marone
Keyword(s):  
Skin Biopsy ◽  
Intravenous Iron ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Raynaud Phenomenon ◽  
The Third ◽  
Left Elbow ◽  
Right Hand ◽  
The Right ◽  
Trunk Skin

A 55-year-old woman was referred because of diffuse pruritic erythematous lesions and an ischemic process of the third finger of her right hand. She was known to have anaemia secondary to hypermenorrhea. She presented six months before admission with a cutaneous infiltration on the left cubital cavity after a paravenous leakage of intravenous iron substitution. She then reported a progressive pruritic erythematous swelling of her left arm and lower extremities and trunk. Skin biopsy of a lesion on the right leg revealed a fibrillar, small-vessel vasculitis containing many eosinophils.Two months later she reported Raynaud symptoms in both hands, with a persistent violaceous coloration of the skin and cold sensation of her third digit of the right hand. A round 1.5 cm well-delimited swelling on the medial site of the left elbow was noted. The third digit of her right hand was cold and of violet colour. Eosinophilia (19 % of total leucocytes) was present. Doppler-duplex arterial examination of the upper extremities showed an occlusion of the cubital artery down to the palmar arcade on the right arm. Selective angiography of the right subclavian and brachial arteries showed diffuse alteration of the blood flow in the cubital artery and hand, with fine collateral circulation in the carpal region. Neither secondary causes of hypereosinophilia nor a myeloproliferative process was found. Considering the skin biopsy results and having excluded other causes of eosinophilia, we assumed the diagnosis of an eosinophilic vasculitis. Treatment with tacrolimus and high dose steroids was started, the latter tapered within 12 months and then stopped, but a dramatic flare-up of the vasculitis with Raynaud phenomenon occurred. A new immunosupressive approach with steroids and methotrexate was then introduced. This case of aggressive eosinophilic vasculitis is difficult to classify into the usual forms of vasculitis and constitutes a therapeutic challenge given the resistance to current immunosuppressive regimens.

scholarly journals RARE-29. PRIMARY CENTRAL NERVOUS SYSTEM NON-HODGKIN LYMPHOMA IN AN 11-YEAR-OLD BOY: A CASE REPORT

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii448-iii448
Author(s):  
Jorge Luis Ramírez-Melo ◽  
Regina M Navarro-Martin del Campo ◽  
Manuel D Martinez-Albarran ◽  
Fernando Sánchez-Zubieta ◽  
Ana L Orozco-Alvarado ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Hodgkin Lymphoma ◽  
Central Nervous System Lymphoma ◽  
Complete Response ◽  
High Dose ◽  
Illustrative Case ◽  
Tumor Biopsy ◽  
Non Hodgkin Lymphoma ◽  
The Right

Abstract BACKGROUND Primary central nervous system lymphoma (PCNSL) are very rare in children. CLINICAL CASE: An 11-year-old male presented with a 2 months history with myoclonic movements in the upper right limb, and a sudden frontal headache, gait disturbance due to right hemiparesis and an ipsilateral convulsive episode. Upon admission he had critical condition, with hypertensive skull syndrome, Glasgow of 12, Karnofsky 40%, right hemiparesis, swallowing disorder, facial paralysis, and loss of photo motor reflex and unilateral amaurosis. A CT and MRI showed a huge tumor mass in the left tempo-parietal region, infiltrating the white matter and shifting the midline. A Tumor biopsy was done, and reported diffuse small cell non-Hodgkin lymphoma of high-grade, Burkitt type. Systemic lymphoma workup was negative. He received six cycles of chemotherapy based on high dose methotrexate, rituximab and triple intrathecal.After the second cycle an ophthalmologic evaluation was done, and found infiltration to the right retina, for which 6 cycles of intra vitreous chemotherapy with methotrexate were applied, he showed an excellent response, and recovered all his neurological functions except that right hemianopia persist. Control MRI showed partial response at 2nd cycle and complete response after the 4th cycle. No Radiation was performed. CONCLUSION This report highlights the fact that pediatric PCNSL may be effectively treated by a combination of HDMTX and rituximab-based chemoimmunotherapy without irradiation. Lack of awareness of this rare entity may lead to extense resections of brain, and potential permanent secuelae that were avoided in this illustrative case.

scholarly journals What comprises the plate-like structure between the pancreatic head and the celiac trunk and superior mesenteric artery? A proposal for the term “P–A ligament” based on anatomical findings

2021 ◽  
Author(s):  
Satoru Muro ◽  
Wachirawit Sirirat ◽  
Daisuke Ban ◽  
Yuichi Nagakawa ◽  
Keiichi Akita
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Pancreatic Head ◽  
Celiac Trunk ◽  
Dorsal Side ◽  
Uncinate Process ◽  
Anatomical Basis ◽  
The Right ◽  
Upper Abdomen ◽  
Macroscopic Examination

AbstractA plate-like structure is located posterior to the portal vein system, between the pancreatic head and roots and/or branches of two major arteries of the aorta: the celiac trunk and superior mesenteric artery. We aimed to clarify the distribution and components of this plate-like structure. Macroscopic examination of the upper abdomen and histological examination of the plate-like structure were performed on 26 cadavers. The plate-like structure is connected to major arteries (aorta, celiac trunk, superior mesenteric artery) and the pancreatic head; it contains abundant fibrous bundles comprising nerves, vessels, collagen fibers, and adipose tissue. Furthermore, it consists of three partly overlapping fibrous components: rich fibrous bundles (superior mesenteric artery plexus) fused to the uncinate process of the pancreas; fibrous bundles arising from the right celiac ganglion and celiac trunk that spread radially to the dorsal side of the pancreatic head and superior mesenteric artery plexus; and fibrous bundles, accompanied by the inferior pancreaticoduodenal artery, entering the pancreatic head. The plate-like structure is the pancreas–major arteries (aorta, celiac trunk, superior mesenteric artery) ligament (P–A ligament). The term “P–A ligament” may be clinically useful and can facilitate comprehensive understanding of the anatomy surrounding the pancreatic head and provide an anatomical basis for further pancreatic surgery studies.

scholarly journals Multiple hepatic aneurysms and dry gangrene of fingertips in eosinophilic granulomatosis with polyangiitis: a case report

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Eunsil Koh ◽  
Noeul Kang ◽  
Jin-Young Lee ◽  
Duk-Kyung Kim ◽  
Young Soo Do ◽  
...  
Keyword(s):  
Eosinophil Count ◽  
Granulomatosis With Polyangiitis ◽  
Stable State ◽  
Clinical Situation ◽  
High Dose ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Case Presentation ◽  
The Right ◽  
Small Aneurysms ◽  
Eosinophilic Granulomatosis

Abstract Background Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic necrotizing vasculitis mainly affecting small-sized arteries. Involvement of medium-sized vessels is very rare in EGPA. Here we present the case of a patient with EGPA who showed multiple hepatic aneurysms and distal gangrene. Case presentation A known EGPA patient visited to the emergency room (ER) with abrupt squeezing abdominal pain. She had suffered from gangrene in the fingertips of both hands for 1 year because of arterial thrombosis associated with hypereosinophilia. However, her absolute eosinophil count in the ER was 1120 cells/µL. An abdomen-pelvis CT demonstrated subcapsular hematoma in the right hepatic lobe. A celiac angiogram demonstrated multiple sized aneurysms in both hepatic lobes and some aneurysms in S7 and S8 were huge, more than 1 cm in size. The shape of the small aneurysms resembled a string of beads, as in polyarteritis nodosa. Given the clinical situation, emergency embolization was performed. Before this patient visited to the ER, she had been treated with a high dose of systemic corticosteroid, azathioprine, and cyclophosphamide. After addition of mepolizumab, the eosinophil count remained stable state with a near zero percentage of total white blood cell count. Conclusions Aneurysm and gangrene resulting from the involvement of medium-sized vessels can occur in EGPA. Destruction of vessels might occur even if eosinophil count is below 1500 cells/µL. If involvement of medium-sized arteries is suspected, thorough investigation to identify the involved organs and prompt management are needed to prevent fatal complications.

Sudden onset blindness treated with pulse steroid therapy in a patient with microscopic polyangiitis

Open Medicine ◽  
2011 ◽  
Vol 6 (5) ◽  
pp. 631-633
Author(s):  
Yoshiro Horai ◽  
Tomoya Miyamura ◽  
Karin Shimada ◽  
Soichiro Takahama ◽  
Rumi Minami ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Microscopic Polyangiitis ◽  
Oral Prednisolone ◽  
Sudden Onset ◽  
High Dose ◽  
Pulse Steroid Therapy ◽  
Ocular Manifestations ◽  
Dose Oral ◽  
The Right ◽  
Pulse Steroid

AbstractWe report a 71-year-old male with microscopic polyangiitis (MPA) who developed sudden-onset, progressive, bilateral visual loss associated with a relapse of MPA symptoms. The patient was referred to our hospital, and treated with intravenous pulse steroid therapy and high-dose oral prednisolone. Although the right eye remained vision deficient, visual acuity in the left eye recovered. Ocular manifestations of MPA are quite uncommon. This case emphasizes the necessity of early detection and initiation of prompt therapy where ocular manifestations of MPA occur.

Role of MRI in Detecting and Characterizing Small Hepatic Focal Lesions

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Rania Ali Maarouf ◽  
Ali Haggag Ali ◽  
Mahmoud Abdelatif Onsy
Keyword(s):  
Tumor Staging ◽  
Left Lobe ◽  
Diagnostic Process ◽  
Liver Imaging ◽  
Focal Lesions ◽  
Focal Hepatic Lesions ◽  
Malignant Lesions ◽  
Hepatic Lesions ◽  
The Right

Abstract Background Despite the recent advances in liver imaging, the detection and characterization of small hepatic focal lesions is still a real challenge. Particularly in cancer patients where the characterization of a small HFL as thus the precise tumor staging is critical for optimal treatment planning. Aim of the Work To explore the effectiveness, and hence the clinical utility, of MRI detection and characterization of small focal hepatic lesions either only discovered on MRI or as a further work up of CT/US-indeterminate lesions. Patients and Methods We reviewed our database for individuals who underwent liver MR imaging between March 2018 and March 2019 for the evaluation of small hepatic lesions that were discovered for the first time or had been previously visualized on routinely performed CT and had been considered indeterminate. Results The present study included 44 patients of which 26 were males (59.1%) and 18 were females (40.9%). The age range of the study group was 19 to 77 years. The mean age for Malignant lesions was 51 years. The right lobe of liver was involved in 23 cases (52.3%), left lobe in 5 cases (11.4%) and both lobes in 16 cases (36.4%). There were 30 (68.18%) benign, 13 (29.54%) malignant lesions and 1 (2.3%) indeterminate, hemangiomas were predominant in benign lesions whereas hepatocellular carcinomas were predominant in malignant lesions. N'TRI could characterize 92% cases. Conclusion The diagnostic process of small hepatic focal lesions, either detection or characterization or both, continues to represent a challenge. Contrast-enhanced MR can accurately detect and characterize majority of small hepatic focal lesions.

scholarly journals Reversible Catecholamine Induced Cardiomyopathy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A1005-A1005
Author(s):  
Kathrin Sandra Tofil ◽  
Malek Mushref
Keyword(s):  
Neuroendocrine Tumor ◽  
Metastatic Disease ◽  
Left Ventricular ◽  
Uncontrolled Hypertension ◽  
Endocrine Tumors ◽  
Retroperitoneal Mass ◽  
Distal Pulse ◽  
Hepatic Lesions ◽  
Poor Outcomes ◽  
The Right

Abstract Background: Pheochromocytomas and paragangliomas (PPGL) are rare neuro-endocrine tumors associated with a myriad of poor outcomes as a result of long-term exposure to catecholamines. Although paragangliomas are less commonly associated with increased catecholamine production than adrenal pheochromocytomas, there have been a few reports of catecholamine-induced cardiomyopathy in patients diagnosed with PPGL. We report a case of a PPGL associated with hypercoagulability and cardiomyopathy. Clinical Case: 42-year-old man with uncontrolled hypertension presented to the emergency department with abdominal pain. On CT imaging, he was found to have hepatic lesions, aortocaval lymph node concerning for metastatic disease, left renal infarct, and a left ventricular thrombus. Soon after his admission, he developed acute ataxia, gaze palsies and left hemiparalysis. CTA of the head showed a basilar artery thrombus [FJ1] which was treated with emergent thrombectomy. In addition patient had absent distal pulse of the right foot[FJ2], and found to have thrombus of the popliteal artery, which was treated with thrombectomy. Further workup with abdominal MRI showed retroperitoneal mass[FJ3] and multiple hepatic lesions concerning for metastatic extra-adrenal neuroendocrine tumor. Plasma normetanephrine was 4.5 nmol/L (ULN 0.89), plasma metanephrine 0.3 nmol/L (ULN 0.49) Chromogranin A was 387 ng/ml (ULN 160). Ga-68 DOTATE scan was consistent with an extra adrenal paraganglioma with less prominent radiotracer activity in hepatic lesion concerning for dedifferentiated metastatic disease. In addition, echocardiogram showed reduced LV ejection fraction of 24% with global hypokinesis, and confirmed the LV thrombus. Cardiac MRI showed infiltrative nonischemic cardiomyopathy and mild dilation of left ventricle, as well as patchy delayed enhancement in the basal and inferoseptal walls suggestive of myocarditis. Treatment included rivaroxaban[FJ4], lisinopril, doxazosin, furosemide, and carvedilol. Several months after discharge, his EF improved to 48%. Hepatic lesions concerning for dediffertiated tumor vs unrelated malignancy was biopsied[FJ5] and consistent with neuroendocrine tumor. Future plan for his PPGL include revaluation for resection of retroperitoneal mass or DOTA Lutathera therapy. Conclusions: This case highlights a young man who was incidentally found to have metastatic paraganglioma with catecholamine-induced cardiomyopathy. The patient was asymptomatic until he developed significant heart failure. Cardiomyopathy in this setting is thought to be secondary to uncontrolled hypertension, as well as sympathetic overdrive from overstimulation of norepinephrine. We present the case to highlight the management challenges in a patient with PPGL with significant cardiovascular compromise and limited therapeutic options.

scholarly journals ETMR-07. ETANTR: A RARE TUMOR IN A RESOURCE-LIMITED SETTING

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii324-iii324
Author(s):  
Julieta Hoveyan ◽  
Manushak Avagyan ◽  
Anna Avagyan ◽  
Ruzanna Papyan ◽  
Samvel Iskanyan ◽  
...  
Keyword(s):  
Survival Rates ◽  
Tumor Resection ◽  
Large Mass ◽  
Intrathecal Methotrexate ◽  
High Dose ◽  
Ongoing Research ◽  
Resource Limited ◽  
The Right ◽  
Immunohistochemical Analyses ◽  
Limited Setting

Abstract INTRODUCTION Embryonal tumor with abundant neuropil and true rosettes (ETANTR) is a rare aggressive brain tumor with low survival rates. There are about 80 cases reported in literature since 2000 when it was first described. There is no standard treatment scheme for ETANTR yet. CASE REPORT: A 2 years old boy presented with a month-long of headache and inability to hold his head. CT scan and MRI revealed a large mass in the right frontal lobe with midline shift. Subtotal tumor resection was done. Histological and immunohistochemical analyses was consistent with ETANTR in one laboratory and PNET in another. The second opinion suggested by the Center of Pediatric Oncology, Hematology and Immunology in Moscow the diagnosis ETANTR was confirmed. Taking into account certain similarities with medulloblastoma was decided to provide treatment according to HIT-2014 protocol. Control MRI done after 2 cycles of Block SKK Carboplatin/Etoposide found tumor progression and for that reason patient underwent second surgical resection. Considering the age of the child radiation therapy was not expedient and the decision was to continue treatment with HIT 2014 intensified regimen, which includes Cisplatin, Vincristine, Etoposide, Cyclophosphamide and intravenous High dose Methotrexate with intrathecal Methotrexate. Aiming to evaluate the effectiveness of treatment we are planning to perform MRI after this 2nd cycle of intensified regimen. DISCUSSION There are difficulties in diagnosis of rare types of cancers in Armenia. Since there is no approved treatment for ETANTR, there is a need for ongoing research to improve its prognosis.

Neem tree (Azadirachta indica) extract specifically suppresses the growth of tumors in H22-bearing Kunming mice

2016 ◽  
Vol 71 (7-8) ◽  
pp. 201-208 ◽  
Author(s):  
Zhenxiang He ◽  
Cuihua Jiang ◽  
Jian Zhang ◽  
Zhiqi Yin ◽  
Zengfang Yin ◽  
...  
Keyword(s):  
Body Weight ◽  
Survival Rate ◽  
Azadirachta Indica ◽  
Normal Liver ◽  
Positive Control ◽  
High Dose ◽  
Intragastric Administration ◽  
Neem Tree ◽  
Specific Cytotoxicity ◽  
The Right

Abstract Recently, neem tree (Azadirachta indica) extract (NTE) has been reported to have various antitumor activities against gastric, breast, prostate, and skin cancer, respectively. The current study was designed to evaluate the effect of NTE on hepatic cancer in a mouse model. The possible side effects elicited by NTE were also evaluated. The components in NTE were analyzed by liquid chromatography–mass spectrometry (LC-MS). H22 cells-bearing Kumming mice were generated by injecting H22 cells subcutaneously into the right forelimb armpit of the mice. Then the mice were treated daily for 27 days with NTE (150, 300, and 600 mg/kg body weight) by intragastric administration, using carboxymethyl cellulose (CMC, 1%) as blank control and cyclophosphamide (CTX, 20 mg/kg) as positive control. The antitumor effect of NTE was evaluated by assessment of survival rate, body weight, tumor volume and weight, tumor histology, thymus and spleen indexes, and liver histology. The tumor weight and volume in groups of NTE and CTX were significantly lower than those in the CMC group. The survival rate in the NTE group receiving the high dose (600 mg/kg) was significantly higher than that in the CTX and CMC groups. Compared with CTX, NTE was observed to have a tumor-specific cytotoxicity without impairing the normal liver tissue. Additionally, the higher indexes of thymus and spleen indicated that NTE could facilitate the growth of immune organs. The results indicate that NTE is a promising candidate for the antitumor treatment with high efficacy and safety.

Sign in / Sign up

Export Citation Format

Share Document