A case of primary breast diffuse large B cell lymphoma

Primary breast diffuse large B-cell lymphoma (DLBCL) is a rare non-Hodgkin’s lymphoma with limited data. We here report a case of primary breast diffuse large B-cell lymphoma mimicking breast cancer. A 52-year-old woman had a painless mass in her right breast. Fine needle aspiration cytology and core biopsy were performed which suggested malignant features but could not confirm the specific subtype. Excisional biopsy then was conducted revealing non-Hodgkin lymphoma, which was subsequently confirmed with histopathology and diagnosed as diffuse large B-cell lymphoma (DLBCL). A chest computed tomography scan revealed a 3.5 cm sized breast mass with skin thickening and modest lymphadenopathy in the ipsilateral axilla. The patient received six courses of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone plus rituximab) chemotherapy, then whole breast radiation (30Gy in 15 fractions). At 12 months of follow-up, the patient survives with no evidence of disease. No morbidities occurred in this patient during the follow-up period. We briefly review the current practice pattern in patients with primary breast diffuse large B-cell lymphoma.

Rectal metastasis in Lung cancer: A case report and review of the literature

Gastrointestinal metastasis in lung cancer is not commonly encountered clinically, of which rectal involvement is a sporadic event. There were few reports about rectal metastasis in lung cancer. All of them had a dismal prognosis. We report a case of synchronous rectal metastasis in a lung cancer patient with a different clinical scenario, treatment, and prognosis. The patient presented with infrequent hematochezia due to a rectal mass confirmed as adenocarcinoma on core biopsy. Computer tomography showed many nodules in both lungs, which raised the initial diagnosis of pulmonary metastasis in rectal cancer. However, we decided to perform immunohistochemistry on the rectal biopsy specimen, which, surprisingly, revealed the site of origin was from the lung. Subsequently, next gene sequencing was performed and detected an exon 19 deletion on the EGFR gene. Though he had infrequent hematochezia, we decided to treat him with Erlotinib (a first-generation TKI) and closely monitored the rectal symptoms. Six months later, he achieved a complete response of both lung and rectal lesions. At present, he has been progression-free for 14 months. Thus, physicians should always be aware of this differential diagnosis in synchronous tumors and carefully consider the optimal treatment to start.

ST-elevation myocardial infarction complicated by cardiac arrest in a young patient with familiar dyslipidemia

Coronary heart disease in young patients always poses great challenges for every healthcare system with differences in clinical manifestations, etiology, epidemiology, angiographic characteristics and prognosis. The objective of this study was to describe a case of ST-elevation myocardial infarction complicated by cardiac arrest in a young patient with familial dyslipidemia. A 30-year-old male visited our hospital with typical angina. During the examination, he suffered a sudden loss of consciousness, the monitor showed ventricular fibrillation. After successful resuscitation of cardiac arrest, electrocardiography showed apparent ST-elevation from V2 to V6 leads consistent with the diagnosis of anterolateral infarction. Emergency coronary angiogram showed severe three-vessel lesions including complete occlusion of the LAD artery and 80 - 90% stenosis of the other two coronary branches. Our patient’s coronary arteries were revascularized using drug-eluting stents in LAD artery and subsequently RCA artery, stem cell therapy was applied during the interventional process. Routine laboratory test results showed dyslipidemia and his family records suggested familiar (hereditary) dyslipidemia which affected his mother and sister. 1-month follow-up echocardiography showed a drastic improvement of LVEF by roughly 15%. The combination of revascularization, stem cell therapy, and lipid-lowering therapy has shown a good therapeutic effect.

Evaluation of acute and subchronic toxicity of “Tran Chau Nguu Hoang Hoan” in experimental animals

“Tran chau nguu hoang hoan” was prepared from 12 herbal ingredients. So far, the safety of this product, has not been reported yet. Thus, this study aimed to evaluate the acute and subchronic toxicity of “Tran chau nguu hoang hoan” through oral administration in experimental animals. The acute toxicity was determined by the method of Litchfield Wilcoxon in mice at the doses of 2.42 g/kg b.w/day to 6.04 g/kg b.w/day. The subchronic toxicity was evaluated followed the Guideline of WHO and OECD in rats with oral doses of 58.0 mg/kg b.w/day and 174.0 mg/kg b.w/day for 12 consecutive weeks. As a result, in the course of the acute toxicity test, the mice showed no abnormal sign or death. In terms of the subchonic toxicity test, hematological indexes, hepato-renal functions and microscopic images of liver and kidney were unchanged. In conclusion, “Tran chau nguu hoang hoan” does not appear to produce acute and subchronic toxicities in mice and rats.

Evaluating the result of sphincteric-preserving surgery (Parks procedure) for low rectal cancer

Sphincter-preserving surgery for low rectal cancer improved the quality of life while maintaining the oncologic outcomes. A retrospective, descriptive study was conducted with 45 patients who underwent sphincter-preserving surgery for low rectal cancer at the National Cancer Hospital and Hanoi Medical University Hospital between January 2016 and April 2020. The mean age was 55.6 years old. Male: female ratio = 0.7:1. Nearly all patients presented with hematochezia (95.6%). 75.6% of the tumors are located within 4-6 cm from the anal verge. The anastomotic leak rate was 4.4%. All patients had a normal postoperative urinary function. The sexual dysfunction rate was low (15.8%) and reversible. None had erectile or ejaculation dysfunction. 97.8% satisfied with sphincter function after one year. Tumors located > 4 cm and the anastomosis sites located > 2 cm from the anal verge were good prognostic factors for the recovery of sphincter function (p < 0.05). The Parks procedure had optimistic postoperative outcomes with a low complication rate, minimal sexual dysfunction, and good sphincter function in long-term follow-up.

Acute and sub-chronic oral toxicities of DA.AMLODEPON HVD hard capsule in experimental animals

Assessment of toxicities of DA.AMLODEPON HVD hard capsule on experimental animals. The acute toxicity of DA.AMLODEPON HVD was assessed on Swiss mice according to World Health Organization Guidance, and LD50 determination according to the method of Litchfield – Wilcoxon. The sub-chronic toxicity study of DA.AMLODEPON HVD at two doses (0.42 g/kg/day and 1.26g/kg/day) was conducted in rats for four consecutive weeks. After administration, general conditions and the body weight of rats were evaluated. Blood samples were collected for analyzing serum parameters before treatment (T0), second week (T1), and fourth week (T2). Histopathological analysis of livers and kidneys was observed at the end of the experiment. The results revealed that mice were taken up to a maximum dose of 39.15 g/kg with no symptoms of acute toxicity, LD50 of DA.AMLODEPON HVD has not been determined. The sub-chronic toxicity study at two doses did not change the body weight of rats, general conditions. The parameters for structures and functions of livers and kidneys and microscopic of the livers and kidneys are in a normal range during the study period.

The proximal fibular free flap - an ideal material for reconstructing distal radius defect after Giant tumor cell resection. A case report

Giant cell tumors (GCT) of the distal end of radius are relatively common tumors, representing approximately 5% of all primary bone tumors. It is the third most common location for GCT following distal femur and proximal tibia. In general, treatment includes thorough tumor excision, reconstruction of the defect, and wrist joint rehabilitation. The proximal fibular free flap is an ideal material for distal radius reconstruction after giant cell tumor excision. We present a case of a 57-year-old female, admitted to the hospital due to painful and limited proper wrist movement. Based on X-ray and Magnetic resonance imaging (MRI) images and histopathology findings, the patient was diagnosed with a stage 3 giant cell tumor of the distal radius. The patient underwent a one-step surgery of tumor excision and distal radius reconstruction by a vascularized proximal fibular free flap. 2 years follow-up post-surgery showed that the patient had no pain of the wrist, improved wrist joint function, no sign of recurrence, and good flap vitality and the knee joint remains normal. In conclusion, the surgery was successful with no further prolonged pain, improvement of the wrist joint function and overall improvement of the patient quality of life.

Nutritional status of patients undergoing upper gastrointestinal cancer surgery: A cross-sectional study at a single centre

Malnutrition is closely related to the outcome of disease treatment, especially in digestive cancer surgery. The aim of this study was to assess the nutritional condition of pre-operative patients with upper digestive cancers (including stomach and oesophagus) at the Department of General Surgery, Bach Mai Hospital in 2016. We conducted a cross-sectional descriptive analysis of 76 malignancies of the upper gastrointestinal tract with surgical treatments. The results revealed that the weight loss rate of hospitalized patients with gastric cancer and esophageal cancer was 76.6% and 66.7%, respectively. The rate of weight loss above 10% of body weight was 19.7%. The prevalence of chronic energy deficit was 29.9%. The risk of malnutrition according to SGA was 77.6%, of which mild to moderate and severe was 67.2% and 10.4%, respectively. The rate of low blood albumin level (less than 35 g/L) was 36.5%. The average net nutritional value was 1146.3 ± 592.7 Kcal (range 246.7 – 3653.5), which equals to 55.7% of the necessary daily intake. Protein, lipid, and glucid contents reached 73.4%, 57.8%, and 52.1% of the recommended levels, respectively. Conclusion: malnutrition was still prevalent among patients undergoing upper gastrointestinal cancer surgery, and pre-operative nutritional status does not achieve recommended levels.

Efficacy and safety of Trang Phuc Linh Plus tablets in patients with irritable bowel syndrome-diarrhea

A double-blind, randomized, phase II clinical trial was conducted within a 14-week follow-up including 2 weeks of the non-drug run-in period, 8 weeks of medication, and 4 weeks of follow-up after discontinuation. The objective of the study was to evaluate the efficacy and safety of Trang Phuc Linh Plus in irritable diarrhea syndrome patients. Group I took Trang Phuc Linh Plus 3 tablets/time x 2 times/day for 8 weeks; Group II took placebo 3 tablets/time x 2 times/day for 8 weeks. Patients will be re-examined, tested, and evaluated over the phone for symptom recurrence and adverse events (AEs). This study showed that the Trang Phuc Linh Plus tablets tended to improve symptoms in patients suffering from irritable bowel syndrome with diarrhea, suggesting its safety and tolerability.

Cerebral venous sinus thrombosis related to vaccine-induced immune thrombotic thrombocytopenia: First reported case in Vietnam

Vaccination remains one of the most important public health interventions to control and mitigate the impacts of COVID-19 worldwide. A number of post-vaccination reactions have caused concern and are the cause of vaccine hesitancy. Vaccine-induced immune thrombotic thrombopenia (VITT) has been reported in several countries such as Norway at a rate of 1 per 26000 doses of the ChAdOx1 nCoV vaccine (AstraZeneca), 15 per 8 million doses of Ad26.COV2.S (Janssen; Johnson & Johnson) vaccines in the US. In Vietnam, 11.5 million doses of AstraZeneca vaccine have been administered since the commencement of a nation-wide vaccination program five months ago. We report the first case of cerebral venous thrombosis related to VITT which was promptly diagnosed and successfully treated with rivaroxaban alone. Thus, VITT is very rare in Vietnamese people vaccinated with the AstraZeneca vaccine in the prevention of COVD-19 infection.