Tanhjort0934

Children diagnosed with high grade gliomas (HGG) have dismal prognoses and treatment options remain limited. Tumor treating fields (TTFields) in combination with temozolomide (TMZ) is approved for the treatment of newly diagnosed and recurrent glioblastoma (GBM) in adult patients. However, clinical experience with TTFields in the pediatric HGG population is lacking. This retrospective review of four clinical cases was undertaken to evaluate the feasibility of treating children diagnosed with HGG off-label with TTFields. Patients were evaluated for device compliance, safety, and outcome. Treatment with TTFields was delivered via four transducer arrays placed on the shaved scalp, which were connected to a portable device generating 200 kHz alternating electric fields. One female and three male patients (ages 4-16 years) with heavily pretreated HGG were treated with TTFields off-label from March 2015 to December 2016. In three of these cases, TTFields were administered in combination with TMZ. Across all four patient cases, average wear compliance rates ranged between 53% and 92%. No device-related toxicities were reported during treatment with TTFields delivered for up to four months. All patients eventually died of the disease. TTFields was well tolerated in our limited cohort of patients. Compliance times were similar to what has been reported in adults without significant toxicity. Further studies of the efficacy and safety of TTFields in children with HGG are underway in a clinical trial setting.Primary angiitis of the central nervous system (PACNS) is a rare disorder and difficult to diagnose. The time period from the presentation of the patient until a diagnosis can be protracted, which may result in further progression of the disease and poor patient outcomes. It has immensely varied symptomatology, further confounding swift diagnosis. We present a case of a 33-year-old male who had focal motor seizures with intact awareness of the right upper limb for three weeks prior to presenting to our hospital with acute right hemiparesis. One month into hospital admission, the patient developed complete motor aphasia while being investigated for the cause of multiple ischemic brain infarcts. The patient underwent immunosuppression along with plasmapheresis and pulse steroid therapy started prophylactically on suspicion of PACNS, which was subsequently confirmed by brain biopsy. Disease remission was achieved with rituximab.Introduction Urothelial carcinoma (UC) is the most common bladder cancer. The most censorious pathological aspect of UC is deep muscle invasion and tumor grade. In this study, we assessed the prognostic implications of tumor grade and deep muscle invasion in UC. Methods It was a retrospective cross-sectional study conducted at the Department of Histopathology, Liaquat National Hospital, from July to December 2019. The data were collected over five years from January 2014 till December 2018. Records from archives of the anatomic pathology were searched, clinical characteristics were recorded, and histopathological slides were reviewed. Histological parameters, including tumor grade and muscle invasion, were evaluated. Records of patient follow-up were assessed by reviewing clinical records. Recurrence of UC and overall survival was also recorded. Multivariate binary logistic regression was applied for variables that were significant on univariate logistic regression. Survival analysis was performed using the Kaplan-Meier method. Results The mean age of the patients was 63.39 ± 14.1 years. More than half (53%) cases were of low-grade papillary UC. Disease recurrence was observed in 53 (39.1%) patients, whereas the mortality rate was 16.6%. In our study, 49 (32.5%) patients were found to have deep muscle invasion. By multivariate analysis, we found that the deep muscle invasion was significantly associated with male gender and grade. In addition, a significant association of high-tumor grade with survival status of the patients was noted. Conclusions A high proportion of UC cases in our study were found to have deep muscle invasion and high-tumor grade. Moreover, a significant association of deep muscle invasion with tumor grade and an association of tumor grade with survival signify the prognostic value of these factors in UC.Cytomegalovirus (CMV) infection generally causes asymptomatic infection in the majority of immunocompetent individuals. However, the presentation may be complicated by life-threatening conditions in immunocompromised patients. We report a case of a 23-year-old healthy Caucasian female with acute CMV infection and splenic infarction. Serological studies confirmed acute CMV infection, and echocardiography did not show any evidence of endocarditis or mural thrombosis. We did not consider antiviral and anticoagulation therapies due to the immunocompetent nature of the patient and since the condition was suspected to be a minor vessel disease likely triggered by CMV infection.Polycythemia vera (PV) is a chronic myeloproliferative neoplasm (CMN) characterized by the accumulation of red blood cells, granulocytes and platelets in the peripheral blood. The main complications of PV are an increased risk of thrombosis, bleeding and transformation to myelodysplasia or acute leukemia. The authors report the case of a 28-year-old man with a complaint of macroscopic hematuria, low back pain and edema of the left arm associated with elevated hemoglobin, hematocrit and lactic dehydrogenase, leukocytosis and increased renal volume. Computed tomography of the chest and abdomen with contrast showed venous ectasia in the left upper limb and thrombosis of the right renal vein with extension to the inferior vena cava. selleck chemicals A diagnosis of PV was confirmed by the presence of the JAK2 mutation and a bone marrow biopsy that showed panmyelosis. The patient was anticoagulated and treatment for PV was started with aspirin, phlebotomy and hydroxyurea. Then, the patient was discharged for outpatient follow-up with a hematologist. The case emphasizes the importance of clinical suspicion for atypical presentation of the disease in an unusual age range and of adequate etiological investigation of thrombosis in unusual sites.