Stensgaardcheek8116

Cancer cells can be selectively targeted by identifying and developing antibodies to specific antigens present on the cancer cell surface. Cytotoxic agents can be conjugated to these antibodies that bind to these cell surface antigens in order to significantly increase the therapeutic index of whichever cytotoxic agent is utilized. This approach of conjugating the cytotoxic drugs to antibodies to target specific surface antigens enhances the anti-tumor activity of antibodies and improves the tumor-to-normal tissue selectivity of chemotherapy. Critical parameters in the development of these antibody-drug conjugates include 1) selection of most appropriate antigen, 2) the ability of an antibody to be internalized after binding to the antigen, 3) cytotoxic drug potency and 4) stability of the antibody-drug conjugate. For prostate cancer, prostate-specific membrane antigen (PSMA, also known as folate hydrolase-1) is the most validated theragnostic target to date. PSMA is overexpressed on the prostate cancer cell surface, which makes it an even better target for selective drug delivery through conjugated antibodies. Here, we review the PSMA-based antibody-drug conjugates for metastatic castration-resistance prostate cancer (mCRPC). Copyright © 2020, Niaz et al.Although aortoesophageal fistulas are rare, they can present as life-threatening emergencies. This condition can develop secondary to an aneurysm, foreign bodies, infiltrating tumors, and radiotherapy. We report a patient with hemorrhagic shock secondary to an aortoesophageal fistula. A 69-year-old male with squamous cell carcinoma of the esophagus treated with chemoradiation and metallic stent placement was admitted to the intensive care unit (ICU) after an episode of hematemesis. The patient was hemodynamically unstable, requiring fluid resuscitation, blood transfusions, and respiratory and vasopressor support. The patient developed electric pulseless activity, and cardiopulmonary resuscitation was performed for 40 minutes. An upper endoscopy showed the esophageal tumor infiltrating into the stent, and computed tomography (CT) angiogram showed leakage of contrast from the thoracic aorta to the esophagus. The diagnosis of aortoesophageal fistula was made. The patient underwent endovascular management for the fistula. However, his critical condition did not improve, and the patient perished. Copyright © 2020, Guerrero et al.Objective Diabetes mellitus (DM) is associated with poor oral health and osteoporosis (OP). The aim of this study was to assess the relationship between OP, periodontal disease (PD), and other dental and health outcomes in a cohort of hospitalized patients with and without DM. Method Using a cross-sectional study design, we enrolled consecutive hospitalized patients. We administered a questionnaire to gather demographic information, oral health history, smoking history, and history of OP. We inspected their dentition and reviewed their charts. Data were analyzed using t-tests, chi-square tests, and logistic regression models. Result  Out of 301 patients enrolled, 275 had PD, 102 had DM, and 30 had OP. In univariate analyses, factors associated with OP included older age (p less then 0.001), female gender (p=0.046), presence of DM (p=0.049), and having more discharge medications (p=0.01). There was no significant relationship between PD and OP. In logistic regression analyses, age remained significantly associated with having OP among all hospitalized patients and in the non-DM populations. In the DM population, female gender was the only significant predictor for having OP. Conclusion Although we found no significant relationship between having PD and OP in our population, we found that among patients with DM, female gender predicted OP, whereas in patients without DM, age was a stronger predictor. Earlier screening for OP in female patients with DM may be useful in identifying and treating OP sooner in this population. Copyright © 2020, Izuora et al.Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic necrotizing inflammation of the small vessels. Central nervous system (CNS) ANCA-associated vasculitis is a rare manifestation of AAV. Three mechanisms of AAV affecting the CNS have been reported which include contiguous granulomatous invasion from nasal and paranasal sinuses, remote granulomatous lesions, and vasculitis of small vessels. Chronic hypertrophic pachymeningitis (CHP) is the meningeal-site involvement in AAV caused by granulomatous inflammation in the dura mater. We present a case of pachymeningitis manifested with slowly progressive cognitive dysfunction, leptomeningeal enhancement on MRI, and necrotic vessels with surrounding inflammation on biopsy. This case represents a rare development of subsequent CNS AAV in a patient with ANCA-associated interstitial lung disease treated with rituximab with a resolution of leptomeningeal enhancement on a follow-up magnetic resonance imaging (MRI). Copyright © 2020, Haikal et al.Lipomas represent the most common benign mesenchymal tumor. They are usually located subcutaneously and rarely become symptomatic. Occasionally pressure symptoms on adjacent neurovascular structures may be exerted, thereby causing functional impairment. Lipomas rarely grow larger than 5 cm, becoming the so-called giant lipomas, posing a real diagnostic and surgical challenge. We report an unusual case of a 43-year-old Caucasian female with an accidental pelvic ultrasound finding of a giant mass, which was also palpable over the right gluteal region. Mito-TEMPO cost Interestingly the patient was free of any sciatic nerve compression symptoms. Magnetic resonance imaging (MRI) revealed a soft tissue tumor, partially located in between the external rotator muscles of the hip and the gluteus muscle. The tumor forced up and advanced through the great sciatic foramen into the pelvis. The patient underwent an uneventful complete and safe surgical excision of the gluteal mass, via a wide transgluteal approach. Pathology confirmed lipoma diagnosis. Patient is free from recurrence two years post operatively. Physicians involved in the diagnosis and treatment of gluteal masses should always consider in their differential diagnosis the presence of a sciatic hernia. Copyright © 2020, Lazaridis et al.Hereditary thrombophilia (HT), including the mutation of factor V gene and the deficiency of proteins C, protein S, or antithrombin, is a risk factor for portal vein thrombosis (PVT). PVT in acute cases is usually asymptomatic, whereas chronic cases mostly present as variceal bleeding and splenomegaly. However, cavernous transformation of the portal vein secondary to a long-standing PVT is very rare. Here we present a case of a 28-year-old female who was admitted with complaints of left upper abdominal pain and swelling for four to five years. Using laboratory and radiological examinations, a confirmatory diagnosis of cavernous transformation of a thrombosed portal vein due to protein C and S deficiency was made. The patient was managed through splenectomy with splenorenal shunting along with life-long prescription of anticoagulants. Copyright © 2020, Majid et al.The supratrochlear artery represents a terminal branch of the ophthalmic artery. Cosmetic interventions may traumatize it, resulting in a circulation in the lesion in glabellar region and in the medial aspect of the forehead. This review article aims to synopsise the existing knowledge of the anatomy of the supratrochlear artery in close correlation with minimally invasive cosmetic procedures in the facial area such as soft-tissue filler injections. Their possible adverse effects and their safe application based on the topographic anatomy were included. A literature review was performed in PubMed/Medline online medical database. The superficial course of the supratrochlear artery, as well as the rich, variable anastomotic network that it forms with the supraorbital, angular and dorsal nasal artery raise clinical questions in the case of soft-tissue filler injections in the nasoglabellar and central forehead area. Accidental cannulation of the supratrochlear artery and ultimately, the risk of embolization of the central retinal artery in a retrograde fashion might lead to injury with questionable cosmetic results. Although the risk of complications from the use of soft tissue fillers is considered rare, once happen, the results could be devastating for the quality of life. Thus, the comprehension of the anatomy of the supratrochlear artery is paramount for the health practitioners. Copyright © 2020, Agorgianitis et al.Purpose The aim of this study was to evaluate the relationship between Fibroblast Growth Factor-23 (FGF23) serum levels and cardiovascular disease and early graft failure in renal transplant recipients.  Methods This cross-sectional study was conducted on renal transplant recipients followed by our adult kidney transplant clinic. The patients were divided into two groups according to the mean FGF23 levels (mean FGF23 level=71.2 ± 34.6pg/mL). The patients included in the study were classified as Group 1 (FGF23 less then 71 pg/mL, n= 42) and Group 2 (FGF23 ≥ 71pg/mL, n= 46) and the data was analyzed as a statistical significance between the two groups. The presence of atherosclerosis was determined by a Doppler ultrasound for evaluate the carotid artery intima-media thickness (CA-IMT). Intrarenal Doppler spectra were obtained with same Doppler ultrasound to determine the renal resistivity index (RRI) for evaluate graft renal failure. Results A total of 88 kidney transplantation recipients were included in the study. In the multivariate analysis adjusted for age and gender, the eGFR (β =-0.217, p=0.048), CA-IMT (β =0.318, p=0.009) and RRI (β =0.246, p=0.019) parameters were statistically significant, while the remaining parameters were not statistically significant. In the group analysis, Ca (9.6 ± 0.3 vs. 8.8 ± 0,2, p less then 0.05), CA-IMT (0.9 ± 0.2, vs. 0.6 ± 0.3, p less then 0.05) and RRI (0.69 ± 0.04 vs. 0.60 ± 0.01, p less then 0.05) were significantly higher in the patients in group 2 than the patients in group 1.  Conclusion According to our results, FGF23 can be considered as a descriptive biomarker for cardiovascular prognosis and graft function for patients with kidney transplantation. Copyright © 2020, Algul Durak et al.The majority of cases of dyspepsia are functional, with a very rare cause of organic dyspepsia being gastric sarcoidosis. Although gastric sarcoidosis is the most common gastrointestinal manifestation of sarcoidosis, it is asymptomatic in >99% of cases. This is a case of a 48-year-old with known pulmonary sarcoidosis who was diagnosed with gastric sarcoidosis after presenting with dyspepsia. Copyright © 2020, Gala et al.A choristoma is a tumor-like outgrowth consisting of heterotopic, histologically mature tissue located at an anatomically unusual part of the body. Salivary gland choristoma at the gastrointestinal junction (GEJ) is an extremely rare entity with only one other case reported in the literature. In this report, we present the case of an 87-year-old female with long-standing gastroesophageal reflux disease (GERD) history who was incidentally found to have salivary gland choristoma at GEJ through an upper endoscopy-guided biopsy. We suggest that the finding of salivary gland choristoma at the GEJ could be metaplasia secondary to the patient's long-standing history of GERD with esophagitis. Copyright © 2020, Hanke et al.