Idiopathic nephrotic syndrome (INS) is one of the chronic kidney diseases that occurs in childhood. Starting from a few case reports in the 1950s–1970s and up to the present, the relationship between idiopathic nephrotic syndrome (INS) and the occurrence of atopic disorders in these patients has been discussed in many medical publications. These publications show that in certain patients, mainly children and adolescents, but also in adults with INS, various clinical symptoms and laboratory indicators of an atopic allergic process may be present. This process has been shown to involve Th2 lymphocytes, to have an excessive production of interleukins (IL-4, IL-5, IL-13), and to have an increased serum level of immunoglobulin E (IgE). This leads to the development of a systemic allergic inflammatory process, of which the kidneys can also become the effector organ. The coexistence of an allergic process which may adversely affect the course of nephrotic syndrome may be confirmed by the increased serum IgE level and the hypersensitivity reaction of the patient’s body to various environmental allergens (through the presence of allergen-specific IgE /asIgE/ antibodies to food, pollen, mould, dust, or other allergens in the blood serum). High concentrations of IL-13 and other plasma mediators of this inflammation (e.g., histamine, bradykinin) structurally and functionally damage the renal filtration barrier, and in particular, the function of podocytes in the glomeruli. Podocyte dysfunction disturbs the physiological process of plasma filtration in the glomeruli, leading to excessive protein loss in the urine. These disorders initiate the development of idiopathic nephrotic syndrome in these patients. This publication presents the coexistence of an allergic process caused by allergy to cow’s milk proteins and hypersensitivity to other allergens in a child with idiopathic nephrotic syndrome. This publication also assesses whether treatment of the allergic process coexisting with INS with an elimination diet (milk-free, hypoallergenic) and anti-allergic drugs affected the course and treatment of INS in this child.
{"title":"Allergy to Cow’s Milk Proteins and Other Allergens—An Unrecognized Co-Factor of Idiopathic Nephrotic Syndrome in Children or a Factor Interfering with the Treatment of This Disease? A Case Report","authors":"M. Kaczmarski","doi":"10.3390/reports6020025","DOIUrl":"https://doi.org/10.3390/reports6020025","url":null,"abstract":"Idiopathic nephrotic syndrome (INS) is one of the chronic kidney diseases that occurs in childhood. Starting from a few case reports in the 1950s–1970s and up to the present, the relationship between idiopathic nephrotic syndrome (INS) and the occurrence of atopic disorders in these patients has been discussed in many medical publications. These publications show that in certain patients, mainly children and adolescents, but also in adults with INS, various clinical symptoms and laboratory indicators of an atopic allergic process may be present. This process has been shown to involve Th2 lymphocytes, to have an excessive production of interleukins (IL-4, IL-5, IL-13), and to have an increased serum level of immunoglobulin E (IgE). This leads to the development of a systemic allergic inflammatory process, of which the kidneys can also become the effector organ. The coexistence of an allergic process which may adversely affect the course of nephrotic syndrome may be confirmed by the increased serum IgE level and the hypersensitivity reaction of the patient’s body to various environmental allergens (through the presence of allergen-specific IgE /asIgE/ antibodies to food, pollen, mould, dust, or other allergens in the blood serum). High concentrations of IL-13 and other plasma mediators of this inflammation (e.g., histamine, bradykinin) structurally and functionally damage the renal filtration barrier, and in particular, the function of podocytes in the glomeruli. Podocyte dysfunction disturbs the physiological process of plasma filtration in the glomeruli, leading to excessive protein loss in the urine. These disorders initiate the development of idiopathic nephrotic syndrome in these patients. This publication presents the coexistence of an allergic process caused by allergy to cow’s milk proteins and hypersensitivity to other allergens in a child with idiopathic nephrotic syndrome. This publication also assesses whether treatment of the allergic process coexisting with INS with an elimination diet (milk-free, hypoallergenic) and anti-allergic drugs affected the course and treatment of INS in this child.","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41596604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iulia Cristina Pîrvulescu, Alfred Najm, Eduard Cristian Popa, A. Chiotoroiu, S. Crețoiu, B. Gașpar
The ingestion of foreign bodies is a common cause for presentation in the emergency department by pediatric, adult, or elderly psychiatric patients. Swallowed foreign bodies sometimes represent a great challenge for surgeons due to the obstruction or perforation of the digestive tube’s upper or lower segments. Occasionally, the foreign bodies detected in the lower parts of the digestive tube (colon and rectum) could be introduced through the anal route with the risk of perforation of the rectum or sigmoid colon. In this report, we describe a unique case of a foreign body located in the sigmoid colon, where it arrived due to backstabbing and was retained for 7 years without acute symptoms. The 43-year-old male patient came to the emergency department with pain in the left iliac fossa. Before his presentation, a computerized tomography (CT) scan examination had suggested a foreign body. A surgical approach was decided. The surgery started as an exploratory laparoscopy and was converted to a xiphoid-pubic incision to extract the foreign body (a piece of glass about 8 cm long) through a sigmoid colotomy followed by a double-layer sigmoidorrhaphy. The postoperative evolution of the patient was uneventful. As far as we know, this is the first case of a patient with a foreign glass body positioned in the sigmoid colon that got there by stabbing and not by ingestion or introduced per anum. In conclusion, we suggest that aggressive behavior and abdominal wall penetration by different sharp objects should be considered when foreign bodies are detected in the abdomen.
{"title":"A Unique Case of Foreign Body Acquired by Stabbing and Retained for 7 Years in the Sigmoid Colon","authors":"Iulia Cristina Pîrvulescu, Alfred Najm, Eduard Cristian Popa, A. Chiotoroiu, S. Crețoiu, B. Gașpar","doi":"10.3390/reports6020024","DOIUrl":"https://doi.org/10.3390/reports6020024","url":null,"abstract":"The ingestion of foreign bodies is a common cause for presentation in the emergency department by pediatric, adult, or elderly psychiatric patients. Swallowed foreign bodies sometimes represent a great challenge for surgeons due to the obstruction or perforation of the digestive tube’s upper or lower segments. Occasionally, the foreign bodies detected in the lower parts of the digestive tube (colon and rectum) could be introduced through the anal route with the risk of perforation of the rectum or sigmoid colon. In this report, we describe a unique case of a foreign body located in the sigmoid colon, where it arrived due to backstabbing and was retained for 7 years without acute symptoms. The 43-year-old male patient came to the emergency department with pain in the left iliac fossa. Before his presentation, a computerized tomography (CT) scan examination had suggested a foreign body. A surgical approach was decided. The surgery started as an exploratory laparoscopy and was converted to a xiphoid-pubic incision to extract the foreign body (a piece of glass about 8 cm long) through a sigmoid colotomy followed by a double-layer sigmoidorrhaphy. The postoperative evolution of the patient was uneventful. As far as we know, this is the first case of a patient with a foreign glass body positioned in the sigmoid colon that got there by stabbing and not by ingestion or introduced per anum. In conclusion, we suggest that aggressive behavior and abdominal wall penetration by different sharp objects should be considered when foreign bodies are detected in the abdomen.","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43056163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. K. Vestergaard, Nicolai S. Mikkelsen, Douglas N P Oliveira, T. Poulsen, E. Hoegdall
The implementation of next-generation sequencing (NGS) in clinical oncology has enabled the analysis of multiple cancer-associated genes for diagnostics and treatment purposes. The detection of pathogenic and likely pathogenic mutations is crucial to manage the disease. Obtaining the mutational profile may be challenging in samples with low yields of DNA—reflected by the type of biological material, such as formalin-fixed paraffin-embedded tissue (FFPE), needle biopsies, and circulating free/tumor DNA, as well as a sparse tumor content. Moreover, standardized strict procedures for the extraction of DNA in a clinical setting might contribute to lower amounts of DNA per µL. The detection of variants in low-yield DNA samples remains a challenge in clinical diagnostics, where molecular analyses such as NGS are needed. Here, we performed vacuum centrifugation on DNA extracted from five FFPE tissue blocks, with concentrations below 0.2 ng/µL. Through NGS analysis, we found that low-yield DNA samples could be concentrated to sufficient levels, without compromising the mutational profile.
{"title":"Rescue of Low-Yield DNA Samples for Next-Generation Sequencing Using Vacuum Centrifugal Concentration in a Clinical Workflow","authors":"L. K. Vestergaard, Nicolai S. Mikkelsen, Douglas N P Oliveira, T. Poulsen, E. Hoegdall","doi":"10.3390/reports6020023","DOIUrl":"https://doi.org/10.3390/reports6020023","url":null,"abstract":"The implementation of next-generation sequencing (NGS) in clinical oncology has enabled the analysis of multiple cancer-associated genes for diagnostics and treatment purposes. The detection of pathogenic and likely pathogenic mutations is crucial to manage the disease. Obtaining the mutational profile may be challenging in samples with low yields of DNA—reflected by the type of biological material, such as formalin-fixed paraffin-embedded tissue (FFPE), needle biopsies, and circulating free/tumor DNA, as well as a sparse tumor content. Moreover, standardized strict procedures for the extraction of DNA in a clinical setting might contribute to lower amounts of DNA per µL. The detection of variants in low-yield DNA samples remains a challenge in clinical diagnostics, where molecular analyses such as NGS are needed. Here, we performed vacuum centrifugation on DNA extracted from five FFPE tissue blocks, with concentrations below 0.2 ng/µL. Through NGS analysis, we found that low-yield DNA samples could be concentrated to sufficient levels, without compromising the mutational profile.","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46471072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marina Antonini, Cristina Aguzzi, A. Fanelli, A. Frassineti, Laura Zeppa, M. Morelli, G. Pastore, M. Nabissi, Margherita Luongo
Glioblastoma is the most aggressive malignant tumor overall and remains an incurable neoplasm with a median survival of 15 months. Since 2005, the gold standard treatment for glioblastoma has remained unchanged, and it is a common goal of the scientific community to work towards a better prognosis and improved survival for glioblastoma patients. Herein, we report a case of glioblastoma multiforme in a patient with a poor prognosis who, following partial removal of the neoplasm, refused conventional therapy consisting of a combination of radiotherapy and temozolomide-based chemotherapy due to personal serious side effects. The patient started an unconventional therapeutic path by alternating periods of oxygen–ozone therapy with concomitant administration of legal medical cannabis products (Bedrocan and Bedrolite) and melatonin. This approach resulted in a complete and durable remission of the disease and long survival. Indeed, the patient is still alive. The exceptional result obtained here encourages us to share and carefully investigate this unconventional treatment as a possible future direction in the management of glioblastoma.
{"title":"The Effects of a Combination of Medical Cannabis, Melatonin, and Oxygen–Ozone Therapy on Glioblastoma Multiforme: A Case Report","authors":"Marina Antonini, Cristina Aguzzi, A. Fanelli, A. Frassineti, Laura Zeppa, M. Morelli, G. Pastore, M. Nabissi, Margherita Luongo","doi":"10.3390/reports6020022","DOIUrl":"https://doi.org/10.3390/reports6020022","url":null,"abstract":"Glioblastoma is the most aggressive malignant tumor overall and remains an incurable neoplasm with a median survival of 15 months. Since 2005, the gold standard treatment for glioblastoma has remained unchanged, and it is a common goal of the scientific community to work towards a better prognosis and improved survival for glioblastoma patients. Herein, we report a case of glioblastoma multiforme in a patient with a poor prognosis who, following partial removal of the neoplasm, refused conventional therapy consisting of a combination of radiotherapy and temozolomide-based chemotherapy due to personal serious side effects. The patient started an unconventional therapeutic path by alternating periods of oxygen–ozone therapy with concomitant administration of legal medical cannabis products (Bedrocan and Bedrolite) and melatonin. This approach resulted in a complete and durable remission of the disease and long survival. Indeed, the patient is still alive. The exceptional result obtained here encourages us to share and carefully investigate this unconventional treatment as a possible future direction in the management of glioblastoma.","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48905461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of the current study is to examine the effect of epilepsy recovery on personality traits by analyzing data from a large representative cohort from the United Kingdom. This study used data from Understanding Society: the UK Household Longitudinal Study (UKHLS). A predictive normative modelling approach along with one-sample t-tests were used to analyze the personality trait differences between 190 current epilepsy patients (40% male) with a mean age of 43.95 ± 15.68 years and 102 previous epilepsy patients (45.1% male) with a mean age of 47.50 ± 15.27 years. People who recovered from epilepsy had lower Neuroticism but higher Openness, Conscientiousness, and Extraversion scores than people who did not recover from epilepsy after controlling for demographic covariates, which can be potentially explained by the psychophysiological pathways. Health professionals can make better post-discharge plans based on personality traits as a result of epilepsy recovery.
{"title":"Personality Functioning in Current Epilepsy Patients and People Recovered from Epilepsy","authors":"Weixi Kang, Antonio Malvaso","doi":"10.3390/reports6020021","DOIUrl":"https://doi.org/10.3390/reports6020021","url":null,"abstract":"The aim of the current study is to examine the effect of epilepsy recovery on personality traits by analyzing data from a large representative cohort from the United Kingdom. This study used data from Understanding Society: the UK Household Longitudinal Study (UKHLS). A predictive normative modelling approach along with one-sample t-tests were used to analyze the personality trait differences between 190 current epilepsy patients (40% male) with a mean age of 43.95 ± 15.68 years and 102 previous epilepsy patients (45.1% male) with a mean age of 47.50 ± 15.27 years. People who recovered from epilepsy had lower Neuroticism but higher Openness, Conscientiousness, and Extraversion scores than people who did not recover from epilepsy after controlling for demographic covariates, which can be potentially explained by the psychophysiological pathways. Health professionals can make better post-discharge plans based on personality traits as a result of epilepsy recovery.","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44308939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In all regions of the world, musculoskeletal disorders are a significant contributor to the burden of chronic illnesses. The effectiveness of treatments, such as rehabilitation, may vary intersectionally across demographic and other categories. The present study examines this intersectionality with respect to a lack of improvement in health conditions after rehabilitation of patients in Germany. Routine data from 298,617 patients aged 18–65 years residing in Germany who received rehabilitation because of arthropathies, dorsopathies, or soft tissue disorders during 2006–2016 were included in the analysis. Odds of the outcome were compared across demographic groups and across diagnostic sub-groups by means of multivariable logistic regression. Interaction terms were included to examine intersectional differences across these groups and over time. Women were more likely than men to have an impairment despite treatment (adjusted odds ratio [aOR] = 1.11; 95%-CI = 1.08, 1.13). In addition, patients in semi-skilled/unskilled employment were at higher odds of a poor outcome compared to patients in skilled positions (aOR = 1.13; 95%-CI = 1.10–1.17). Nationality also affected health care outcomes, with Turkish nationals and nationals from a Yugoslav successor state having higher odds of a poor outcome than Germans (aOR = 1.56; 95%-CI = 1.45–1.67 and aOR = 1.52; 95%-CI = 1.41–1.65, respectively). The findings highlight the importance of an intersectional perspective in health research and practice and can support the development of strategies and measures that aim to reduce disparities in health care.
{"title":"Intersectional Differences in Health Care Outcomes among Patients with Musculoskeletal Disorders in Germany","authors":"P. Brzoska, Kübra Annac, Y. Yılmaz-Aslan","doi":"10.3390/reports6020020","DOIUrl":"https://doi.org/10.3390/reports6020020","url":null,"abstract":"In all regions of the world, musculoskeletal disorders are a significant contributor to the burden of chronic illnesses. The effectiveness of treatments, such as rehabilitation, may vary intersectionally across demographic and other categories. The present study examines this intersectionality with respect to a lack of improvement in health conditions after rehabilitation of patients in Germany. Routine data from 298,617 patients aged 18–65 years residing in Germany who received rehabilitation because of arthropathies, dorsopathies, or soft tissue disorders during 2006–2016 were included in the analysis. Odds of the outcome were compared across demographic groups and across diagnostic sub-groups by means of multivariable logistic regression. Interaction terms were included to examine intersectional differences across these groups and over time. Women were more likely than men to have an impairment despite treatment (adjusted odds ratio [aOR] = 1.11; 95%-CI = 1.08, 1.13). In addition, patients in semi-skilled/unskilled employment were at higher odds of a poor outcome compared to patients in skilled positions (aOR = 1.13; 95%-CI = 1.10–1.17). Nationality also affected health care outcomes, with Turkish nationals and nationals from a Yugoslav successor state having higher odds of a poor outcome than Germans (aOR = 1.56; 95%-CI = 1.45–1.67 and aOR = 1.52; 95%-CI = 1.41–1.65, respectively). The findings highlight the importance of an intersectional perspective in health research and practice and can support the development of strategies and measures that aim to reduce disparities in health care.","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47942286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kazuki Furuyama, M. Tsukita, Y. Shirato, Yusaku Sasaki, Y. Ashino, Toshio Hattori
A 75-year-old female with a history of stomach cancer and depression was referred to our hospital for left cervical lymphadenopathy. The biopsy of her left cervical lymph node revealed noncaseating granulomas with multinucleated giant cells. The positron emission tomography/computed tomography (PET/CT) indicated general lymphadenopathy (left supraclavicular left axillary, hepatic lymph nodes), except for the hilar lymph node. Both histology by transbronchial lung biopsy (TBLB) and analysis of broncho alveolar lavage fluid (BALF) were indicative of sarcoidosis. C-reactive protein (CRP) and soluble interleukin-2 receptor (sIL-2R) were increased in the sera. An alternative cause of granulomatous disease was ruled out, and on follow-up, she was diagnosed with sarcoidosis. Two years later, she was hospitalized for fever, anorexia, lymph node tenderness, and erythema nodosum with significant increases in CRP and sIL-2R. After admission, the repetitive axillary lymph biopsy showed the same histological findings as before, but the G-band staining showed clonal abnormalities. Bone marrow biopsy revealed abnormal lymphocytes with petal-like nuclei. Finally, she was diagnosed with malignant lymphoma infiltrating the bone marrow. After CHOP-based chemotherapy, her laboratory data, lymphadenopathy, and clinical findings improved, and she was discharged from the hospital on the 90th day. Careful medical treatment, including genetic analysis of the lymph node, is necessary in patients with sarcoidosis if lymphadenopathy is predominant.
{"title":"A Case of Sarcoid-Lymphoma Syndrome with Various Etiological Factors","authors":"Kazuki Furuyama, M. Tsukita, Y. Shirato, Yusaku Sasaki, Y. Ashino, Toshio Hattori","doi":"10.3390/reports6020019","DOIUrl":"https://doi.org/10.3390/reports6020019","url":null,"abstract":"A 75-year-old female with a history of stomach cancer and depression was referred to our hospital for left cervical lymphadenopathy. The biopsy of her left cervical lymph node revealed noncaseating granulomas with multinucleated giant cells. The positron emission tomography/computed tomography (PET/CT) indicated general lymphadenopathy (left supraclavicular left axillary, hepatic lymph nodes), except for the hilar lymph node. Both histology by transbronchial lung biopsy (TBLB) and analysis of broncho alveolar lavage fluid (BALF) were indicative of sarcoidosis. C-reactive protein (CRP) and soluble interleukin-2 receptor (sIL-2R) were increased in the sera. An alternative cause of granulomatous disease was ruled out, and on follow-up, she was diagnosed with sarcoidosis. Two years later, she was hospitalized for fever, anorexia, lymph node tenderness, and erythema nodosum with significant increases in CRP and sIL-2R. After admission, the repetitive axillary lymph biopsy showed the same histological findings as before, but the G-band staining showed clonal abnormalities. Bone marrow biopsy revealed abnormal lymphocytes with petal-like nuclei. Finally, she was diagnosed with malignant lymphoma infiltrating the bone marrow. After CHOP-based chemotherapy, her laboratory data, lymphadenopathy, and clinical findings improved, and she was discharged from the hospital on the 90th day. Careful medical treatment, including genetic analysis of the lymph node, is necessary in patients with sarcoidosis if lymphadenopathy is predominant.","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42202858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Onoyama, Minoru Kawakami, Kazuhisa Hachisuga, Shoji Maenohara, Keisuke Kodama, H. Yagi, M. Yasunaga, T. Ohgami, K. Asanoma, H. Yahata, Yuya Kitamura, R. Sakamoto, Daisuke Kiyozawa, Kiyoko Kato
Immune checkpoint inhibitors (ICIs) enhance antitumoral immune mechanisms and are used to treat various types of solid tumors including those that are microsatellite instability (MSI)-high. Uterine endometrial cancer is one of the most frequent tumor types that shows MSI-high, and, consequently, opportunities to use ICIs for endometrial cancer treatment are increasing. While using ICIs, it is important to monitor and manage various immune-related adverse events (irAEs). Here, we report two cases of secondary adrenal insufficiency during treatment of endometrial cancer with pembrolizumab. Both cases showed appetite loss and general fatigue after the 6th or 12th cycle of pembrolizumab. They were admitted to our hospital because of remarkable hyponatremia. Both cases showed no adrenocorticotropic hormone (ACTH) or cortisol response to CRH loading tests. Other pituitary hormone levels were normal, and MRI revealed no sign of hypophysitis in either patient. They were diagnosed with secondary adrenal insufficiency due to isolated ACTH deficiency and recovered soon after the administration of hydrocortisone and hydration. Thus, we should be aware of irAEs with the use of ICIs. In particular, adrenocortical insufficiency is sometimes lethal without appropriate treatment. Because the clinical symptoms are fatigue, appetite loss, and nausea, patients might be misjudged to have symptoms related to cancer. Checking serum morning cortisol before ICIs use and monitoring serum sodium levels could provide clues to diagnose secondary adrenal insufficiency.
{"title":"Secondary Adrenal Insufficiency Due to Isolated ACTH Deficiency Induced by Pembrolizumab: A Report of Two Cases of Uterine Endometrial Cancer","authors":"I. Onoyama, Minoru Kawakami, Kazuhisa Hachisuga, Shoji Maenohara, Keisuke Kodama, H. Yagi, M. Yasunaga, T. Ohgami, K. Asanoma, H. Yahata, Yuya Kitamura, R. Sakamoto, Daisuke Kiyozawa, Kiyoko Kato","doi":"10.3390/reports6020018","DOIUrl":"https://doi.org/10.3390/reports6020018","url":null,"abstract":"Immune checkpoint inhibitors (ICIs) enhance antitumoral immune mechanisms and are used to treat various types of solid tumors including those that are microsatellite instability (MSI)-high. Uterine endometrial cancer is one of the most frequent tumor types that shows MSI-high, and, consequently, opportunities to use ICIs for endometrial cancer treatment are increasing. While using ICIs, it is important to monitor and manage various immune-related adverse events (irAEs). Here, we report two cases of secondary adrenal insufficiency during treatment of endometrial cancer with pembrolizumab. Both cases showed appetite loss and general fatigue after the 6th or 12th cycle of pembrolizumab. They were admitted to our hospital because of remarkable hyponatremia. Both cases showed no adrenocorticotropic hormone (ACTH) or cortisol response to CRH loading tests. Other pituitary hormone levels were normal, and MRI revealed no sign of hypophysitis in either patient. They were diagnosed with secondary adrenal insufficiency due to isolated ACTH deficiency and recovered soon after the administration of hydrocortisone and hydration. Thus, we should be aware of irAEs with the use of ICIs. In particular, adrenocortical insufficiency is sometimes lethal without appropriate treatment. Because the clinical symptoms are fatigue, appetite loss, and nausea, patients might be misjudged to have symptoms related to cancer. Checking serum morning cortisol before ICIs use and monitoring serum sodium levels could provide clues to diagnose secondary adrenal insufficiency.","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46207490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Extracorporeal membrane oxygenation (ECMO) can be a life-saving intervention in cases of potentially reversible refractory respiratory failure. One such indication can be bleomycin-induced lung injury. However, in some cases, the injury can be so severe that it becomes irreversible and creates complex medical decisions regarding life support and the continuation of care when no additional therapeutic options are feasible, particularly in cases of patients who were young and fully functional prior to an acute illness. In cases of full pulmonary replacement with mechanical support and the degree of functionality that can be attained utilizing modalities such as ECMO can obscure the true severity of illness and make end-of-life decisions significantly harder for families and caregivers.
{"title":"A Bridge to Nowhere: Enabling Autonomy in a Case of Failed ECMO Rescue of Bleomycin-Induced Pulmonary Toxicity","authors":"JamesS. Hall, M. Khilkin, S. Murphy, G. Botros","doi":"10.3390/reports6010017","DOIUrl":"https://doi.org/10.3390/reports6010017","url":null,"abstract":"Extracorporeal membrane oxygenation (ECMO) can be a life-saving intervention in cases of potentially reversible refractory respiratory failure. One such indication can be bleomycin-induced lung injury. However, in some cases, the injury can be so severe that it becomes irreversible and creates complex medical decisions regarding life support and the continuation of care when no additional therapeutic options are feasible, particularly in cases of patients who were young and fully functional prior to an acute illness. In cases of full pulmonary replacement with mechanical support and the degree of functionality that can be attained utilizing modalities such as ECMO can obscure the true severity of illness and make end-of-life decisions significantly harder for families and caregivers.","PeriodicalId":74664,"journal":{"name":"Reports (MDPI)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42120482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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