Programmed Death-1 Inhibitor Immunotherapy-Induced Symptomatic Toxic Thyroid Nodule.

Immune checkpoint inhibitors, specifically programmed death-ligand 1 (PD-LI) inhibitors, are immune modifying medications that increasingly treat specific types of cancer. They are known to cause many side effects, including thyroid-related side effects. The use of PD-L1 inhibitors can cause hypothyroidism most commonly, while hyperthyroidism occurs less frequently. This case report describes a patient who developed a toxic thyroid nodule while taking the PD-L1 inhibitor, avelumab, for the treatment of Merkel cell carcinoma. It highlights the need for more research into the specific mechanisms by which these therapies can cause hyperthyroidism. It also raises the question regarding the association between the use of these medications and the development or worsening of thyroid nodules.

An Unusual Case of Severe Atelectasis: Mucus Impaction in a Young Obese Female.

Atelectasis is defined as the the loss of lung volume due to collapse of lung tissue and is usually associated with symptoms of respiratory distress, including increased work of breathing and increased oxygen requirements. It is common in hospitalized patients with limited mobility and in patients with underlying lung conditions. Treatment is largely supportive when no underlying condition is identified. It is rare to occur in otherwise healthy individuals. The patient in this case presented to the emergency department with complaints of progressive shortness of breath, productive cough, chest tightness, subjective fever, chills, and nasal congestion for two weeks. Physical exam revealed decreased breath sounds on the left side, raising the suspicion for atelectasis or pneumothorax. Chest X-ray revealed complete white-out of the left lung. Bronchoscopy was performed and revealed mucus impaction in the left mainstem bronchus, which was removed. Repeat chest X-ray revealed resolution of atelectasis. The patient's symptoms improved, and she was discharged with outpatient pulmonary follow-up. The case described below illustrates that even in young patients with no underlying comorbidities, other than obesity, atelectasis as a cause of respiratory complaints should always be considered.

Thoracic Splenosis in the Setting of Abdominal Trauma.

The uncommon case of thoracic splenosis is presented in this paper. A patient presents to the hospital with the complaint of dyspnea on exertion. He is incidentally found to have thoracic splenosis. The case of thoracic splenosis is a vital topic to discuss in order to accurately diagnose, recognize, treat symptoms, and explore how it can exacerbate pulmonary or cardiology pathology.

Effects of Initiating or Switching to a Six-Monthly Triptorelin Formulation on Prostate Cancer Patient-Healthcare Interactions and Hospital Resource Use: a Real-World, Retrospective, Non-Interventional Study.

INTRODUCTION: Luteinising hormone-releasing hormone agonist (LHRHa) injections are currently used in the treatment of advanced prostate cancer, but the frequency of injections may represent a burden to patients and healthcare services. The aim of this study was to collect real-world evidence about clinical and practical outcomes for patients with prostate cancer initiating six-monthly triptorelin, or switching from shorter-acting formulations to six-monthly triptorelin, in hospitals in the DEcapeptyl SERVice Evaluation project. METHODS: Up to 2 years of data were collected retrospectively by physicians from records of 88 patients receiving six-monthly triptorelin at three centres. The primary outcome measure was the change in the number of patient-healthcare interactions (patient reviews, prostate-specific antigen (PSA) tests, and LHRHa injections) over a 24-month treatment period. RESULTS: This analysis included 47 patients newly initiated on six-monthly triptorelin and 41 who received 12 months of a one- or three-monthly LHRHa before switching to six-monthly triptorelin. After switching to six-monthly triptorelin, there was a statistically significant reduction in patient reviews (46.8%), injections (46.8%), and PSA tests (26.6%; all P < 0.0001). The total number of patient-healthcare interactions was significantly reduced (41.5%; P < 0.0001). Based upon cost of these interactions only, the cost reduction of switching to six-monthly triptorelin was £10,214.85 (£249.14 per patient) over 12 months. At 12 months, median PSA was 1.30 ng/mL (23.50 ng/mL at diagnosis) for newly treated patients and 0.24 ng/mL (0.35 ng/mL at switch) for patients who had switched treatment. No safety issues were identified. CONCLUSION: Switching from one- or three-monthly LHRHa to six-monthly triptorelin significantly reduced patient-healthcare interactions and associated costs while maintaining PSA control over a 12-month treatment period. This not only translates into healthcare savings but may release men from the restriction of repeated healthcare interactions and thus improve the overall patient experience as the population of long-term prostate cancer survivors continues to increase. FUNDING: Ipsen Limited.

Initial experience of an algorithm-based protocol for the community follow-up of men with prostate cancer.

OBJECTIVE: To evaluate the implementation of a novel algorithm-based discharge programme for the community follow-up of men with prostate cancer. PATIENTS AND METHODS: Men with prostate cancer considered suitable for discharge were identified from consultant-led and clinical nurse-specialist telephone clinics at Nottingham University Hospitals National Health Service Trust. Patients were discharged on to one of four discharge pathways: watchful waiting, androgen-deprivation therapy (ADT), post-prostatectomy, and post-radiotherapy. Primary care providers were asked to adhere to specific surveillance measures and refer patients back to secondary care after breach of pre-defined prostate-specific antigen (PSA) level threshold criteria. Reasons for non-compliance, re-referral, and cause of death were determined for all discharged men. RESULTS: In all, 573 men were discharged across all four pathways; 169 on the watchful-waiting pathway, 229 on the ADT pathway, 95 on the post-prostatectomy pathway, and 80 on the post-radiotherapy pathway. All patients had ≥12 months of follow-up. In all, 48 of 54 (88.9%) men were re-referred promptly after a PSA-threshold breach. Of the remaining six patients there were three refusals, one unrelated death before referral, and two late referrals at 4 months. Three patients were lost to follow-up due to database non-registration and were subsequently recalled, none of whom had a PSA-threshold breach. There were three unexpected deaths attributed to prostate cancer: two were community deaths with no biochemical or clinical evidence of prostate cancer progression, while one was due to a likely progressive PSA non-secreting tumour. CONCLUSION: Initial results suggest the algorithm-based protocol is a viable, effective, and oncologically safe method for the controlled discharge of men from secondary to primary care. Longer-term follow-up, patient satisfaction and cost-effectiveness data are required to assess the true impact of the initiative.

Anatomical studies of the neurovascular bundle and cavernosal nerves.

OBJECTIVE: To accurately define the anatomy of the neurovascular bundle (NVB) in men. MATERIALS AND METHODS: The NVB was microdissected in detail bilaterally in 12 fixed human male adult cadavers. The anatomy of the NVB and its relationship to surrounding pelvic structures was ascertained in each specimen. RESULTS: Previous reports of the anatomy of the NVB have not mentioned its levator ani and anterior rectal component. The anatomy of the cavernosal nerves is such that accurate graft anastomosis to proximal and distal cavernosal nerve segments is extremely difficult. CONCLUSION: The current anatomical description of the cavernosal nerve and NVB is inaccurate.

Cowper's syringocele causing painful haematuria in an adult.

A Cowper's syringocele in an adult is rare. Ten cases are reported in the world literature. The authors report a case of painful haematuria due to the presence of a Cowper's syringocele in an adult. The classification of lesions of the Cowper's gland is discussed together with common symptoms and differential diagnosis.