Evaluation of Eltrombopag in Thrombocytopenia Post Hematopoietic Cell Transplantation: Rertrospective Observational Trial.

BACKGROUND: Thrombocytopenia remains a life-threatening late complication of HCT with an incidence of 5-20%. Currently, there is no approved drug for the treatment of persistent thrombocytopenia post HCT and platelet transfusion is the maintain stay of treatment. Eltrombopag is approved for the treatment of thrombocytopenia associated with different diseases, however; data on eltrombopag treatment post HCT are limited. METHODS: This is a retrospective cohort study evaluating the effect of eltrombopag on platelet recovery in patients with persistent thrombocytopenia post HCT. The primary endpoint was platelet recovery to ≥ 20,000/µL for 7 consecutive days without transfusion support after starting eltrombopag. Secondary endpoint was platelet recovery to ≥ 50,000/µL for 7 consecutive days. RESULTS: Twenty-one patients were included. Twelve (75%) of 16 patients became independent from platelet transfusions. Median time from starting eltrombopag to last transfusion was 60 days (range, 9-226 days). Ten (63%) of 16 transfusion dependent patients with platelet count < 20,000/µL achieved the primary endpoint. Seven (33%) patients of 21 included had successful platelet recovery (ie, ≥50,000/µL without transfusion support) and the median time to platelet recovery in patients who achieved it was 32 days (range, 13-265 days). Ten patients (48%) were able to successfully discontinue eltrombopag without recurrence of thrombocytopenia. CONCLUSION: Our findings demonstrated that eltrombopag appears to have a clinically significant impact on platelet recovery in persistent thrombocytopenic patients post HCT.

Intraperitoneal rupture of cysticercosal cyst mimicking appendicular perforation.

Anaphylaxis following intraperitoneal rupture of a cysticercosal cyst mimicking pelvic peritonitis secondary to appendicular perforation is reported. Human cysticercosis occurs following ingestion of Taenia solium eggs, usually from faecally contaminated food. A case of pelvic cysicercosis presenting with signs and symptoms of anaphylaxis and peritonitis is reported, with plausible explanations for this unusual presentation.

Taenia-induced ileal perforation.

An unusual case of taenia-induced ileal perforation is reported and the management is discussed.

A new technique for correction of disproportionate preputial growth with phimosis.

A new surgical solution to correct the rare anomaly of asymmetric phimosis is described, with a note on its symptomatology and etiopathogenesis.

Drainage of deep-seated amoebic liver abscess by Supra cath.

Supra cath is an effective alternative to trocar for drainage of deep-seated liver abscess especially in obese or muscular patients with a thick parietal wall.

Primary spinal extradural hydatid cyst.

We report a rare case of spinal cord compression caused by primary multiple extradural hydatid cysts.

Pulmonary mucormycosis diagnosed by fine needle aspiration cytology. A case report.

BACKGROUND: The usefulness of fine needle aspiration cytology (FNAC) in the diagnosis of lung lesions is well documented. Fungal lesions are among nonneoplastic lesions of the lung in which FNAC has proven a useful technique in both immunocompromised and immunocompetent patients. These include cryptococcosis, aspergillosis, histoplasmosis and coccidiodomycosis. Pulmonary mucormycosis, an aggressive fungal infection, is rarely diagnosed on FNAC. We report a case of isolated pulmonary mucormycosis diagnosed on FNAC. CASE: A 62-year-old renal transplant recipient with diabetes mellitus and hypertension, asymptomatic for four months, presented with tachypnea, generalized malaise and weakness. Radiologic studies showed an enlarging, cavitating lesion in the right lung. Computed tomography-guided fine needle aspiration performed on the lung lesion showed fungal profiles with broad, ribbonlike, aseptate hyphae with right-angled branching consistent with the Zygomycetes class of fungi, which includes Rhizopus and Mucor species. Fungal cultures confirmed the presence of Rhizopus. The patient underwent right pneumonectomy, was placed on liposomal amphotericin B therapy and discharged with good pulmonary status and stable kidney function. CONCLUSION: FNAC is a useful technique in the diagnosis of pulmonary mucormycosis.

AAEM case report 16. Botulism. American Association of Electrodiagnostic Medicine.

Early diagnosis of botulism is essential for effective treatment. Electrophysiologic testing can be of major help to establish a prompt diagnosis, but the classic electrodiagnostic features of botulism are often elusive. Decrement or increment of compound muscle action potential (CMAP) amplitudes to slow or fast rates of nerve stimulation are often unimpressive or totally absent. Reduction of CMAP amplitudes, denervation activity, or myopathic-like motor unit potentials in affected muscles are found more frequently but they are less specific. In general, the electrophysiologic findings taken together suggest involvement of the motor nerve terminal, which should raise the possibility of botulism. The case reported here illustrates a common clinical presentation of botulism. This study emphasizes realistic expectations of the electrodiagnostic testing, the differential diagnosis, and the potential pitfalls often encountered in the interpretation of the electrophysiologic data.

Diagnostic difficulties in patients with adul botulism type a.

Although the ekcuodiagnostic abnormalities in botulism have bean well characterized, the expected abnormalities, such as facilitation of compound muscle anion potential amplitudes after sustained activation or with repetitive stimulation at fast tales, may not always be present especially early m the disease. This may lead to etectrodtagnosttc difficulties and sometimes a delay in establishing a diagnosis. We describe four serologically proven cases of type A botulism in adults that illustrate the variability in ekctrodiagnostic findings in this disease.

Prognostic significance of DNA ploidy and S-phase fraction in malignant serous cystadenocarcinoma of the ovary.

OBJECTIVE: To determine the prognostic value of DNA ploidy and S-phase fraction in malignant serous cystadenocarcinoma of the ovary. STUDY DESIGN: Flow cytometric analysis of nuclear DNA content was performed on paraffin-embedded tissues of 31 serous cystadenocarcinomas of the ovary. DNA ploidy, DNA index and S-phase fraction were determined without knowing the final outcome in the patients. RESULTS: Histograms in 14 (46%) cases were aneuploid, whereas 17 (54%) were diploid. Aneuploidy was more frequent at the advanced stages of the disease as well as in the poorly differentiated histologic types. However, ploidy had a prognostic influence: both the disease-free survival and overall survival were better in diploid than aneuploid tumors at early and advanced stages. S-phase fraction (SPF) could be correctly assessed in 19 cases (62%) and was > 15% in 21% (4 cases). The survival of those patients, however, was not significantly different from that of those with SPF < 15%. CONCLUSION: If used as an adjunct, DNA ploidy is of value in predicting tumor behavior, response to chemotherapy and disease recurrence.

Fulminant demyelinating neuropathy mimicking cerebral death.

Guillain-Barré syndrome can very rarely present with acute quadripares and cranial nerve involvement resembling a locked-in state. We describe a very unusual case of fulminant neuropathy in a child who was previously exposed to vincristine. The clinical picture resembled brain death; however, electrodiagnostic studies led to the diagnosis of a peripheral neuropathy. Serial electrodiagnostic studies and pathologic findings confirmed demyelination.