-
Foreman Appel posted an update 6 months, 1 week ago
Two years and four months later, the sinus rhythm converted to atrial tachycardia. At a follow-up examination at four years and eight months, right branch block appeared. Then degree of intraventricular conduction was worsened, and the low voltage of the limb leads was not observed. Seven years after the diagnosis, she was eventually hospitalized for the treatment of pneumonia and heart failure with tachycardia. On the seventh day of hospitalization, heart rhythm was changed to atrial stand-still with escaped ventricular rhythm and died of cardiac arrest. These ECG changes may provide valuable information regarding the pathophysiological changes that occur in AL cardiac amyloidosis.External iliac artery (EIA) injuries caused by blunt trauma are rare. Here, we present the case of a 16-year-old boy who suffered a blunt EIA injury following a motorbike accident. Despite conservative treatment, the intermittent claudication persisted. He was successfully treated using elective endovascular stent-graft implantation on day 59 after the injury. The patient’s ankle-brachial index (ABI) improved along with his symptoms. A contrast-enhanced computed tomography scan on postoperative day 90 showed no residual stenosis and favorable peripheral blood flow. This report suggests that elective endovascular stent-graft implantation might be a viable option for the treatment of blunt EIA injuries.Clear cell sarcoma of the kidney (CCSK) is a rare aggressive pediatric renal tumor. Intratumoral hemorrhage and tumor rupture are considered as oncologic emergencies, requiring a quick and appropriate response. Herein, we report the case of an 11-year-old boy, who visited our hospital with abdominal distension that started a month earlier. Computed tomography (CT) revealed a tumor in the left kidney (size 200 mm), and a diagnosis of CCSK was established with a biopsy. Chemotherapy was initiated to shrink the large and densely vascularized tumor before surgical removal. Two days after initiating chemotherapy, the patient developed abdominal and back pain, anemia, and hypotension. The CT scan showed intratumoral bleeding. Emergency transcatheter arterial embolization (TAE) was performed to control the bleeding. Three tumor feeding vessels were identified an ascending branch from the celiac artery, an intermediate branch from the left renal artery, and a descending branch from the inferior mesenteric artery, of which the intermediate and descending branches were large and bleeding profusely; therefore, the intermediate branch was injected with ethanol and the descending branch was subjected to gel-foam embolization. Chemotherapy was resumed, and the patient’s condition stabilized gradually. The tumor began to shrink, and subsequent chemotherapy progressed well. In week 12 of chemotherapy, the patient underwent tumor resection and left nephrectomy. Postoperative chemotherapy was completed without complications, and there was no recurrence during a 6-year follow-up. Therefore, TAE can effectively control intratumoral bleeding in pediatric solid tumors and consequently prevent an unnecessary high-risk open surgical procedure.
PIK3CA is associated with tumor progression, and the prevalence of its mutation is high in breast cancer. Liquid biopsy offers convenient, non-invasive, and real-time insight into genetic alternation. In this study, we attempted to detect PIK3CA mutations in breast cancer patients through liquid biopsy.
We recruited patients with histologically confirmed breast cancer with distant metastases between April 2020 and September 2020. KRAS G12C inhibitor 36 Circulating DNA was extracted from plasma (ctDNA) and exosomes (exoDNA). PIK3CA mutations (exons 9 and 20) were analyzed by droplet digital PCR.
Of a total of 52 patients recruited, 16 had PIK3CA mutations in their tumor tissue or blood, which comprised 9 with exon 9 mutations (E542K and E545K) and 8 with exon 20 mutations (H1047L and H1047R). In 8 (15%) of the 52 patients, PIK3CA mutations were detected by liquid biopsies using ctDNA in 5 (9%), exoDNA in 6 (11%), and both ctDNA and exoDNA in 3 (6%). Of the 8 patients with PIK3CA mutations detected by liquid biopsies, 3 had no PIK3CA mutations in the primary tumors.
PIK3CA mutations can be detected using liquid biopsy even in patients with no PIK3CA mutations in their primary tumors; thus, combination analysis using tissue and liquid biopsies can provide clinically useful information for patients with breast cancer.
PIK3CA mutations can be detected using liquid biopsy even in patients with no PIK3CA mutations in their primary tumors; thus, combination analysis using tissue and liquid biopsies can provide clinically useful information for patients with breast cancer.
Although the efficacy of rikkunshito in patients with treatment-resistant non-erosive gastroesophageal reflux disease (NERD) has been reported, it is unclear for which subgroups of NERD patients (per the Rome IV criteria) rikkunshito is effective. The objective of this study was to investigate the efficacy of rikkunshito in patients with functional heartburn.
Ten patients with functional heartburn who experienced symptoms of dyspepsia were enrolled. The patients were administered rikkunshito for 8 weeks. The frequency scale for the symptoms of GERD (FSSG), Japanese translation of quality of life in reflux and dyspepsia questionnaire (QOLRAD-J), and hospital anxiety and depression scale (HADS) were evaluated before and 4 and 8 weeks after administration. Overall treatment efficacy (OTE) was evaluated 8 weeks after administration.
One patient was discontinued 4 weeks after administration because of voluntary withdrawal. Total FSSG score was significantly (P = 0.039) lower 8 weeks after treatment or at discontinuation (13.2 ± 8.0) than before treatment (18.3 ± 10.7). Although QOLRAD-J score tended to increase 8 weeks after treatment or at discontinuation compared with before treatment, no significant difference was observed. HADS score did not decrease significantly 8 weeks after treatment or at discontinuation compared with before treatment. However, a correlation was found between total FSSG and HADS anxiety scores (correlation coefficient 0.684, P = 0.027).
This was the first study to investigate the efficacy of rikkunshito in patients with functional heartburn. Rikkunshito may be effective in these patients.
This was the first study to investigate the efficacy of rikkunshito in patients with functional heartburn. Rikkunshito may be effective in these patients.