Clinical Treatment Modalities Research Articles

P-41648991-91 - Giant cell lesions manifesting as underlying primary hyperparathyroidism

<h3>Aims and Objective</h3> To evaluate clinical features, prevalence, biochemical findings and treatment modality of giant cell lesions associated with primary hyperparathyroidism in the maxillofacial region. <h3>Materials and Methods</h3> All histopathologically diagnosed cases of giant cell lesions in the maxillofacial region were evaluated retrospectively from eight year old data base in the department of oral and maxillofacial surgery at Govt Dental College Srinagar. Giant cell lesions associated with primary hyperparathyroidism were studied with respect to serum calcium, phosphate, alkaline phosphate and parathormone and other clinical features. The cases were studied and co -related after the correction of primary hyperparathyroidism. <h3>Result</h3> Histopathologically 51 proven giant cell lesions were evaluated and 7 cases were found associated with primary hyperparathyroidism. Two cases had simultaneous maxillary and mandibular involvement. The patients had high values of alkaline phosphate and parathormone on follow up. All 7 patients of primary hyperparathyroidism had significant reduction of lytic bone lesions after parathyroidectomy eliminating the need for surgical intervention for bony lesions. <h3>Conclusion</h3> The prevalence of primary hyperparathyroidism associated giant cell lesions is 5.9%. and is therefore rare. Sometimes the giant cell lesions associated with primary hyperparathyroidism may be the only manifestation and so appropriate work up of patients clinically,rdiographically and biochemically is important to rule out such lesions which are otherwise similar to other giant cell lesions like central giant cell granuloma.

Treatments for AIDS/HIV-related Kaposi sarcoma: A systematic review of the literature.

Treatment guidelines are not well established in AIDS-related Kaposi sarcoma (KS). We aim to review the evidence on efficacy of treatments for AIDS-related Kaposi sarcoma. We searched the Cochrane Library, PubMed, and Embase Database from date of database inception till July 2020. Randomized controlled trials reporting intervention consisting of any type of treatment compared to control/placebo to a different treatment modality or different combination of treatment/treatment doses with a diagnosis of AIDS-related KS are selected. Primary outcomes were response rates defined as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Secondary outcomes were cosmesis and adverse outcomes such as pain and erythema. Thirteen out of 536 articles met our eligibility criteria. Three studies reported the efficacy of chemotherapy, two studies looked at different doses of radiotherapy regimes, and three studies compared different antiretroviral therapy (ART) and chemotherapy regimens. Other studies reported topical therapies such as alitretinoin gel, IM862, and bHCG injection which showed varied efficacies. Lack of standardization classification of disease activity and clinical outcomes and treatment modalities precluded meaningful comparison of studies. The evidence of efficacy of any particular intervention is overall varied and there was insufficient evidence to recommend any particular intervention. We have provided an overview of treatments for KS but larger studies need to be carried out to verify the efficacy of treatment options reported in the literature.

Carbon dots enhance extracellular matrix secretion for dentin-pulp complex regeneration through PI3K/Akt/mTOR pathway-mediated activation of autophagy.

Pulp injury is one of the most common clinical diseases, and severe cases are usually associated with the functional loss of the tooth, while the current clinical treatment modality is only a cavity filling procedure without the regeneration of the dentin-pulp complex, thus leading to a devitalized and brittle tooth. In this study, carbon dots (CDots) with excellent biocompatibility are prepared from ascorbic acid and polyethyleneimine via a hydrothermal method. The as-prepared CDots can enhance extracellular matrix (ECM) secretion of human dental pulp stem cells (DPSCs), giving rise to increased cell adhesion on ECM and a stronger osteogenic/odontogenic differentiation capacity of DPSCs. Further, the mechanism underlying CDots-enhanced ECM secretion is revealed by the transcriptome analysis, Western blot assay and molecular dynamics simulation, identifying that the pharmacological activities of CDots are originated from a reasonable activation of the autophagy, which is mediated by regulating phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin signaling pathway. Based on the abundant CDots-induced ECM and thereby the reinforcement of the cell-ECM adhesion, an intact dental pulp stem cell sheet can be achieved, which in return promote in vivo the efficient regeneration of dentin-pulp complex as well as blood vessels.

Treatment for clear cell carcinoma of the abdominal wall at a tertiary cancer center

Clear cell carcinoma (CCC) of the abdominal wall is a rare and agressive disease. We aim to elucidate the clinical and prognostic characteristics of this disease. Medical records of ten patients diagnosed with CCC of the abdominal wall at Fudan University Shanghai Cancer Center were reviewed. We illustrate the clinical characteristics, treatment modality, and development of local recurrence or distant metastasis, as well as the survival outcome. The median (range) age of patients was 47 (39–61) years old. All patients had a history of cesarean section and abdominal wall endometriosis. All patients had primary surgery before referred to our center. Seven patients had only tumor resection, while two patients had lymph node metastasis at primary diagnosis. Four patients underwent supplementary surgery, and all postoperative pathology were negative. Genetic analyses had also been performed. The median (range) follow-up time was 20 (12–59) months. Local recurrence and lymph node metastasis were the most common recurrence types. The median (95% confidence interval) PFS was 11 (8.08–13.92) months. In summary, primary surgery should consider wide tumor resection and lymph node dissection. Adjuvant chemotherapy and radiotherapy should be recommended for potential benefits. More cases are still needed to elucidate the clinical management of this disease.

Treatment and prognosis of pleuropulmonary blastoma: A single-center report of 31 cases.

Pleuropulmonary blastoma (PPB) is a very rare and highly aggressive neoplasm occurring in children, mostly under 6 years of age. We assessed the clinical characteristics, treatment modalities, treatment outcomes, and prognostic factors affecting survival in patients with PPB treated at our institution over a 10-year period to improve the prognosis. From November 2008 to November 2019, 31 children (21 boys and 10 girls) with a median age of 30 months (ranging, 22 days to 54 months) were treated at our institution. Herewe describe the patient characteristics, treatment modalities, and treatment outcomes. The Kaplan-Meier method was used to estimate the progression-free survival (PFS) and overall survival (OS). Log-rank test was performed for comparison between groups. Three children were lost to follow-up and two were dead due to postoperative complications. Of the 26 patients included in the follow-up, 16 PPB patients displayed tumor-free survival. The 5-year PFS and OS were 60.4% and 60.1% respectively. By stratified statistical analysis, the 5-year PFS and OS of type I PPB were 100%, while those of type III PPB were 43.7% and 43%, respectively. The 5-year PFS and OS of complete tumor resection were 76.5% and 75.6%, respectively, while those with tumor residue were 31.3%. The 5-year PFS and OS combined with chemotherapy were 62.2% and 61.6%, respectively, while those without chemotherapy were 0%. PPB is an aggressive neoplasm. The main factors related to the prognosis of PPB are pathological type, tumor resection degree, and postoperative adjuvant therapy.

Study on clinical evaluation and management of ectopic pregnancy

Background: After an ectopic pregnancy has been confirmed, treatment options include medical, surgical, or expectant management. For patients who are medically unstable or experiencing life-threatening haemorrhage, a surgical approach is indicated. Aims: To study the clinical presentation, risk factors and treatment modalities of ectopic pregnancy. Materials and methods: This prospective open labelled study carried out among patients attending to Department of Obstetrics and Gynaecology in which 50 cases of diagnosed ectopic pregnancies were analysed over a period of 1 1⁄2 year. Results: Ectopic pregnancies are most common in women between the ages of 26 -30. Multiparous women have the highest rate of ectopic pregnancies. H/o tubal procedures (tubal ligation) have the highest prevalence. The majority of patients are with a missing period, lower abdomen pain, and vaginal bleeding. In this study, the ampullary component was the most common site of tubal ectopic in 54 percent of cases, the isthmic part in 38 percent, and the fimbrial region was implicated in 8%. In two cases, medical therapy with a single dose regimen failed, whereas in three cases, medical treatment with a multidose regimen failed. Laparotomy is commonly done because most of the patients come in acute condition.

Acromegaly Caused by Ectopic Growth Hormone Releasing Hormone Secretion: A Review.

IntroductionEctopic acromegaly is a rare condition caused most frequently by growth hormone releasing hormone (GHRH) secretion from neuroendocrine tumors. The diagnosis is often difficult to establish as its main symptoms do not differ from those of acromegaly of pituitary origin.ObjectivesTo determine most common clinical features and diagnostic challenges in ectopic acromegaly.Patients and MethodsA search for ectopic acromegaly cases available in literature was performed using PubMed, Cochrane, and MEDline database. In this article, 127 cases of ectopic acromegaly described after GHRH isolation in 1982 are comprehensively reviewed, along with a summary of current state of knowledge on its clinical features, diagnostic methods, and treatment modalities. The most important data were compiled and compared in the tables.ResultsNeuroendocrine tumors were confirmed in 119 out of 121 patients with histopathological evaluation, mostly of lung and pancreatic origin. Clinical manifestation comprise symptoms associated with pituitary hyperplasia, such as headache or visual field disturbances, as well as typical signs of acromegaly. Other endocrinopathies may also be present depending on the tumor type. Definitive diagnosis of ectopic acromegaly requires confirmation of GHRH secretion from a tumor using either histopathological methods or GHRH plasma concentration assessment. Hormonal evaluation was available for 84 patients (66%) and histopathological confirmation for 99 cases (78%). Complete tumor resection was the main treatment method for most patients as it is a treatment of choice due to its highest effectiveness. When not feasible, somatostatin receptor ligands (SRL) therapy is the preferred treatment option. Prognosis is relatively favorable for neuroendocrine GHRH-secreting tumors with high survival rate.ConclusionAlthough ectopic acromegaly remains a rare disease, one should be aware of it as a possible differential diagnosis in patients presenting with additional symptoms or those not responding to classic treatment of acromegaly.

LINC-21. PROGNOSTIC FACTORS AND SURVIVAL OF LOW-GRADE GLIOMAS IN CHILDREN AND ADOLESCENTS – A MULTICENTER STUDY IN PERU

BACKGROUND: Low-grade gliomas (LGG) are the most common central nervous system (CNS) tumors in children. Peru is an index country for the Global Initiative for Childhood Cancer (GICC). As part of the Initiative, a multidisciplinary brain tumor team was formed in 2020 that includes five national reference centers: National Institute of Neoplastic Diseases, National Children’s Health Institute-San Borja, National Children’s Health Institute-Breña, Edgardo Rebagliati Martins National Hospital and Guillermo Almenara Irigoyen National Hospital. This multicenter study sought to evaluate the survival and prognostic factors of patients younger than 18 years diagnosed with LGG, an index cancer for the GICC. METHODS: A retrospective study included all patients diagnosed with LGG in the five centers between 2014 and 2018. We analyzed clinical characteristics, histology, and treatment modalities. We used the Kaplan-Meier method for survival. RESULTS: 194 patients were registered; 136 patients were included. M/F ratio was 1.2, mean age 7 years old. The most frequent location was infratentorial (42.2%), supratentorial (34.9%), optic/chiasm/sellar (11%) and brainstem (11.9%). The most frequent histological types were pilocytic astrocytoma (61%), diffuse astrocytoma (10.3%), oligodendroglioma (5.2%), and other low-grade neoplasms (23.5%). Surgery was performed in 109 patients (83.2%). Chemotherapy alone was used in 17 (12.5%), while radiotherapy in 20 (14.7%). Overall survival at 5 years was 82.9% (95% CI 73.3 - 89.4). Age younger than 3 years (p=0.002), diffuse histological type (p=0.04), and location in the brainstem (p=0.001) were factors associated with a worse prognosis. CONCLUSIONS: Within the framework of the GICC, this work is one of the first steps to understand the current context of pediatric CNS tumor care in Peru. Although the reported survival rate is about the GICC goal of 60%, further improvements in care are needed to increase survival to level closer to high-resource setting and decrease long term morbidity.

Challenges and opportunities in the development of metal-based anticancer theranostic agents.

Around 10 million fatalities were recorded worldwide in 2020 due to cancer and statistical projections estimate the number to increase by 60% in 2040. With such a substantial rise in the global cancer burden, the disease will continue to impose a huge socio-economic burden on society. Currently, the most widely used clinical treatment modality is cytotoxic chemotherapy using platinum drugs which is used to treat variety of cancers. Despite its clinical success, critical challenges like resistance, off-target side effects and cancer variability often reduce its overall therapeutic efficiency. These challenges require faster diagnosis, simultaneous therapy and a more personalized approach toward cancer management. To this end, small-molecule ‘theranostic’ agents have presented a viable solution combining diagnosis and therapy into a single platform. In this review, we present a summary of recent efforts in the design and optimization of metal-based small-molecule ‘theranostic’ anticancer agents. Importantly, we highlight the advantages of a theranostic candidate over the purely therapeutic or diagnostic agent in terms of evaluation of its biological properties.

A Retrospective Analysis of Clinical Characteristics, Treatment Modalities and Outcome of the Patients With Infantile Hepatic Hemangiomas: Single-center Experience From Turkey.

Hepatic hemangiomas (HH) are the most common vascular tumors of the liver. It is important to distinguish hemangiomas from malignant liver tumors. The patients 0 to 1 years old, were diagnosed with HH and followed up in the oncology outpatient clinic between 2009 and 2020 were included in the study. A total of 127 patients with the diagnosis of HH were included in the study. Of the patients, 99 (78%) had focal, 20 (15.7%) had multifocal, and 8 (6.3%) had diffuse HHs. Surgery was performed and the diagnosis was confirmed histopathologically in 6 patients (4.7%). During the follow-up, 16 (12.5%) patients received medical treatment. Thirteen (10.2%) were treated with propranolol, 2 (1.5%) with corticosteroids, and 1 (0.8%) with propranolol and corticosteroids. Complete response was obtained in 9 (9/16) patients and partial response was obtained in 6 (6/16) patients with medical treatment. Although HH is a benign tumor, it is important to make its differential diagnosis with malignant tumors of the liver. Over the years, the need for histopathologic examination for diagnosis has decreased. The success rate of propranolol is high, and the need for other treatment options with a high side-effect profile has decreased significantly since 2008.

The value of FDG PET/CT in the management of malignant melanoma: a retrospective study

Objectives: Positron Emission Tomography with Computed Tomography (PET/CT) is a valuable imaging method for the restaging of malignant diseases as well as the evaluation of treatment outcomes. Malignant melanoma is an aggressive tumor. Surgical resection is the primary treatment. As melanoma lesions are mostly FDG-avid, whole-body 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging modality can be used to determine the spread of the tumor. In the present study, we intended to share our clinical experience with FDG PET/CT in malignant melanoma patients under different kinds of treatment. Methods: In this retrospective study, the data sets of 122 patients who had surgical resection of known primary tumors, all of which were histopathology-proven malignant melanoma, were analyzed. All patients underwent baseline 18F-FDG PET/CT scan no sooner than 45 days and at least once after surgery. Clinical information, radiological imaging, histopathology, and treatment modalities were noted for all patients, and 18F-FDG PET/CT findings were examined. Results: All patients were histopathology-proven and 47 of them had acral lentiginous, 37 nodular, 23 amelanotic, and 15 atypical malignant melanoma. Local recurrence was detected by 18F-FDG PET/CT in 13 (10.6%; 3 male, 10 female) of the 122 patients, and the mean recurrence time after diagnosis was 3 ± 1.4 years. 10 patients with brain and bone metastases underwent radiotherapy. 19 patients with lung, bone, and hepatic metastases received chemotherapy and 22 patients immunotherapy. Conclusions: Malignant melanoma is a type of skin cancer that may involve any organ. In localized cases, complete surgical resection may be adequate for a cure. If diagnosed with the latter type, the whole body of the patient must be examined.

Endophthalmitis, Visual Outcomes, and Management Strategies in Eyes with Intraocular Foreign Bodies.

PurposeOcular trauma with intraocular foreign body (IOFB) can have devastating visual consequences. Management and antimicrobial strategies remain variable due to the infrequency and heterogeneity of presentation. Our goal was to identify risk factors for endophthalmitis and poor visual outcomes in cases of IOFB and investigate management strategies.Patients and MethodsA retrospective chart review was conducted in 88 eyes of 88 patients suffering traumatic injury with IOFB at the University of Michigan between January 2000 and December 2019. Medical records were reviewed to characterize the injuries and IOFBs as well as how clinical presentation and treatment modalities were associated with outcomes.ResultsDelayed presentation (P=0.016) and organic IOFB (P=0.044) were associated with development of endophthalmitis. Retinal detachment (P=0.012), wound length greater than 5 mm (P=0.041), and poor presenting visual acuity (P=0.003) correlated with poor final visual outcome. Antibiotic prophylaxis was given to all patients, though agents and routes of delivery varied. Endophthalmitis developed in 4.9% of the eyes after initial management, with primary and secondary removal of posterior segment IOFBs associated with similar rates of endophthalmitis (P=1.000).ConclusionPoor presenting visual acuity and severity of injury, as measured by large wound and retinal detachment, correlate with poor visual outcome. Prompt globe closure and antimicrobial prophylaxis are critical for infection prevention. In cases where IOFB removal and globe closure cannot be performed concurrently, primary globe closure with aggressive antibiotic prophylaxis offers a reasonable alternative to prevent endophthalmitis.

Experience with Congenital Adrenal Hyperplasia in Tripoli Children's Hospital, Libya

AbstractCongenital adrenal hyperplasia (CAH) denotes a group of autosomal recessive disorders. Its clinical spectrum varies from classical CAH (CCAH) to nonclassic CAH. It may be a simple virilizing form or salt-wasting type. The study described the clinical presentation, treatment modalities, and sequelae of CAH, including its effect on patient growth during long-term follow-up. A case series study was conducted on patients with CAH who attended and followed up in the Endocrine Clinic in Tripoli Children's Hospital from January 1, 2000 to December 31, 2018. The presentation and the last visit captured demographic and clinical features at the time of diagnosis, types of CAH (classical vs. nonclassical), investigations, treatment details, and height. All patients underwent biochemical testing and hormonal assay, including adrenocorticotropin hormone (ACTH), 17-hydroxyprogesterone (17-OHP), and plasma renin activity (PRA) levels before and after treatment. Fifty-eight patients were included; 38 (65.5.2%) were female, age at presentation in 94.8% ranged between 1 day and 10 years, with a mean age of 2.3 ± 1.1 years. Ambiguous genitalia was the presenting feature in 55.2 and 84% of total and female patients, respectively. Salt wasting was present in 37.9%. Of 32 female patients with ambiguous genitalia, only 11 (34.4%) out of them and 19% of all patients had a surgical correction. The mean and standard deviation of height at diagnosis was 78.327 + 31.070, and the last visit after treatment was 108.345 + 31.781. The relation between the date of birth and height throughout follow-up for those at last visit with age ranges from 13 to 18 years old, their mean and standard deviation of height was 135.650 + 29.286, and for patients who were less than13 years at last visit, the mean and standard deviation of height was 101.079 + 32.121; p-value = 0.003. The Z-scores were calculated and showed that about eight patients were positively above the average mean of the population. Biochemical disturbances were improved after treatment, including sodium, potassium, and glucose in CCAH type; p-value &lt; 0.001. Hormonal findings included levels of ACTH, 17-OHP, and PRA; all levels were reduced with treatment; p-value &lt; 0.001. In this single-center series, most of our patients with biochemical and hormonal abnormalities were normalized with hormonal replacement and limited surgical correction of females with ambiguous genitalia.

Factors associated with swallowing dysfunction in patients with head and neck cancer.

The aim of this prospective cohort study was to investigate swallowing function in relation to personal and clinical factors among patients with head and neck cancer (HNC) from diagnosis up to 2years after treatment. The 100ml water swallow test was measured before treatment, and 3, 6, 12, and 24months after treatment. Linear mixed-effects model analysis was conducted to investigate changes over time and the association with personal (sex and age) and clinical (tumor site, tumor stage, and treatment modality) factors. Among 128 included patients, number of swallows increased from baseline to 3months after treatment and decreased to baseline again at 6months after treatment. The number of swallows was associated with age and treatment modality. In patients with HNC, swallowing (dys)function changes over time with the worst score 3months after treatment. A higher age and being treated with surgery are factors associated with swallowing dysfunction over time.

GIANT PERIPHERAL OSSIFYING FIBROMA OF THE MANDIBLE: CASE REPORT OF A RARE AND DISTINCT PATHOLOGY

Peripheral ossifying fibroma usually presents as a small, pedunculated, gingival nodule, the pathogenesis of which is believed to be reactive rather than neoplastic. The lesion is typically less than two cm in size; however, there are reported cases where the lesion grew quite large. The oversize mass-like clinical appearance might be confused for other similar neoplastic lesions of the oral cavity, and the radiographic presentation of soft tissue calcification may lead to misdiagnosis; however, the histological features are diagnostic. There are very few cases reported of a giant POF; hence, we present a new case of a giant mandibular POF that was managed with resection and reconstruction. A brief review of previously reported cases on the clinical presentation, radiographic features, treatment modalities, and outcomes is performed to inform clinical decision making. This lesion represents a distinct clinical entity with a set of features requiring recognition for accurate diagnosis and a radical management approach due to its aggressive growth and a high recurrence rate.

Recurrent respiratory papillomatosis: clinical presentation, treatment modalities, and outcomes in Khartoum state

BackgroundIn this hospital-based cohort study, a total number of 52 patients with recurrent respiratory papillomatosis were studied. The medical histories of all the patients were taken and physical examination was conducted thoroughly. Types of surgeries were also observed and the sites of papillomatous lesions were identified. The patients then followed up after surgeries to assess the outcomes and to evaluate the satisfaction levels of the patients.ResultThere was obvious gender predilection toward male patients. Ninety percent of the cases were younger than 20 years old, and 50% of the cases were found to be in the group of 5–10 years old. The most predominant symptom that had been noticed in all of the patients was the change of voice. The study also found that around 46% of the patients had a history of surgical interventions as trials to treat the disease. Acyclovir tabs were prescribed for only 4 patients. No other forms of adjuvant therapies were prescribed. It is also showed that around 65.4% of the cases underwent surgical removal of the papillomata by debulking using cold steel. 30.8% underwent laser and two patients underwent coblation surgeries. Forty-two percent of the patients reported good and satisfactory outcomes with obvious relief from presenting symptoms and no apparent papilloma after IDL examination.ConclusionRecurrent respiratory papillomatosis presents with a highly variable clinical course in both juvenile and adult patients, with a spectrum from indolent to aggressive disease. But the severity of the condition is more among the younger ages. Change of voice was the first symptom in all of the cases. The use of adjuvant medical treatment in Sudan to treat respiratory papillomatosis is not a routine practice.

Are Root-Supported Overdentures Still an Alternative to Implant-Supported Overdentures? A Scoping Review.

To compare the outcomes of prosthodontic treatment for subjects wearing a complete maxillary denture opposing a root-supported mandibular overdenture (RSO) or an implant-supported mandibular overdenture (ISO). A literature search was performed in seven electronic databases: MEDLINE via PubMed interface, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, and AgeLine. The search terms were developed by the primary investigators and the health sciences librarian, who then started with PubMed and adapted the original search strategy for the other databases. Included articles were those that compared the outcomes for mandibular RSOs and those with ISOs, for persons wearing a maxillary complete denture. Seven articles were included in the review. There were limitations in this review because of small sample sizes, short study durations, and different methodologies. Also, no comparative studies were identified for clinically important outcomes, such as survival rates of abutments, prosthodontics/maintenance problems, and longitudinal cost of care. For prosthodontic complications, patient satisfaction, and ability to clean, no differences were reported. For oral tactile sensibility, RSOs presented significantly improved sensibility, whereas ISOs had higher maximum bite force capability, but the difference was not statistically significant, except when subjects had a cross-bite or a lingualized occlusion. The results of this scoping review were not conclusive, except for maximum bite force, where ISOs seem to perform better than RSOs by the measured criteria. ISOs had higher survival rates than RSOs, and required less maintenance, but were more expensive. It was disappointing to find so few studies comparing these clinical treatment modalities, which suggests that either treatment may be clinically acceptable and depends upon a shared decision between patients and their dentists.

Clinical Manifestations and Outcomes of Tubercular Uveitis in Taiwan-A Ten-Year Multicenter Retrospective Study.

Background andObjectives: This 10-year multicenter retrospective study reviewed the clinical manifestations, diagnostic tests, and treatment modalities of tubercular uveitis (TBU), including direct infection and indirect immune-mediated hypersensitivity to mycobacterial antigens in Taiwan. Materials and Methods: This retrospective chart review of patients with TBU was conducted at 11 centers from 1 January 2008 to 31 December 2017. We used a multiple regression model to analyze which factors influenced best-corrected visual acuity (BCVA) improvement. Results: A total of 79 eyes from 51 patients were included in the study. The mean age was 48.9 ± 16.4 years. The mean change of LogMAR BCVA at last visit was −0.21 ± 0.45. Diagnostic tools used include chest X-ray, chest computed tomography, Mantoux test, interferon gamma release test (QuantiFERON-TB Gold test), intraocular fluid tuberculosis polymerase chain reaction, and bronchial alveolar lavage. The clinical manifestations included 48% posterior uveitis and 37% panuveitis. In the sample, 55% of the cases were bilateral and 45% unilateral. There was 60.76% retinal vasculitis, 35.44% choroiditis, 21.52% serpiginous-like choroiditis, 17.72% vitreous hemorrhage, 12.66% posterior synechiae, 6.33% retinal detachment, and 3.80% choroidal granuloma. Treatment modalities included rifampicin, isoniazid, pyrazinamide, ethambutol, oral steroid, posterior triamcinolone, non-steroidal anti-inflammatory drugs, vitrectomy, and immunosuppressants. BCVA improved in 53.2% of eyes and remained stable in 32.9% of eyes. In the final model of multiple regression, worse initial BCVA, pyrazinamide, and receiving vitrectomy predicted better BCVA improvement. Ethambutol was associated with worse visual outcomes. Seven eyes experienced recurrence. Conclusions: This is the largest 10-year multicenter retrospective study of TBU in Taiwan to date, demonstrating the distribution of clinical manifestations and clinical associations with better treatment outcomes. The study provides a comprehensive description of TBU phenotypes in Taiwan and highlights considerations for the design of further prospective studies to reliably assess the role of ATT and vitrectomy in patients with TBU.

Primary Diffuse Large B Cell Lymphoma of Bone: A Single-Center Experience.

BackgroundPrimary diffuse large B-cell lymphoma of the bone (PB-DLBCL) is a rare type of extra-nodal lymphoma. This study aimed to examine the clinical characteristics, outcomes, treatment modalities and risk of central nervous system relapse (CNSR) among adult Jordanian patients with PB-DLBCL.MethodsThis retrospective study included patients aged >16 years who were diagnosed with PB-DLBCL and treated at our hospital between 2002 and 2021. Clinical characteristics, treatment modalities, outcomes and CNSR events were extracted from the hospital’s data system and analysed. Patients were categorised into unifocal (UF) and multifocal (MF) PB-DLBCL groups according to the number of bone sites involved. The involvement of only one site was defined as UF, whereas the involvement of two or more sites was defined as MF.ResultsIn total, 12 patients were diagnosed with PB-DLBCL. Their median age was 47.5 years (range, 17–80 years). The male:female ratio was 1:1. There were eight patients in the UF PB-DLBCL group and four in the MF PB-DLBCL group. All patients received treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone. In the UF PB-DLBCL group, the male:female ratio was 5:3, the median age was 41 years, and the follow-up duration was 9–135 (mean, 83.3) months. In the MF PB-DLBCL group, the male:female ratio was 1:3, the median age was 51.5 years, and the survival time was 3–11 (mean, 7) months. Three patients with vertebral UF PB-DLBCL underwent early vertebroplasty without complications. The most common site involved was the vertebral column. Most patients with UF PB-DLBCL achieved complete remission (CR), whereas no patients with MF PB-DLBCL achieved CR.ConclusionPB-DLBCL is rare in adult Jordanian patients. UF PB-DLBCL is more common than MF PB-DLBCL. Patients with UF PB-DLBCL had a good prognosis. Patients with MF PB-DLBCL had a high international prognostic index score, risk of CNSR and short survival time.

Factors affecting hemostasis in the control of iatrogenic renal hemorrhage.

To investigate factors affecting hemostasis in iatrogenic renal hemorrhage. Seventy-three patients with iatrogenic renal hemorrhage experiencing selective renal artery angiography between Jan 2015 and Dec 2020 were enrolled in this study. The clinical features, treatment modalities and outcomes were reviewed. Factors affecting hemostasis were analyzed by univariate and multivariate models using linear regression techniques. The optimum values of the independent factors to predict postangiographic hemostasis were conducted by receiver operating characteristic (ROC) curve analysis. Of the 73 iatrogenic renal hemorrhage patients, 47 (64.4%) patients had positive angiographic findings and received therapeutic embolization. Of the patients with negative angiographic findings, 20 (76.9%) and 6 (23.1%) received conservative therapy and prophylactic embolization, respectively. The red blood cell (RBC) count (OR = 0.61, P = 0.04), the hematuria time before angiography (OR = -0.19, P < 0.01) and treatment modality were independent factors affecting hemostasis time. The ROC curve analysis showed that the RBC count of 3.5 × 109/L and the hematuria time before angiography of 7days were the optimum indicators. Therapeutic embolization and prophylactic embolization were protective factors affecting hemostasis time compared with conservative treatment (OR = -1.59, P = 0.02; OR = -3.31, P < 0.01). The hematuria time before selective renal artery angiography, the RBC count, and embolization treatment are associated with rapid hemostasis. Embolization is an effective strategy for iatrogenic renal hemorrhage, and also enables rapid hemostasis in patients with negative angiographic findings.