Medicine
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Observational Study
Coagulation markers and echocardiography predict atrial fibrillation, malignancy or recurrent stroke after cryptogenic stroke.
We evaluated the utility of left atrial volume index (LAVI) and markers of coagulation and hemostatic activation (MOCHA) in cryptogenic stroke (CS) patients to identify those more likely to have subsequent diagnosis of atrial fibrillation (AF), malignancy or recurrent stroke during follow-up. Consecutive CS patients who met embolic stroke of undetermined source (ESUS) who underwent transthoracic echocardiography and outpatient cardiac monitoring following stroke were identified from the Emory cardiac registry. In a subset of consecutive patients, d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex and fibrin monomer (MOCHA panel) were obtained ≥2 weeks post-stroke and repeated ≥4 weeks later if abnormal; abnormal MOCHA panel was defined as ≥2 elevated markers which did not normalize when repeated. ⋯ We report the novel use of the MOCHA panel in CS patients to identify a subgroup of patients more likely to have occult AF, occult malignancy or recurrent stroke during follow-up. A normal MOCHA panel identified a subgroup of CS patients at low risk for recurrent stroke on antiplatelet therapy. Further study is warranted to evaluate whether the combination of an elevated LAVI and abnormal MOCHA panel identifies a subgroup of CS patients who may benefit from early anticoagulation for secondary stroke prevention.
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Phyllodes tumors (PTs) of the breast are rare biphasic fibroepithelial neoplasms which usually present with unilateral palpable breast lumps. Here we reported a case of borderline PTs with multifocal intraductal lesions whose primary clinical manifestation was nipple discharge. ⋯ The lesions of the PTs are often manifested with unilateral, palpable masses in the breast. There are very few case reports of PTs manifested with nipple discharge in the literature. We should improve the understanding of the multiple clinical manifestations of PTs.
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Sodium valproate is a widely used antiepileptic drug and also used to prevent postoperative seizures in neurosurgery. Anemia caused by sodium valproate is occasionally reported and most are from pediatric patients. ⋯ Hematologic toxicity of sodium valproate can occur quickly. Regular complete blood count test helps to make prompt diagnosis and drug discontinuation leads to the recovery.
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Mucormycosis is a rare fungal infection which mainly develops in compromised hosts and the associated mortality rate is high. ⋯ This is the first report of mucormycosis after routine endoscopic sinus surgery. We did not miss headache symptom after FESS surgery, and diagnosed mucormycosis through early endoscopic biopsy, which played an important role in curing the patient. In addition to the importance of medical therapy such as DM control for patients, emotional support and psychiatric treatment are also important factors as these patients require hospitalization for a long period, 3 months in the case of this patient.
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Case Reports
Elevation of tumor mutation burden in ROS1-fusion lung adenocarcinoma resistant to crizotinib: A case report.
Although most of non-small cell lung cancer (NSCLC) patients with ROS1-fusions respond to crizotinb, acquired resistance eventually develop. The next-generations of ROS1 inhibitors have made some achievements, but the effects of immunotherapy have not been explored. ⋯ The genetic profile of NSCLC patients might be altered in various therapeutic processes. Thus, repeated genetic testing might be important at each progression. Moreover, immunotherapy might be a powerful weapon to overcome the resistance to Tyrosine kinase inhibitors (TKIs) in future.