Internal medicine
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This report describes the case of a 29-year-old patient with chronic myeloid leukemia in the blast phase who underwent hematopoietic stem cell transplantation (HSCT) after living-donor liver transplantation. Donor selection, conditioning regimens, and graft-versus-host disease (GVHD) prophylaxis are discussed. ⋯ Maintenance therapy with ponatinib effectively maintained remission. This case highlights the complexities of managing HSCT after solid organ transplantation and suggests strategies for future cases.
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Although sarcoid-like reactions are uncommon in colorectal cancer, they can coexist with other cancers. We herein report a 50-year-old woman with sigmoid adenocarcinoma and osseous sarcoid-like reactions that resembled metastases. ⋯ Bone and lymph node biopsies revealed epithelioid non-caseating granulomas with bone trabeculae, resulting in a final diagnosis of pathological T2N2aM0, Stage IIIB. When the expected depth of invasion differs from that of typical bone metastases, colorectal cancer-associated bone lesions should be evaluated for sarcoid-like reactions.
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Objective The efficacy of anamorelin in pancreatic cancer (PC) patients with a poor performance status (PS) is uncertain, as previous trials have excluded such patients. This study evaluated the efficacy of anamorelin in PC patients with a poor PS (2) compared with those with a good PS (0-1). Methods We retrospectively reviewed consecutive PC patients with cachexia who received anamorelin at our institution. ⋯ A poor PS was associated with early discontinuation of anamorelin. Conclusion The efficacy of anamorelin is extremely limited in PC patients with a poor PS. Patients with PC with a poor PS may not be good candidates for anamorelin compared to those with a good PS.
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Objective Although the management of coronavirus disease 2019 (COVID-19) has improved, chemoprevention remains a challenge. We recently identified that ursodeoxycholic acid (UDCA) is associated with subclinical infection with severe acute respiratory syndrome coronavirus, implying a reduction in the severity of COVID-19. We analyzed a large medical database to assess the utility of UDCA in the reduction of COVID-19 severity. ⋯ The UDCA group had significantly more complications with liver cirrhosis, hepatocellular carcinoma, type 2 diabetes, and hypertension. The UDCA group had a higher in-hospital mortality rate than the non-UDCA group, even after propensity score matching (7.4% vs. 4.3%, p =0.03), whereas there was no difference in the risks of hospitalization, oxygen therapy, or ventilation. Conclusions Although the observed increase in mortality among UDCA users could have been due to unmeasured confounding factors, UDCA did not reduce the severity of COVID-19 in viral hepatitis patients.
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Case Reports
Cholecystocutaneous Fistula Associated with Edwardsiella tarda as a Result of Aggressive Lymphoma Development.
A cholecystocutaneous fistula is a type of external biliary fistula that occurs when there is an abnormal connection between the gallbladder and skin. We report the first case of a cholecystocutaneous fistula that occurred in association with the development of lymphoma in the gallbladder. ⋯ Edwardsiella tarda was cultured from both the abdominal subcutaneous abscess and percutaneous transhepatic gallbladder drainage, demonstrating cholecystocutaneous fistula, and open cholecystectomy revealed lymphoma cell infiltration into the gallbladder. Our case showed unique complications, and its successful management was associated with aggressive lymphoma development.