Internal medicine
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A 74-year-old woman presented with sudden dyspnea 22 h after orthopedic surgery. Echocardiography revealed significant right ventricular dilatation, suggesting the development of acute pulmonary embolism. ⋯ After administration, her hemodynamic status improved promptly, and she soon showed normotension. The current case suggests the possibility of high-dose methylprednisolone for hemodynamic improvement in FES.
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A 70-year-old woman was admitted to our hospital with dyspnea. Atypical cells with multilobated nuclei were observed in the pleural effusion. Diffuse large B-cell lymphoma (DLBCL) was diagnosed based on a cell block analysis. ⋯ The patient's disease was refractory to chemotherapy, and she died within one year. Although flower-like nuclei are typical of adult T-cell lymphoma/leukemia, similar multilobated nuclei may occur in DLBCL. Although multilobated DCBCL have been reported to have a better prognosis than other forms of DLBCL, the abovementioned translocations may have contributed to the patient's aggressive clinical course.
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Objective Intravascular large B-cell lymphoma (IVLBCL) is a critical cause of fever of unknown origin (FUO). While a pathological analysis is essential for diagnosing IVLBCL, the indications for an invasive procedure may be ascertained using easy, non-invasive tests. The lymphocyte-to-monocyte ratio (LMR) can reportedly predict the diagnosis of malignant lymphoma in patients with lymphadenopathy; however, its clinical utility in predicting an IVLBCL diagnosis in patients with FUO remains to be elucidated. ⋯ A receiver operating characteristic analysis demonstrated that a WBC ≤7,200 and LMR ≤3.0 predicted the diagnosis with a sensitivity of 88.2% and 100%, and a specificity of 65.0% and 43.3%, respectively. In addition, the probability of IVLBCL increased to 71.4% in patients with both variables but was 0% in those with neither variable, indicating its potential utility in determining the need for an invasive procedure. Conclusion The WBC count and LMR predicted an IVLBCL diagnosis in patients presenting with FUO.
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Objective The Glasgow Coma Scale (GCS) is widely used to assess the levels of consciousness. This study examined whether or not the initial GCS score could be a marker of the length of hospital stay (LOS) in patients with thyroid storm. Methods We retrospectively analyzed 29 patients with thyroid storm in our hospital between January 2010 and December 2023. ⋯ The baseline parameters that were significantly correlated with LOS were the GCS (ρ =-0.665; p <0.001) and SOFA score (ρ =0.670; p <0.001). The subsequent rank partial correlation analysis showed that GCS was still inversely correlated with LOS, independent of SOFA score (ρ =-0.390; p =0.040). Conclusions GCS, which can be evaluated more easily and quickly than the SOFA score, is a useful marker of LOS in patients with thyroid storm.
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A 64-year-old man with cirrhosis was diagnosed with unresectable hepatocellular carcinoma and treated with a combination of durvalumab and tremelimumab. The patient had no history of diabetes mellitus. ⋯ The patient was diagnosed with fulminant type 1 diabetes mellitus. Although fulminant type 1 diabetes mellitus is a rare immune-mediated adverse event, it requires prompt attention shortly after the initiation of these agents owing to its severe and emergent nature.