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  • Author: Yu Ma x
  • Clinical Medicine x
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Late-stage Use of Low-dose Corticosteroids Aid Recovery of Severe H1N1 Viral Pneumonia

Abstract

The role of corticosteroids in the management of severely ill patients with influenza A (H1N1) viral infection is unclear and controversial. Two critically ill cases with influenza A (H1N1) infections complicated with organizing pneumonia (OP) in 2011 successfully treated with low dose corticosteroids were reported here. After initial clinical improvement, the condition of both patients aggravated 20-23 days after the onset of illness. Chest X-ray and computed tomographies (CT) showed an increment of lung infiltrates. Cultures of blood, pleural fluid and transbronchial aspirate were negative for bacteria and fungi. Organizing pneumonia was diagnosed clinically and both patients were successfully treated with low-dose corticosteroids. Low-dose corticosteroids initiated during convalescence may be beneficial for severe swine-origin influenza A H1N1 pandemic 2009 virus (S-OIV) infections.

Open access
Giant malignant peripheral nerve sheath tumors of the occipital scalp

Abstract

Background: Malignant peripheral nerve sheath tumors (MPNST) are rare neoplasms, usually arising from peripheral nerves or showing a nerve sheath differentiation. Primary MPNSTs of the scalp is exceptionally rare, and only sporadic cases have been reported recently.

Objectives: Report a rare case of giant malignant peripheral nerve sheath tumor (MPNST) beneath occipital scalp, and discuss how to treat with this kind of tumor.

Methods: Descriptive study of a rare case of giant peripheral nerve sheath tumors of occipital scalp without adjuvant treatment with nine months follow up.

Results: In a 52-year-old man with MPNSTs beneath occipital scalp, the tumor was treated with complete surgical resection. Histological examination proved that the lesion was a scalp MPNST. The patient was followed up asymptomatic for the following nine months after surgical resection without adjuvant radiotherapy.

Conclusion: MPNSTs beneath the occipital scalp should be treated individually, for those well-circumscribed MPNSTs without bone destruction or brain invasion (low-grade tumors), complete surgical resection with clear margins (if possible) is recommended. Otherwise, adjuvant postoperative radiotherapy is necessary.

Open access
Dumbbell-shaped primary CNS lymphoma involving the hypothalamus and pituitary gland

Abstract

Background: Primary central nervous system lymphoma (PCNSL) involving the hypothalamus and pituitary gland is extremely rare. Therefore, no case to our knowledge has been reported to date.

Objective: We described our findings in a 48-year-old immunocompetent man, who presented with four months progressive diabetes insipidus (DI) and two months subsequent headache.

Methods and Results: A radiological study and magnetic resonance imaging (MRI) suggested a homogeneous enhancing dumbbell-shaped lesion, 2.4⃞1.2 cm in size, involving both the hypothalamus and pituitary gland. A brain biopsy was conducted through a transnasal transsphenoidal approach, and a final histopathological diagnosis of the tumor was confirmed as diffuse large B-cell malignant lymphoma. After extensive tumor surveys, including computed tomography, MRI, ultrasound, bone marrow biopsy, lumbar puncture, and positron emission tomography (PET), no evidence of other lesions found. Subsequently, he received six cycles of intravenous highdose methotrexate-based chemotherapy followed by one cycle of whole-brain radiotherapy. The progressive DI and headache completely resolved and he was in good health 11 months later.

Conclusion: Clinicians should consider the possibility of PCNSL in non specific clinical presentations.

Open access
A current review of dose-escalated radiotherapy in locally advanced non-small cell lung cancer

Abstract

Background

The mainstay therapy for locally advanced non-small cell lung cancer is concurrent chemoradiotherapy. Loco-regional recurrence constitutes the predominant failure patterns. Previous studies confirmed the relationship between increased biological equivalent doses and improved overall survival. However, the large randomized phase III study, RTOG 0617, failed to demonstrate the benefit of dose-escalation to 74 Gy compared with 60 Gy by simply increasing fraction numbers.

Conclusions

Though effective dose-escalation methods have been explored, including altered fractionation, adapting individualized increments for different patients, and adopting new technologies and new equipment such as new radiation therapy, no consensus has been achieved yet.

Open access