Diabetic Ketoacidosis as the Initial Presenting Symptom of Pancreatic Adenocarcinoma: A Discussion about Screening Utilizing ENDPAC Scoring Coupled with CT Scans and Endoscopic Ultrasound.

Pancreatic adenocarcinoma is often discovered at an advanced stage due to a lack of early symptomology, resulting in this being the fourth leading cause of cancer-related death in the USA. The relationship between diabetes mellitus and pancreatic cancer has been known for many years; however, it is not well understood. Studies have suggested that long-standing type 2 diabetes mellitus can increase the risk of pancreatic cancer by 1.

Ventriculorenal shunts in the treatment of pediatric and adult hydrocephalus-historical perspective and analysis of current practice.

Hydrocephalus is a complex pathology that can have a significant impact on the quality of life in all age groups. Cerebrospinal fluid (CSF) diversions from the lateral ventricle to the peritoneal cavity are regarded as the treatment of first intent, but they have a high revision rate, and there are multiple factors which can impair their proper insertion and function. One of the many alternatives to peritoneal shunting is redirecting the CSF towards the renal system.

Stage 4 Cytokine Release Syndrome Caused by the First Dose of Nivolumab and Ipilimumab Combination Therapy in a Patient with Metastatic Melanoma Successfully Treated with Methylprednisolone, Tocilizumab, and Etanercept.

The authors report the first case of stage 4 cytokine release syndrome (CRS) (graded by the National Cancer Institute Common Terminology Criteria for Adverse Effects scale) involving a patient with advanced metastatic melanoma who was treated with the combination of two monoclonal antibodies, nivolumab (anti-programmed cell death receptor 1 inhibitor [PD-1]) and ipilimumab (a cytotoxic T lymphocyte-associated antigen 4 inhibitor [CTLA-4]) after her first dose of both. The patient was treated initially with methylprednisolone and tocilizumab but was refractory to treatment. A trial of etanercept was initiated due to her elevated levels of TNF-α which elicited a satisfactory response.

Acute Hyperhemolysis Syndrome in a Patient with Known Sickle Cell Anemia Refractory to Steroids and IVIG Treated with Tocilizumab and Erythropoietin: A Case Report and Review of Literature.

Patients with sickle cell anemia often receive multiple red blood cell (RBC) transfusions during their lifetime. Hyperhemolysis is a life-threatening phenomenon of accelerated hemolysis and worsening anemia that occurs when both transfused RBCs and autologous RBCs are destroyed. The level of hemoglobin post-transfusion is lower than pre-transfusion levels, and patients are usually hemodynamically unstable.

Spontaneous Tumor Lysis Syndrome in a Patient with Bulky Chronic Lymphocytic Leukemia Diagnosed after Resolution of Symptoms.

Tumor lysis syndrome (TLS) is an oncologic emergency characterized by the destruction of tumor cells leading to an influx of large amounts of uric acid, potassium, and phosphorus into systemic circulation. It most often occurs after the initiation of cytotoxic therapy in high-grade lymphomas and leukemias; however, rarely it may occur spontaneously. The authors report a case of spontaneous tumor lysis causing electrolyte abnormalities and acute kidney injury in a patient with subsequently diagnosed large chronic lymphocytic leukemia tumor burden.

The Development of Immune Thrombocytopenia Due to COVID-19 Presenting as Menorrhagia.

Immune thrombocytopenia (ITP), also known as immune thrombocytopenic purpura, is a hematological disorder characterized by a decreased platelet count, predisposing patients to bleeding. Coronavirus disease 2019 (COVID-19) has been linked to multiple cases of newly diagnosed ITP and is usually found in moderate-to-severe infections, peaking in children and elderly adults. Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding occurring at regular intervals or prolonged uterine bleeding lasting more than seven days.

Cyclical Thrombocytopenia Synchronized With the Patient's Menstrual Cycle Treated With Danazol.

Cyclical thrombocytopenia (CTP) is a very rare condition and often misdiagnosed as immune thrombocytopenia (ITP) due to similar features existing between the two. When evaluating a patient for the possible diagnosis of ITP, CTP must be high on the differential diagnosis. The main difference between the two conditions is that CTP is usually unresponsive to the treatment given to ITP and will ultimately display a cyclical nature with periods of low, normal and elevated platelets.

Hyperleukocytosis and Pseudohyperkalemia in a Patient With Severe SARS-COVID 19 Unmasks Chronic Lymphocytic Leukemia.

Coronavirus disease 2019 (COVID-19) has caused significant morbidity and mortality in a vast majority of the patient population, especially those with malignancies. Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults and is often an indolent disease. High white blood cell counts greater than 120 k/cumm in chronic lymphocytic leukemia may be implicated in cases of COVID-19.

Evaluation of the ventriculocholecystic shunt-an overview of present practice in adult and pediatric hydrocephalus.

In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the current elected clinical solution, various receptacles have been utilized when experiencing contraindications. Along with the ventriculoatrial or ventriculopleural, the ventriculocholecystic shunt was also described as an alternative.

[The diagnostic and surgical treatment characteristics in gastric ulcer].

The work analyses a number of 283 patients suffering from gastric ulcer, which were hospitalised and operated between 1981-1991. In 64% of cases the surgical treatment decision was an emergency one for major complications of this disease such as: the upper digestive hemorrhage (27%), penetration (22%), perforation (11%), digestive stenosis (4%). In 36% of cases the decision of operation was taken for different reasons: unsatisfactory evolution under the conservatory treatment, the existence of an irreparable anatomic lesion, the recurrent ulcer or the difficulty of differential diagnosis between gastric ulcer and gastric carcinoma.

[The diagnosis and therapeutic approach in acute necrotic-hemorrhagic pancreatitis].

The work contains the clinical and therapeutic analysis of a group of 72 patients with acute necrotic-haemorrhagic pancreatitis (ANHP), admitted in the period 1979-1989 to the Ist Surgical Clinic of the Municipal Clinical Hospital of Bucharest. The etiology of ANHP, its clinical forms of manifestation, the peculiarities of shock and its dynamic course are shown and discussed. Stress is laid on the criteria of severity, on the course and on the complications occurred.

[Acute diffuse peritonitis, a rare complication of perianorectal suppuration].

The paper reports on two peculiar clinical observations of diffuse acute peritonitis in which the abdominal cavity was contaminated by perianorectal suppurative acute processes, insufficiently solved surgically. The diagnosis difficulties, peculiarities of the surgical treatment, and their special seriousness are revealed.

Estradiol and progesterone receptor levels in human breast cancer in relation to cytosol and plasma estrogen level.

Estradiol receptor (ER) and progesterone receptor (PR) content along with the cytosol and plasma estrone and estradiol levels in 15 premenopausal and 26 postmenopausal women with breast cancer in different clinical stages (T123, N01, M0) were measured. ER-positive tumor frequency and the ER content tended to be higher in postmenopausal than in premenopausal patients. There was no evidence for a relationship between high cytosol estrogen levels and low receptor measurements.

[Importance of hormone dependence of malignant tumors of the breast in orientation of the surgical treatment].

The authors have investigated the presence of oestrogenic and progesteronic receptors in 38 patients with breast cancer. It was noted that these receptors were present in 20 patients, and that the hormone-dependent tumours are more frequent in patients which are in the post-menopausal stage. The level of circulating oestrogens was also investigated, as well as the amount of oestrogens in the cytosol of tumor cells, and in the normal cells from the diseased breast.

[Tumors of the soft parts of the extremities. Anatomoclinical and therapeutic aspects].

A total of 60 cases are presented, of patients with tumours of the soft parts of the limbs, from a total of 14,000 surgical interventions. Of the total 18 were malignant tumours, while the remaining 42 cases had benign tumours. Tumours of the soft parts of the limbs include a large variety of histologic forms, and this raises particular problems of diagnosis and treatment.

[Phyllode tumors: anatomoclinical and therapeutic aspects (5 clinical cases)].

The phyllodes tumour is a bi-tissular mammary tumour. It is essentially benign but potentially sarcomatous, presenting multiple clinical and histologic-aspects, and raises difficult problems of diagnosis and therapeutic attitude. Four histological types are described, from the adenofibromatous type to the sarcomatous one.