Beyond the bull\u27s eye: Recognizing Lyme disease

A rash occurs in 80% of Lyme disease cases, but only about a third of the rashes develop into a classic bull\u27s-eye lesion. Here\u27s what to look for and how best to treat

Beyond the bull\u27s eye: Recognizing Lyme disease

A rash occurs in 80% of Lyme disease cases, but only about a third of the rashes develop into a classic bull\u27s-eye lesion. Here\u27s what to look for and how best to treat

Beyond The Bull\u27S Eye: Recognizing Lyme Disease

A rash occurs in 80% of Lyme disease cases, but only about a third of the rashes develop into a classic bull\u27s-eye lesion. Here\u27s what to look for and how best to treat

Brain metastasis as exclusion criteria in extensive-stage small cell lung cancer trials: a trend over decades

Aim: To investigate the frequencies and trends of brain metastases (BMs) as exclusion criteria in extensive-stage small cell lung cancer (ES-SCLC) trials.Methods: We conducted a comprehensive search to identify prospective clinical trials in patients with ES-SCLC. PubMed searches were conducted with the key words “small cell lung cancer” and “extensive”. The online archives of 20 oncology journals were also searched. Recent review articles in ES-SCLC were also investigated for additional articles. Eligible studies must have enrolled primarily ES-SCLC and been published in English. Studies involving brain/chest radiation and brain metastasis-specific trials were excluded. Studies were categorized into allowed/undefined, conditional, or complete exclusion of BM.Results: In total, 491 published studies were identified by PubMed (240), journal websites (198), and review articles (53). Early publication year (1970-1999) and first-line/maintenance setting were associated with higher incidence of complete exclusion of cases with BMs (P < 0.0001 and 0.0233, respectively). Incidence of complete exclusion was 27% in the 1990s, and then decreased to 12% in the 2000s and 8% in the 2010s.Conclusion: A significant number of ES-SCLC trials continues to exclude patients with BM. Future studies need to ease eligibility regarding BM according to ASCO/Friends recommendations

Renal Cell Carcinoma Presenting as Syncope due to Saddle Pulmonary Tumor Embolism

Pulmonary embolism (PE) is defined as the obstruction of the pulmonary artery or one of its branches by a blood clot, tumor, air, or fat emboli originating elsewhere in the body. A saddle PE occurs when the obstruction affects the bifurcation of the main pulmonary artery trunk. We present a case of a 46-year-old man who presented to our hospital due to an episode of syncope. Computed tomography angiography (CTA) of the chest showed extensive PE and abdominal CT scan showed a large 8 cm left renal mass with inferior vena cava (IVC) thrombus. Emergent embolectomy, left total nephrectomy, and IVC tumor removal were performed yielding the diagnosis of clear cell renal cell carcinoma (RCC). Interestingly, our patient did not experience any symptoms related to his RCC until the diagnosis of PE due to syncope, and the asymptomatic tumor was found out to be the possible cause of this PE due to the presence of tumor cells constituting the tumor embolus. It is thus recommended to improve the early screening process for RCC. Besides, clinicians should pay attention to patients presenting with uncharacteristic symptoms of RCC who might present with symptoms of saddle PE