AIDS-Related Non-Hodgkin's Lymphoma in the Era of Highly Active Antiretroviral Therapy

In economically developed countries, AIDS-related lymphoma (ARL) accounts for a large proportion of malignances in HIV-infected individuals. Since the introduction of highly active anti-retroviral therapy (HAART) in 1996, epidemiology and prognosis of ARL have changed. While there is a slight increase in the incidence of Hodgkin's lymphoma in HIV-infected individuals, use of HAART has contributed to a decline in the incidence of non-Hodgkin's lymphoma (NHL) and also a decrease in the overall incidence of ARL. Strategies that employ HAART, improved supportive care, and the use of Rituximab with multi-agent chemotherapy have contributed to improved rates of complete remission and survival of patients with ARL that rival those seen in stage and histology matched HIV negative NHL patients. Most recent clinical trials demonstrate better outcomes with the use of rituximab in ARL. Tumor histogenesis (germinal center vs. non-germinal center origin) is associated with lymphoma-specific outcomes in the setting of AIDS-related diffuse-large B cell lymphoma. High-dose chemotherapy (HDCT) and autologous stem cell rescue (ASCT) can be effective for a subset of patients with relapsed ARL. HIV sero-status alone should not preclude consideration of ASCT in the setting of ARL relapse. Clinical trials investigating the role of allogeneic hematopoietic stem cell transplant in ARL are currently underway

All-Trans Retinoic Acid-Induced Pseudotumor Cerebri during Induction Therapy for Acute Promyelocytic Leukemia: A Case Report and Literature Review

All-trans retinoic acid (ATRA), a derivative of vitamin A, is an essential component in the treatment of acute promyelocytic leukemia (APL). Though considered to be a relatively safe drug, use of ATRA can lead to several side effects such as retinoic acid syndrome and pseudotumor cerebri (PC). PC is a rare disorder characterized by neurologic and ocular signs and symptoms of increased intracranial pressure, but with normal cerebrospinal fluid composition and normal brain imaging. Most of the previous studies suggest that PC, as a complication of ATRA therapy, occurs predominantly in the pediatric age group. Herein, we report a rare case of ATRA-induced PC in a 38-year-old woman undergoing induction treatment for APL. Symptoms improved with discontinuation of ATRA and treatment with acetazolamide. Concomitant administration of medications such as triazole antifungals which influence the cytochrome P-450 system can exacerbate this potential complication of ATRA. In this paper, we also review the current literature, provide a descriptive analysis of clinical features, and discuss the principles of management of ATRA-induced PC

COVID-19 Vaccination-Associated Spontaneous Heparin-Induced Thrombocytopenia Syndrome

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has emerged as the deadliest outbreak in recent American history, surpassing the estimated U.S. fatalities from the 1918 influenza pandemic. Since its identification in December 2019 in Wuhan, China, COVID-19 has contributed to the death of nearly six million people worldwide. The United States (U.S.) Food and Drug Administration (FDA) initially issued emergency use authorization for three vaccines for prevention of COVID-19, and currently two have received full FDA approval. Herein, we report a case of severe thrombocytopenia in a man following heterologous booster vaccination with the Pfizer-BioNTech COVID-19 vaccine with concomitant presence of a heparin-P4 antibody but without proximate heparin exposure. The degree of thrombocytopenia was severe, but the patient had a natural recovery of platelet count over the next 2 weeks without need for any immunomodulatory therapies. This is the first case report of COVID vaccine-associated heparin-induced thrombocytopenia (HIT)-like platelet disorder without proximate heparin exposure, also called spontaneous HIT syndrome. Keywords: Thrombocytopenia, Co

System Design and Implementation of a National Image Registry for Orthopaedic Oncology Image Management, Research and Teaching

Orthopaedic oncology is highly dependent on imaging studies to diagnose and treat patients. However, many types of bone tumors are rare creating a lack of teaching and research cases. We have developed a system to locally document and nationally register electronic images for teaching and research on bone tumors. The system minimizes storage requirements and maintains confidentiality using a unique approach. This paper demonstrates the system design and current implementation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46052/1/10796_2004_Article_5150940.pd