15 research outputs found

    Случай раннего выявления метастазов в бедренной кости у больного раком полового члена

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    Background. Bone metastasis is very common in the advanced stage of numerous carcinomas. In penile carcinoma, lymph nodes metastasis is somehow common but it is very rare reported to be secondary from penile cancer. till the date, there are only few cases of penis carcinoma reported bone metastasis in literature worldwide.Case Presentation. Herein, We presented a 51-year-old Nepalese male with squamous cell carcinoma of penis. computed tomography (ct) scan of the patient revealed that there was carcinoma involving glans penis and precure with bilateral external & internal inguinal lymphadenopathies. After then, the patient was under gone for partial penectomy and bilateral inguinal lymphadenectomy and complete 6-cycle chemotherapy. After one year of treatment, patient developed thigh pain and headache and he advised to have magnetic Resonance imaging (mRi) of brain, 99mTc-MDP whole body bone scan and ct scan of pelvis and thigh. The examination report reveals that there was a sclerotic change in vertex of skull bone and moderate 99mTc-MDP uptake in right proximal shaft of femur just below the neck d/d metastasis. The histopathological examination of the true cut biopsy taken from the lesion of the femur showed metastatic keratinizing squamous cell carcinoma which is rare case of femoral shaft bone metastasis secondary from penile carcinoma. Then patient was sent for surgical reconstruction of femur. Based on the case studies review femur shaft bone metastasis from penile cancer is extremely rare.Conclusion. The best of our knowledge; this is the first early detected bone metastases to shaft of the femur in a patient with penile cancer. early diagnosis helps to radical treatment as well as palliative treatment. surgery is the preferred option of the treatments, especially for metastatic foci in the long bones.Аннотация Метастазы в кости часто встречаются на поздних стадиях разных злокачественных новообразований. Для рака полового члена характерно лимфогенное метастазирование, костные метастазы встречаются очень редко. На данный момент в мировой литературе зарегистрировано лишь несколько случаев рака полового члена с метастазами в кости.Описание клинического случая. Мы представляем описание клинического случая плоскоклеточного рака полового члена у 51-летнего мужчины из Непала. Компьютерная томография (КТ) выявила рак полового члена, локализованный на головке и крайней плоти с двусторонней паховой лимфаденопатией. Пациенту выполнена частичная пенэктомия, двусторонняя паховая лимфаденэктомия, проведено 6 курсов адъювантной химиотерапии. Через один год после завершения лечения у пациента появились боли в бедре и головная боль, рекомендована МРТ головного мозга, сканирование костей скелета с 99mTc-MDP и КТ таза и бедра. Обследование показало наличие склеротических изменений в теменной кости черепа и умеренное накопление 99mTc-MDP в проксимальном отделе правом бедренной кости ниже шейки. Гистологическое исследование биоптата, взятого из очага в бедренной кости, выявило метастаз ороговевающего плоскоклеточного рака, что является редким случаем метастазирования рака полового члена в диафиз бедренной кости. Пациент был направлен на хирургическую реконструкцию бедренной кости. Согласно обзору клинических исследований, метастазы в диафизе бедренной кости при раке полового члена встречаются крайне редко.Заключение. Представлен первый случай раннего выявления костных метастазов в диафизе бедренной кости у пациента с раком полового члена. Ранняя диагностика помогает как радикальному, так и паллиативному лечению. Хирургическое вмешательство является предпочтительным вариантом лечения, особенно при метастатических очагах в длинных костях

    Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

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    IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

    Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19