Unilateral Eye Findings: A Rare Herald of Acute Leukemia
|
|
- Miranda Collins
- 5 years ago
- Views:
Transcription
1 Cse Series nd Brief Reports Received: Septemer 10, 2015 Accepted fter revision: Novemer 20, 2015 Pulished online: Jnury 13, 2016 Unilterl Eye Findings: A Rre Herld of Acute Leukemi Avni V. Ptel John B. Miller, Rjneesh Nth c Helen A. Shih d Michel K. Yoon, e Suznne K. Freitg, e George Ppliodis, f Teres C. Chen, g Den Eliott, Ivn K. Kim, Deprtment of Ophthlmology, Hrvrd Medicl School, nd Retin Service, Msschusetts Eye nd Er Infirmry, Boston, Mss., c Deprtment of Hemtology/Oncology, UMss Memoril Medicl Center nd University of Msschusetts Medicl School, Worcester, Mss., d Deprtment of Rdition Oncology, Msschusetts Generl Hospitl nd Hrvrd Medicl School, e Deprtment of Ophthlmic Plstic Surgery, f Oculr Immunology nd Uveitis Service, nd g Glucom Service, Msschusetts Eye nd Er Infirmry, Boston, Mss., USA Key Words Choroidl infiltrtion Leukemi Oculr mnifesttions of leukemi Oculr oncology Rdition Astrct Bckground/Aim: Unilterl choroidl infiltrtion s the initil mnifesttion of leukemic relpse in dults is rre, prticulrly fter n extended period of remission. This report descries this unique ophthlmic presenttion, highlights the ssocited dignostic chllenges, nd reviews the literture. Methods: Two cses re descried nd n extensive literture review ws conducted. Results: A 59-yer-old mle with cute lymphoid leukemi, in remission for 18 months, presented with unilterl scleritis, exudtive retinl detchment, nd choroidl thickening. A 57-yer-old mle with history of cute myeloid leukemi, in remission for 4 yers, presented with unilterl choroidl thickening leding to secondry ngle closure. In oth cses, there ws significnt lg from the onset of eye symptoms to estlishing systemic dignosis of cute leukemi, leding to dely in definitive systemic tretment, despite high suspicion of disese sed on ophthlmic findings. Conclusions: These two cses illustrte the fundus findings consistent with leukemic choroidl infiltrtion tht cn represent the first sign of relpsed leukemi. The successful tretment of these ptients hinges on collortion etween ophthlmologists nd oncologists to optimize ptient outcomes, highlighting the need for oth groups to e wre of this rre ophthlmic presenttion S. Krger AG, Bsel Introduction While ophthlmic involvement is well-documented compliction of leukemi, it is rre for ophthlmic findings to e the initil mnifesttion of new or relpsed disese [1, 2]. Additionlly, when eye findings re present, they usully mnifest simultneously nd ilterlly in systemic diseses such s leukemi. We report two cses of unilterl oculr involvement s the initil mnifesttion of relpsed leukemi in two ptients without prior evidence of centrl nervous system involvement. Additionlly, thorough literture serch ws conducted (PuMed, keywords: leukemi, oculr, eye, nd E-Mil krger@krger.com S. Krger AG, Bsel /16/ $39.50/0 Ivn Kim Msschusetts Eye nd Er Infirmry 243 Chrles Street Boston, MA (USA) E-Mil meei.hrvrd.edu
2 Fig. 1. Fundus photo of the ptient s left eye (cse 1) shows n inferior serous retinl detchment with choroidl thickening nd effusions. Anterior segment photo of the ptient s left eye (cse 1) demonstrting the lood-tinged leukemic hypopyon with the dshed line outlining hypopyon. dult ) to review the vriety of presenttions of oculr leukemic disese nd highlight the uncommon fetures of these cses. These exmples emphsize the need for ophthlmologists nd oncologists like to e wre of the full spectrum of oculr signs of leukemi, s prompt nd thorough systemic workup nd tretment in these cses my not only slvge the ptient s sight ut lso e lifesving. Color version ville online A 59-yer-old mle physicin with Phildelphi chromosome (BCR-ABL)-positive cute lymphoid leukemi (ALL), in complete remission fter myeloltive chemotherpy nd mtched relted donor hemtopoietic stem cell trnsplnt 18 months prior, presented with progressive irrittion, redness, nd decresed vision in his left eye over 1 month. His pst oculr history ws notle for recent episodes of nterior uveitis nd scleritis in the left eye only, which were previously treted with topicl nd systemic steroids, difluprednte nd prednisone, respectively. He ws lso on imtini mesylte (Gleevec, Novrtis Phrmceuticl Corp., Est Hnover, N.J., USA) s mintennce therpy for his hemtologic disese. On presenttion to our clinic, his est-corrected visul cuity ws 20/20 in the right eye (OD) nd counting fingers in the left eye (OS). His introculr pressures were 24 mm Hg OD nd 20 mm Hg OS. The slit-lmp exmintion of the right eye ws unremrkle. The left eye hd rre cells in the nterior chmer, mild nucler sclerotic ctrct, nd 2+ vitreous cells. The fundus exm ws notle for retinl detchment with shifting suretinl fluid, with inferior choroidl thickening nd effusions ( fig. 1 ). Centrl serous retinopthy ws n initil considertion for this ptient s presenttion, ut most concerning to the ophthlmologist ws the potentil dignosis of leukemic infiltrtion cusing the choroidl thickening nd serous detchment given the ptient s pst medicl history. However, the ptient s one mrrow iopsy 3 months prior did not show ny signs of recurrence, nd moleculr studies showed tht BCR-ABL or the Phildelphi chromosome, fusion gene of chromosomes 9 nd 22 present in this ptient s form of ALL, ws not detected. Given this recent negtive testing, these eye findings lone were not ccepted s signs of relpsed ALL y his oncologist. One month lter, the ptient returned with worsening scleritis, uveitis, nd lood-tinged hypopyon with neovsculriztion of the iris ( fig. 1 ). At this time, he hd totl retinl detchment with persistent choroidl effusions further incresing the ophthlmologist s suspicion for leukemic recurrence. However, the ptient s oncologists remined uncertin tht the oculr mnifesttions could e sign of relpsed disese given the lck of systemic findings. He ws followed with repet BCR-ABL testing every few months, which remined negtive. Over the next 6 months, the ptient s vision continued to deteriorte to light perception, nd the possiility of mlignnt infiltrtion ws discussed repetedly; however, the ptient deferred iopsy or surgicl intervention for his oculr mnifesttions. When the eye ecme pinful, enucletion of the eye ws considered; however, prior to the procedure, he presented to the emergency room with severe hedche, ftigue, nd weight loss. Cererospinl fluid smpling t tht time showed cler evidence of centrl nervous system leukemi, with over 3,000 white cells, 72% of which were lsts. At this time, he received intrthecl chemotherpy nd high-dose methotrexte. Systemic therpy with dstini (Sprycel, Bristol-Meyers Squi, Princeton, N.J., USA) ws lso initited, nd rdition tretment of 20 Gy to the left orit ws delivered. His vision remined 20/25 in the right eye without ny fundus chnges nd light perception in the left eye without pin. He is currently receiving ongoing neuro-oncologic tretment for his relpsed disese. Cse 1 Cse 2 A 57-yer-old mle with history of cute myeloid leukemi (AML; norml cytogenetics with Flt-3 nd NPM-negtive), in complete remission for 4 yers fter induction chemotherpy with dunoruicin nd high-dose cytrine (HIDAC), consolidtion chemotherpy with 3 cycles of HIDAC nd utologous stem cell trnsplnt followed y mintennce 5-zcytdine, ws dmitted to n outside hospitl with progressive right eye pin, redness, nd swelling. He ws presumed to hve right oritl cellulitis, ut lck of improvement on rod-spectrum ntimicroils prompted trnsfer to our institution. On presenttion, the ptient s visul cuity ws decresed to 20/200 OD nd stle t 20/20 OS. His introculr pressure ws elevted t 49 mm Hg OD nd norml t 17 mm Hg OS. Slit-lmp exmintion ws notle for right perioritl erythem nd edem, diffusely injected conjunctiv, microcystic cornel edem, nd shllow nterior chmer. Exmintion of the left eye ws unremrkle, including deep nd quiet nterior chmer. Gonioscopy reveled no visile ngle structures OD, consistent with closed ngle, while OS, the ngle ws open to sclerl spur 360. A B-scn ultrsound showed diffusely thickened choroid, nd ultrsound iomicroscopy confirmed secondry ngle closure due to nterior rottion of the lens-iris diphrgm. Introculr pressure-lowering medictions nd cyclopentolte were strted. After the introculr pressure egn to improve, diffuse irregulr choroidl elevtion ws seen on fundus exmintion of the right eye. Fluorescein ngiogrphy showed pinpoint lekge in the inferotemporl periphery nd diffuse lte suretinl lekge (fig. 2 ). Unilterl Eye Findings: A Rre Herld of Acute Leukemi 167
3 Color version ville online Before rdition After rdition Fig. 2. Fundus photo of the ptient s right eye (cse 2) showing diffuse, irregulr choroidl elevtion nd rre intrretinl hemorrhges. Arrows help demrcte res where prominent elevtion is seen. Fluorescein ngiogrphy (cse 2) demonstrting pinpoint lekge in the inferotemporl periphery, shown with rrows. Fig. 3. B-scn ultrsonogrphy imges of the ptient s right eye (cse 2) efore ( ) nd fter rdition ( ) with resolution of the diffuse choroidl thickening with rdition tretment. Arrows delinete thickening in the ultrsound imge efore rdition. As the ptient s leukocyte count ws elevted to 33,700 with numerous monocytes nd rre lsts on peripherl smer, leukemic recurrence ws of concern to oth the ophthlmology nd oncology tems. An initil one mrrow iopsy, cytogenetics nd next-genertion sequencing did not show ny signs of relpsed or new leukemic disese. Lumr puncture nd CT-PET scn to evlute for extrmedullry disese were negtive nd systemic chemotherpy ws deferred. As choroidl thickening progressed nd given the high suspicion for leukemic involvement, the ptient ws offered choroidl iopsy ut deferred in fvor of empiric rdition tretment. Irrdition to the right eye ws initited 2 weeks fter symptom onset for totl of 20 Gy delivered over 10 frctions with drmtic improvement in his visul cuity to 20/15, normliztion of his introculr pressure, nd resolution of the choroidl thickening y dy 3 of tretment ( fig. 3 ). Two weeks fter eginning rdition to the right eye, the ptient developed similr symptoms nd choroidl thickening in the left eye s well s worsening thromocytopeni. A repet hemtologicl evlution showed findings consistent with chronic myelomonocytic leukemi. He susequently hd rdition therpy with 20 Gy delivered to the left eye. He ws strted on decitine for worsening thromocytopeni. After 4 cycles of tretment, the ptient presented with recurrent left eye conjunctivl injection nd choroidl thickening. Bone mrrow iopsy reveled 5% lsts nd new muttion. He ws re-induced with HIDAC nd within week, his eye symptoms nd choroidl thickening resolved. However, repet one mrrow iopsy performed 4 weeks lter reveled trnsformtion to AML with 29% lsts. The ptient underwent n unrelted donor stem cell trnsplnt nd is currently in remission 9 months lter. Discussion nd Review of the Literture In oth of the ove-descried cses, unilterl oculr involvement ws the initil mnifesttion of relpsed cute leukemi tht ws otherwise thought to e in complete remission. Serous retinl detchment is n uncommon presenttion of new or relpsed leukemic disese, ut it hs een previously reported in cses of ALL nd AML in the dult popultion. In the mjority of reported cses of serous retinl detchment or choroidl infiltrtion, the systemic disese hd een dignosed prior to the development of oculr symptoms [3 9]. A review of the literture reveled only 5 cses of decresed vision nd serous retinl detchment s initil presenting signs of new leukemi in n dult ptient [10 14]. Kim et l. [10] nd Yoshid et l. [11] oth descried dult women presenting with ilterl serous retinl detchments s the initil sign of Phildelphi chromosome-positive ALL. In oth cses, the serous detchments completely resolved with full recovery of vision once systemic chemotherpy ws promptly initited. Riss et l. [12] nd Cillux et l. [13] descried similr presenttions of ilterl serous detchments reveling new dignosis of AML in two dult ptients. In ll of these cses, the ptients presented with ilterl simultneous serous retinl detchments while in oth of our ptients, the initil ophthlmic involvement ws unilterl. There re dditionlly four cses in the literture of retinl involvement in dults s the initil sign of relpsed leukemic disese s in our ptients. However, ll prior cses hd much shorter time from remission to retinl infiltrtive disese s mrker of relpse, with only 3 5 months of disese-free period compred to the 18 months nd 4 yers seen in ech of our ptients [14 17]. Wu et l. [15] descried 30-yer-old womn with AML type M4 M5 who ws in complete remission documented y one mrrow spirtion nd presented with decresed vision, ilterl serous retinl detchments, nd choroidl infiltrtion 3 months lter. As she hd no systemic evidence of relpsed disese, oncology initilly de- 168 Ptel/Miller/Nth/Shih/Yoon/Freitg/ Ppliodis/Chen/Eliott/Kim
4 ferred tretment. Only fter choroidl iopsy nd repet one mrrow workup 3 months lter demonstrted relpsed disese ws chemotherpy restrted [15]. Similrly, three other cses re reported in the literture, one with ilterl choroidl elevtion nd two with ilterl simultneous serous retinl detchments. The time from remission to presenttion with oculr symptoms rnged from just few weeks to 5 months fter remission in these cses [14, 16, 17]. Further, choroidl infiltrtion cusing ngle closure, s in our second cse, is exceedingly rre. There is only one other report of ptient who presented with ilterl ngle closure nd proptosis due to uveosclerl thickening in the setting of leukemi [18]. This ptient lredy hd n estlished dignosis of AML t the time of visul symptoms, nd his presenttion ws ilterl. In the cse of our ptient, the disese ws in remission for severl yers, nd he did not develop symptoms in the second eye until fter rdition tretment ws initited for the first eye. In oth cses presented in this report, the unilterlity of symptoms nd findings mde the dignosis of relpsed disese prticulrly chllenging. Oculr mnifesttions of leukemi my present s direct infiltrtion of the conjunctiv, uve, optic nerve or orit or s secondry chnges due to the hemtologic chnges ssocited with leukemi such s nemi, thromocytopeni, hyperviscosity, nd opportunistic infections [2, 19]. Studies hve shown vrying prevlence of leukemic involvement of the eye rnging from 50 80% with higher incidence of involvement in histopthologic postmortem studies [1, 20]. This is likely explined y the often sutle clinicl signs tht my indicte oculr involvement, prticulrly choroidl involvement. A higher incidence of oculr involvement, including choroidl infiltrtion, is seen in eyes with cute leukemi compred to chronic leukemi: 80 versus 29% [20]. If cliniclly evident choroidl infiltrtion is present, it most often presents with retinl pigmentry chnges, thickening, nd serous retinl detchment in the most conspicuous cses [1]. Serous retinl detchment is thought to occur due to direct leukemic infiltrtion of the choroid cusing decresed lood flow in the choriocpillris, resulting in ischemi to the overlying retinl pigment epithelium (RPE) nd disrupting intercellulr tight junctions nd the ility of the RPE to effectively pump fluid [21, 22]. Specil ncillry tests, such s fluorescein ngiogrphy nd B-scn ultrsonogrphy, my e especilly helpful in mking the dignosis of choroidl infiltrtion. Fluorescein ngiogrphy revels diffuse pinpoint lekge, while B-scn ultrsonogrphy my revel serous detchment or choroidl thickening [22, 23]. Introculr mnifesttions of leukemi such s those descried in these cses should prompt thorough systemic workup. Systemic tretment is recommended first in these cses, ut if not n option or if the oculr disese is not responsive, oculr rdition my e implemented. The dose of externl em rdition required in these cses is usully lower thn tht required for lymphom nd is most commonly 20 Gy delivered t frctions of Gy dily [24]. If left untreted, leukemic oculr infiltrtive disese my cuse significnt visul loss; however, it is usully very responsive to systemic tretment with chemotherpy, locl rdition tretment to the eye, or comintion of oth. Physicins should e wre tht unilterl eye findings cn e n initil mnifesttion of recurrent leukemi, nd in ptients with pst history of leukemi, prctitioners must mintin heightened wreness for relpsed hemtologic disese. Both of these cses show tht leukemic involvement of the eye my mimic other disese, such s centrl serous retinopthy in the first cse or infectious cellulitis in the second cse, nd the unilterl nture of symptoms my mke the dignosis of systemic etiology prticulrly difficult. Prompt referrl to n ophthlmologist will help determine if there is high suspicion for relpsed leukemi nd systemic tretment is often integrl to resolution of the oculr prolems. Sttement of Ethics This study ws conducted in complince with the rules nd regultions of the Helth Insurnce Portility nd Accountility Act s well s in dherence to the Declrtion of Helsinki nd ll other relevnt federl nd stte lws. Disclosure Sttement The uthors hve no finncil disclosures or conflicts of interest to report. Unilterl Eye Findings: A Rre Herld of Acute Leukemi 169
5 References 1 Kincid MC, Green WR: Oculr nd oritl involvement in leukemi. Surv Ophthlmol 1983; 27: Schcht AP: Ophthlmic mnifesttions of leukemi. Arch Ophthlmol 1989; 107: Ghosh K, Mitr S, Hiwse D: Choroidl infiltrtes simulting fundl chnges of cute leukemi during hemtologicl recovery following high-dose chemotherpy in cute myelomonocytic leukemi in remission. Am J Hemtol 2000; 63: Mdjlessi F, Dnn K, Althus C, Sundmcher R, Meckenstock G: Choroid infiltrtion in myelodysplstic syndrome. Klin Monl Augenheilkd 1998; 213: Krtş M, Altn Yycıoğlu R, Boğ C, Ulş B: Akut myeloid lösemiye ğlı ilterl seröz mkül dekolmnı. Türk Oftlmol Derg 2014; 44: Burns CA, Blodi FC, Willimson BK: Acute lymphocytic leukemi nd centrl serous retinopthy. Trns Am Acd Ophthlmol Otolryngol 1965; 69: Murphy JA, Pitts JF, Dudgeon J, Hogg RB, Hrnett AN: Retinl detchments due to chronic lymphocytic leukemi. Clin L Hemtol 1991; 13: Hine JE, Kinghm JD: Myelogenous leukemi nd ilterl exudtive retinl detchment. Ann Ophthlmol 1979; 11: Cndoni A, Simeone E, Bndello F, Fnin R: Leukemic infiltrtion of the retin t onset of Phildelphi-positive cute lympholstic leukemi reveled y strtus opticl coherence tomogrphy. Br J Hemtol 2006; 133: Kim J, Chng W, Sgong M: Bilterl serous retinl detchment s presenting sign of cute lympholstic leukemi. Koren J Ophthlmol 2010; 24: Yoshid A, Kwno Y-I, Eto T, et l: Serous retinl detchment in n elderly ptient with Phildelphi-chromosome-positive cute lympholstic leukemi. Am J Ophthlmol 2005; 139: Riss JM, Kplnski G, Righini-Chossegros M, Hrle JR, Escoffier P, Srcco JB: Bilterl serous detchment of neuroepithelium of the posterior pole disclosing cute leukemi. J Fr Ophtlmol 1990; 13: Cillux V, Querques G, Rmhefsolo C, Drugr A, Souied EH: Bilterl mculr serous retinl detchment reveling cute myelolstic leukemi. Retin Cses Brief Rep 2013; 7: Fckler TK, Berelly S, Odom T, Fekrt S, Cooney MJ: Acute lympholstic leukemi presenting s ilterl serous mculr detchments. Retin 2006; 26: Wu L, Clderón M, Hernández G, Mris J, Rmírez V: Bilterl exudtive retinl detchment s the first sign of relpsing cute myelogenous leukemi. Clin Experiment Ophthlmol 2006; 34: Chng WJ, Mow BM, Sundr G: Leukemic infiltrtion of the choroid. Eur J Hemtol 2005; 74: Goln S, Goldstein M: Acute lymphocytic leukemi relpsing s ilterl serous retinl detchment: cse report. Eye (Lond) 2011; 25: Tumuluri K, Woo T, Crowston J, Heley PR, Gottlie D, Mloof AJ: Bilterl leukemic oritl infiltrtion presenting s proptosis nd nrrow-ngle glucom. Ophthl Plst Reconstr Surg 2004; 20: Shields JA, Shields CL: Introculr Tumors: An Atls nd Textook. Phildelphi, Lippincott Willims & Wilkins, Allen RA, Strtsm BR: Oculr involvement in leukemi nd llied disorders. Arch Ophthlmol 1961; 66: Stewrt MW, Gitter KA, Cohen G: Acute leukemi presenting s unilterl exudtive retinl detchment. Retin 1989; 9: Miymoto K: Serous retinl detchment cused y leukemic choroidl infiltrtion during complete remission. Br J Ophthlmol 2000; 84: Armson DH, Jere B, Wollner N, Murphy L, Ellsworth RM: Leukemic ophthlmopthy detected y ultrsound. J Peditr Ophthlmol Strismus 1983; 20: Brdy LW, Shields JA, Augsurger JJ, Dy JL: Mlignnt introculr tumors. Cncer 1982; 49: Ptel/Miller/Nth/Shih/Yoon/Freitg/ Ppliodis/Chen/Eliott/Kim
PNEUMOVAX 23 is recommended by the CDC for all your appropriate adult patients at increased risk for pneumococcal disease 1,2 :
PNEUMOVAX 23 is recommended y the CDC for ll your pproprite dult ptients t incresed risk for pneumococcl disese 1,2 : Adults ged
More informationConcomitant Intraocular Retinoblastoma and Choroidal Hemangioma in a 1-Year-Old Boy
Cse Report doi: 10.5146/tjpth.2017.01411 Concomitnt Introculr Retinoblstom nd Choroidl Hemngiom in 1-Yer-Old oy Ycoub A. Yousef 1, Mys Al-Hussini 2, Freed H. rkt 2, Al Sleh 3, Mon Mohmmd 1, Rsh Deebjh
More informationCase Report Acute Zonal Occult Outer Retinopathy with Atypical Findings
Cse Reports in Medicine Volume 24, Article ID 29696, 7 pges http://dx.doi.org/.55/24/29696 Cse Report Acute Zonl Occult Outer Retinopthy with Atypicl Findings Dimitrios Krginnis, Georgios A. Kontdkis,
More informationIntravitreal Triamcinolone Acetonide in Macular Edema due to Retinal Vein Occlusions: A Comparative Study of 1 mg and 4 mg Doses
Originl Article DOI: 10.17354/ijss/2015/548 Intrvitrel Trimcinolone Acetonide in Mculr Edem due to Retinl Vein Occlusions: A Comprtive Study of 1 mg nd 4 mg Doses Siknder A K Lodhi 1, Sntosh Devulplly
More informationTales of the Unexpected: Incidental Findings in Ophthalmic Imaging
62 The Journl of Ophthlmic Photogrphy Volume 35, Numer 2 Fll 2013 ORIGINAL ARTICLE Angel J Chppell B.App.Sci, CRA, OCT-C Jmie E Crig MBBS(hons), D.Phil., FRANZCO Ophthlmology Deprtment Flinders Medicl
More informationBright Futures Medical Screening Reference Table 2 to 5 Day (First Week) Visit
Bright Futures Medicl Reference Tle 2 to 5 Dy (First Week) Visit Universl Action Metolic nd Verify documenttion of neworn metolic screening results, pproprite rescreening, nd needed follow-up. Document
More informationBENIGN ulceration along the greater curvature of the pars media of the
BENIGN ULCERS OF THE GREATER CURVATURE OF THE STOMACH Report of Two Cses CHARLES H. BROWN, M.D. Deprtment of Gstroenterology nd ANTHONY D. INTRIERE, M.D.* BENIGN ulcertion long the greter curvture of the
More informationCASE REPORT. Abstract. Introduction
CASE REPORT Myelodysplstic Syndrome with Ph Negtive Monosomy 7 Chromosome following Trnsient Bone Mrrow Dysplsi during Imtini Tretment for Chronic Myeloid Leukemi Kori Krimt 1, Msyoshi Msuko 2, Tkshi Ushiki
More informationIncidence and influence of GB virus C and hepatitis C virus infection in patients undergoing bone marrow transplantation
Bone Mrrow Trnsplnttion, (1998) 21, 1131 1135 1998 Stockton Press All rights reserved 0268 3369/98 $12.00 http://www.stockton-press.co.uk/mt Incidence nd influence of GB virus C nd heptitis C virus infection
More informationSecondary Precursor T-Cell Lymphoblastic Lymphoma Following Precursor B-cell Acute Lymphoblastic Leukemia: A Case Report and Review of the Literature
Journl of Cncer Reserch Updtes, 2014, 3, 117-122 117 Secondry Precursor T-Cell Lympholstic Lymphom Following Precursor B-cell Acute Lympholstic Leukemi: A Cse Report nd Review of the Literture Jenny L.
More informationGeneral Microscopic Changes
Generl Microscopic Chnges 2 This chpter covers collection of microscopic chnges tht lck dignostic specificity ut occur in different specific diseses, s will ecome pprent in susequent chpters. Almost ll
More informationEffectiveness of Infliximab in Treating Selected Cases of Sarcoidosis
Specil Articles Efficcy of Inflixim in the Mngement of Srcoidosis Effectiveness of Inflixim in Treting Selected Cses of Srcoidosis Om P. Shrm, MD, FRCP, Professor of Medicine, Keck School of Medicine of
More informationMetabolic syndrome as a risk factor for high-ocular tension
Interntionl Journl of Oesity (2010) 1 9 & 2010 Mcmilln Pulishers Limited All rights reserved 0307-0565/10 $32.00 www.nture.com/ijo ORIGINAL ARTICLE Metolic syndrome s risk fctor for high-oculr K Imi 1,
More informationIdentical twins with borderline lepromatous leprosy mimicking extensive alopecia areata: A rare presentation
Lepr Rev (2018) 89, 301 305 CASE REPORT Identicl twins with orderline lepromtous leprosy mimicking extensive lopeci ret: A rre presenttion RUBINA JASSI*, KRISHNA DEB BURMAN**, BHAVYA SWARNKAR** & RADHIKA
More informationInvasive Pneumococcal Disease Quarterly Report July September 2018
Invsive Pneumococcl Disese Qurterly Report July Septemer Introduction Since 17 Octoer 2008, invsive pneumococcl disese (IPD) hs een notifile to the locl Medicl Officer of Helth under the Helth Act 1956.
More informationThe Dynamics of Varicella-Zoster Virus Epithelial Keratitis in Herpes Zoster Ophthalmicus
Chpter 2 The Dynmics of Vricell-Zoster Virus Epithelil Kertitis in Herpes Zoster Ophthlmicus The morphology of n individul VZV lesion reflects sequence of events triggered y the virus impct on cornel epithelil
More informationR Martino 1, P Romero 1, M Subirá 1, M Bellido 1, A Altés 1, A Sureda 1, S Brunet 1, I Badell 2, J Cubells 2 and J Sierra 1
Bone Mrrow Trnsplnttion, (1999) 24, 283 287 1999 Stockton Press All rights reserved 0268 3369/99 $12.00 http://www.stockton-press.co.uk/bmt Comprison of the clssic Glucksberg criteri nd the IBMTR Severity
More informationSYNOPSIS Final Abbreviated Clinical Study Report for Study CA ABBREVIATED REPORT
Finl Arevited Clinicl Study Report Nme of Sponsor/Compny: Bristol-Myers Squi Ipilimum Individul Study Tle Referring to the Dossier (For Ntionl Authority Use Only) Nme of Finished Product: Yervoy Nme of
More informationColonoscopic decompression of childhood sigmoid and cecal volvulus
CASE REPORT Colonoscopic decompression of childhood sigmoid nd cecl volvulus Irj Shhrmin 1, Ali Bzi 1,2, Dnil Edti 3, Krim Rostmi 3, Mojt Delrmns 1,2 1 Peditric Digestive nd Heptic Reserch Center, Zol
More informationUltrasound biomicroscopy findings in fireworksrelated blunt eye injuries
Eur J Ophthlmol 2011 ; 00 ( 00) : 000-000 DOI: 10.5301/ejo.5000017 ORIGINAL ARTICLE Ultrsound iomicroscopy findings in fireworksrelted lunt eye injuries Seyed-Frzd Mohmmdi, Mehdi Zndin, Ghsem Fkhrie, Mercede
More informationEFFECTS OF AN ACUTE ENTERIC DISEASE CHALLENGE ON IGF-1 AND IGFBP-3 GENE EXPRESSION IN PORCINE SKELETAL MUSCLE
Swine Dy 22 Contents EFFECTS OF AN ACUTE ENTERIC DISEASE CHALLENGE ON IGF-1 AND IGFBP-3 GENE EXPRESSION IN PORCINE SKELETAL MUSCLE B. J. Johnson, J. P. Kyser, J. D. Dunn, A. T. Wyln, S. S. Dritz 1, J.
More informationSubthreshold Micropulse Laser (577 nm) Treatment in Chronic Central Serous Chorioretinopathy
Originl Pper Received: Mrch 24, 2015 Accepted fter revision: August 17, 2015 Published online: September 26, 2015 Subthreshold Micropulse Lser (577 nm) Tretment in Chronic Centrl Serous Chorioretinopthy
More informationA Rare Manifestation of Solitary Primary Bone Lymphoma of the Finger: a Case Report
pissn 2384-1095 eissn 2384-1109 imri 2018;22:240-244 A Rre Mnifesttion of Solitry Primry Bone Lymphom of the Finger: Cse Report Jeong A Yeom 2, You Seon Song 1 *, In Sook Lee 1, Kyung Un Choi 3, Jeung
More informationof comorbid conditions, interventions Diagnosis and treatment, treatment reduction of risk factors for CVD to slow disease progression,
Tble 5.1. NKF Clssifiction of Chronic Kidney Disese nd Clinicl Fetures Stge Description GFR (ml/ min/1.73 m 2 ) U.S. Prevlence, b # Affected (%) Clinicl Fetures Action Pln c At incresed risk for CKD >60
More informationUltrasound Energy in Phacoemulsification: A Comparative Analysis of Phaco-Chop and Stop-and-Chop Techniques According to the Degree of Nuclear Density
c l i n c i l s c i e n c e Ultrsound Energy in Phcoemulsifiction: A Comprtive Anlysis of Phco-Chop nd Stop-nd-Chop Techniques According to the Degree of Nucler Density Jung Hyun Prk, MD; Sng Mok Lee,
More informationEffects of physical exercise on working memory and prefrontal cortex function in post-stroke patients
Effects of physicl exercise on working memory nd prefrontl cortex function in post-stroke ptients M Moriy, C Aoki, K Sktni Grdute School of Helth Sciences Reserch, Mjor of Physicl Therpy, TeikyoHeisei
More informationThallium-201 chloride scintigraphy in soft tissue tumors
136 ORIGINAL Thllium-201 chloride scintigrphy in soft tissue tumors Hideki Otsuk, Kori Terzw, Nomi Morit, Yoichi Otomi, Shoichiro Tko, Seiji Iwmoto, Kyosuke Oski, Msfumi Hrd, nd Hiromu Nishitni Deprtment
More informationThe Efficacy of Low-Energy Selective Laser Trabeculoplasty
c l i n i c l s c i e n c e The Efficcy of Low-Energy Selective Lser Treculoplsty Min Tng, MD; Yng Fu, MD; Ming-shui Fu, MD; Ying Fn, MD; Hi-dong Zou, MD; Xio-dong Sun, MD; Xun Xu, MD n BACKGROUND AND
More informationUsing Paclobutrazol to Suppress Inflorescence Height of Potted Phalaenopsis Orchids
Using Pcloutrzol to Suppress Inflorescence Height of Potted Phlenopsis Orchids A REPORT SUBMITTED TO FINE AMERICAS Linsey Newton nd Erik Runkle Deprtment of Horticulture Spring 28 Using Pcloutrzol to Suppress
More informationFindings in spontaneous intramural intestinal hematoma imaging
Brief report Findings in spontneous intrmurl intestinl hemtom imging F. Mirs Azcón, A. Mrtínez Mrtínez, A. Sntigo Chinchill*, A. Medin Benítez, E. Ochndo Pulido nd M.A. Pérez Rosillo Imging deprtment,
More informationLocalized IgG4-related Cholecystitis Mimicking Gallbladder Cancer
CASE REPORT Loclized IgG4-relted Cholecystitis Mimicking Gllldder Cncer Tdhis Inoue 1, Fumihiro Okumur 1, Tkshi Mizushim 1, Hirotd Nishie 1, Hiroysu Iwski 1, Kiki Ane 1, Tknori Ozeki 1, Kent Kchi 1, Shigeki
More informationFundamentals of Spine MRI and Essential Protocols
Fundmentls of Spine MRI nd Essentil Protocols A. C. Dougls-Akinwnde, MD Octoer 13, 2009 Fundmentls of Spine MRI Lerning Ojectives: 1. List the essentil sequences for Spine MRI exmintion 2. Discuss the
More informationEfficacy of Pembrolizumab in Patients With Advanced Melanoma With Stable Brain Metastases at Baseline: A Pooled Retrospective Analysis
Efficcy of Pembrolizumb in Ptients With Advnced Melnom With Stble Brin Metstses t Bseline: A Pooled Retrospective Anlysis Abstrct 1248PD Hmid O, Ribs A, Dud A, Butler MO, Crlino MS, Hwu WJ, Long GV, Ancell
More informationReal-world outcomes of anti-vegf treatment for retinal vein occlusion in Portugal
EJO ISSN 1120-6721 Eur J Ophthlmol 2017; 00 (00): 000-000 DOI: 10.5301/ejo.5000943 ORIGINAL RESEARCH ARTICLE Rel-world outcomes of nti-vegf tretment for retinl vein occlusion in Portugl Sr Vz-Pereir 1,2,
More informationEtiology of Vocal Cord Paralysis
Originl Pper ORL 2007;69:167 171 DOI: 10.1159/000099226 Received: Mrch 6, 2006 Accepted fter revision: August 25, 2006 Published online: Jnury 30, 2007 Etiology of Vocl Cord Prlysis Hsin-Chien Chen Yee-Min
More informationNational audit of the
(2002) 16, 771 777 2002 Nture Publishing Group All rights reserved 0950-222X/02 $25.00 www.nture.com/eye JA Thompson 1, MP Sned 2, BM Billington 3, Ntionl udit of the T Brrie 4, JR Thompson 5 nd JM Sprrow
More informationCase Report Surgical Resection of a Leiomyosarcoma of the Inferior Vena Cava Mimicking Hepatic Tumor
Cse Reports in Medicine Volume 2013, Article ID 235698, 5 pges http://dx.doi.org/10.1155/2013/235698 Cse Report Surgicl Resection of Leiomyosrcom of the Inferior Ven Cv Mimicking Heptic Tumor Junji Ued,
More informationSevere Gummy Smile with Class II Malocclusion Treated with LeFort I Osteotomy Combined with Horseshoe Osteotomy and Intraoral Vertical Ramus
2013 67 1 5560 Severe Gummy Smile with Clss II Mlocclusion Treted with LeFort I Osteotomy Comined with Horseshoe Osteotomy nd Introrl Verticl Rmus Osteotomy * 56 Shimo et l. Act Med. Okym Vol. 67, No.
More informationOuter retinal tubulation in diabetic macular edema following anti-vegf treatment
Al-Hlfi Eye nd Vision (2015) 2:9 DOI 10.1186/s40662-015-0018-2 RESEARCH Open Access Outer retinl tuultion in dietic mculr edem following nti-vegf tretment Ali M Al-Hlfi Astrct Bckground: To ddress the
More informationA review of the patterns of docetaxel use for hormone-resistant prostate cancer at the Princess Margaret Hospital
MEDICAL ONCOLOGY A review of the ptterns of docetxel use for hormone-resistnt prostte cncer t the Princess Mrgret Hospitl S.N. Chin MD,* L. Wng MSc, M. Moore MD,* nd S.S. Sridhr MD MSc* ABSTRACT Bckground
More informationAnus,Rectum and Colon
JOURNAL OF THE Anus,Rectum nd Colon http://journl-rc.jp CASE REPORT Anl Cnl Dupliction Associted with Prescrl Cyst in n Adult Tkyuki Toyong 1), Hiromitsu Mtsud 1), Ryuichi Miu 1), Yohei Toming 1), Keiji
More informationCopy Number ID2 MYCN ID2 MYCN. Copy Number MYCN DDX1 ID2 KIDINS220 MBOAT2 ID2
Copy Numer Copy Numer Copy Numer Copy Numer DIPG38 DIPG49 ID2 MYCN ID2 MYCN c DIPG01 d DIPG29 ID2 MYCN ID2 MYCN e STNG2 f MYCN DIPG01 Chr. 2 DIPG29 Chr. 1 MYCN DDX1 Chr. 2 ID2 KIDINS220 MBOAT2 ID2 Supplementry
More informationBioactive milk components to secure growth and gut development in preterm pigs ESTER ARÉVALO SUREDA PIGUTNET FA1401 STSM
Bioctive milk components to secure growth nd gut development in preterm pigs ESTER ARÉVALO SUREDA PIGUTNET FA1401 STSM STSM Pigutnet FA1401 STSM 03/Septemer 30/Novemer/2017 (3 months) Host: Home: Thoms
More informationC reactive protein: an aid to assessment and
C rective protein: n id to ssessment nd monitoring of cute pncretitis J Clin Pthol 1984;37:27-211 AD MAYR,* MJ McMAHON,* MARGART BOWN,t H COOPRt From the *University Deprtment ofsurgery, Generl Infrmry,
More information308 nm excimer lamp in combination with topical tacrolimus: A retrospective study of its efficacy and safety in childhood vitiligo
ORIGINAL ARTICLE 308 nm excimer lmp in comintion with topicl tcrolimus: A retrospective study of its efficcy nd sfety in childhood vitiligo BS Chndrshekr, N Shoh, P Deprtment of Dermtology, Cutis, Acdemy
More informationPersistent changes in the immune system 4 10 years after ABMT
Bone Mrrow Trnsplnttion, (1999) 24, 873 878 1999 Stockton Press All rights reserved 268 3369/99 $15. http://www.stockton-press.co.uk/mt Persistent chnges in the immune system 4 yers fter ABMT T Nordøy
More informationThe effects of diversion of intestinal contents on the progress of Crohn's disease of the large bowel
Gut, 1971, 12, 11-15 The effects of diversion of intestinl contents on the progress of Crohn's disese of the lrge owel J. H. BURMAN, H. THOMPSON, W. T. COOKE, AND J. ALEXANDER WILLIAMS From the Nutritionl
More informationElectroretinogram b/a wave ratio improvement in central retinal vein obstruction
BritishJournl ofophthlmology 1994; 78: 191-198 Schepens Eye Reserch Institute, 20 Stniford Street, Boston, USA Y Mtsui O Ktsumi T Hirose Retin Assocites, 100 Chrles River Plz, Boston, USA O Ktsumi T Hirose
More informationSupplementary Online Content
Supplementry Online Content Zulmn DM, Pl Chee C, Ezeji-Okoye SC, et l. Effect of n intensive outptient progrm to ugment primry cre for high-need Veterns Affirs ptients: rndomized clinicl tril. JAMA Intern
More informationChanges in the retinal-nerve-fiber layer due to ethambutol toxic optic neuropathy
VOL. 34 NO. 1 PHILIPPINE JOURNAL OF Ophthlmology JANUARY CASE REPORT JUNE 2009 Christopher Npoleon G. Delos Reyes, MD 1 John Michel L. Dquiog, MD 1 Milgros H. Arroyo, MD, MPH 1, 2 Sidney Y. Cheng, MD 1
More informationSupernormal scotopic ERG in cone dystrophy
British Journl of Ophthlmology, 1984, 68, 69-78 Supernorml scotopic ERG in cone dystrophy KENNETH R. ALEXANDER AND GERALD A. FISHMAN From the Deprtment of Ophthlmology, University ofillinois Eye nd Er
More informationSurgical Neurology International
Surgicl Neurology Interntionl SNI: Unique Cse Oservtions, supplement to Surgicl Neurology Interntionl OPEN ACCESS For entire Editoril Bord visit : http://www.surgiclneurologyint.com Editor: Jmes I. Ausmn,
More informationPrime Enrollees Consumer Watch NHC Patuxent River FY 2016 Defense Health Cost Assessment & Program Evaluation
Prime Enrollees Consumer Wtch NHC Ptuxent River 16 Defense Helth Cost Assessment & Progrm Evlution NHC Ptuxent River: Smple size-1,457 Response rte-1.2% Source: Helth Cre Survey of DoD Beneficiries Inside
More informationInvasive Pneumococcal Disease Quarterly Report. July September 2017
Invsive Pneumococcl Disese Qurterly Report July September 2017 Prepred s prt of Ministry of Helth contrct for scientific services by Rebekh Roos Helen Heffernn October 2017 Acknowledgements This report
More informationORIGINAL ARTICLE. Diagnostic Signs of Accommodative Insufficiency. PILAR CACHO, OD, ÁNGEL GARCÍA, OD, FRANCISCO LARA, OD, and M A MAR SEGUÍ, OD
1040-5488/02/7909-0614/0 VOL. 79, NO. 9, PP. 614 620 OPTOMETRY AND VISION SCIENCE Copyright 2002 Americn Acdemy of Optometry ORIGINAL ARTICLE Dignostic Signs of Accommodtive Insufficiency PILAR CACHO,
More informationVitamin D and Mushrooms: Enrichment With Pulsed UV Light. Michael Kalaras Department of Food Science The Pennsylvania State University
Vitmin D nd Mushrooms: Enrichment With Pulsed UV Light Michel Klrs Deprtment of Food Science The Pennsylvni Stte University Vitmin D Synthesis Source: http://vitmind.ucr.edu/imges/chem1.gif Vitmin D In
More informationXII. HIV/AIDS. Knowledge about HIV Transmission and Misconceptions about HIV
XII. HIV/AIDS Knowledge bout HIV Trnsmission nd Misconceptions bout HIV One of the most importnt prerequisites for reducing the rte of HIV infection is ccurte knowledge of how HIV is trnsmitted nd strtegies
More informationReview article. Key words non specific low back pain, exercise therapy, stretching, motor control. Grade D
Spinl Surgery 31 2 140 144 2017 総説 Review rticle Astrct Exercise therpy is useful for low ck pin. Exercise therpy ims to improve posturl lignment, muscle strength, nd endurnce, nd lso contriutes to pin
More informationArthroscopic Anatomy of Shoulder
Arthroscopic Antomy of Shoulder Murt Bozkurt, Mehmet Emin Simsek, nd Hlil İrhim Açr 2 2.1 Introduction In the lst 30 yers, shoulder rthroscopy hs ecome of greter importnce in the dignosis nd tretment of
More informationChapter. Imaging of SARS in North America. Introduction. Clinical Manifestations of SARS in North America
content Chpter 13 Nestor L. Müller, Hrry Shulmn Introduction Clinicl Mnifesttions of SARS in North Americ Rdiogrphic Mnifesttions of SARS in North Americ High Resolution CT Findings of SARS in North Americ
More informationHealth-Related Quality of Life and Symptoms of Depression in Extremely Obese Persons Seeking Bariatric Surgery
Oesity Surgery, 15, 3-39 Helth-Relted Qulity of Life nd Symptoms of Depression in Extremely Oese Persons Seeking Britric Surgery Anthony N. Frictore, PhD; Thoms A. Wdden, PhD; Dvid B. Srwer, PhD; Myles
More informationSupplementary Online Content
Supplementry Online Content Rieckmnn N, Kronish IM, Shpiro PA, Whng W, Dvidson KW. Serotonin reuptke inhibitor use, depression, nd long-term outcomes fter n cute coronry : prospective cohort study. JAMA
More informationPrimary extramedullary plasmacytoma of the sigmoid colon with perforation: a case report
Kitmur et l. Surgicl Cse Reports (2018) 4:28 https://doi.org/10.1186/s40792-018-0437-0 CASE REPORT Open Access Primry extrmedullry plsmcytom of the sigmoid colon with perfortion: cse report Fumims Kitmur
More informationMultiple sclerosis (MS) affects approximately. Triaging Patients with Multiple Sclerosis in the Emergency Department. Room for Improvement
Systemtic Review of Tools for Anxiety in MS MS CARE DELIVERY: CHALLENGES AND INVATIONS Triging Ptients with Multiple Sclerosis in the Emergency Deprtment Room for Improvement Heshm Abboud, MD, PhD; Krin
More informationSummary of Package Insert 1
Summry of Pckge Insert 1 For Sttes with Non-Published Policies Indictions Non-infected prtil nd full-thickness skin ulcers due to VSU 2 of greter thn 1 month durtion nd which hve not dequtely responded
More informationSkull fracture vs. accessory sutures: how can we tell the difference?
Emerg Rdiol (2010) 17:413 418 DOI 10.1007/s10140-010-0877-8 PICTORIAL ESSAY Skull frcture vs. ccessory sutures: how cn we tell the difference? Thoms Snchez & Deorh Stewrt & Mtthew Wlvick & Leonrd Swischuk
More informationThe Prevalence of Bacteremia in Pediatric Patients With Community-Acquired Pneumonia: Guidelines to Reduce the Frequency of Obtaining Blood Cultures
RESEARCH ARTICLE The revlence of Bcteremi in editric tients With Community-Acquired neumoni: Guidelines to Reduce the Frequency of Obtining Blood Cultures bstrct OBJECTIVE: The gol of this study ws to
More informationLipase and Pancreatic Amylase Activities in Tissues and in Patients with Hyperamylasemia
CLINICAL CHEMISTRY Originl Article Lipse nd Pncretic Amylse Activities in Tissues nd in Ptients with Hypermylsemi FRED APPLE, PH.D, PETER BENSON, M.D., LYNNE PREESE, MT, M.B.A., STEVEN EASTEP, M.D., LAURA
More informationVisual and Anatomic Outcomes of Vitrectomy With Temporary Keratoprosthesis or Endoscopy in Ocular Trauma With Opaque Cornea
CLINICAL SCIENCE Visul nd Antomic Outcomes of Vitrectomy With Temporry Kertoprosthesis or Endoscopy in Oculr Trum With Opque Corne Dl W. Chun, MD; Mrcus H. Colyer, MD; Keith J. Wroblewski, MD BACKGROUND
More informationUnilateral exophthalmos
Brit. J. Ophthl. (97) 56, 678 Unilterl exophthlmos Aetiologicl study of 85 cses HANNA-SAMR ZAKHARA, KEVORK ASDOURAN, AND CAMLLE S. MATTA From the Deprtment of Ophthlmology, Americn University Medicl Center,
More informationMeat and Food Safety. B.A. Crow, M.E. Dikeman, L.C. Hollis, R.A. Phebus, A.N. Ray, T.A. Houser, and J.P. Grobbel
Met nd Food Sfety Needle-Free Injection Enhncement of Beef Strip Loins with Phosphte nd Slt Hs Potentil to Improve Yield, Tenderness, nd Juiciness ut Hrm Texture nd Flvor B.A. Crow, M.E. Dikemn, L.C. Hollis,
More informationTHE BONE MARROW AS A DIAGNOSTIC AID IN ACUTE DISSEMINATED LUPUS ERYTHEMATOSUS*
THE BONE MARROW AS A DIAGNOSTIC AID IN ACUTE DISSEMINATED LUPUS ERYTHEMATOSUS REPORT ON THE HARGRAVES' "L. E." CELL JOHN R. HASERICK, M.D., AND R. DOROTHY SUNDBERG, PH.D. In 1946 Hrgrves observed phgocytic
More informationRUBY I. THOMPSON. demonstrating the Ph1 chromosome in myeloblasts in the spinal fluid of a
From www.bloodjournl.org by guest on November 18, 218. For personl use only. Chromosomes in the Spinl Fluid: Evidence for Metsttic Origin of Meningel Leukemi By RENATO MASTRANGELO, WOLF W. ZUELZER, PETER
More informationMisdiagnosed Vogt-Koyanagi-Harada (VKH) disease and atypical central serous chorioretinopathy (CSC)
HPTER 12 Misdiagnosed Vogt-Koyanagi-Harada (VKH) disease and atypical central serous chorioretinopathy (S) linical Features VKH disease is a bilateral granulomatous panuveitis often associated with exudative
More informationPolypoidal choroidal vasculopathy associated with Doyne s familial choroiditis: treatment with thermal laser
E u ropen Journl of Ophthlmology / Vol. 14 no. 3, 2004 / pp. 2 6 4-2 6 8 S H O RT COMMUNICAT I O N Cse re p o r t Polypoidl horoidl vsulopthy ssoited with Doyne s fmilil horoiditis: tretment with therml
More informationChapter 02 Crime-Scene Investigation and Evidence Collection
Nme: Clss: Dte: Chpter 02 Crime-Scene Investigtion nd Evidence Collection 1. The terms grid, liner, qudrnt, zone, nd spirl re typiclly used to descrie dtum points... Flse Flse 2. An evidence log nd chin
More informationAssessment of Depression in Multiple Sclerosis. Validity of Including Somatic Items on the Beck Depression Inventory II
Assessment of Depression in Multiple Sclerosis Vlidity of Including Somtic Items on the Beck Depression Inventory II Peggy Crwford, PhD; Noh J. Webster, MA Signs nd symptoms of multiple sclerosis (MS)
More informationbuild Firm, sexy arms
w uild Firm, sexy rms Wnt toned, strong rms tht crown you pushup queen t oot cmp? Wnt to rock tnk top? These four moves re wht you need. Achieve Totl Arm Envy Mny women zero in on the show-off muscles,
More informationSeveral types of benign and malignant tumors
Retinl Hemngioms: Understnding Clinicl Fetures, Imging, nd Therpies Severl different vsculr tumors cn occur in the retin, ech with its own fetures nd findings. Y CROL L. SHIELDS, MD; LEXZNDR DOUGLSS, S;
More informationStart ORKAMBI today. INDICATIONS AND USAGE IMPORTANT SAFETY INFORMATION. Sydney Age 4
F O R H E A L T H C A R E P R O F E S S I O N A L S For ptients ge 2 yers nd older who re homozygous for the F508del muttion 1,2 Modify the course. Strt tody. Sydney Age 4 F508del/F508del INDICATIONS AND
More informationA cross-sectional and follow-up study of leukopenia in tuberculosis patients: prevalence, risk factors and impact of anti-tuberculosis
Originl Article A cross-sectionl nd follow-up study of leukopeni in tuberculosis ptients: prevlence, risk fctors nd impct of nti-tuberculosis tretment Fei-Shen Lin 1 *, Mei-Ying Wu 2 *, Wen-Jun Tu 3, Hong-Qiu
More informationC ytomegalovirus (CMV) pneumonia is a major complication
Long-term Sequele fter Recovery from ytomeglovirus Pneumoni in Allogeneic Bone Mrrow Trnsplnt Recipients* Sin-Ming hien, M.D., Ph.D.;t hrles K. hn, M.D., Ph.D., F...P; George Ksupski, Ph.D; Den hmberlin,
More informationSEIZURES AND EPILEPSY
SEIZURES AND EPILEPSY CONTENT CREATED BY Lern more t www.helth.hrvrd.edu TALK WITH YOUR DOCTOR Tble of Contents WHAT IS A SEIZURE? 4 WHAT IS EPILEPSY? 6 TESTING 7 TREATMENT OPTIONS 9 ANTI-SEIZURE MEDICATION
More informationPulmonary langerhans cell histiocytosis: Two cases with varied radiologic findings
CASE REPORT Est J Med 21(1): 45-49, 2016 Pulmonry lngerhns cell histiocytosis: Two cses with vried rdiologic findings Huly Guntr 1,*, Alpsln Yvuz 2, Bunymin Sertogullrindn 1, Selmi Ekin 1, Selvi Asker
More informationSuccessful Diagnosis of a Thymoma by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: A Report of Two Cases
CASE REPORT Successful Dignosis of Thymom y Endoronchil Ultrsound-guided Trnsronchil Needle Aspirtion: A Report of Two Cses Ysushi Yoshid 1, Msto Singyoji 1, Hironori Ashinum 1, Meiji Itkur 1, Toshihiko
More informationTreatment for Hearing Loss among the Elderly: Auditory Outcomes and Impact on Quality of Life
Audiology Neurotology Proceedings Audiol Neurotol 216;21(suppl 1):29 35 DOI: 1.1159/448352 Pulished online: Novemer 3, 216 Tretment for Hering Loss mong the Elderly: Auditory Outcomes nd Impct on Qulity
More informationCheckMate 153: Randomized Results of Continuous vs 1-Year Fixed-Duration Nivolumab in Patients With Advanced Non-Small Cell Lung Cancer
CheckMte 53: Rndomized Results of Continuous vs -Yer Fixed-Durtion Nivolumb in Ptients With Advnced Non-Smll Cell Lung Cncer Abstrct 297O Spigel DR, McCleod M, Hussein MA, Wterhouse DM, Einhorn L, Horn
More informationSymptom Management and Supportive Care
This mteril is protected y U.S. Copyright lw. Unuthorized reproduction is prohiited. For reprints contct: Reprints@AlphMedPress.com Symptom Mngement nd Supportive Cre Erly Intervention with Epoetin Alf
More informationSymptomatic Remote Cyst after BCNU Wafer Implantation for Malignant Glioma
Cse Report doi: 10.2176/nmc.cr.2017-0218 Neurol Med Chir (Tokyo) 58, 270 276, 2018 Symptomtic Remote Cyst fter BCNU Wfer Implnttion for Mlignnt Gliom Online My 21, 2018 Hideki MATSUMURA, 1 Eiichi ISHIKAWA,
More informationS Seropian 1, R Nadkarni 1, AP Jillella 1, E Salloum 1, B Burtness 1,GLHu 2, D Zelterman 2 and DL Cooper 1. Summary:
Bone Mrrow Trnsplnttion, (1999) 23, 599 605 1999 Stockton Press All rights reserved 0268 3369/99 $12.00 http://www.stockton-press.co.uk/bmt Neutropenic infections in 100 ptients with non-hodgkin s lymphom
More informationTracheobronchitis with Dyspnea in a Patient with Ulcerative Colitis
CASE REPORT Trcheoronchitis with Dyspne in Ptient with Ulcertive Colitis Msy Hiyoshi 1,2, Kzushige Kwi 2, Mihoko Shiuy 3, Tsuyoshi Ozw 2, Junko Kishikw 2, Tkko Nirei 2, Toshiki Tnk 2, Junichiro Tnk 2,
More informationimri 2015;19:
pissn 2384-1095 eissn 2384-1109 imri 2015;19:241-247 http://dx.doi.org/10.13104/imri.2015.19.4.241 Pncretic Arteriovenous Mlformtion s n Unusul Cuse of Chronic Gstrointestinl Bleeding in Ptient with Erly
More informationThe potential future of targeted radionuclide therapy: implications for occupational exposure? P. Covens
The potentil future of trgeted rdionuclide therpy: implictions for occuptionl exposure? Introduction: Trgeted Rdionuclide Therpy (TRT) Systemic tretment Molecule lbelled with rdionuclide delivers toxic
More informationOriginal Article. Abstract
Originl Article Grnulocyte Colony stimulting Fctor primed Bone Mrrow: An Excellent Stem cell Source for Trnsplnttion in Acute Myelocytic Leukemi nd Chronic Myelocytic Leukemi Yuhng Li 1, Min Jing 1, Chen
More informationAgilent G6825AA MassHunter Pathways to PCDL Software Quick Start Guide
Agilent G6825AA MssHunter Pthwys to PCDL Softwre Quick Strt Guide Wht is Agilent Pthwys to PCDL? Fetures of Pthwys to PCDL Agilent MssHunter Pthwys to PCDL converter is stnd-lone softwre designed to fcilitte
More informationHeparanase promotes tumor infiltration and antitumor activity of CAR-redirected T- lymphocytes
Supporting Online Mteril for Heprnse promotes tumor infiltrtion nd ntitumor ctivity of -redirected T- lymphocytes IgnzioCrun, Brr Svoldo, VlentinHoyos, Gerrit Weer, Ho Liu, Eugene S. Kim, Michel M. Ittmnn,
More informationIntroduction. These patients benefit less from conventional chemotherapy than patients identified as MMR proficient or microsatellite stable 3-5
Nivolumb + Ipilimumb Combintion in Ptients With DNA Mismtch Repir-Deficient/Microstellite Instbility-High Metsttic Colorectl Cncer: First Report of the Full Cohort From CheckMte-142 Abstrct 553 André T,
More informationStudy of Stress Distribution in the Tibia During Stance Phase Running Using the Finite Element Method
Ksetsrt J. (Nt. Sci.) 48 : 729-739 (2014) Study of Stress Distriution in the Tii During Stnce Phse Running Using the Finite Element Method Thepwchr Ruchirh 1, Tumrong Puttpitukporn 1, * nd Siriporn Ssimontonkul
More informationSafety and Tolerability of Subcutaneous Sarilumab and Intravenous Tocilizumab in Patients With RA
Sfety nd Tolerbility of Subcutneous Srilumb nd Intrvenous Tocilizumb in Ptients With RA Pul Emery, 1 Jun Rondon, 2 Anju Grg, 3 Hubert vn Hoogstrten, 3 Neil M.H. Grhm, 4 Ming Liu, 4 Nncy Liu, 3 Jnie Prrino,
More informationBreast carcinomas: why are they missed?
O r i g i n l A r t i c l e Singpore Med J 2006; 47(10) : 851 Brest crcinoms: why re they missed? Muttrk M, Pojchmrnwiputh S, Chiwun B ABSTRACT Introduction: Mmmogrphy hs proven to e n effective modlity
More information