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The article discusses a rare case of neurolymphomatosis affecting the cauda equina, a condition characterized by the infiltration of malignant lymphoma cells in the spinal cord. The patient presented with weakness in the limbs and facial paralysis, leading to a challenging diagnostic process involving imaging studies, lumbar puncture, and laboratory tests. The diagnosis of primary neurolymphomatosis of the cauda equina is rare and poses both diagnostic and therapeutic challenges, with treatment options including chemotherapy, radiotherapy, or a combination of both. The prognosis depends on the extent of infiltration, speed of diagnosis, age, and comorbidities of the patient. [Extracted from the article]

Objective: In this experimental study, we aimed to determine whether platelet-rich plasma (PRP) is a suitable preservative for dermo-epidermal grafts. An additional objective was to investigate how long grafts can be stored without biological degradation., Methods: We compared pig skin graft preservation using PRP versus saline solution and crystalloid Custodiol ® , which is used for hypothermic preservation of organs for transplantation. Grafts (10 × 10 mm) were placed on gauze impregnated with one of the tested solutions, and stored for 3, 7, 11, and 15 days at a constant temperature of 4°C. We evaluated a total of 240 pig skin samples: 120 by histopathology and 120 by fluorescence optical microscopy., Results: Overall, Custodiol ® solution appeared to be the best medium for preservation of dermo-epidermal grafts, with beneficial properties manifested on days 7 and 11. Although we expected PRP to be a better preservative than saline, this was not confirmed by our results, as we found no significant difference between these two media. In fact, by day 3, the histopathological results were better with standard saline solution than with PRP. On day 15, with each tested solution, some samples showed histological changes that are incompatible with graft viability., Conclusion: Overall, Custodiol ® appears to be the best medium for dermo-epidermal graft preservation. Moreover, the present findings suggest a maximum graft storage time of 11 days in all of the tested solutions. We do not recommend using grafts stored for 15 days, due to isolated signs of graft biodegradation with all solutions., Competing Interests: None., (IJBT Copyright © 2024.)

Aims and Objectives: The aim of this research was to explore the processes used by older individuals to self-manage their health during the first 30 days after being discharged from the hospital. The underlying philosophy for this research was symbolic interactionism. From this perspective, individuals make meaning out of their experiences and act on the basis of those meanings., Background: Little is known about the processes older adults use to adjust to and self-manage their evolved health status after returning home from the hospital. Few studies have explored this period from the perspective of the older individual living in the situation., Methods: We used case study method to develop a collective, instrumental case to explain the phenomena of older individuals self-managing their health after hospitalisation. Data included interviews, participant diaries and researcher field notes., Results: The sample included three women who were at least 75 years old, had been hospitalised for at least 24 hr and had been discharged within the week prior to the first interview. Data from the participants were used to create a composite case, Mrs. C. She managed her autonomy, activity, attitude, health and relationships across three phases of posthospitalisation, returning home, adjusting and the evolved normal., Conclusions: This study provides insight into the experience of older individuals during the first 30 days after a stay in a healthcare facility and supports previous research findings regarding hospitalisation and self-management of chronic health problems., Implications for Practice: The findings provide evidence that returning home is a process that usually takes about a month to get into a new routine. Nurses can use this case study to describe some people's experience after discharge, and to help the older individual to identify friends and family who can provide physical and emotional support during the time immediately after discharge., (© 2019 John Wiley & Sons Ltd.)

Background: The use of nivolumab in the treatment of metastatic melanoma has become well established during past years. Despite its undeniable efficacy, immune-related side effects may occur, including acute liver injury. Liver toxicity caused by nivolumab is usually observed as liver enzyme elevation with mild or no symptoms; further, there is limited information regarding any histopathological findings., Case: We report a case of a 38-year-old woman with metastatic melanoma who developed unusual nivolumab-induced hepatic injury after a single dose of nivolumab. A liver biopsy was performed to assess the aetiology of hepatic lesions as no other analysis concerning biochemistry, virology, autoantibodies, nor imaging studies revealed any pathology. The histopathological analysis showed an oedema in the portal fields and mixed inflammation consisting of eosinophilic and neutrophilic granulocytes. The major finding was a prominent, predominantly intracellular, cholestasis., Conclusion: To our knowledge, no such histopathological pattern of liver injury has been described in relation to nivolumab therapy elsewhere. This type of liver injury shows higher resistance to corticosteroids, which may warrant upfront high-dose corticotherapy combined with other immunosuppressive agents, including mycophenolate mofetil. This case highlights a necessary awareness regarding immunotherapy-related adverse events, which could be severe and potentially life-threatening.

The criteria for distinction between independent primary tumors and metastasis from one site to the other in synchronous endometrioid endometrial and ovarian carcinoma (SEO) has been a matter of dispute for a long time. In our study we performed a comprehensive clinico-pathological and molecular analysis of 22 cases of SEO. Based on conventional clinico-pathological criteria the cases were classified as independent primary tumors (10 cases) and metastasis from one location to the other (12 cases). All tumors were analyzed by NGS with a panel of 73 genes (219 kbp). Clonal origin was confirmed in all cases by at least one shared mutation in PTEN, AKT1, PIK3CA, KRAS, TP53 and ARID1A . Two patients carried germline pathogenic mutation in cancer-predisposing genes BRCA1 or BARD1 . Microsatellite instable phenotype was detected in 5/22 (22.7%) SEO, but in one case only in the endometrial tumor. In conclusion, our results showed that all 22 SEOs were clonally related, irrespectively of their clinico-pathological features. Even low grade and low stage tumors classified as independent primaries, according to the conventional morphological criteria, have a clonal origin. From the practical point of view, only the conventional morphological criteria should be used for the classification (staging) of these tumors. However, molecular profiling of these tumors may have prognostic and predictive meaning.

Background: Great progress has recently been made in the treatment of metastatic renal cell carcinoma, including the introduction of nivolumab, an immune checkpoint inhibitor. Despite promising results, this treatment brings a completely new spectrum of adverse events, distinct from those experienced with small-molecule kinase inhibitors. Neurologic immune-related adverse events may be serious and potentially life-threatening complications requiring immediate immunosuppressive therapy. Only a few cases of immune-related encephalitis induced by checkpoint inhibitors have been described and the data regarding the management of this serious adverse event are limited., Case Presentation: We report the case of a 63-year-old white man with metastatic renal cancer who developed severe chorea-like dyskinesia during nivolumab therapy. The findings on brain magnetic resonance imaging and flow cytometry of cerebrospinal fluid, and the positivity of anti-paraneoplastic antigen Ma2 immunoglobuline G class autoantibodies were consistent with a diagnosis of immune-related encephalitis. High-dose intravenous corticosteroid therapy was started immediately, with no signs of improvement, even when infliximab was added. Our patient refused further hospitalization and was discharged. Three weeks later, he presented with signs of severe urosepsis. Despite intensive treatment, he died 4 days after admission., Conclusions: The management of less frequent immune-related adverse events has not been fully established and more information is required to provide uniform recommendations. Immune-related encephalitis is a severe and potentially fatal complication requiring immediate hospital admission and extensive immunosuppressive therapy. The examination of cerebrospinal fluid for paraneoplastic antibodies, such as anti-N-methyl-D-aspartate receptor and anti-Ma2 antibodies, in order to distinguish autoimmune etiology from other possible causes is essential and highly recommended.