Solitary vertebral metastasis of unknown primary renal cell carcinoma treated with surgical resection plus tyrosine kinase inhibitor: A case report.

INTRODUCTION: Although 25-30 % of renal cell carcinomas (RCC) might be diagnosed in metastatic stage, occurrence of metastatic renal cell carcinoma (mRCC) as a cancer of unknown primary site (CUP-mRCC) is extremely rare. Here, we present a case of vertebral mass causing radicular pain that has been diagnosed to be mRCC through core needle biopsy while no renal mass has been found during serial imaging. CASE PRESENTATION: A 60-year-old woman presented with severe lumbar pain radiating to left leg. Lumbar X-ray suggested a mass in second lumbar vertebra which was confirmed by MRI. Biopsy showed that the mass was clear cell RCC. Abdominopelvic CT scan and other metastatic work-up found no primary source for the cancer -in kidneys- nor any other metastasis. Tumor resection was performed followed by sunitinib administration. 3 months after the surgery, she is symptom free with no signs of disease progression nor kidney tumor. DISCUSSION: 26 cases of CUP-mRCC has been reported in literature. Lymph nodes are the most commonly involved organ in CUP-mRCC. Exclusive bone involvement -similar to our case- have been reported in only 3 cases. No specific treatment guideline exists but surgery, systemic therapy, combination therapy, and radiotherapy have been used, with the first two items being the most commonly used ones. CONCLUSION: Tumor resection plus sunitinib seems to be a reasonable option in solitary CUP-mRCC involving vertebral column. Our patient is symptom free and there are no signs of disease progression nor kidney cancer in follow-up imaging after 3 months of surgery.

Migration of nephrostomy tube into right atrium during percutaneous nephrolithotomy: A case report.

INTRODUCTION AND IMPORTANCE: Percutaneous nephrolithotomy (PCNL) is one of the most commonly performed surgeries in urology. Due to blind nature of the procedure unexpected events are inevitable. Misplacement of percutaneous nephrostomy (PCN) during PCNL into the venous system is one of the rarest complications causing great stress to both physician and the patient. Due to scarcity of data, no standard treatment has been proposed. Here, we present a case with misplaced PCN into venous system moving up to the right atrium and discuss its management with a review of the literature. CASE PRESENTATION: After stone removal of a 65-year old man by PCNL, PCN was passed through access sheath supposedly into renal pelvis but it actually misplaced into venous system and traversed into right atrium. The complication was diagnosed by immediate CT scan and managed by PCN pulling back without the need to perform open surgery. CLINICAL DISCUSSION: Blind nature of PCNL makes it susceptible to inadvertent complications. Misplaced PCN into venous system is very rare, happening in about 13 patients worldwide. While some ended up open surgery, all of them were managed by pulling the PCN backwards. Our case is the first case in whom PCN traversed through IVC and reached right atrium during PCNL. Pulling back the PCN was a successful treatment in our case either. CONCLUSION: While horrifying, misplaced PCN into venous system can be managed conservatively by pulling it backwards, even if it reaches the right atrium as happened in our case.

Relationship between medical history and multiple sclerosis: A-case-control study.

This project sought to explore the potential association between medical history and the development of multiple sclerosis (MS) by conducting a retrospective study. This population-based case-control study included 200 MS cases and 2 control groups of 200 patients and healthy individuals each. Data was collected through face-to-face interviews, medical file reviews, and an electronic checklist. Multivariable analysis was used to calculate odds ratios and 95% confidence intervals to estimate the risk of each medical history on MS occurrences. Of 600 participants, 381 (63.5%) individuals were female. The mean age of the participants was 36.5 ±â€…11.9 years. The adjusted risks of MS were 4.40; 95% CI: 1.73 to 11.1 for measles and 4.75; 95% CI: 2.05 to 11 for amoxicillin consumption. The adjusted MS odds for autoimmune disease including 4.63; 95% CI: 0.35 to 60.6 for psoriasis and 7.15; 95% CI: 1.87 to 27.2 for myasthenia gravis. On the other hand, the calculated adjusted odds of MS occurrence were 0.14; 95% CI: 0.03 to 0.69 for seizure and 0.17; 95% CI: 0.02 to 1.49 for epilepsy. This study suggested that individuals with autoimmune diseases should be monitored more closely, as they may be at an increased risk of developing other autoimmune conditions, particularly MS.

Evaluation of response to different COVID-19 vaccines in vaccinated healthcare workers in a single center in Iran.

Due to the recent coronavirus disease 2019 (COVID-19) pandemic and emergent administration of various vaccines worldwide, comprehensive studies on the different aspects of vaccines are in demand. This study evaluated antibody response after the second dose of the COVID-19 vaccine in the Children's Medical Center personnel. The blood samples of 174 healthcare workers were gathered at least 10 days after vaccination. The administered vaccines included Oxford/AstraZeneca, COVAXIN, Sinopharm, and Sputnik V. This study assessed all antibodies employing ELISA methods, including anti-SARS-CoV-2 neutralizing antibody by DiaZist and Pishtazteb kits, anti-SARS-CoV-2-nucleocapsid by Pishtazteb kit, and anti-SARS-CoV-2-Spike by Razi kit. The cutoff for the tests' results was calculated according to the instructions of each kit. Totally, 174 individuals with an average age of 40 ± 9 years participated in this study, the proportion of men was 31%, and the frequency of past COVID-19 infection was 66 (38%). Sixteen (9%) personnel received Oxford/AstraZeneca, 28 (16%) COVAXIN, 29 (17%) Sinopharm, and 101 (58%) Sputnik V. anti-SARS-CoV-2-nucleocapsid and anti-SARS-CoV-2-Spike were positive in 37 (21%), and 163 (94%) participants and their mean level were more in adenoviral-vectored vaccines (p value < 0.0001). Neutralizing antibody was positive in 74% using Pishtazteb kit while 87% using DiaZist kit. All antibodies' levels were significantly higher in those with a past COVID-19 infection (p value < 0.0001). In conclusion, Oxford/AstraZeneca and Sputnik V had a similar outcome of inducing high levels of anti-SARS-Cov-2-spike and neutralizing antibodies, which were more than Sinopharm and COVAXIN. The titers of Anti-SARS-CoV-2-nucleocapsid antibody were low in all of these four vaccines.