Successful treatment with lenvatinib in a patient with thymic carcinoma presenting with cardiac tamponade: a case report and review of literature.

Thymic carcinoma (TC) presenting with cardiac tamponade has a poor prognosis because of the difficulty in controlling malignant pericardial effusion using conventional chemotherapy. Lenvatinib, a multitargeted kinase inhibitor of vascular endothelial growth factor receptor and other kinases, has recently been proven effective against TC. As the inhibition of vascular endothelial growth factor signaling is effective in malignant pericardial effusion, lenvatinib may also be effective in TC presenting with cardiac tamponade. However, no reports have shown that lenvatinib is effective in such cases. Herein, we present a case of successful treatment with lenvatinib in a patient with TC presenting with cardiac tamponade. The present case suggests that lenvatinib should be considered an effective treatment option for such cases.

A case of non-small cell lung cancer presenting anti-amphiphysin antibody-positive paraneoplastic neurological syndrome.

Paraneoplastic neurological syndrome (PNS) is associated with malignancies, such as small-cell lung cancer. However, patients with non-small cell lung cancer (NSCLC) rarely develop PNS. We herein report a 72-year-old man with NSCLC who developed disturbance of consciousness on the day of initiation of treatment with an immune checkpoint inhibitor. Blood test results revealed anti-amphiphysin (AMPH) antibody positively, leading to the diagnosis of PNS. The disturbance of consciousness was improved with intravenous administration of steroid and immunoglobulin. To our knowledge, this is the first report of anti-AMPH antibody-positive PNS in a patient with NSCLC.

Successful Re-administration of Atezolizumab for a Non-small-cell Lung Cancer Patient after Cardiac Tamponade Development as a Manifestation of Pseudo-progression Induced by Combination Treatment with Atezolizumab and Cytotoxic Chemotherapy.

Pseudo-progression is a phenomenon induced by treatment with immune checkpoint inhibitors and is characterized by an increase in tumor size or the appearance of new lesions, followed by tumor regression. However, life-threatening conditions, such as cardiac tamponade, can develop in such patients. We herein report on a 69-year-old man with lung adenocarcinoma who developed cardiac tamponade as a manifestation of pseudo-progression induced by treatment with atezolizumab combined with cytotoxic chemotherapy. After managing the cardiac tamponade, atezolizumab was successfully re-administered along with cytotoxic chemotherapy without disease progression.

Comparison of the pain-reducing effects of EMLA cream and of lidocaine tape during arteriovenous fistula puncture in patients undergoing hemodialysis: A multi-center, open-label, randomized crossover trial.

Arteriovenous fistula puncture pain is a serious problem for patients undergoing dialysis and a good indication for topical anesthetics. No previous study has compared lidocaine/prilocaine cream (EMLA) with lidocaine tape for pain relief during arteriovenous fistula puncture in patients undergoing maintenance hemodialysis. To this end, we conducted a multicenter randomized crossover study including 66 patients (mean age, 65.8 years; males, 57.6%) undergoing maintenance hemodialysis thrice/week. Subjects were assigned to Sequence EL (EMLA administration followed by lidocaine, with 1-week wash-out) or Sequence LE (reverse administration, first lidocaine then EMLA). All subjects completed the study. At each puncture site, 1 g EMLA (25 mg lidocaine + 25 mg prilocaine) or one sheet of lidocaine tape (18 mg lidocaine) was applied 1 h or 30 min prior to arteriovenous fistula puncture, respectively. The primary endpoint was puncture pain relief, which was measured using a 100-mm visual analog scale. The secondary endpoints included quality of life, which was measured by SF-36, and safety. EMLA produced a 10.1-mm greater visual analog scale improvement than lidocaine tape (P = 0.00001). However, there was no statistically significant difference in the quality of life between the two groups, and no significant carryover/period effect was observed in any analysis. Further, no drug-related adverse events were observed. Taken together, these results suggest that EMLA cream is superior to lidocaine tape for the relief of arteriovenous fistula puncture pain in patients undergoing maintenance hemodialysis. Trial registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000027885).

[Case of pulmonary coccidioidomycosis presented with multiple infiltrative opacities].

A 54-year-old man was admitted to our hospital to be operated on for inguinal hernia, but complained of dry cough and cervical lymph nodes swelling after traveling to California in the United States. The chest X-ray films taken on admission showed consolidations in both lungs. The laboratory data revealed an increase in white blood cell counts with eosinophilia, and elevated ESR, IgE and beta-D-glucan. The biopsied lung specimen by VATS showed epithelioid granulomas consisting of giant cells and eosinophils. In addition, spherulitic forms filled with endopores were detected in the specimen. A diagnosis of primary pulmonary coccidioidomycosis was made. Eosinophilia and elevated in IgE and beta-D-glucan were closely related to the severity of the disease gravity after the treatment with fluconazole.