Extramedullary relapse of acute myeloid leukemia in brachial plexus after allogeneic stem cell transplantation: a case report.

BACKGROUND: Allogeneic hematopoietic stem cell transplantation is a potentially curative treatment for acute myeloid leukemia. However, extramedullary relapse of acute myeloid leukemia can occur after hematopoietic stem cell transplantation, causing treatment failure. Extramedullary relapse rarely involves the peripheral nerves, and it is not influenced by the effect of the graft on leukemia. CASE PRESENTATION: We report a case of extramedullary relapse of acute myeloid leukemia in the brachial plexus of a 41-year-old woman treated with allogeneic hematopoietic stem cell transplantation (HSCT). Complete hematological remission was confirmed by bone marrow examination 1 month after HSCT, and she developed no major complications immediately after HSCT. The immunosuppressant was discontinued 5 months later. However, 2 weeks after immunosuppressant withdrawal, the patient developed left arm pain and paresthesia, with subsequent development of a mass in the left brachial plexus. She was initially diagnosed with brachial plexus neuropathy because of concomitant graft-versus-host disease. Despite the administration of immunosuppressive agents, the mass continued to enlarge. The biopsy of the lesion revealed leukemic relapse. Thus, the patient was diagnosed with extramedullary relapse and underwent radiotherapy, resulting in tumor shrinkage. CONCLUSION: Extramedullary relapse should be considered a differential diagnosis in post-transplant patients with leukemia presenting with paresthesia.

Adult-Onset Still's Disease After an mRNA COVID-19 Vaccine in an Older Woman.

Adult-onset Still's disease (AOSD) is an uncommon autoinflammatory disorder without a clear etiology that primarily affects young adults. New-onset disease at > 80 years of age is uncommon. We present the case of an 82-year-old woman with AOSD which developed after receiving a messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccine. COVID-19 vaccines are known to cause overproduction of cytokines, systemic inflammation, and some immune-mediated adverse events, such as rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, vasculitis, and polymyalgia rheumatica after the vaccination has been reported. A handful of cases of AOSD after the vaccination have also been reported and the median age was 40s. However, AOSD related to COVID-19 vaccination can develop even in older individuals.

Polymyalgia Rheumatica (PMR) Lacking Shoulder Pain Following COVID-19 Vaccination.

This case highlights a 77-year-old woman with polymyalgia rheumatica (PMR) following coronavirus disease 2019 (COVID-19) vaccination without shoulder pain and its characteristic positron emission tomography-computed tomography (PET-CT) findings. Some cases of PMR following COVID-19 vaccination have been reported. However, patients without shoulder pain or PET-CT findings without uptake at the shoulders are not described. Our case suggests that PMR should be considered in the differential diagnosis of patients with neck pain following COVID-19 vaccination, even if they lack shoulder pain.

Gaze-evoked nystagmus in Wernicke encephalopathy.

Wernicke encephalopathy is caused by vitamin B1 deficiency. It presents as a triad consisting of altered mental status, oculomotor dysfunction, and gait ataxia. Early vitamin B1 administration alleviates symptoms. We present a video of gaze-evoked nystagmus in an elderly patient with Wernicke encephalopathy.

Feasibility and suitability of the routine use of bilateral internal thoracic arteries.

BACKGROUND: It has been demonstrated that bilateral use of internal thoracic arteries (ITAs) confers better long-term results in patients than does unilateral use. However, routine use of bilateral ITAs has usually been avoided. METHODS: Since 1997, we have used bilateral ITAs extensively for patients who required multivessel bypasses. Recently, 243 consecutive patients, including 127 diabetic patients, were reviewed. RESULTS: Every patient received at least one ITA graft, and 200 patients (82%) received bilateral ITAs. The majority (93%) of ITA grafts were used as in situ grafts. The hospital mortality rate was 0.41%, and deep sternal infections were observed in 5 patients (2.0%). There was no difference in the incidence of chest wound infection between the group treated with bilateral ITA grafting and that treated by unilateral ITA grafting. CONCLUSIONS: These observations suggest that ITAs can be used bilaterally for treatment in the majority of patients who require multivessel bypass, with low mortality and morbidity.

Reoperation for coronary artery disease: devised management for reoperation including digital subtraction angiography.

Between December 1990 and August 1999, a consecutive series of 494 patients underwent coronary artery bypass grafting, while 19 (3.8%) patients underwent isolated reoperative coronary bypass grafting. The mean age of 16 males and 3 females who underwent reoperation was 63.4 +/- 6.4 years. The mean interval from the initial operation to reoperation was 50.7 +/- 61.0 months (range 3 days to 16 years). There were neither operative nor in-hospital deaths. Postoperative graft patency was 96.9% in all the bypass grafts and 96.7% in the arterial grafts. Despite the small number of reoperations, the outcomes were favorable due to our devised management: the patients who had received coronary artery bypass grafting underwent intra-aortic digital subtraction angiography 7 days postoperatively to evaluate the early graft patency, which subsequently avoided reoperation 1 to 3 months after the initial operation when the pericardial adhesion was tight; in the primary operation, internal thoracic artery grafts were covered with thymus, and the pericardium was closed for an easy sternal re-entry; and in the reoperation, stenotic grafts were dissected and ligated after aortic cross-clamping, all sides of the heart were dissected to obtain a good operative field and to prepare for any cardiac accident, arterial grafts were used to avoid re-reoperation, and aprotinin was useful in reducing perioperative bleeding. The present findings suggest that intra-aortic digital subtraction angiography, appropriate preparation for follow-up surgery at the primary operation, and complete revascularization using arterial grafts at reoperation appear to have contributed to the satisfactory outcome in coronary reoperation.