ABSTRACT
The pegylated interferon plus ribavirin combination therapy has been used as the primary treatment for chronic hepatitis C (CHC) but fails to produce a sustained viral response (SVR) in many patients. In recent years, the treatment of CHC has been rapidly changing because of the introduction of direct-acting antivirals (DAAs), which have a high cure rate. However, retreatment of patients after failure of the first DAA therapy is difficult. We report two rare cases of CHC that showed acquired SVR with other DAA combinations after failure to daclatasvir and asunaprevir.
ABSTRACT
Leptomeningeal carcinomatosis (LMC) is rare metastatic form of gastric cancer. Most cases are diagnosed in the final stage after multiple distant metastasis. An 84-year-old woman was admitted with melena, headache and vomiting. Esophagogastro-duodenoscopy showed an ulceroinfiltrating lesion at the stomach (Borrmann class III), and biopsy revealed a signet ring cell carcinoma. The abdominal-pelvic CT showed no evidence of metastasis. A sudden decrease of consciousness was noted, but the brain CT showed no active lesion while the brain MRI revealed enhancement of leptomeninges. A lumbar puncture was performed and the cerebrospinal fluid study revealed malignant neoplastic cells. With family consent, no further evaluation and treatment were administered and she died six weeks after the diagnosis of gastric cancer. We report an extremely rare case of a patient who initially presented with neurologic symptoms, and was diagnosed LMC from advanced gastric cancer without any evidence of metastasis in abdomen and pelvis.
Subject(s)
Aged, 80 and over , Female , Humans , Abdomen , Biopsy , Brain , Carcinoma, Signet Ring Cell , Cerebrospinal Fluid , Consciousness , Diagnosis , Headache , Magnetic Resonance Imaging , Melena , Meningeal Carcinomatosis , Neoplasm Metastasis , Neurologic Manifestations , Pelvis , Spinal Puncture , Stomach , Stomach Neoplasms , VomitingABSTRACT
Distortion product otoacoustic emissions(DPOAEs) have emerged as a promising clinical tool for measuring hearing status. This investigation examined the influence of four variable (test/retest reliability, test environment, gender and number of measurement points of resolution/octave) on the DPOAE response when obtained using a commercially available system, Otodynamics ILO92. Twenty normal hearing adults(10 males and 10 females) served as participants in this study. DPOAE measurements were obtained over three test sessions(baseline, 1 week retest, and a 10 minute retest following the one week measurement). Results showed that: 1) correlations were high across the three test sessions;2) test environment considerably affected the DPOAE measures below 4kHz;3) DPOAE amplitudes were significantly greater in females than males at 3 and 6kHz;and 4) DPOAE amplitudes were not affected significantly by the number of resolution points employed.