Synchronous skull base and spinal metastases in a patient with treatment-resistant, high-grade serous adenocarcinoma of tubo-ovarian origin.

Brain metastases (BMs) arising from ovarian cancer remain rare. Spinal cord metastases are even rarer, accounting for just 0.4% of total metastatic spinal cord compressions. In this report, we describe a case of a woman in her 70s who developed sequential brain and spinal cord metastases during her treatment for high-grade serous ovarian cancer, without a germline or somatic BRCA mutation. Following completion of neoadjuvant chemotherapy, interval debulking surgery and adjuvant chemotherapy, relapsed disease was ultimately identified as a single BM, curiously mimicking an acoustic neuroma. Subsequently, spinal cord metastases rapidly developed. Throughout, multidisciplinary team meetings guided decisions on patient management. In this report, we highlight the rarity of such a presentation and discuss the possible role of disease pathophysiology, associated systemic anticancer therapy resistance, and treatment possibilities for both cerebral and spinal metastases.

Humoral and cellular responses to SARS-CoV-2 in patients with B-cell haematological malignancies improve with successive vaccination.

Patients with haematological malignancies are more likely to have poor responses to vaccination. Here we provide detailed analysis of the humoral and cellular responses to COVID-19 vaccination in 69 patients with B-cell malignancies. Measurement of anti-spike IgG in serum demonstrated a low seroconversion rate with 27.1% and 46.8% of patients seroconverting after the first and second doses of vaccine, respectively. In vitro pseudoneutralisation assays demonstrated a poor neutralising response, with 12.5% and 29.5% of patients producing a measurable neutralising titre after the first and second doses, respectively. A third dose increased seropositivity to 54.3% and neutralisation to 51.5%, while a fourth dose further increased both seropositivity and neutralisation to 87.9%. Neutralisation titres post-fourth dose showed a positive correlation with the size of the B-cell population measured by flow cytometry, suggesting an improved response correlating with recovery of the B-cell compartment after B-cell depletion treatments. In contrast, interferon gamma ELISpot analysis showed a largely intact T-cell response, with the percentage of patients producing a measurable response boosted by the second dose to 75.5%. This response was maintained thereafter, with only a small increase following the third and fourth doses, irrespective of the serological response at these timepoints.

The Pattern of Hospital Admissions Prior to Care Home Placement in People With Parkinson's Disease: Evidence of a Period of Crisis for Patients and Carers.

Objectives: We hypothesized that the number and length of hospital admissions in people with Parkinson's disease (PD) would increase immediately prior to admission to a care home relative to those who were able to continue living at home or who died. Method: PD patients at Hoehn and Yahr Stages III to V were followed-up over two and a half years with deaths and care home placements recorded. Hospital admissions data were collected over this period. Results: Of 286 patients included in the study, 7.3% entered a care home and 28.3% died. In the final 120 days prior to the study exit point (care home placement, death, or continued living at home), longer hospital stay was significantly associated with care home placement, after adjusting for the competing risk of death. Conclusion: Our data provide evidence that, for many people with PD, a period of crisis is reached immediately prior to care home placement.

Philosophers and physicians on the scientific validity of Latin physiognomy, 1200-1500.

The article surveys and contextualizes the main arguments among philosophers and academic physicians surrounding the status of physiognomy as a valid science from the thirteenth to the early sixteenth centuries. It suggests that despite constant doubts, learned Latin physiognomy in the later Middle Ages was recognized by natural philosophers (William of Spain, Jean Buridan, William of Mirica) and academic physicians (Rolandus Scriptor, Michele Savonarola, Bartolomeo della Rocca [Cocles]) as a body of knowledge rooted in a sound theoretical basis. Physiognomy was characterized by stability and certainty. As a demonstrative science it was expected to provide rational explanation for every bodily sign. In this respect, learned physiognomy in the Middle Ages was dramatically different from its classical sources, from Islamic and possibly from early-modern physiognomy as well.

The physiognomist's kidney in the fifteenth century.

Physiognomy, the art of deciphering a person's character and potential behavior by his or her external appearance, is an ancient body of knowledge which was gradually revived in the Latin West in the twelfth and particularly in the thirteenth century. This is a philological study of the scientific discourse about the physiognomy of the kidney in physiognomic sources from Pseudo-Aristotle's Physiognomonics (third century B.C.) through Pietro d'Abano's Liber compilationis phisonomie (ca 1295) to Rolandus Scriptoris's Reductorium phisonomie (ca 1430). Fifteenth-century learned physiognomists devoted specific chapters to the kidney. The physiognomists analyzed the fleshiness of the body-surface outside the kidneys (i.e. the loins and their vicinity). Firm loins denoted boldness, agility, and good fighting capacity and vice versa. The pre-modern kidney was of interest not only to physicians and surgeons wishing to treat kidney conditions and other pathologies arising from the urinary system. There were learned physicians who examined the body not to diagnose diseases, but to decipher their patient's personality. When engaged in this activity the kidneys, that is, the loins or the external area of the kidneys, were one of the body parts that could provide vital physiognomic information.

The medieval kidney.

This article surveys the various perceptions of the kidney and its pathologies by encyclopedists, preachers, natural philosophers, surgeons and academic physicians around 1300. It focuses on the medical works of Arnau de Vilanova (d. 1311) and shows the medical discourse about the kidney in all its complexity. It draws attention to the incorporation of the medical nephrological debate into the scholastic frame, and to the close links between nephrology and astrology as well as alchemy.