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In recent years, both the number of patients with breast cancer and those with associated brain metastases (BMs) have increased. Human epidermal growth factor receptor 2 (HER2)-positive breast cancer has a high BM frequency. The prognosis of BM from breast cancer is poor, and establishing effective treatment for this disease is essential. We report a HER2-positive patient with multiple BM and right-eye blindness due to pituitary metastasis. She responded promptly to trastuzumab deruxtecan (T-DXd) in the 5th line of treatment, which shrunk the tumors and restored vision. Although the Graded Prognostic Assessment (GPA) predicted survival of 13 months, the patient recovered well after treatment and continued T-DXd use with no progression, including vision loss at 22 months after treatment initiation. This case demonstrates the successful action of T-DXd in the face of multiple BM and poorly predicted outcomes. [ABSTRACT FROM AUTHOR]

Adults with minimal-change nephrotic syndrome (MCNS) generally receive oral prednisolone (PSL) at an initial dosage of 1.0 mg/kg/day for a minimum of 4 weeks, with 80% of patients achieving clinical remission. However, relapses are frequent, necessitating repeated treatment with high-dose PSL. Long-term treatment with high-dose steroids increases the risk of steroid toxicities, such as diabetes mellitus, gastric complications, infections, osteoporosis, and steroid-induced psychiatric syndrome (SIPS), which may compromise the patient's quality of life. Strategies are therefore needed to reduce the dosage and duration of steroid therapy for frequently relapsing MCNS (FRNS). Here, we suggest a new combination therapy of low-dose and short-term steroid with cyclosporine (CsA). We encountered an adult patient who developed recurrence of FRNS with depression arising from SIPS and was treated using low-dose, short-term PSL combined with CsA. He was successfully treated with PSL at an initial dosage of 0.3 mg/kg/day (20 mg/day) for just 2 weeks combined with CsA, allowing earlier induction of complete remission. We then promptly reduced the dose of PSL to below a physiological dosage (5 mg/day) over 3 weeks without relapse after episodes of SIPS and quickly resolved psychiatric symptoms. CsA in combination with PSL can reduce the initial dosage of PSL, shorten the time to remission, and easily maintain clinical remission. This protocol appears clinically useful and potentially applicable as a future treatment strategy for FRNS troubled by SIPS. [ABSTRACT FROM AUTHOR]

Background: The presence of renal failure in patients with multiple myeloma (MM) has been considered an ominous prognostic factor associated with a significantly decreased life expectancy. The prognostic factors have seldom been analyzed to predict discontinuation of hemodialysis (HD) therapy in MM patients with renal failure after HD initiation. It is clinically very important to predict whether HD can be discontinued after introducing HD in such patients. Methods: All medical and HD records were reviewed in MM patients who underwent HD in the National Center for Global Health and Medicine Hospital between January 1995 and May 2009. Thirty-two patients with MM had undergone HD. The clinical features and the factors that might be associated with recovery of renal function leading to discontinuation of HD in MM patients with severe renal failure were examined. Results: The factors associated with recovery of renal function and discontinuation of HD were: low International Staging System (ISS) score (p = 0.0034); high response to chemotherapy (p = 0.036); low serum Ca (p = 0.006); low Cr (p = 0.019), and low serum β2-microglobulin (sβ2M) (p = 0.002). On multivariate analysis, low serum Ca and sβ2M were significantly associated with HD discontinuation. Moreover, discontinuing HD was the significant factor associated with improved overall survival in MM patients who required HD at least once. Conclusion: sβ2M and Ca were the laboratory parameters that were significant, independent prognostic factors for predicting the probability of recovery from severe renal failure and discontinuation of HD in MM patients who needed HD at least once. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Three patients are reported: two with acute renal failure (ARF) and acute interstitial nephritis (AIN); and one with ARF and rapidly progressive glomerulonephritis (RPGN). In the latter two cases, a percutaneous renal biopsy was performed. In both AIN cases, 2-[18F] fluoro-2-deoxy-D-glucose (FDG) positron emission tomography combined with computed tomography (PET-CT) showed high and diffuse FDG uptake in the renal parenchyma without excretion. Based on the diagnosis of AIN, probable offending drugs were discontinued. Consequently, ARF and AIN recovered gradually in both cases, though haemodialysis (HD) was performed several times. On the other hand, the patient who presented with ARF and RPGN did not accumulate FDG absolutely. Maintenance HD had to be initiated in this patient. FDG-PET-CT might become an auxiliary examination for the diagnosis and follow-up of AIN in oliguric or HD patients. [ABSTRACT FROM PUBLISHER]