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The article describes the case of a 43-year-old pregnant woman who was admitted to the labor and delivery service of a hospital due to vaginal bleeding. Her medical history included obesity and migraine headaches. During cesarean delivery, the patient experienced suddent onset of bradycardia, chest pain, loss of consciousness and apnea. She was diagnosed with amniotic-fluid embolism. Treatment options for her condition are mechanical circulatory support and extracorporeal membrane oxygenation.

The article describes the case of a 55-year-old man who experienced alcohol withdrawal delirium and multifactorial delirium. The patient was admitted to the intensive care unit (ICU) at the Massachusetts General Hospital because of seizures and agitation. He was found to be confused and afebrile after he stopped drinking alcohol. Signs and symptoms of alcohol withdrawal delirium include hallucinations, hypertension, tachycardia, fever and diaphoresis.

Background: Enzalutamide (formerly called MDV3100) targets multiple steps in the androgen-receptor–signaling pathway, the major driver of prostate-cancer growth. We aimed to evaluate whether enzalutamide prolongs survival in men with castration-resistant prostate cancer after chemotherapy. Methods: In our phase 3, double-blind, placebo-controlled trial, we stratified 1199 men with castration-resistant prostate cancer after chemotherapy according to the Eastern Cooperative Oncology Group performance-status score and pain intensity. We randomly assigned them, in a 2:1 ratio, to receive oral enzalutamide at a dose of 160 mg per day (800 patients) or placebo (399 patients). The primary end point was overall survival. Results: The study was stopped after a planned interim analysis at the time of 520 deaths. The median overall survival was 18.4 months (95% confidence interval [CI], 17.3 to not yet reached) in the enzalutamide group versus 13.6 months (95% CI, 11.3 to 15.8) in the placebo group (hazard ratio for death in the enzalutamide group, 0.63; 95% CI, 0.53 to 0.75; P<0.001). The superiority of enzalutamide over placebo was shown with respect to all secondary end points: the proportion of patients with a reduction in the prostate-specific antigen (PSA) level by 50% or more (54% vs. 2%, P<0.001), the soft-tissue response rate (29% vs. 4%, P<0.001), the quality-of-life response rate (43% vs. 18%, P<0.001), the time to PSA progression (8.3 vs. 3.0 months; hazard ratio, 0.25; P<0.001), radiographic progression-free survival (8.3 vs. 2.9 months; hazard ratio, 0.40; P<0.001), and the time to the first skeletal-related event (16.7 vs. 13.3 months; hazard ratio, 0.69; P<0.001). Rates of fatigue, diarrhea, and hot flashes were higher in the enzalutamide group. Seizures were reported in five patients (0.6%) receiving enzalutamide. Conclusions: Enzalutamide significantly prolonged the survival of men with metastatic castration-resistant prostate cancer after chemotherapy. (Funded by Medivation and Astellas Pharma Global Development; AFFIRM ClinicalTrials.gov number, NCT00974311.) [ABSTRACT FROM PUBLISHER]

The article discusses the medical case of a 49-year-old man presented with fever, pain and cranial nerve deficits after squamous-cell cancer of the oral cavity treatment. The patient's medical history is detailed. Results of pathological examination on the patient are discussed as well as the differential diagnosis centered on an infectious process and recurrent cancer. Management of squamous-cell carcinoma of the head and neck and the risk of r5ecurrence are discussed.

The article describes the case of a 30-year-old woman presented with shock and abdominal-wall necrosis after a cesarean section. The patient had undergone cesarean section at 36.4 weeks gestation due to suspected chorioamnionitis, fetal tachycardia and a prolonged deceleration on a fetal heart-rate tracing during labor augmented by oxytocin. Her medications on admission included prenatal vitamins, iron and acetaminophen. Details of the results of her laboratory tests are discussed.

The article describes the case of a 60-year-old woman who complained of painful muscle spasms, weakness and hyperreflexia. Information on her medical history is provided, as well as the results of her laboratory tests. Degenerative changes of both the cervical and lumbar spine were detective via magnetic resonance imaging. Differential diagnosis include limbic encephalitis and herpes encephalitis. She was diagnosed with stiff person syndrome and anti-amphiphysin antibodies.

The article discusses the case of newborn boy who was confined in a neonatal intensive care unit (NICU) due to respiratory distress. An overview of the baby's medical background as well as his mother's is given. Results of the examination performed on the patient in the NICU are discussed. The baby developed the neonatal abstinence syndrome characterized by tremors, agitation and poor sleeping. The differential diagnosis made on the patient is biventricular hypertrophy.

The article discusses a case of a 67-year-old man with persistently elevated serum level of prostate-specific antigen (PSA). The patient had very little tumor on just one of several biopsies. The evidence in favor of metastatic bone disease was weak and a biopsy specimen of the suspicious focus was negative. Doctors suggested discontinuing hormone therapy and performing transperineal template-guided mapping biopsy (TTMB) of the prostate.

The article discusses the case of a 53-year-old man suffering from Crohn's disease who was undergoing immunosuppressive therapy and was hospitalized due to diarrhea, fever and bacteremia. The results of physical and laboratory tests performed on the patient are discussed. The patient also has osteopenia of the femoral neck, Parkinson's disease, insomnia, allergic rhinitis and hypertriglyceridemia. The medications prescribed to the patients are also discussed.

The article discusses a case of a 79-year-old male diagnosed with necrotizing noninflammatory myopathy that is consistent with exposure to statins. The patient developed weakness in both legs and had difficulty walking. On the third day of admission, abdominal distention and pain developed. A radiograph revealed gas-filled loops of bowel, consistent with ileus. Electromyography findings for the patient were indicative of a myopathic process with membrane irritability.

The article discusses the clinical case of a 45-year-old man who was admitted to a hospital due to rapid cognitive decline and worsening jaundice. The patient's physical, laboratory and imaging examinations revealed jaundice, bilateral facial telangiectasias, hypodensity and mass effect in the right temporal lobe and insula. He underwent brain surgery and was placed under a treatment regimen composed of clindamycin, pyrimethamine, and atovaquone, along with antiretroviral therapy.

The article discusses the clinical case of a 39-year-old man who was diagnosed with HIV-associated dementia along with mycobacterium tuberculosis. The patient's delusions, attentional problems and disorientation led to the diagnosis of delirium related to AIDS and severe immune suppression. The treatment administered to the patient is described, including the clinical outcome.

The article describes the case of a 52-year-old man who was admitted to a hospital because of swelling and weakness in his legs. He was readmitted to another hospital a couple of weeks after discharge due to pain in the right arm. The patient underwent transsphenoidal resection after the sellar mass was identified on magnetic resonance imaging (MRI). The ectopic sources of excess corticotropin are also discussed.

The article describes the case of a woman in her 90s with ptosis of the left eyelid. It says that the patient had been in her normal health until 4 days earlier when she was not able to open her left eye on awakening. She was diagnosed with dysfunction of the levator palpebrae superioris muscle, which was possibly caused by spontaneous disinsertion of the levator palpebrae tendon. She was administered intravenously with vancomycin, furosemide, metronidazole, methylprednisolone and cefepime.

The article describes the case of a 66-year-old woman who was admitted to a hospital due to cardiac and renal failure. The patient presented with dyspnea on exertion and leg edema and T-wave inversions in leads I and aVL were shown by an electrocardiogram (ECG). She received furosemid and levofloxacin. The management of renal failure in myeloma is also discussed.

The article discusses a medical case of a 4-year-old Haitian boy who was admitted with vomiting and diarrhea. The patient's medical history is provided. The initial treatment administered on the patient which is reduced-osmolarity oral rehydration solution (ORS) is described. The differential diagnosis of acute watery diarrhea is discussed. The article also discusses patient care, including classifying the type of diarrheal illness and rehydration.

Summary: Angioimmunoblastic T-cell lymphoma (AITCL) is a histologically distinct and relatively common subtype of T-cell lymphoma. Although the putative normal cell counterpart is a mature CD4+ T cell, the precise cell of origin remains elusive. We evaluated cases with a diagnosis of AITCL to determine the specificity and utility of CD10 coexpression, particularly by flow cytometry (FCM), in facilitating this diagnosis. Coexpression of BCL6 was also assessed. Eight AITCL cases were evaluated histologically, immunohistochemically, and by 4-color FCM. Four cases of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), were also analyzed. The lymphoma cells in all 8 AITCL cases were CD4+, CD45RO+ T cells, with classic extrafollicular meshworks of CD21/CD23/CD35+ follicular dendritic cells. Furthermore, all cases of AITCL cases contained interfollicular CD10+ cells by immunohistochemistry, and increased coexpression of CD10 on T cells was also detected in 6 of 8 cases by FCM. CD10 coexpression was not observed in all 4 PTCL-NOS cases. Although not specific for AITCL, increased numbers of BCL6+ cells were seen in AITCL as compared with PTCL-NOS. Double immunohistochemistry performed on an AITCL case with high numbers of BCL6+ cells highlighted coexpression of BCL6 and CD4 on the same cells. The finding suggests that AITCL may be a neoplasm of (possibly intrafollicular) CD10+, BCL6+, and CD4+ memory T cells. Although our series is small, our results suggest that CD10 coexpression may be a useful discriminant, particularly if the differential diagnosis is PTCL-NOS, and demonstrate that this can be determined by FCM. [Copyright &y& Elsevier]