Patient: Male, 41Final Diagnosis: Non-Hodgkin’s lymphomaSymptoms: Fast-growing subcutaneous tumors with lower-extremity edemaMedication: —Clinical Procedure: —Specialty: HematologyObjective:Unusual clinical courseBackground:Diffuse large B-cell lymphoma (DLBCL) accounts for the large majority of AIDS-related non-Hodgkin’s lymphoma (NHL). DLBCL usually arises in lymph nodes, presenting as a painless rapid swelling mass in the neck, armpit, or groin.Case Report:Here, we report a case of DLBCL that needed only 3 months to develop a tumor 20×15 cm in diameter in the right groin and even caused scrotum swelling and lower-extremity edema. Furthermore, this case of DLBCL had developed other 3 subcutaneous tumors in the chest wall and their diameters were 16×9 cm, 7×7 cm, and 3×3 cm. A thoracic computed tomography (CT) scan presented with bilateral pleural effusion and the chest wall tumors with rib lesions.Conclusions:It is rare that a DLBCL needed only 3 months to develop a tumor 20×15 cm in diameter and even caused scrotum swelling and unilateral lower-extremity edema due to the large mass located in the right groin. Furthermore, it is extremely rare that this lymphoma infiltrated the chest wall and even resulted in rib lesions.
Background and Aims: Using grafts from donors after cardiac death (DCD) influence the risk of acute kidney injury (AKI) after liver transplantation (LT). The goal of this study is to develop a novel prediction model that quantifies the impact of each risk factor on AKI after transplantation using DCD grafts.Methods: Total of 132 patients undergoing LT using DCD grafts were evaluated retrospectively to develop a prediction model using the Cox proportional hazards regression model. The independent validation cohort included 112 patients recruited prospectively in the same institution. Results: Overall, 103 (42.2%) of the recipients developed AKI. A prediction score model included five risk factors leading to a range of -2 to 8 score points was establishment. The predicted probability of AKI by the Model for End-Stage Liver Disease (MELD) score≥15 alone was 43.9% rising to 85.3% when combined with cold ischemia time (CIT) ≥ 7 hours. Excessive red blood cell (RBC) transfusions during operation also attribute to AKI. Surprisingly, a mild elevate AST pre-transplant was negative with the AKI, while mechanical ventilation ≥ 40 hours was associate with AKI after LT. Three risk classes were defined based on the risk of AKI: high (30%), medium (11-29%), and low (10%). Model fits were adequate in both derivation (P=0.3185) and validation cohorts (P=0.3247).Conclusion: MELD score and CIT were the key determinants of post-LT AKI using DCD grafts. Improved organ preservation techniques and other strategies reducing the IRI may lower the risk of AKI.
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