03), mitotic rate (p = 0.02), stratified mitotic rate (p = 0.01), and composite variable of disease (p = 0.004). SM-164 order The OS was found to have statistical associations with cortisol hypersecretion (p = 0.02), DHEA SO4 excess (p = 0.01), Modified Weis Score (p less then 0.001), mitotic rate (p = 0.02), stratified mitotic rate (p = 0.003), and composite variable of disease (p = 0.001). Linear regression (forward-type) analysis suggested that the functional status of the tumor and the disease recurrence index statistically predicted the variance in RFS and OS, respectively. Multiple clinical and histopathological variables appear to affect the prognosis of ACC. However, based on multivariable analysis, it appears that the functional status of the tumor and the composite variable of disease recurrence are predictors of RFS and OS, respectively.Pseudoxanthoma elasticum, or Gronblad-Strandberg syndrome, is an inherited disorder that involves multiple organ systems. The characteristic degeneration and calcification of the elastic fibers caused by this disease were first observed by Ferdinand Jean Darrier in 1896. We report a case of a 27-year-old female who was diagnosed with pseudoxanthoma elasticum based on a skin biopsy prior to her presentation to our ophthalmology outpatient clinic. The past ocular history of the patient was unremarkable for any previous eye complaint or surgery. Her ocular and fundus examination showed pigmented grayish irregular post choroidal crack-like linear dehiscence, forming a network-like pattern, originating at the optic disc and extending radially involving the macular area and the posterior pole in both eyes, representing bilateral angioid streaks. There were no clinical or optical coherent tomographic signs of choroidal neovascularization. Periodic follow up for patients with pseudoxanthoma elasticum is recommended to detect choroidal neovascularization which is a sight-threatening complication. Ophthalmologists should be aware of this association as early recognition and treatment are vital to prevent irreversible visual loss.Acute inflammation of the pancreas, known as pancreatitis, can result in many complications ranging from acute distress respiratory syndrome to pancreatic necrosis. A relatively common vascular complication of pancreatitis is splenic vein thrombosis (SVT) due to intimal inflammation leading to platelet aggregation and thrombosis. The management of SVT with regard to anticoagulation (AC) might appear to be perplexing at first given the recommendation to withhold any sort of AC. Research studies have shown that these patients have an increased risk of gastrointestinal bleeding without AC. In this report, we discuss a case of hypertriglyceridemia-induced pancreatitis. During hospitalization, our patient complained of worsening abdominal pain with objective fevers and leukocytosis in which CT scan of the abdomen was significant for hemorrhagic pancreatitis with necrosis, acute SVT, and splenomegaly. The patient was managed conservatively with IV fluids, pain relief medications, and antibiotics.Cerebral radiation necrosis (RN) is a known complication of brain radiotherapy (RT). The incidence rate of RN varies with the total dose, dose fractionation, and radiotherapy modality. Concurrent treatment with immunotherapy can increase the risk factors for developing RN through a synergistic mechanism. Here, we describe a patient who developed cerebral RN after receiving conventional RT to an extra-cranial site, while he was receiving immune checkpoint inhibitor (ICI) therapy.Histoplasmosis is a fungal disease caused by a dimorphic fungus known as Histoplasma capsulatum (H. capsulatum), which is endemic to areas around river valleys and southeastern states in the United States (US). Patients with histoplasmosis are asymptomatic, and the condition is usually diagnosed by an incidental finding of a pulmonary granuloma on a chest radiograph. In rare cases, this disease can develop into a progressive disseminated form and cause fatal and diffuse pulmonary infiltrates in immunocompromised adults. Moreover, there is a close association between disseminated histoplasmosis and the use of tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA). Our case report discusses a unique presentation of disseminated histoplasmosis in a patient with RA who was not on any biological immune modulators. The disseminated histoplasmosis in this case was progressive and involved the central nervous system, liver, lungs, and oral mucosa and was treated successfully with amphotericin therapy. We also discuss the disease process in detail and hypothesize that RA could be an independent risk factor for the increased incidence of disseminated histoplasmosis in adults. Based on the findings in this case report, we recommend screening for latent Histoplasma infections in adults with RA living in endemic areas and keeping a low threshold to evaluate flare-ups from this disease regardless of the use of anti-TNF inhibitors. Specific experimental and epidemiological studies can be conducted to examine the association between RA and similar indolent fungal infections.Background Subarachnoid block (SAB) with hyperbaric bupivacaine is routinely administered for abdominal and lower limb surgeries. Various agents have been used intrathecally as adjuvants to local anesthetic to increase efficacy and prolong the duration of SAB, among which opioids and α2 agonists are most commonly used. Intravenously administered dexmedetomidine has also been shown to prolong the duration of sensory and motor blockade obtained with subarachnoid block. Methods A total of 212 adult patients scheduled to undergo abdominal or lower limb surgeries were enrolled in this prospective, double-blind, randomized study. They were divided into two equal groups to receive either intravenous dexmedetomidine (group D) 1μg/kg loading followed by maintenance at 0.5μg/kg or intravenous normal saline (group C) after 15 mins of subarachnoid block; no other intraoperative sedatives were used. The onset of sensory block and motor block, and the highest level of sensory block attained were assessed. The time taken for sensory regression to L1, Modified Bromage scale 0, and rescue analgesia requirement were assessed.