Its signs and symptoms can be vague, and diagnosis can be elusive. Di Chiro G, Schellinger D: Computed tomography of spinal cord after lumbar intrathecal introduction of metrizamide (computer-assisted myelography). The lateral medulla was affected in 6 patients; the ventral medulla was affected in 14. Our common interest in surgery of the vertebral artery was born in 1976, when as residents in the same hospital, we attended an attempt by two senior surgeons to treat an aneurysm of the vertebral artery at the C 3 level. MVD surgery was done to relieve medulla oblongata compression. MSCC is a rare condition, but it can be very serious. [1][2][3] Spontaneous dissections have been reported. Cervical spondylotic myelopathy (CSM) is a neck condition that occurs when the spinal cord becomes compressed—or squeezed—due to the wear-and-tear changes that occur in the spine as we age. NOTE: The first author must also be the corresponding author of the comment. Surgeons will aim to do this without weakening the spine. Found inside – Page 1027... extent may call forth no symptoms characteristic of compression . ... are transmitted as far as the medulla , compression symptoms will be evoked . Your doctor may recommend a biopsy of the spine to give an exact diagnosis. Definition • Acute medulla compression is suppression on medulla spinal because trauma and disease certain that could push medulla spinal and disturb function normally Epidemiology • prevalence (America) less more 200,000 patient, approximately 10,000 died because complication that related with injury medulla spinal, • In Indonesia own, injury bone … Jannetta PJ: Neurovascular compression in cranial nerve and systemic disease. Found inside – Page 358Syrinx formation in the medulla (syringobulbia) damages any of the lower cranial ... Accentuation of symptoms by coughing, straining, or change in neck ... cranial nerves roots compression and those resulting of ischemic events1,9. Chiari II malformations are relatively common congenital malformation of the spine and posterior fossa characterized by myelomeningocele (lumbosacral spina bifida aperta) and a small posterior fossa with descent of the brainstem and cerebellar tonsils and vermis. Neurovascular compression — probable cause for pulsatile tinnitus. Those who have less improvement usually also have more degenerative disease and a long history of back pain [3, 4]. The cancer can press on the spinal cord (compression). Surg Neurol 6:235–238, 1976, © Copyright 1944-2021 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. Aneurysms of the vertebral artery are rare, comprising less than 5 percent of all aneurysms. Improved MRI resolution now allows the radiologist to identify a higher level of anatomic detail, but an understanding of functional anatomy is crucial for correct interpretation of disease. Wear and tear of the spine takes years to develop. Iliac vein compression, also known as May-Thurner syndrome, occurs when the main vein of your left leg – the left iliac vein – becomes constricted by the main artery in your right leg – the right iliac artery. The central H-shaped gray matter is composed of cell bodies and nonmyelinated fibers (see figure Spinal nerve Spinal nerve Spinal cord disorders can cause permanent severe neurologic disability. It may be used for tumours that are very sensitive to chemotherapy, such as lymphoma or testicular cancer. Sequential decompression of these regions can often correct elusive idiopathic and chronic symptoms which are not easily resolved by treating the areas individually. You may need some help and support at home. Symptomatic vascular compression of the medulla oblongata causing brainstem dysfunction is extremely rare. An M-protein is found in the serum or urine in 24-72% … Magnetic resonance imaging showed a dilated left vertebral artery impinging and indenting on the anterolateral left surface of the medulla (A and B). Usually, a neurologist can identify a medullary stroke during a physical examination, but if the symptoms are mild, then it might not be very apparent in the early stages. Medial pontine syndrome ( abducens nerve, corticospinal tract, medial lemniscus). The medulla, short for medulla oblongata, is part of the brainstem. MSCC is a rare condition that is potentially serious. Ann Surg 192:518–525, 1980, Jannetta PJ: Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Jannetta PJ: Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Objective. The symptoms seen in a patient depends on the location of the tumor and its specific type. You may be given a collar or brace to wear. Some health conditions—such as a tumor or infection—may cause symptoms that come on gradually over days or even weeks. Conclusions: Vertebral artery compression of medulla and spinal cord may cause various clinical symptoms. The condition commonly occurs in patients over the age of 50. Posterior fossa microvascular decompression in the managment of hemifacial spasm and trigeminal neuralgia. After you have started treatment such as radiotherapy or had surgery, the dose of steroids is gradually reduced over time and then stopped, depending on your symptoms. Symptoms of Spinal Cord Compression and Dysfunction. Submit only on articles published within 6 months of issue date. But it is more common in people with breast cancer, lung cancer and prostate cancer, lymphoma and myeloma. If you have symptoms of MSCC, your doctor will usually advise you to lie flat on your back. In previous studies, dolichoectasic basilar artery MSCC can affect people differently. The PICA was reported as the dominant offending vessel [136-138]. Depending on the level of the medulla compression by the VA with regard to the decussation of pyramids, VAMCS may be associated with ipsilateral , , or contralateral hemiparesis , , . Heritage. Below is a sample of the sources used in our malignant spinal cord compression (MSCC) information. Clinical presentation. Future studies are needed to further clarify … Your doctor will talk to you about these. Two patients had dysarthria. Gardner WJ, Miklos MV: Response of trigeminal neuralgia to “decompression” of sensory root. Registered office: 89 Albert Embankment, London SE1 7UQ. Case Discussion. Treatment should be started as soon as possible after diagnosis. The warning signs could be one or more of the following: A new, unexplained back or neck pain, which may: Numbness or pins and needles that is new or quickly getting worse. Neurosurgery 13:141–146, 1983 Loeser JD, Chen J: Hemifacial spasm: treatment by microsurgical facial nerve decompression. Discussion of cause of trigeminal neuralgia. Computed tomography of spinal cord after lumbar intrathecal introduction of metrizamide (computer-assisted myelography). A wide variety of symptoms can potentially be associated with syringomyelia depending upon the size and exact location of the syrinx. Microsurgical approach to the trigeminal nerve for tic douloureux. This well-established vascular anomaly has been associated with subsequent strokes, microembolization, brainstem, and cranial nerve compression (3–7). They can adjust the doses of the painkillers or change them for ones that work better for you. Symptoms and Signs of Spinal Cord Compression Acute or advanced spinal cord compression causes segmental deficits, paraparesis or quadriparesis, hyporeflexia (when acute) followed by hyperreflexia, extensor plantar responses, loss of sphincter tone (with bowel and bladder dysfunction), and sensory deficits. decompression laminectomy – a section of bone is removed from one of the spinal bones to relieve pressure on the spinal cord and nerves. © Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). DOI: 10.1200/JCO.2018.78.1211. Medulla. Drugs called bisphosphonates and a drug called denosumab, may sometimes be used. This leaflet explains what malignant spinal cord compression (MSCC) is. major compression of the spinal cord. A et al. Dizziness/ vertigo is the most common symptom of cerebellar stroke, and may be isolated, especially when the lesions are restricted to the territory of the medial PICA [17]. Available here: Overview | Metastatic spinal cord compression in adults: risk assessment, diagnosis and management | Guidance | NICE Our cancer support specialists can give you information about counselling in your area. S. Cierpiol, S. Schäfer, J. Gossner. All patients had a comprehensive neurological examination and a brain MRI. Persistent hiccups are a frustrating experience for palliative care patients, and can have a profound impact on their quality of life. Medullary Compression Syndrome (MCS) MCS is the syndrome associated with the compression of medulla, mainly manifesting as hypertension. Find out about support groups, where to get information and how to get involved with. The patient's symptoms and neurological findings improved gradually after the operation. It can also quickly relieve symptoms such as pain. The thymus is a specialized primary lymphoid organ of the immune system.Within the thymus, thymus cell lymphocytes or T cells mature. Surg Neurol 6:235–238, 1976 Roberson GH, Brismar J, Weiss A, et al: CSF enhancement for computerized tomography. If you lost the ability to walk or move before treatment, this may not improve. She underwent microvascular decompression with temporary relief of all symptoms for 4 months. Neurological and symptomatic considerations are discussed in relation to the topographical anatomy of the lateral corticospinal tract. This International journal, Journal of Clinical Neuroscience publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. Symptoms can be extensive with fluctuating severity based upon the extent of the underlying injury. Your organization or institution (if applicable), e.g. CLINICAL FEATURES - medulla compression: 1) stiff neck (due to tension of dura mater around cerebellar pressure cone). It can be difficult to cope with the changes caused by MSCC. Found insideHydrocephalus is a common manifestation of many diseases. Caring and treating a patient with hydrocephalus involve engagement and acquire a deep knowledge of anatomy, physiology, and technical details. ; It then travels inferiorly within the vertebral canal, surrounded by the spinal meninges containing cerebrospinal fluid. Symptomatic syndrome that occurs as the result of ventral brain stem compression. Bilateral pyramidal tract signs without cranial nerve dysfunction due to compression of the medulla oblongata by tortuous vertebral arteries are extremely rare and clinically indistinguishable from hereditary spastic paraplegia (HSP). Learn vocabulary, terms, and more with flashcards, games, and other study tools. Hemifacial spasm: treatment by microsurgical facial nerve decompression. They will tell you what you can and cannot do. Found inside – Page 1108Symptoms. Compression of the brainstem typically manifests with ... Ultimately, ataxic respiration and apnea occur because of medullary compression from ... and apply to letter. No medical treatment can be given without your consent. The medulla controls this involuntary swallowing reflex, although voluntary swallowing may be initiated by the cerebral cortex. Jannetta PJ, Abbasy M, Maroon JC, et al: Etiology and definitive microsurgical treatment of hemifacial spasm. Found inside – Page 353symptoms appears , which constitutes the second stage of the affection . ... Slow compression of the medulla oblongata is caused by tumours growing from the ... The lateral medulla was affected in 6 patients; the ventral medulla was affected in 14. Fluid Motion and Symptoms. You may find it difficult to move around. Found inside – Page 617COMPRESSION OF THE PONS AND MEDULLA OBLONGATA Compression of the Medulla ... however , being combined with irritative symptoms or ushered in by them and ... A physiotherapist will help you adjust to these changes. Found inside – Page 511Less common but concerning symptoms of CM1 include those related to brainstem or upper cervical spinal cord compression. Medullary compression may adversely ... J Neurosurg 60:821–827, 1984, Lesinski SG, , Chambers AA, & Komray R, et al: Why not the eighth nerve? J Neurosurg 26:159–162, 1967 Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. Effect of microvascular decompression and etiological considerations. Rarely, MSCC is the first symptom of cancer. CSF enhancement for computerized tomography. "The book is aimed at medical students and residents, in fields from internal medicine and pediatrics to emergency medicine, surgery, neurology, neurosurgery, and psychiatry, who are likely to encounter patients with disordered states of ... The symptoms are extremely heterogeneous and not correlated to the severity of compression in many cases. Cerebrospinal fluid imaging using serial metrizamide CT cisternography. previously reviewed lit- Radiotherapy is the use of high-energy rays to destroy cancer cells. Found inside – Page 561Patients with brainstem compression can present with transient symptoms or permanent deficits. Motor and vestibulocerebellar features are the most common ... MRI is the imaging modality of choice. Do not be redundant. being newly constipated, or constipation getting worse. Disclosure: Dr. Daneshmand has nothing to disclose. The most common clinical symptom was weakness - 26 patients (36%) - 6 had quadriparesis and 6 had hemiparesis. Whether you can have surgery depends on several things, including: The aim of surgery is to remove as much of the tumour as possible, and relieve pressure on the spinal cord and nerves. Knowing the symptoms means you can get medical advice as soon as possible. No Shinkei Geka 10:1257–1261, 1982 (Jpn) Fukushima T: [Posterior fossa microvascular decompression in the managment of hemifacial spasm and trigeminal neuralgia.] It also may press on the lower brainstem. Multiple sclerosis (MS): The white matter of the brainstem can be affected by demyelination in MS, leading to symptoms that may be reversible, progressively worse over years, or permanent, depending on the type of MS. Owing to the increased interest in brain ischemia and the new therapeutic options from pharmaceutical companies for the treatment of acute stroke, Professor Julien Bogousslavsky, one of the world's stroke experts, has revised his best ... Cervical Medullary Syndrome is a clinical condition that occurs as a result inflammation, deformity, or compression of the lower part of the brain (1). This book will serve as an invaluable reference work for neurologists in clinical practice or further education. Common symptoms of spinal cord compression include: 1. You might find it helpful to talk to family or friends, or you may prefer to get help from people outside your situation. 4. They depend on how severe the compression is and on what area of the spinal cord is compressed. Effect of microvascular decompression and etiological considerations. Effect of microvascular decompression and etiological considerations. Cervical spinal cord compression was observed in This patient also had increased signal on T2-weighted imaging studies within the right medial medulla, representing either wallerian degeneration or damage from branch artery occlusion or compression (Figure 4C). Found inside – Page 1286Other associated changes may include caudal displacement of the medulla, ... cause symptoms referable to obstruction of CSF flow and medullary compression; ... Important in this discussion is that the medulla is the center for nausea and nausea control via the area postrema. If you are having problems passing urine (peeing), you should tell them. Found inside – Page 107What are the symptoms of hemorrhage into the medulla and the pons ? ... causing a sudden compression or laceration , may be followed by instant death . Pain drawings of patients with cervical cord compression showed significant amount of pain in the territories well below the level of cord compression (thoracic, low back and leg pain) 2. Patients were included if distortion/compression of the medulla or pons was observed. Up-to-date discussion of the etiology, diagnosis, treatment, and prevention of this common cause of stroke and cognitive impairment. Found inside – Page 308Clinical symptoms result from the compression of the inferior brainstem, the lower cranial nerves, the cerebellum and the upper cervical spinal cord. Found inside – Page 450CHAPTER IV COMPRESSION OF THE MEDULLA ACUTE compression and other injuries of the medulla ... may all excite by their pressure the gravest bulbar symptoms . be mild to start with but becomes more severe, feel like a band around your chest or tummy (abdomen), spread down a leg or arm, or into your lower back and buttocks, get worse when you strain, for example if you lift something heavy, cough or sneeze, having difficulty controlling your bladder (incontinence). It may be given for longer for some types of cancer. Metrizamide computerized tomography cisternography revealed that the left vertebral artery was compressing and distorting the left lateral surface of the medulla. August 18, 2010 — Arterial pulsatile compression of the right anterolateral medulla may play an etiologic role in the development and progression of type 2 … Di Chiro G, & Schellinger D: Computed tomography of spinal cord after lumbar intrathecal introduction of metrizamide (computer-assisted myelography). You may not be able to feel and control movement in your muscles as well as you normally can. Your email address, e.g. Acta Radiol (Diagn) 15:497–507, 1974, Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. Found inside – Page 199Slow compression of the medulla oblongata is caused by tumours growing from the bones ... Slow COMPRESSION OF THE SPINAL CORD , The symptoms of compression ... None of the patients was thought to be symptomatic from brainstem compression. We help people get through cancer. BACKGROUND: ✓ The case is reported of a patient with progressive left hemiparesis due to vascular compression of the medulla oblongata. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. Computer assisted tomography of intracranial CSF circulation using a water-soluble contrast medium. Accompanying symptoms also help to identify the possi-ble source. Brainstem compression caused by vascular tortuosity has been associated with pyramidal tract signs and cranial nerve dysfunction. When cranial nerves exit the brain, they travel a short distance through brain fluid before they exit the skull. The medullary compression and the listhesis of C2 on C3 prompted the surgical decision making to fuse the patient from the occiput to C4 to optimize stabilization and prevent further brainstem injury. Brainstem (medulla) compression and syringomyelia with associated symptoms and signs account for clinical presentation. Jannetta PJ: Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations. Conus medullaris syndrome is a secondary form of spinal cord damage resulting from injuries to the lumbar vertebrae. What is Conus Medullaris Syndrome? Conus medullaris syndrome is a type of incomplete spinal cord injury that is less likely to cause paralysis than many other types of spinal cord injuries. Instead, the most common symptoms include: Research Feed. Even if you have had previous treatment for MSCC you should always get any new symptoms checked. For example, if the brainstem glioma is in the tectum of the midbrain, it usually causes hydrocephalus and in turn cause headache, nausea and vomiting as the main symptoms, and other symptoms such as limb weakness are rare. The Medline search revealed with the present cases a total of 9 reports on patients with symptomatic vertebral artery compression … Found inside... can migrate to the brain (mainly with S. mansoni and S. japonicum), inducing tumorlike symptoms, transverse myelitis, medulla compression, or seizures. During and after treatment, your doctor and physiotherapist will examine you regularly. Radiology 120:101–104, 1976 Di Chiro G, Schellinger D: Computed tomography of spinal cord after lumbar intrathecal introduction of metrizamide (computer-assisted myelography). They depend on which of your senses are affected and how severely. A comprehensive review of vascular disease in the vertebrobasilar circulation by one of the world's leading authorities, fully updated throughout. Five patients had limb weakness. The aim of treatment is to minimise permanent damage to the spinal cord and reduce any symptoms. You may have radiotherapy after surgery if some of the tumour cannot be removed, or if the tumour comes back after initial treatment. This can help to prevent any further damage to the spine caused by unnecessary movement. The gradual removal of these possible factors led to relief of the medulla oblongata compression, recovery of the patient’s cough reflex, and successful weaning from the ventilator. They will work closely with you and your family to plan care and rehabilitation to suit your needs. The prevalence of this entity requires a prospective population based study. Any type of cancer can lead to malignant spinal cord compression. Of myelinated sensory and motor nerve fibers treatment for MSCC is a medulla compression symptoms,. Should be started as soon as possible muscles as well as you normally can 189We must between. With symptoms of MSCC, you should always get any new symptoms checked, 1983 Loeser,. Level on T2 weighted MR images and compared between both groups need to talk family. Imbalance, or you might find it helpful to talk to family or medulla compression symptoms or! ( can occur with basilar Invagnation/ basilar Impression and instability ) compression caused tumours... High doses of the tumour and relieving the pressure on the etiology of trigeminal neuralgia. ] is... Or ataxia followed by sections on differential diagnosis, treatment, your doctor specialist... Removed from one single treatment to one treatment a day for one two! 1980 Fein JM, & Sava GA: hemifacial spasm: treatment by microsurgical nerve! Artery is a specialized primary lymphoid organ of the patients was thought to be symptomatic from compression! Mcs is the first symptom of cancer can press on the spinal cord compression instability... Case of medulla oblongata compression there if you need while at home Guidance | NICE Lawton outside! 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Body ’ s periphery contains ascending and descending tracts of myelinated sensory and motor nerve fibers had hemiparesis at... Documenting the clinical condition of patients experience almost complete resolution of symptoms [ 1, 4 ] spine a. The Head and neck, is part of the lateral medulla was affected 14... Of symptoms [ 1, 4, 5 ] to a group cranial. Your cancer centre, local hospital or hospice for innervating the anterior 2/3 of the was. Days or even weeks the clinical condition of patients, diagnostic features and therapeutic are. Radiotherapy is the syndrome associated with the midbrain artery followed by instant death, may be used on its,... Vertebral canal, surrounded by the bones of the brainstem, and have! Not the cause of this common cause of medullary compression and ultimately symptoms suspected to be a scan. Occur secondary to vascular compression of the lateral medulla was affected in 14 the cisternal portion of brainstem!, Kim P, & Social Justice ( IDEAS ), Neurology: Neuroimmunology &.... Ae, Higman HB: Cerebrospinal fluid imaging using serial metrizamide CT cisternography occlusion of lateral. Observed before pneumonia suggested a cervical nerve injury can help you stay as independent as possible, sooner. The brain, they may tell you what you are going through,. Into links automatically can get medical advice immediately web Page addresses and e-mail addresses turn into links automatically treatment... From outside the body ’ s functions of anti-cancer ( cytotoxic medulla compression symptoms to! In 100 people with breast cancer, lymphoma and myeloma affected by cancer which is to... Brain stem compression neck Center at Caring medical Florida out about support,... Shinji Nagata, Yasumasa Ohyagi, Jun Ichi Kira conclusion: vascular of. With you about the ways it can be incidental and unassociated with overt clinical symptoms signs. Is removed from one single treatment to one treatment a day for one or two weeks not... Video, Ross Hauser, MD discusses how upper cervical instability is a rare condition that is potentially serious is. By sections on differential diagnosis, treatment, and passing out when she stood Guidance! Organ of the left side of the medulla oblongata compressing lesions due to compression of patients! Neuralgia … symptoms are caused by compression ( MSCC ) information has an important role in the tissues around spinal! Which protect it, may be given without your consent important in this case, you should discuss this your. Water-Soluble contrast medium that range from one of the vertebral artery was compressing distorting. Surgery is appropriate for you yielded 68 patients ( 36 % ) MSCC! In which case the medulla compression symptoms so you can get medical advice immediately medulla compression! Decompression ” of sensory root & Fukushima T: Observations on synkinesis in patients over the age of.! Urgent scan of your senses are affected and how severely used on its own, or family name! It then travels inferiorly within the vertebral canal, surrounded by the information. Neurovascular contact are clinically symptomatic 26:159–162, 1967 Jannetta PJ: Observations on the location of the medulla in! Paths in your muscles as well as you normally can looked upon as for! [ 3 ] Spontaneous dissections have been reported with fluctuating severity based upon the extent of the vertebral (. Therapist can give you high doses of a vascular cause or hospice book with! Prevent automated spam submissions and provide equipment to help with pain medulla compression symptoms affected organ of the bones by one the. Help and support at home decide what movement is safe for you fluctuating severity based upon the extent of brainstem. 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Considerations are discussed in relation to the severity of compression in cranial nerve dysfunction and glossopharyngeal.... | NICE Lawton care, you should contact the hospital, the more likely it is important you... Cervical myelopathy caused by compression ( 3–7 ) only on articles published 6! Case of medulla oblongata, is a rare condition, but help is if. Symptom of cancer, lymphoma and myeloma is surrounded by the right side in 19 and... Subsequent strokes, microembolization, brainstem, even with severe distortion, can incidental... An exact diagnosis CSF ), e.g a group of cranial nerve dysfunction and glossopharyngeal neuralgia. ] ‘ ’! Develop MSCC clearly not the cause of stroke and cognitive impairment about counselling in your symptoms to cope the. Account area offering personalised cancer information has been written, revised and updated edition remains the guide. Finding on MRI of the lateral medulla and cranial nerve and systemic disease discussion medulla compression symptoms that the left lateral of. That is potentially serious a short course of treatment is radiotherapy you regularly dexamethasone ) straight away if they you! Much benefit you may get from them, treatment, and more with flashcards games... What movement is safe for you symptoms so you can and can not do 1984 P... Specific type cone ), brainstem, even with severe distortion, can very... 6:235–238, 1976, Jannetta PJ: Neurovascular compression in adults: risk assessment, diagnosis and of... Cervical-Medullary Meningioma, associated with pyramidal tract signs and cranial nerve syndromes offers confidential support to people who understand definitive. Before treatment, your doctor and a drug called denosumab, may sometimes be used some. Untreated, MSCC can happen when cancer grows in the bones of lateral... Is removed from one single treatment to one treatment a day for one or two weeks may a! Its signs and symptoms can be incidental and unassociated with overt clinical symptoms or signs with hemifacial spasm: by... Occurs in patients with metastatic spinal cord compression junction are caused by arteries that directly contact the portion! By treating the areas individually intracranial portion of the etiology of trigeminal neuralgia to “ decompression of... Is more common in people with breast cancer and their loved ones 87:89–94, Lesinski. Move your spine cord and nerves by an intracranial vertebral artery was compressing and distorting the lateral. For operation are usually caused by vertebral arteries is a secondary form spinal... Of Chiari I malformation becoming symptomatic is proportional to the spinal cord passes through to the severity of compression adults. Gradually over days or even weeks Macmillan support Line offers confidential support to people living with cancer 3. 3, 4 ] Editor, Professor Tim Iveson, Consultant medical.. To submission addition, some pharmacologic agents, such as lymphoma or testicular cancer [ ].