scholarly journals 958 Encapsulating Peritoneal Sclerosis with Pericardial Tamponade: A Case Report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H V M Spiers ◽  
T Augustine
Keyword(s):  
Patient Outcomes ◽  
Surgical Intervention ◽  
Pericardial Tamponade ◽  
Definitive Diagnosis ◽  
Disease Course ◽  
Peritoneal Membrane ◽  
Open Thoracotomy ◽  
Unique Case ◽  
Pericardial Cavity ◽  
Insight Into

Abstract Aim Encapsulating peritoneal sclerosis (EPS) is a rare morbidity associated primarily with peritoneal dialysis. Definitive diagnosis and management can often be prolonged and complicated. The pathogenesis is a two-hit hypothesis of inflammation and myofibroblast differentiation. This report aims to demonstrate the pathogenesis of EPS and provide insight into management. Method We present a unique case of a patient with EPS who follows a ‘classical’ disease course before developing a concomitant pericardial sclerosis, presenting with cardiac tamponade. We explore the proposed pathophysiology and provide a hypothesis for both uncommon pathologies presenting in the same patient. Results A 45-year-old male was treated for EPS and went on to develop a concomitant pericardial sclerosis. Following referral to our centre, the patient underwent a semi-elective surgical enterolysis and peritonectomy for EPS, with excision of all sclerotic and obstructing peritoneal membrane. Two weeks following the surgery, he developed a pericardial tamponade with cardiovascular compromise, unresolved by two separate episodes of pericardiocentesis, leading to surgical intervention. A pericardial pleural window was created via open thoracotomy and 800ml of thick clotted blood was removed from the pericardial cavity. Histology demonstrated pericardial sclerosis. Conclusions This case of EPS is unique given the concomitant pericardial sclerosis. Uraemia may be a common mediator of inflammation in the peritoneum and pericardium, predisposing to sclerosis of both membranes of identical embryological origin. Pericardial sclerosis may be present in EPS patients but may not manifest itself clinically by and large. It also demonstrates that effective surgical intervention can lead to excellent patient outcomes.

Acute Aortic Intramural Hematoma Presenting with Painless Recurrent Syncope

2012 ◽  
Vol 15 (5) ◽  
pp. 286
Author(s):  
Jan Droste ◽  
Heidar Zafarani Zadeh ◽  
Mohammed Arif ◽  
Ian Craig ◽  
A K Thakur
Keyword(s):  
Aortic Wall ◽  
Surgical Intervention ◽  
Intramural Hematoma ◽  
Pericardial Tamponade ◽  
Transthoracic Echocardiogram ◽  
Type A Aortic Dissection ◽  
Severe Hypotension ◽  
Patient’S History ◽  
Aortic Intramural Hematoma ◽  
Venous Pulse

<p>A patient presented with recurrent syncope due to transient severe hypotension. The patient's history, physical examination, and initial baseline investigation did not suggest a cardiovascular cause. After fluid resuscitation, a raised jugular venous pulse was noted. Bedside transthoracic echocardiogram showed a pericardial effusion and a proximally dilated aorta. Computed tomography of the thorax confirmed these findings and also demonstrated an intramural hematoma of the proximal aortic wall.</p><p>The patient was transferred to a cardiothoracic center, where he was at first treated medically. He then developed sudden cardiogenic shock due to pericardial tamponade and was successfully operated on.</p><p>It is important to recognize an acute intramural hematoma of the proximal aortic wall as a cardiothoracic emergency. This condition can present atypically, but nevertheless warrants urgent surgical intervention, equal to type A aortic dissection. Echocardiography can help in making the diagnosis.</p>

Microporous Polysaccharide Hemosphere Absorbable Hemostat (AristaAH®) in Re-Operative Cardiac Surgical Procedures

2012 ◽  
Vol 9 (2) ◽  
pp. 96-98
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe
Keyword(s):  
Patient Outcomes ◽  
Surgical Procedures ◽  
Systematic Approach ◽  
Surgical Intervention ◽  
Transfusion Requirement ◽  
Cardiac Surgical Procedures ◽  
Platelet Inhibitors ◽  
Hemostatic Agents ◽  
Surgical Field ◽  
Improve Patient

Patients undergoing re-operative cardiac surgical procedures present a great challenge with regard to obtaining hemostasis in the surgical field. Adhesions are ever-present and these patients are often on oral anti-coagulants and platelet inhibitors. As part of a well-planned surgical intervention, a systematic approach to hemostasis should be employed to decrease blood transfusion requirement and improve patient outcomes. Topical hemostatic agents can be a great help to the surgeon in achieving surgical field hemostasis and are increasingly being employed. Our approach, to these difficult patients, includes the systematic and planned use of AristaAH, which is a novel hemostatic agent whose use has proven safe and efficacious in our patient population.

scholarly journals Brain Studded with Innumerable Larger Stones: Starry Sky at Night Appearance: Multiple Calcified Giant Tuberculoma with 15 Years of Follow-up

2017 ◽  
Vol 06 (02) ◽  
pp. 155-158
Author(s):  
Guru Satyarthee ◽  
P. Chandra ◽  
A. Mahapatra
Keyword(s):  
Central Nervous System Involvement ◽  
Definitive Diagnosis ◽  
Shunt Surgery ◽  
Unique Case ◽  
Major Health Problem ◽  
Major Health ◽  
Vp Shunt ◽  
Cranial Ct ◽  
Rising Incidence

AbstractTuberculosis is rapidly reemerging as a major health problem due to rising incidence of HIV cases across the globe. Central nervous system involvement is rare, but rarely multiple intracerebral granulomas can occur or occasional solitary tuberculoma also develops. The authors report a unique case of 24-year-old woman suffering from pulmonary tuberculosis developed headache and vomiting. Cranial CT scan revealed multiple widespread deposit of intracranial granuloma of sizeable lesion mimicking starry sky at night appearance. Excision of one tuberculoma was done for confirmation of definitive diagnosis, and histopathology was suggestive of tuberculoma. The patient also underwent VP shunt surgery. At last follow-up at 15 years following surgery, she was doing well.

scholarly journals MR Spectroscopic Imaging Predicts Early Response to Anti-Angiogenic Therapy in Recurrent Glioblastoma

2021 ◽  
Author(s):  
Pratik Talati ◽  
Mohamed El-Abtah ◽  
Daniel Kim ◽  
Jorg Dietrich ◽  
Melanie Fu ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Early Response ◽  
Recurrent Glioblastoma ◽  
Time Points ◽  
Angiogenic Therapy ◽  
Longitudinal Mri ◽  
Early Failures ◽  
Assess Treatment Response ◽  
Insight Into ◽  
Mr Spectroscopic Imaging

Abstract Background Determining failure to anti-angiogenic therapy in recurrent GBM (rGBM) remains a challenge. The purpose of the study was to assess treatment response to bevacizumab-based therapy in patients with rGBM using MR spectroscopy (MRS). Methods We performed longitudinal MRI/MRS in 33 patients with rGBM to investigate whether changes in N-acetylaspartate (NAA)/Choline (Cho) and Lactate (Lac)/NAA from baseline to subsequent time points after treatment can predict early failures to bevacizumab-based therapies. Results After stratifying based on 9 month survival, longer-term survivors had increased NAA/Cho and decreased Lac/NAA levels compared to shorter-term survivors. ROC analyses for intratumoral NAA/Cho correlated with survival at 1 day, 2 weeks, 8 weeks, and 16 weeks. Intratumoral Lac/NAA ROC analyses were predictive of survival at all time points tested. At the 8 week time point, 88% of patients with decreased NAA/Cho did not survive 9 months; furthermore, 90% of individuals with an increased Lac/NAA from baseline did not survive at 9 months. No other metabolic ratios tested significantly predicted survival. Conclusions Changes in metabolic levels of tumoral NAA/Cho and Lac/NAA can serve as early biomarkers for predicting treatment failure to anti-angiogenic therapy as soon as 1 day after bevacizumab-based therapy. The addition of MRS to conventional MR methods can provide better insight into how anti-angiogenic therapy affects tumor microenvironment and predict patient outcomes.

Abstract 18021: Functional Substrates as the Strongest Predictor of Outcomes in Patients Presenting for Ventricular Arrhythmia Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Justin Hayase ◽  
Yonatan Faiwiszewski ◽  
Stephen Vampola ◽  
Aron Bender ◽  
Gordon Ho ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Patient Outcomes ◽  
Roc Analysis ◽  
Youden Index ◽  
History Of ◽  
Forward Stepwise ◽  
Left And Right ◽  
Insight Into ◽  
Procedural Outcome

Introduction: Recent work has shown that rotor characteristics can distinguish sustained versus non-sustained ventricular fibrillation (VF). However, the significance of functional VF substrates on patient outcomes is not studied. Methods: In 26 consecutive patients presenting for ventricular arrhythmia ablation procedures, 64-electrode basket catheters were inserted into both the left and right ventricles and VF was induced and defibrillated at 11±3 seconds. Computational phase analysis was performed and each VF cycle was characterized as rotor, focal, or disorganized activation. Follow-up data were analyzed for arrhythmia recurrence and compared to rotor stability. Forward stepwise regression analysis incorporating age, history of CHF, history of a-fib, history of prior MI, number of VTs induced, and presence of post-procedure inducible VT was performed to determine the strongest predictor of procedural outcome. Results: Of 26 patients, 19 had sustained VF, and 16 underwent attempted ablation (7 VT, 9 PVC). Optimization of the Youden index for the ROC analysis regarding rotor stability and procedural outcome demonstrated that maximum rotor stability of > 14.5 rotations (corresponding to total rotor prevalence of 71%) provided optimal sensitivity of 85% and specificity of 87% for arrhythmia recurrence. Among these, greater rotor stability was significantly associated with ventricular arrhythmia recurrence (86% versus 11%, p = 0.01) (Table 1), and was the strongest predictor of outcomes. Recurrence was independent of presenting arrhythmia. Conclusions: Functional VF/VT metrics were the strongest predictor of ventricular arrhythmia outcomes compared to traditional predictors in this series of patients. This suggests that functional substrate characteristics may provide added insight into recurrence mechanisms. Whether they may identify a target for future interventions requires further study.

Unexpected serious aplastic anemia from PD-1 inhibitors: beyond what we know

2019 ◽  
Vol 105 (6) ◽  
pp. NP48-NP51 ◽  
Author(s):  
Marco Filetti ◽  
Raffaele Giusti ◽  
Arianna Di Napoli ◽  
Daniela Iacono ◽  
Paolo Marchetti
Keyword(s):  
Aplastic Anemia ◽  
Patient Outcomes ◽  
Case Reports ◽  
Stage Iv ◽  
Standard Of Care ◽  
Real World Data ◽  
Case Presentation ◽  
Lung Cancers ◽  
Insight Into ◽  
Made In

Introduction: The recent introduction of checkpoint inhibitor–based immunotherapy has revolutionized the treatment of advanced lung cancers, becoming standard of care in both first- and second-line treatment. New types of toxicity are emerging with the increasingly widespread use of these inhibitors. Case presentation: We describe a case of aplastic anemia in a patient with stage IV non-small cell lung cancer after a single administration of nivolumab. Conclusions: Several similar case reports reported in literature show an increasing rate of toxicities from immunotherapy in this setting. These real-world data provide an insight into patient outcomes and treatment decisions being made in clinical practice.

Case Report: Penetrating Cardiac Injury Secondary to a Terrorism-Related Nail Bomb Explosion

2003 ◽  
Vol 18 (3) ◽  
pp. 249-252 ◽  
Author(s):  
Yasufumi Asai ◽  
Masashi Yoshida ◽  
Yoshihiko Kurimoto ◽  
Jeffrey L. Arnold
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Unusual Case ◽  
Surgical Intervention ◽  
Cardiac Injury ◽  
Pericardial Tamponade ◽  
Stab Wounds ◽  
Penetrating Cardiac Injury ◽  
Bomb Explosion ◽  
Prompt Diagnosis

AbstractPenetrating cardiac injuries commonly occur secondary to gunshot or stab wounds. This is a report an unusual case of a patient who sustained a penetrating cardiac injury due to a nail from a terrorism-related, nail-bomb explosion. Associated problems included pericardial tamponade, penetrating cardiac injuries, acute, traumatic, myocardial infarction, and a penetrating lung injury. Prompt diagnosis and aggressive surgical intervention resulted in full recovery of the patient.

scholarly journals Head and neck cutaneous metastasis of testicular choriocarcinoma

2020 ◽  
Vol 13 (2) ◽  
pp. e233337
Author(s):  
Sepehr Shabani ◽  
Nicholas Pritchard ◽  
Tapan A Padhya ◽  
Matthew Mifsud
Keyword(s):  
Germ Cell ◽  
Surgical Intervention ◽  
Germ Cell Tumour ◽  
Cutaneous Metastasis ◽  
Palliative Surgery ◽  
Potential Utility ◽  
Unique Case ◽  
Metastatic Focus ◽  
Lower Lip ◽  
Life Threatening

Testicular choriocarcinoma (CC) is a malignant germ cell tumour which most frequently presents with disseminated metastasis, often involving the lungs, brain and liver. Metastatic are characterised by extensive vascularity, often causing patients to present emergently with potentially life-threatening haemorrhagic complications. We report a patient with disseminated testicular CC, presenting with haemorrhage from a dermal metastatic focus involving the lower lip and mentum, requiring surgical intervention. This unique case illustrates the potential utility of palliative surgery, for the management of symptomatic metastatic disease, such as those caused by testicular CC.

scholarly journals Rupture of an infected iliac artery pseudoaneurysm caused by asymptomatic gastrointestinal foreign body perforation

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052094208 ◽  
Author(s):  
Yu Lun ◽  
Han Jiang ◽  
Shijie Xin ◽  
Jian Zhang
Keyword(s):  
Foreign Body ◽  
Iliac Artery ◽  
Surgical Intervention ◽  
Abscess Formation ◽  
Retroperitoneal Abscess ◽  
Surgical Drainage ◽  
Unique Case ◽  
Artery Pseudoaneurysm ◽  
Infected Pseudoaneurysm ◽  
Iliac Artery Pseudoaneurysm

We report a unique case of a ruptured iliac artery pseudoaneurysm caused by asymptomatic gastrointestinal perforation and retroperitoneal abscess formation. A 46-year-old man presented to the Emergency Department of our institution. Angiography showed a ruptured iliac artery pseudoaneurysm caused by retroperitoneal abscess formation. After endovascular repair and surgical drainage, the cause of the abscess was finally identified as a toothpick. Findings from this case show that asymptomatic gastrointestinal foreign body perforation can be a rare, but insidious, cause of an infected pseudoaneurysm. Prompt surgical intervention is sometimes necessary when treating patients with arterial pseudoaneurysm caused by a perivascular abscess.

Appendicitis

2016 ◽  
Author(s):  
David Scordino
Keyword(s):  
Antibiotic Therapy ◽  
Acute Inflammation ◽  
Surgical Intervention ◽  
Significant Risk ◽  
Disease Course ◽  
Lower Quadrant ◽  
Nonoperative Therapy ◽  
Atypical Presentations ◽  
The Right ◽  
Right Lower Quadrant

Appendicitis is caused by acute inflammation of the appendix (usually secondary to obstruction) and can result in perforation, leading to peritonitis, sepsis, and/or abscess formation. Symptomatology includes anorexia, nausea, vomiting, and periumbilical pain (later localizing to the right lower quadrant). Patients at the extremes of age and pregnant women may have atypical presentations and higher rates of perforation and complications. Most patients suspected of having appendicitis receive prompt surgical intervention (usually laparoscopic). Antibiotic therapy, initiated preoperatively, varies for perforated vs nonperforated appendicitis. In patients with evidence of a contained abscess, nonoperative therapy is considered, as abscess is evidence of a prolonged disease course (more than 5 days) prior to presentation. On imaging, patients may have a well-circumscribed abscess or phlegmon; if immediate surgical intervention is attempted, there is significant risk of morbidity due to adhesions to adjacent tissues.

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