scholarly journals Preoperative radiation as part of a multidisciplinary strategy for a medically inoperable patient with a bleeding colon cancer

2019 ◽  
Vol 12 (8) ◽  
pp. e229488
Author(s):  
June S Peng ◽  
Neha L Lad ◽  
Edward J Spangenthal ◽  
David M Mattson ◽  
Steven J Nurkin
Keyword(s):  
Colon Cancer ◽  
Complete Response ◽  
Disease Recurrence ◽  
Right Hemicolectomy ◽  
Bare Metal Stent ◽  
Preoperative Radiation ◽  
Vein Thrombosis ◽  
Inoperable Patient ◽  
History Of ◽  
Artery Disease

An 84-year-old man with a history of deep vein thrombosis on warfarin and coronary artery disease presented with haematochezia and was diagnosed with an ascending colon cancer. He was short of breath with lower extremity oedema at the initial surgical consultation. Evaluation revealed an acute exacerbation of congestive heart failure, and further workup and treatment were recommended by the cardiology team. After multidisciplinary discussion, he underwent radiation for the control of bleeding, followed by cardiac catheterisation and placement of a bare metal stent. The patient subsequently underwent robotic-assisted right hemicolectomy. Pathology demonstrated a complete response, and the patient recovered uneventfully. He is alive swith no evidence of disease recurrence 12 months after surgery and 18 months after initial diagnosis.

scholarly journals Sudden Unexpected Deaths due to Multiple Metastasis of Colon Cancer: With a Focus on Cardiac and Dural Metastasis

2021 ◽  
Vol 45 (3) ◽  
pp. 87-92
Author(s):  
Joo-Young Na ◽  
Hee Joo Kwon ◽  
Jin-Haeng Heo ◽  
Young-Il Park ◽  
Sang-Beom Im
Keyword(s):  
Colon Cancer ◽  
Microscopic Examination ◽  
Right Hemicolectomy ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Subdural Hemorrhage ◽  
Manner Of Death ◽  
History Of ◽  
Unexpected Findings ◽  
Dural Metastasis

A malignancy is a fatal condition that could occur through various mechanisms. Forensic pathologists sometimes find unexpected findings during autopsy and post-mortem (PM) tests. Colorectal cancer is one of the leading causes of cancer-related deaths worldwide. The deceased was a 64-year-old man with a medical history of right hemicolectomy due to colon cancer approximately two years earlier. He was found dead at his home. He was admitted to the hospital due to subdural hemorrhage (SDH) two days prior to his demise and was discharged without the permission of the doctor after one day of hospitalization. An autopsy was performed within two days of his death. After gross dissection, the cause and manner of death were assumed to be SDH and unnatural death, respectively. Microscopic examination revealed fresh SDH and dural metastasis of signet-ring cell carcinoma. Furthermore, metastasis was identified in the heart, stomach, and peritoneum. Immunohistochemical examination revealed cancer cells to originate from the colon. After meticulous PM examination, including gross dissection, microscopic examination, PM computed tomography, and PM laboratory tests, the cause and manner of death were determined as SDH and natural death, respectively. This case report highlights the importance of comprehensive PM evaluation for investigating death.

Abstract P596: How Common Are Microembolic Signals After Cerebrovascular Events and Are They Related to Recurrent Admissions?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Behnam SABAYAN ◽  
Simin Mahinrad ◽  
Sanaz Sedaghat ◽  
Eric M Liotta ◽  
Farzaneh A Sorond
Keyword(s):  
Cox Regression ◽  
Hospital Readmissions ◽  
Smoking History ◽  
Vein Thrombosis ◽  
Complication Risk ◽  
Cerebrovascular Events ◽  
History Of ◽  
Artery Disease ◽  
Ischemic Attack ◽  
Deep Vein

Introduction: Microembolic signals (MES) identified by transcranial Doppler (TCD) reflect an ongoing embolic phenomenon with implications for the recurrence of cerebrovascular events and complications. In this study, we investigated the prevalence of MES detected after stroke or transient ischemic attack (TIA) and studied their relationship with future re-admissions. Method: This clinical cohort study is comprised of 961 consecutive patients (mean age 65 years, 59% male) admitted to Northwestern Memorial Hospital with the diagnosis of acute stroke (n: 872) or TIA (n: 89) and underwent TCD evaluation. TCD is performed within the first 48 hours of admission as a routine component of stroke etiology evaluation at our institution. After discharge, patients were followed for an average of 18 months for any hospital readmissions. Cox regression models were used to estimate risk of re-admissions in relation to MES. Results: MES were detected in 99 (10%, 95% CI; 8-12%) patients. During the follow up period, 356 patients had emergency room re-admissions. Compared to patients without MES, those with MES were younger ( p =0.007) and had longer index hospital stay ( p =0.008). Patients with MES, as compared to patients without MES, had 1.56-fold (hazard ratio 95% CI=1.15, 2.13; p =0.005) higher risk of readmission. This association was independent of age, sex, race, smoking, history of hyperlipidemia, diabetes, atrial fibrillation, history of pulmonary emboli, deep vein thrombosis, hypertension, coronary artery disease and heart failure. Conclusion: We show that MES are present in one tenth of patients admitted with stroke or TIA, and they are associated with higher risk of re-admission. These data highlight the importance of embolic signals in stroke complication risk stratification and suggest the need for prospective clinical trials targeting MES in secondary stroke risk and complication prevention.

Effect of hyperlipidemia in patients with a history of colon cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15603-e15603
Author(s):  
Zahid Tarar ◽  
Muhammad Usman Zafar ◽  
Ghulam Ghous ◽  
Umer Farooq ◽  
Arjan Ahluwalia
Keyword(s):  
Coronary Artery Disease ◽  
Colon Cancer ◽  
Coronary Artery ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Inpatient Mortality ◽  
Peripheral Artery ◽  
History Of ◽  
Artery Disease

e15603 Background: The most common cancer of the digestive system is colorectal cancer. 5-year survival rate of early-stage colon cancer is > 90% whereas it is only 10% for patients with distant metastases. Recent studies have shown that lipids influence a tumor’s metastatic capabilities. High fat diet has also been linked with colon cancer. In this study, we try to understand the effect of hyperlipidemia in patients with a history of colon cancer. Methods: This is a retrospective study examining data from the National Inpatient Sample (NIS) Database of the year 2018. We identified patients with any history of Colon cancer using their specific ICD-10 codes. Additionally, we queried for ICD10 codes for hyperlipidemia. Primary outcome was inpatient mortality. Secondary outcome was hospital length of stay and total charge. Utilizing STATA MP 16.1 we performed multivariate logistic regression analysis. Various comorbidities including previous history of coronary artery disease, peripheral artery disease, stroke, smoking, diabetes, hypertension and chemotherapy were incorporated into the analysis. Additionally, hospital demographics were included in the analysis as well including race, hospital bed size teaching status, location, region, insurance and patient income. Data was considered statistically significant if p-value was < 0.05. Results: The total number of patients included in this study were 34,792. They were all adults age > 18 years. Approximately 49% were females. Mean age was 67 years and average hospital length of stay was 6.5 days. After running multivariable analysis for inpatient mortality, we noted that patients with hyperlipidemia had lower odds of mortality (Odds Ratio (OR) 0.64, 95% Confidence Intervals (CI) 0.56 – 0.73). Higher odds of mortality were seen in patients with coronary artery disease (OR 1.23, 95% CI 1.05 – 1.44). Among racial distributions, Blacks had higher odds of mortality when compared with White (OR 1.3, 95% CI 1.1 – 1.5). Hispanics had lower odds of inpatient mortality compared to Whites (OR 0.8, 95% CI 0.6 – 0.9). The odds of mortality were higher with increasing age (OR 1.025, 95% CI 1.02 – 1.031) and lower among females (0.82, 95% CI 0.73 – 0.91). Among secondary outcomes, hyperlipidemia did not affect the hospital length of stay or cost. Several factors increased the hospital length of stay which included any history of coronary artery disease, peripheral artery disease, or diabetes. In addition, patients admitted over the weekend had a higher length of stay. Conclusions: In this study, we find that hyperlipidemia is associated with lower mortality in patients with colon cancer. This could be possible because patients with hyperlipidemia are on statin therapy. This indirectly could point to a potential benefit of statins in colon cancer. Hyperlipidemia does not affect hospital length of stay or cost.

Abstract W P313: Risk of Rebleed with Resumption of Anticoagulation after Intracranial Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jonathan M Weimer ◽  
Errol Gordon ◽  
Jennifer A Frontera
Keyword(s):  
Intracranial Hemorrhage ◽  
De Novo ◽  
Hemorrhagic Complication ◽  
Major Hemorrhage ◽  
Vein Thrombosis ◽  
Ischemic Complications ◽  
History Of ◽  
Artery Disease ◽  
A Minor ◽  
Ischemic Events

Introduction: Rebleed after resumption of anticoagulation following intracranial hemorrhage (ICH) remains a substantial concern, but little data is available describing the occurrence of such events. Methods: Prospectively collected data from 2008-2011 was reviewed in patients with intraparencymal (IPH), subdural (SDH), and subarachnoid (SAH) hemorrhage. Patients with anticoagulant use prior to ictus were identified, as were patients started on full anticoagulation during hospitalization. In hospital rates of ischemic events, major and minor hemorrhages were collected. Univariate analyses were performed using either Fisher’s exact or Mann-Whitney U tests. Results: 387 total ICH patients were identified, including 132 (34.1%) SAH, 134 (34.6%) SDH, and 121 (31.3%) IPH. At time of ictus, 67 (17.3%) were anticoagulated and underwent reversal of coagulopathy. Of these 67 patients, ischemic complications including myocardial infarction (MI), pulmonary embolism (PE), and deep vein thrombosis (DVT) occurred in 8 (11.9%) during hospitalization. 6 of 67 (9.0%) patients resumed full anticoagulation at a median of 14.5 days from ictus. 14 additional patients were started on full anticoagulation de novo at a median of 12 days from ictus. Significant indications for anticoagulation after ICH included: 4 (20%) history of valvular heart disease, 7 (35%) DVT, 1 (5%) PE, 7 (35%) arrhythmia, and 1 (5%) coronary artery disease. Of the 20 patients fully anticoagulated after ICH, 2 (10%) experienced a major hemorrhagic complication. 1 new ICH occurred 36 days from ictus on the day anticoagulation was restarted, and 1 SDH expansion occurred 56 days from ictus and 47 days from resuming anticoagulation. 1 patient experienced a minor hemorrhagic complication (retroperitoneal hematoma). Conclusions: Ischemic complications occurred in 11.9% of ICH patients who underwent coagulopathy reversal. It remains unclear if coagulopathy reversal or delay to resuming anticoagulation is the cause of ischemic events. Initiation of anticoagulation after a median of 14 days from ictus was associated with major hemorrhage in 10% of patients. Reversal of anticoagulation and initiation of anticoagulation after a median of 14 days is associated with an acceptable risk profile.

scholarly journals Single-institution experience with selective internal radiation therapy for the treatment of primary and secondary hepatic tumors

2019 ◽  
Author(s):  
Kabalan Yammine ◽  
Francois G. Kamar ◽  
Jason Nasser ◽  
Claude Tayar ◽  
Marwan Ghosn ◽  
...  
Keyword(s):  
Middle Eastern ◽  
Evaluation Criteria ◽  
Complete Response ◽  
Vein Thrombosis ◽  
Secondary Tumors ◽  
Coil Occlusion ◽  
Private Center ◽  
History Of ◽  
Lung Shunt ◽  
Tumors Of The Liver

Abstract Background Numerous studies have demonstrated that radioembolization of the liver with yttrium-90 microspheres provides a survival advantage for patients with unresectable primary or secondary tumors of the liver. The goal of this study was to provide results of the real-world experience of a single center in Lebanon with the use of radioembolization to treat liver-only or liver-dominant tumors. Methods Patients were included in this retrospective review if they were evaluated for radioembolization between January 2015 and June 2017 and had a lung shunt fraction of 20% or less. Tumor responses were determined using the Response Evaluation Criteria In Solid Tumors. Results Of the 23 patients treated with radioembolization, 8 had hepatocellular carcinoma, 4 had cholangiocellular carcinoma, and 11 had liver-only or liver-dominant metastases from other primary cancers. All were Middle Eastern, with a median age of 64 years (range 36-87 years), and 14 were men. A majority (n=19) had an initial tumor volume of 49% or less. Most (n=17) had multifocal lesions, and 8 had a history of branched or main portal vein thrombosis. Eighteen patients required arterial coil occlusion. Two patients had their cystic artery occluded, and one of these patients developed cholecystitis, which was successfully treated with antibiotics and supportive care. Only one other patient developed a postradioembolization complication, which was a peptic ulcer and was not thought to be due to arterial reflux of microspheres because both the gastroduodenal and right gastric arteries were occluded. Median time to progression was 7 months (range 3-36 months), and median overall survival from radioembolization was 12 months (range 3-40 months). Tumor responses include complete response for 5 patients and partial response for 13 patients. One patient had stable disease and 4 had progressive disease. Conclusion While avoiding prophylactic coiling, we had a positive experience with coiling of the gastroduodenal artery and middle hepatic artery for consolidation of radiotherapy. Performing radioembolization in a nonreferral, private center in Lebanon resulted in good patient outcomes with a low rate of complications.

Giant right coronary artery aneurysm

2020 ◽  
Vol 28 ◽  
pp. 1-3
Author(s):  
Alexandre Bonfim ◽  
Ronald Souza ◽  
Sérgio Beraldo ◽  
Frederico Nunes ◽  
Daniel Beraldo
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Coronary Artery Aneurysm ◽  
Clinical Course ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Coronary Artery Aneurysms ◽  
History Of ◽  
Artery Disease ◽  
The Right

Right coronary artery aneurysms are rare and may result from severe coronary disease, with few cases described in the literature. Mortality is high, and therapy is still controversial. We report the case of a 72-year-old woman with arterial hypertension, and a family history of coronary artery disease, who evolved for 2 months with episodes of palpitations and dyspnea on moderate exertion. During the evaluation, a giant aneurysm was found in the proximal third of the right coronary artery. The patient underwent surgical treatment with grafting of the radial artery to the right coronary artery and ligation of the aneurysmal sac, with good clinical course.

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