Abstract 14814: By Stanza or Story, the Structure of a Poem

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Timothy F Simpson ◽  
Babak Nazer ◽  
Punag Divanji
Keyword(s):  
Pericardial Effusion ◽  
Plasma Cell ◽  
Inflammatory Markers ◽  
Systemic Disease ◽  
Bone Lesion ◽  
Whole Body ◽  
Pleural Effusions ◽  
Lower Extremity Weakness ◽  
Cardiac Symptoms ◽  
Cardiac Manifestations

A 63-year-old male with recent diagnosis of idiopathic pericarditis presented to the hospital with atrial fibrillation and rapid ventricular rates. He reported one week of palpitations and subacute lower extremity weakness. On exam he was hemodynamically stable with evidence of intra- and extravascular fluid overload. Lab analysis showed elevated creatinine, inflammatory markers, and serum protein gap. Chest radiograph showed bilateral pleural effusions and a focal sclerotic thoracic vertebra. TTE revealed mildly reduced biventricular function, elevated RVSP, and moderate pericardial effusion. The presence of pericardial and pleural effusions with elevated inflammatory markers suggest serositis, and a differential of malignant, autoimmune, and infectious etiologies were considered. Hepatosplenomegaly was noted on CT imaging. Blood, pleural, and pericardial cultures revealed no growth and autoimmune serologies were negative. Given these findings- the differential was narrowed to lymphoma, myeloma with or without amyloidosis, and paraneoplastic syndromes. Electrophoresis revealed presence of an M protein, fat pad biopsy was negative for amyloid fibrils. Bone marrow biopsy revealed an abnormal plasma cell population and biopsy of sclerotic vertebra showed no malignancy. Whole body FDG PET showed no focal uptake in the heart nor elsewhere. VEGF levels were significantly elevated. On the basis of the plasma cell dyscrasia, polyneuropathy, sclerotic bone lesion, elevated VEGF level, hepatosplenomegaly, and pericardial effusion the patient was diagnosed with POEMS syndrome- an extremely rare paraneoplastic syndrome with multisystemic end-organ effects. Cardiac manifestations are infrequent, but include pericardial effusion, myocardial edema and dysfunction, pulmonary hypertension, and volume overload. No specific cardiac therapy exists, but involvement may regress with chemotherapy for treatment of the underlying malignancy. This case demonstrates the importance of recognizing cardiac manifestations as the initial or cardinal presentation of underlying systemic disease, where accurate diagnosis may rely on identification of subtle non-cardiac symptoms, laboratory, and imaging findings as demonstrated here.

1168Role of 18FDG(fluorodeoxyglucose)-PET (positron emission tomography) for differential diagnosis of pericardial disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C S A Chang ◽  
H C W Hyeon ◽  
C J Y Choi ◽  
K E K Kim ◽  
P S J Park ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pericardial Effusion ◽  
Systemic Disease ◽  
Parasite Infection ◽  
Diagnostic Methods ◽  
Whole Body ◽  
Initial Assessment ◽  
Pericardial Disease ◽  
Biopsy Site ◽  
18Fdg Pet

Abstract Background Pericardial disease is frequently associated with systemic diseases. Diagnosis is often troublesome because pericardial fluid does not always give an answer and limited assessment for the acquisition of tissue in effusive-constrictive or constrictive pericarditis. Even after biopsy of pericardium, diagnostic yield is very low without further information for the underlying case. 18FDG-PET can visualize both the inflammation and malignancy through whole body assessment; therefore, it can visualize both pericardium and other organs to provide further insight to the systemic disease. Purpose To assess the role of 18FDG-PET for differential diagnosis of pericardial disease in real clinical practice. Methods Patients who admitted to our pericardial disease clinic who underwent 18FDG-PET for diagnostic methods were derived from electrical medical system database and reviewed. Exclusion criteria were known the advanced stage of malignancy, or already diagnosed from pericardial effusion analysis (positive for malignancy or bacterial culture) by pericardiocentesis. Results Forty patients were finally analyzed. Most common final diagnosis was Idiopathic (n=13, 33%) and tuberculosis (n=12, 28%). Malignancy was diagnosed in 6 patients (15%). Diagnosis of malignancy in all the patients was not confirmed in pericardial effusion. One patient was diagnosed by pericardial biopsy and one by pericardial effusion. Other four were diagnosed by biopsy of other organs. Post-radiation therapy associated pericarditis in two patients, post-operative pericarditis in 5 patients, and transudate, hematoma associated pericarditis, parasite infection in one patient each. Lymph node uptake was found in 28 cases, and four of them was “suggestive malignancy”, 18 was “suggestive benign” and other 6 was “need further evaluation”. All of the patients categorized as “suggestive malignancy” was helped by 18FDG-PET which indicated the optimal biopsy site and 3 of them finally diagnosed as malignancy and one as parasite infection. All of the patients who were categorized as “suggestive benign” were finally diagnosed as a non-malignant disease. Pericardial biopsy was performed in 19 cases (48%) and only 4 were diagnostic. Other 15 specimen showed “chronic inflammation”. Guiding the optimal biopsy site by 18FDG-PET was achieved in 6 patients. 19 cases had normal SUV in the pericardium and 7 patients had very high pericardial SUV more than 10. 6 patients with benign LV pattern was finally diagnosed as tuberculosis pericarditis and one patient with the malignant pattern was finally diagnosed as angiosarcoma Conclusion 18FDG-PET is helpful in the initial assessment of pericardial disease in the aspects of 1) presumptive diagnosis of malignancy in especially in nondiagnostic pericardial effusion or technically risky for pericardiocentesis, 2) Selection of optimal biopsy site with a higher yield of disease, and 3) possibly non-invasive diagnosis of tuberculosis pericarditis. Acknowledgement/Funding None

Rheumatoid Arthritis: History, Stages, Epidemiology, Pathogenesis, Diagnosis and Treatment

2017 ◽  
Vol 9 (02) ◽  
Author(s):  
Abeer Fauzi Al-Rubaye ◽  
Mohanad Jawad Kadhim ◽  
Imad Hadi Hameed
Keyword(s):  
Rheumatoid Arthritis ◽  
Medicinal Plants ◽  
Systemic Disease ◽  
Modern Medicine ◽  
Whole Body ◽  
Internal Organs ◽  
Synthetic Drugs ◽  
Relieve Pain ◽  
Medicinal Treatment ◽  
Natural Drugs

The pharmacological mechanisms of the medicinal plants traditionally used for RA in Persian medicine are discussed in the current review. Further investigations are mandatory to focus on bioefficacy of these phytochemicals for finding novel natural drugs. Rheumatoid arthritis is chronic, progressive, disabling autoimmune disease characterized by systemic inflammation of joints, damaging cartilage and bone around the joints. It is a systemic disease which means that it can affect the whole body and internal organs such as lungs, heart and eyes. Although numbers of synthetic drugs are being used as standard treatment for rheumatoid arthritis but they have adverse effect that can compromise the therapeutic treatment. Unfortunately, there is still no effective known medicinal treatment that cures rheumatoid arthritis as the modern medicine can only treat the symptoms of this disease that means to relieve pain and inflammation of joints. It is possible to use the herbs and plants in various forms in order to relieve the pain and inflammation in the joints. There are so many medicinal plants that have shown anti rheumatoid arthritis properties. So the plants and plant product with significant advantages are used for the treatment of rheumatoid arthritis. The present review is focused on the medicinal plants having anti rheumatoid arthritis activity

scholarly journals MUKnine OPTIMUM protocol: a screening study to identify high-risk patients with multiple myeloma suitable for novel treatment approaches combined with a phase II study evaluating optimised combination of biological therapy in newly diagnosed high-risk multiple myeloma and plasma cell leukaemia

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e046225
Author(s):  
Sarah Brown ◽  
Debbie Sherratt ◽  
Samantha Hinsley ◽  
Louise Flanagan ◽  
Sadie Roberts ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
High Risk ◽  
Plasma Cell ◽  
Phase Ii ◽  
Whole Body ◽  
Cell Leukaemia ◽  
High Dose ◽  
Newly Diagnosed ◽  
Genetic Changes ◽  
Novel Treatment

IntroductionMultiple myeloma (MM) is a plasma cell tumour with over 5800 new cases each year in the UK. The introduction of biological therapies has improved outcomes for the majority of patients with MM, but in approximately 20% of patients the tumour is characterised by genetic changes which confer a significantly poorer prognosis, generally termed high-risk (HR) MM. It is important to diagnose these genetic changes early and identify more effective first-line treatment options for these patients.Methods and analysisThe Myeloma UK nine OPTIMUM trial (MUKnine) evaluates novel treatment strategies for patients with HRMM. Patients with suspected or newly diagnosed MM, fit for intensive therapy, are offered participation in a tumour genetic screening protocol (MUKnine a), with primary endpoint proportion of patients with molecular screening performed within 8 weeks. Patients identified as molecularly HR are invited into the phase II, single-arm, multicentre trial (MUKnine b) investigating an intensive treatment schedule comprising bortezomib, lenalidomide, daratumumab, low-dose cyclophosphamide and dexamethasone, with single high-dose melphalan and autologous stem cell transplantation (ASCT) followed by combination consolidation and maintenance therapy. MUKnine b primary endpoints are minimal residual disease (MRD) at day 100 post-ASCT and progression-free survival. Secondary endpoints include response, safety and quality of life. The trial uses a Bayesian decision rule to determine if this treatment strategy is sufficiently active for further study. Patients identified as not having HR disease receive standard treatment and are followed up in a cohort study. Exploratory studies include longitudinal whole-body diffusion-weighted MRI for imaging MRD testing.Ethics and disseminationEthics approval London South East Research Ethics Committee (Ref: 17/LO/0022, 17/LO/0023). Results of studies will be submitted for publication in a peer-reviewed journal.Trial registration numberISRCTN16847817, May 2017; Pre-results.

scholarly journals Bone mineral density and explanatory factors in children and adults with juvenile dermatomyositis at long term follow-up; a cross sectional study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Henriette Schermacher Marstein ◽  
Kristin Godang ◽  
Berit Flatø ◽  
Ivar Sjaastad ◽  
Jens Bollerslev ◽  
...  
Keyword(s):  
Bone Turnover ◽  
Inflammatory Markers ◽  
Juvenile Dermatomyositis ◽  
Inflammatory Myopathy ◽  
Disease Onset ◽  
Whole Body ◽  
Mineral Density ◽  
Z Scores

Abstract Background Juvenile dermatomyositis (JDM) is the most common idiopathic inflammatory myopathy in children and adolescents. Both the disease and its treatment with glucocorticoids may negatively impact bone formation. In this study we compare BMD in patients (children/adolescence and adults) with long-standing JDM with matched controls; and in patients, explore how general/disease characteristics and bone turnover markers are associated with BMD. Methods JDM patients (n = 59) were examined median 16.8y (range 6.6–27.0y) after disease onset and compared with 59 age/sex-matched controls. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD of the whole body and lumbar spine (spine) in all participants, and of ultra-distal radius, forearm and total hip in participants ≥20y only. Markers of bone turnover were analysed, and associations with outcomes explored. Results Reduced BMD Z-scores (<−1SD) were found in 19 and 29% of patients and 7 and 9% of controls in whole body and spine, respectively (p-values < 0.05). BMD and BMD Z-scores for whole body and spine were lower in all patients and for < 20y compared with their respective controls. In participants ≥20y, only BMD and BMD Z-score of forearm were lower in the patients versus controls. In patients, BMD Z-scores for whole body and/or spine were found to correlate negatively with prednisolone use at follow-up (yes/no) (age < 20y), inflammatory markers (age ≥ 20y) and levels of interferon gamma-induced protein 10 (IP-10) (both age groups). In all patients, prednisolone use at follow-up (yes/no) and age ≥ 20y were independent correlates of lower BMD Z-scores for whole body and spine, respectively. Conclusion In long-term JDM, children have more impairment of BMD than adults in spine and whole-body. Associations with BMD were found for both prednisolone and inflammatory markers, and a novel association was discovered with the biomarker of JDM activity, IP-10.

scholarly journals Diagnostic Value of Whole-Body MRI Short Protocols in Bone Lesion Detection in Multiple Myeloma Patients

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1053
Author(s):  
Davide Ippolito ◽  
Teresa Giandola ◽  
Cesare Maino ◽  
Davide Gandola ◽  
Maria Ragusi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow Involvement ◽  
Bone Lesion ◽  
Diagnostic Value ◽  
Lesion Detection ◽  
Lower Limbs ◽  
Whole Body ◽  
Bone Lesions ◽  
Whole Body Mri ◽  
Mri Protocol

The aim of the study is to evaluate the effectiveness of short whole-body magnetic resonance imaging (WBMRI) protocols for the overall assessment of bone marrow involvement in patients with multiple myeloma (MM), in comparison with standard whole-body MRI protocol. Patients with biopsy-proven MM, who underwent a WBMRI with full-body coverage (from vertex to feet) were retrospectively enrolled. WBMRI images were independently evaluated by two expert radiologists, in terms of infiltration patterns (normal, focal, diffuse, and combined), according to location (the whole skeleton was divided into six anatomic districts: skull, spine, sternum and ribs, upper limbs, pelvis and proximal two-thirds of the femur, remaining parts of lower limbs) and lytic lesions number (<5, 5–20, and >20). The majority of patients showed focal and combined infiltration patterns with bone lesions predominantly distributed in the spine and pelvis. As skull and lower limbs are less frequently involved by focal bone lesions, excluding them from the standard MRI protocol allows to obtain a shorter protocol, maintaining a good diagnostic value.

scholarly journals Potential Role of Hepatozoon canis in a Fatal Systemic Disease in a Puppy

Pathogens ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1193
Author(s):  
Andrea De Bonis ◽  
Mariasole Colombo ◽  
Rossella Terragni ◽  
Barbara Bacci ◽  
Simone Morelli ◽  
...  
Keyword(s):  
Potential Role ◽  
Complete Blood Count ◽  
Systemic Disease ◽  
Clinical Signs ◽  
Whole Body ◽  
Hepatozoon Canis ◽  
Veterinary Clinic ◽  
Imidocarb Dipropionate ◽  
Thoracolumbar Region

Canine hepatozoonosis caused by Hepatozoon canis is an emerging disease in Europe. Clinical pictures vary from subclinical to life-threatening and non-specific clinical signs are predominantly reported. A 2-month-old female puppy originating from Southern Italy was adopted and moved to Northern Italy. Then, the dog was brought to a local veterinary practice for gastrointestinal signs, migrating lameness and pruritic dermatitis, and then tested positive for Hepatozoon spp. gamonts at the blood smear. After treatment with imidocarb dipropionate and doxycycline, the dog showed an initial clinical improvement. However, gastrointestinal signs recurred, and diffuse superficial pyoderma appeared on the thoracolumbar region, along with fever, lethargy, and weight loss. Eight months from the first onset of clinical signs, the dog was referred to a veterinary clinic and subjected to complete blood count, urine and fecal analysis, along with abdominal ultrasonography, whole-body CT and gastroduodenal endoscopy. Skin biopsies and blood samples were subjected to a PCR-coupled sequencing protocol, which scored both positive for H. canis. Alterations were consistent with a pre-existing cholangiohepatitis and multiple acquired extrahepatic shunts secondary to portal hypertension. The dog was euthanatized due to a clinical worsening two months later. The potential role of H. canis in the systemic disease observed, clinic-pathological findings and epizootiological implications are discussed.

scholarly journals Insulin sensitivity variations in apparently healthy Arab male subjects: correlation with insulin and C peptide

2021 ◽  
Vol 9 (2) ◽  
pp. e002039
Author(s):  
Noor Suleiman ◽  
Meis Alkasem ◽  
Shaimaa Hassoun ◽  
Ibrahem Abdalhakam ◽  
Ilham Bettahi ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Insulin Sensitivity ◽  
Inflammatory Markers ◽  
The Other ◽  
Whole Body ◽  
Oxidative Stress Markers ◽  
C Peptide ◽  
Stress Markers ◽  
Wide Range ◽  
Apparently Healthy

IntroductionDecreased insulin sensitivity occurs early in type 2 diabetes (T2D). T2D is highly prevalent in the Middle East and North Africa regions. This study assessed the variations in insulin sensitivity in normal apparently healthy subjects and the levels of adiponectin, adipsin and inflammatory markers.Research design and methodsA total of 60 participants (aged 18–45, body mass index <28) with a normal oral glucose tolerance test (OGTT) completed hyperinsulinemic-euglycemic clamp (40 mU/m2/min) and body composition test by dual-energy X-ray absorptiometry scan. Blood samples were assayed for glucose, insulin, C peptide, inflammatory markers, oxidative stress markers, adiponectin and adipsin.ResultsThe subjects showed wide variations in the whole-body glucose disposal rate (M value) from 2 to 20 mg/kg/min and were divided into three groups: most responsive (M>12 mg/kg/min, n=17), least responsive (M≤6 mg/kg/min, n=14) and intermediate responsive (M=6.1–12 mg/kg/min, n=29). Insulin and C peptide responses to OGTT were highest among the least insulin sensitive group. Triglycerides, cholesterol, alanine transaminase (ALT) and albumin levels were higher in the least responsive group compared with the other groups. Among the inflammatory markers, C reactive protein (CRP) was highest in the least sensitivity group compared with the other groups; however, there were no differences in the level of soluble receptor for advanced glycation end products and Tumor Necrosis Factor Receptor Superfamily 1B (TNFRS1B). Plasma levels of insulin sensitivity markers, adiponectin and adipsin, and oxidative stress markers, oxidized low-density lipoprotein, total antioxidant capacity and glutathione peroxidase 1, were similar between the groups.ConclusionsA wide range in insulin sensitivity and significant differences in triglycerides, cholesterol, ALT and CRP concentrations were observed despite the fact that the study subjects were homogenous in terms of age, gender and ethnic background, and all had normal screening comprehensive chemistry and normal glucose response to OGTT. The striking differences in insulin sensitivity reflect differences in genetic predisposition and/or environmental exposure. The low insulin sensitivity status associated with increased insulin level may represent an early stage of metabolic abnormality.

scholarly journals Ten Years of Experience in Treating Patients With Digoxin Toxicity Without Using Digoxin Fab Antibody

2021 ◽  
Vol 11 (1) ◽  
pp. 31239.1-31239.10
Author(s):  
Farzad Gheshlaghi ◽  
◽  
Anselm Wong ◽  
Gholamali Dorooshi ◽  
Rokhsareh Meamar ◽  
...  
Keyword(s):  
Chronic Toxicity ◽  
Digoxin Toxicity ◽  
Years Of Experience ◽  
Medical Sciences ◽  
Ongoing Controversy ◽  
Cardiac Symptoms ◽  
Medical Documents ◽  
Cardiac Manifestation ◽  
N 93 ◽  
Cardiac Manifestations

Background: Digoxin is extensively prescribed for cardiac diseases, so its chronic or acute toxicity commonly occur. Although digoxin specific antibodies (anti-digoxin Fab) are recommended to be used in patients with cardiac symptoms of digoxin toxicity, there is ongoing controversy about the effectiveness and dose of anti-digoxin Fab. Because our department lacks access to anti-digoxin Fab and the high cost of the antidote, we evaluated 10 years of experience in treating patients with digoxin toxicity without using digoxin Fab antibodies considering outcomes. Methods: A retrospective study was performed in Khorshid Hospital, affiliated with Isfahan University of Medical Sciences, from October 2008 to September 2018. Patients with acute or chronic digoxin toxicity were included in the study. The patients’ data were gathered and analyzed according to their medical documents. Results: Out of 150 cases with digoxin toxicity, 38% (n=57) were acute and 62% (n=93) were chronic. About 64.7% (n=97) were female. The most common non-cardiac manifestations of toxicity were gastrointestinal (67.3%, n=101) and neurological symptoms (52.7%, n=79). Bradyarrhythmia (80.5%, n=33) was the most cardiac manifestation in patients with acute (15.8% n=9) and chronic (25.8%, n=24) toxicity. A total of 144 (96%) cases fully recovered with supportive care, and 6 patients (4%) died. None of the cases received anti-digoxin Fab. Conclusion: The majority of presentations with acute or chronic toxicity recovered with supportive measures without using anti-digoxin Fab.

Sensitivity of whole-body CT and MRI versus projection radiography in the detection of osteolyses in patients with monoclonal plasma cell disease

2014 ◽  
Vol 83 (7) ◽  
pp. 1222-1230 ◽  
Author(s):  
Maya B. Wolf ◽  
Fritz Murray ◽  
Kerstin Kilk ◽  
Jens Hillengass ◽  
Stefan Delorme ◽  
...  
Keyword(s):  
Plasma Cell ◽  
Whole Body ◽  
Cell Disease ◽  
Whole Body Ct ◽  
Projection Radiography ◽  
Ct And Mri ◽  
Body Ct

Extreme bradycardia as presentation of an eating disorder

2021 ◽  
Vol 14 (6) ◽  
pp. e238224
Author(s):  
Elizabeth Anderson ◽  
Julian Gunn
Keyword(s):  
Body Mass Index ◽  
Eating Disorder ◽  
Pericardial Effusion ◽  
Body Mass ◽  
Personal History ◽  
Horner’S Syndrome ◽  
Dietary Advice ◽  
Pleural Effusions ◽  
Horner's Syndrome ◽  
Dietary History

We present a case of extreme bradycardia in an 18-year-old man, accompanied by bilateral pleural effusions, pericardial effusion, endocrine dysregulation and Horner’s syndrome. Despite extensive investigations as an inpatient and multidisciplinary input, it was not until subsequent assessment by an endocrine team that it was revealed that his presentation was attributable to an eating disorder. Following dietary advice, easing of extreme exercise and continued support, the patient improved in all parameters including body mass index and he remains well. This case demonstrates the importance of a thorough personal history incorporating all aspects of social and dietary history.

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