A case report of endorectal displacement of a right ureteral stent following radiochemotherapy and Bevacizumab

Abstract Background The angiogenesis inhibitor monoclonal antibody Bevacizumab is presently the standard treatment for numerous neoplasms but particular toxicities are emerging, such as hypertension, haemorrhage, thromboembolism, gastrointestinal perforation, fistulae, and delayed wound healing. The addition of Bevacizumab to radio and chemotherapy has improved the overall survival rate in patients with metastatic, persistent or recurrent cervical carcinoma. However an increased risk of enteric or urinary fistula formation has been documented, related to hypoxia which is induced by the inhibition of angiogenesis. Moreover, previous pelvic surgery, repeated ureteral stenting and radiation are additional risk factors. Case presentation We describe the remarkable case of a right ureteral stent displacement inside the rectum lumen in a patient treated with Bevacizumab for pelvic recurrence of cervical cancer. The patient was referred to our Urology Department with urinary sepsis and bilateral hydronephrosis. Right ureteral stent substitution was planned; at cystoscopy the distal loop of the stent was not visualized inside the bladder. The presence of the distal loop of the right ureteral inside the rectum was clearly demonstrated with a CT scan. Conclusions Since Bevacizumab is increasingly used in the treatment of gynaecological neoplasms and indwelling ureteral stents are often required to treat or prevent ureteral compressions, similar cases are likely to be diagnosed and this complication should be considered in the management of advanced pelvic cancers.

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Bevacizumab and risk of hand-foot syndrome associated with chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e13591 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e13591-e13591

Author(s):

Ronald A. Flores ◽

Mario E. Lacouture ◽

Shenhong Wu

Keyword(s):

Meta Analysis ◽

Angiogenesis Inhibitor ◽

Chemotherapeutic Agents ◽

Randomized Controlled Clinical Trials ◽

Increased Risk ◽

Significant Difference ◽

Hand Foot Syndrome ◽

Inhibition Of Angiogenesis ◽

Cutaneous Side Effect ◽

American Society

e13591 Background: Hand-foot syndrome (HFS) is a dose-limiting cutaneous side effect of many chemotherapeutic agents. Its pathogenesis and risk factors have not been well understood. In this study, we propose that the inhibition of angiogenesis may contribute to the development of HFS. We investigated the risk of chemotherapy-induced HFS in patients treated with bevacizumab, an angiogenesis inhibitor that is widely used for the treatment of various cancers with a systematic review and a meta-analysis of published randomized-controlled clinical trials (RCTs). Methods: Databases from PUBMED, Cochrane Database, and abstracts presented at the American Society of Clinical Oncology until December, 2011 were searched for the identification of relevant studies. Eligible studies included prospective RCTs in which the addition of bevacizumab to chemotherapy was compared directly to chemotherapy alone in cancer patients. Relative risk (RR), and 95% confidence interval (CI) were calculated using a fixed-or random-effects model based on the heterogeneity of the included studies. Results: A total of six RCTs including 5,043 patients (bevacizumab 2665, control 2378) with a variety of tumors were analyzed. The addition of bevacizumab to chemotherapy significantly increased the risk of developing HFS with an RR of 1.68 (95% CI: 1.17-2.40, p=0.005) in comparison to chemotherapy alone. The risk of HFS significantly increased in patients receiving bevacizumab at 2.5 mg/kg/week (RR of 1.88, 95% CI: 1.39-2.54, p<0.001) and at 5 mg/kg/week (RR of 1.19, 95% CI: 1.03-1.36, p=0.016); however, the increased risk of HFS did not vary significantly with bevacizumab dosage (p=0.72) and with tumor types (p=0.92). The increased risk of HFS varied with concurrent chemotherapeutic agents with a significant difference (p=0.034) between docetaxel (RR 6.94, 95% CI: 1.67-28.81) and 5-FU based agents, including capecitabine (RR 1.25, 95% CI: 1.10-1.42). Conclusions: The risk of HFS associated with chemotherapeutic agents significantly increased with the use of bevacizumab, suggesting an important role of angiogenesis in the development of HFS. Moreover, combination with docetaxel appears to confer a higher risk than 5-FU based agents.

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Lung autotransplantation for bronchial necrosis after radiotherapy: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01164-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yuya Nobori ◽

Masaaki Sato ◽

Mizuki Morota ◽

Yoshikazu Shinohara ◽

Daisuke Yoshida ◽

...

Keyword(s):

Radiation Therapy ◽

Pulmonary Function ◽

Treatment Success ◽

Locally Advanced ◽

Fistula Formation ◽

Bronchial Anastomosis ◽

Silicone Stent ◽

Feasible Option ◽

Malignant Germ Cell Tumor ◽

The Right

Abstract Background Bronchial necrosis is a rare but fatal complication after radiation therapy. Because of the anatomical complexity and rarity of this condition, determining the most appropriate management for individual patients is extremely challenging. Lung autotransplantation is a surgical technique that has been applied to hilar neoplastic lesions to preserve pulmonary function and avoid pneumonectomy. We herein report a case of bronchial necrosis secondary to radiotherapy that was treated with lung autotransplantation. Case presentation A 46-year-old man developed broad necrosis and infection of the right bronchus secondary to previous stereotactic body-radiation therapy. This treatment was supplied close to a right hilar metastatic pulmonary tumor derived from a mediastinal malignant germ cell tumor that had been surgically resected with the left phrenic nerve. The bronchial necrosis accompanied by infection with Aspergillus fumigatus was progressive despite antibiotics and repetitive bronchoscopic debridement. Because of the patient’s critical condition and limited pulmonary function, right lung autotransplantation with preservation of the right basal segment was selected. An omental flap was placed around the bronchial anastomosis to prevent later complications. The postoperative course involved multiple complications including contralateral pneumonia and delayed wound healing at the bronchial anastomosis with resultant stenosis, the latter of which was overcome by placement of a silicone stent. The patient was discharged 5 months postoperatively. Three months after discharge, however, the patient developed hemoptysis and died of bronchopulmonary arterial fistula formation. Conclusions We experienced an extremely challenging case of bronchial necrosis secondary to radiotherapy. The condition was managed with lung autotransplantation and omental wrapping; however, the treatment success was temporary and the patient eventually died of bronchopulmonary arterial fistula formation. This technique seems to be a feasible option for locally advanced refractory bronchial necrosis, although later complications can still be fatal.

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Bilateral angle-closure during hospitalization for coronavirus disease-19 (COVID-19): A case report

European Journal of Ophthalmology ◽

10.1177/11206721211012197 ◽

2021 ◽

pp. 112067212110121

Author(s):

Guido Barosco ◽

Roberta Morbio ◽

Francesca Chemello ◽

Roberto Tosi ◽

Giorgio Marchini

Keyword(s):

Visual Impairment ◽

Cataract Extraction ◽

Ultrasound Biomicroscopy ◽

Angle Closure ◽

Blurred Vision ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Increased Risk ◽

The Right ◽

End Stage

Purpose: This report describes a case of bilateral primary angle closure (PAC) progressing to unilateral end-stage primary angle closure glaucoma (PACG) associated with treatment for coronavirus disease-19 (COVID-19) infection. Methods: A 64-year-old man came to our attention because of blurred vision after a 2-month hospital stay for treatment of COVID-19 infection. Examination findings revealed PACG, with severe visual impairment in the right eye and PAC in the left eye due to plateau iris syndrome. The patient’s severe clinical condition and prolonged systemic therapy masked the symptoms and delayed the diagnosis. Medical chart review disclosed the multifactorial causes of the visual impairment. Ultrasound biomicroscopy (UBM) aided in diagnosis and subsequent therapy. Results: The cause behind the primary angle closure and the iridotrabecular contact was eliminated by bilateral cataract extraction, goniosynechialysis, and myotic therapy. Conclusions: COVID-19 treatment may pose an increased risk for PAC. Accurate recording of patient and family ophthalmic history is essential to prevent its onset. Recognition of early signs of PAC is key to averting its progression to PACG.

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Amygdala activation in maltreated children during pre-attentive emotional processing

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.116624 ◽

2013 ◽

Vol 202 (4) ◽

pp. 269-276 ◽

Cited By ~ 112

Author(s):

Eamon J. McCrory ◽

Stéphane A. De Brito ◽

Philip A. Kelly ◽

Geoffrey Bird ◽

Catherine L. Sebastian ◽

...

Keyword(s):

Psychiatric Disorder ◽

Emotional Processing ◽

Community Sample ◽

Age At Onset ◽

Childhood Adversity ◽

Neural Response ◽

Maltreated Children ◽

Amygdala Activation ◽

Increased Risk ◽

The Right

BackgroundChildhood adversity is associated with significantly increased risk of psychiatric disorder. To date, functional magnetic resonance imaging (fMRI) studies of children have mainly focused on institutionalisation and investigated conscious processing of affect.AimsTo investigate neural response to pre-attentively presented affect cues in a community sample of children with documented experiences of maltreatment in the home.MethodA masked dot-probe paradigm involving pre-attentive presentation of angry, happy and neutral facial expressions was employed. Eighteen maltreated children were compared with 23 carefully matched non-maltreated peers.ResultsIncreased neural response was observed in the right amygdala for pre-attentively presented angry and happy faces in maltreated v. non-maltreated children. Level of amygdala activation was negatively associated with age at onset for several abuse subtypes.ConclusionsMaltreatment is associated with heightened neural response to positive and negative facial affect, even to stimuli outside awareness. This may represent a latent neural risk factor for future psychiatric disorder.

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Nontyphi Salmonella Empyema with Bronchopleural Fistula in a Patient with Human Immunodeficiency Virus

Case Reports in Pulmonology ◽

10.1155/2018/4761725 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Douglas Bretzing ◽

Tasnim Lat ◽

Andrew Shakespeare ◽

Mary Lee ◽

Salim Surani ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Bronchopleural Fistula ◽

Fibrinolytic Therapy ◽

Watery Diarrhea ◽

Increased Risk ◽

Pulmonary Manifestations ◽

Immunodeficiency Virus ◽

Night Sweats ◽

The Right

Patients with human immunodeficiency virus (HIV) have an increased risk of inoculation with nontyphoid Salmonella compared to the general population. While nontyphoid Salmonella commonly manifests as gastroenteritis, Salmonella bacteremia can be seen in patients with HIV. We present a case of disseminated Salmonellosis in a patient with HIV complicated by bronchopleural fistula and secondary empyema. Case Presentation. A 40-year-old African American male with HIV noncompliant with HAART therapy presented with complaints of generalized weakness, weight loss, cough, night sweats, and nonbloody, watery diarrhea of four weeks’ duration. A computed tomography (CT) scan demonstrated a bilobed large, thick-walled cavitary lesion in the right upper lobe communicating with the pleural space to form a bronchopleural fistula. Thoracentesis yielded growth of nontyphi Salmonella species consistent with empyema; he was treated with intravenous Ceftriaxone and underwent placement of chest tube for drainage of empyema with instillation of alteplase/dornase twice daily for three days. Repeat CT chest showed a hydropneumothorax. The patient subsequently underwent video-assisted thoracoscopy with decortication. The patient continued to improve and follow-up CT chest demonstrated improved loculated right pneumothorax with resolution of the right bronchopleural fistula and resolution of the cavitary lesions. Discussion. We describe one of the few cases of development of bronchopulmonary fistula and the formation of empyema in the setting of disseminated Salmonella. Empyema complicated by bronchopulmonary fistula likely led to failure of intrapleural fibrinolytic therapy and the patient ultimately required decortication in addition to antibiotics. While Salmonella bacteremia can be seen in immunocompromised patients, extraintestinal manifestations of Salmonella infection such as empyema and bronchopleural fistulas are uncommon. Bronchopleural fistulas most commonly occur as a postoperative complication of pulmonary resection. Conclusions. This case highlights the unusual pulmonary manifestations that can occur due to disseminated Salmonella in an immunocompromised patient as well as complex management decisions related to these complications.

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Morphology of the vertebral artery in Asian population

Asian Journal of Medical Sciences ◽

10.3126/ajms.v5i4.6150 ◽

2014 ◽

Vol 5 (4) ◽

pp. 84-88 ◽

Cited By ~ 1

Author(s):

Maryna Alfaouri-Kornieieva ◽

Azmy M Al-Hadidi

Keyword(s):

Vertebral Artery ◽

Asian Population ◽

Outer Diameter ◽

Medical Sciences ◽

The Third ◽

Asian Patients ◽

Distal Loop ◽

The Right ◽

Occipital Lobes ◽

The Brain

Background: Recent clinical trials have shown a rising trend of stroke in Asian population. Approximately 20% strokes of total occur at the vertebrobasilar basin that supplies the occipital lobes of the brain, the cerebellum, and the brainstem. The anatomical features and variability of the third segment of the vertebral artery (VA) in Asians are analyzed in this study. Methods: A prospective cohort study of 68 consecutive Asian patients underwent MRA examination for head and neck in the Department of Radiology of Hospital of University of Jordan from 1.10.2011 to 30.04.2012. The 116 VA were analyzed on the obtained angiograms. Results: The third segment (V3) of the VA was studied according to its conventional division into vertical, horizontal, and oblique parts. The mean outer diameter of the V3 varied up 3.18 ± 0.73 to 4.28 ± 1.08 mm. The parameter prevailed on the left in 91% cases and was greater in males, than in females. The distal loop of the VA projected downward in 26 cases on the right (78%) and in 28 cases on the left (74%). The tortuosity of loop?formations of V3 was evaluated subject to angles between their ascending and descending bends. Conclusion: In comparison with other ethnic groups, the V3 of the VA in Asians has lesser outer diameter, especially along its oblique part; the zero?distance between the occipital bone and horizontal segment of VA occurs more often (up to 26%); the Lang’s III type of V3 variability is the most common in Asians. DOI: http://dx.doi.org/10.3126/ajms.v5i4.6150 Asian Journal of Medical Sciences 2014 Vol.5(4); 84-88

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S154 – Primary TEP and Patch Free-Flap Laryngectomy Reconstruction

Otolaryngology ◽

10.1016/j.otohns.2008.05.328 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P128-P128 ◽

Cited By ~ 1

Author(s):

Tamer Abdel-Halim Ghanem ◽

Justin McLarty ◽

Farhad Ardeshirpour ◽

Christopher F Baranano ◽

Eben L Rosenthal ◽

...

Keyword(s):

Free Flap ◽

Total Laryngectomy ◽

Demographic Data ◽

Free Flaps ◽

Fistula Formation ◽

Increased Risk ◽

Radial Forearm ◽

Speech Therapist ◽

Fistula Rate ◽

Tracheoesophageal Puncture

Objectives 1. Assess speech outcomes for patients undergoing primary tracheoesophageal puncture (TEP) following total laryngectomy (TL) with patch free flap reconstruction. 2. Evaluate risk of fistulization following primary TEP vs. no TEP in patch free flap TL reconstruction. Methods Patients undergoing reconstruction with patch free-flaps following TL were studied retrospectively. Demographic data, surgical procedures, speech outcomes, and postoperative complications were collected. Patients were divided in 2 groups depending on whether TEP was performed at the time of ablation (primary TEP). Voice outcomes were assessed by a speech therapist. Results 77 patients underwent TL, mean age of 63 years. Glottis (60%), followed by hypopharynx (18%), and supraglottis (17%) were the most common tumor sites. Most patients had T3 and T4 disease (71%) on initial presentation, and there were 57% undergoing salvage total laryngectomy. The radial forearm fascioucutaneous free flap was used in 90% of the cases. Primary TEP was performed in 44 patients (57%), and only 1 of 33 patients underwent a TEP procedure secondarily. Voice outcomes for the TEP group were good. The overall fistula rate was 39%, half of which healed spontaneously. The fistula rate in the primary TEP group was 41%, and in the group not receiving primary TEP it was 36.7% (p=0.87). Conclusions Primary TEP performed at the time of free-flap patch reconstruction after TL enhances speech outcomes for patients, and does not lead to an increased risk in fistula formation.

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Is Nighttime Really Not the Right Time for a Laparoscopic Cholecystectomy?

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/6076948 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Anna C. M. Geraedts ◽

Meindert N. Sosef ◽

Jan Willem M. Greve ◽

Mechteld C. de Jong

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Morbidity ◽

Time Of Day ◽

Outcome Data ◽

Emergency Procedure ◽

Out Of Hours ◽

Increased Risk ◽

The Right ◽

The Impact ◽

Univariate Analyses

Purpose. The impact of an out-of-hours laparoscopic cholecystectomy on outcome is controversial. We sought to determine the association between an out-of-hours procedure and postoperative complications within 90 days. Methods. Between 2014 and 2016, 1553 laparoscopic cholecystectomies were performed. Therapeutic, operative, and outcome data were prospectively collected and analyzed. We defined out of hours as during weekends, national holidays, and daily between 5PM and 8AM. Results. Most patients operated on were female (n=988; 63.6%) and the majority of procedures were electives (n=1341; 86.3%). Although all procedures were performed with a laparoscopic intent, 42 (2.7%) were converted to open procedure. In total, 145 (9.3%) procedures were out of hours, all nonelective, and in most cases for acute cholecystitis (n=111; 7.1%). Overall, there were 212 complications in 191 patients (12.3%), most (n=153; 9.9%) classified as minor. The conversion rate in the out-of-hours group was significantly higher (9.7% vs 2.0%; p<0.001). While univariate analyses revealed out-of-hours procedure (OR=1.83; p=0.008) to be associated with an increased risk of complications, when controlling for confounding factors by multivariate analysis, this association was not found. However, operation by surgical staff (OR=1.71) and conversion to laparotomy (OR=3.74) were found to be independently associated with an increased risk of complications (both p<0.05), while an emergency procedure tended to be associated with postoperative morbidity (OR=1.82; p=0.069). Conclusion. An out-of-hours laparoscopic cholecystectomy was not found to be an independent risk factor for developing postoperative morbidity and time of day should therefore only be a relative contraindication.

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NAD(P)H quinone oxidoreductase (NQO1): an enzyme which needs just enough mobility, in just the right places

Bioscience Reports ◽

10.1042/bsr20180459 ◽

2019 ◽

Vol 39 (1) ◽

Cited By ~ 14

Author(s):

Angel L. Pey ◽

Clare F. Megarity ◽

David J. Timson

Keyword(s):

Active Sites ◽

Physiological Role ◽

Polymorphic Form ◽

Normal Function ◽

Enzyme Mechanism ◽

Quinone Oxidoreductase ◽

Lower Stability ◽

Increased Risk ◽

Wide Range ◽

The Right

AbstractNAD(P)H quinone oxidoreductase 1 (NQO1) catalyses the two electron reduction of quinones and a wide range of other organic compounds. Its physiological role is believed to be partly the reduction of free radical load in cells and the detoxification of xenobiotics. It also has non-enzymatic functions stabilising a number of cellular regulators including p53. Functionally, NQO1 is a homodimer with two active sites formed from residues from both polypeptide chains. Catalysis proceeds via a substituted enzyme mechanism involving a tightly bound FAD cofactor. Dicoumarol and some structurally related compounds act as competitive inhibitors of NQO1. There is some evidence for negative cooperativity in quinine oxidoreductases which is most likely to be mediated at least in part by alterations to the mobility of the protein. Human NQO1 is implicated in cancer. It is often over-expressed in cancer cells and as such is considered as a possible drug target. Interestingly, a common polymorphic form of human NQO1, p.P187S, is associated with an increased risk of several forms of cancer. This variant has much lower activity than the wild-type, primarily due to its substantially reduced affinity for FAD which results from lower stability. This lower stability results from inappropriate mobility of key parts of the protein. Thus, NQO1 relies on correct mobility for normal function, but inappropriate mobility results in dysfunction and may cause disease.

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The 2020 “Padua Criteria” for Diagnosis and Phenotype Characterization of Arrhythmogenic Cardiomyopathy in Clinical Practice

Journal of Clinical Medicine ◽

10.3390/jcm11010279 ◽

2022 ◽

Vol 11 (1) ◽

pp. 279

Author(s):

Francesca Graziano ◽

Alessandro Zorzi ◽

Alberto Cipriani ◽

Manuel De Lazzari ◽

Barbara Bauce ◽

...

Keyword(s):

Clinical Practice ◽

Diagnostic Criteria ◽

Tissue Characterization ◽

Task Force ◽

Positive Family History ◽

Standard Test ◽

Arrhythmogenic Cardiomyopathy ◽

Increased Risk ◽

Criteria For Diagnosis ◽

The Right

Arrhythmogenic Cardiomyopathy (ACM) is a heredo-familial cardiac disease characterized by fibro-fatty myocardial replacement and increased risk of sudden cardiac death. The diagnosis of ACM can be challenging due to the lack of a single gold-standard test: for this reason, it is required to satisfy a combination of multiple criteria from different categories including ventricular morpho-functional abnormalities, repolarization and depolarization ECG changes, ventricular arrhythmias, tissue characterization findings and positive family history/molecular genetics. The first diagnostic criteria were published by an International Task Force (ITF) of experts in 1994 and revised in 2010 with the aim to increase sensitivity for early diagnosis. Limitations of the 2010 ITF criteria include the absence of specific criteria for left ventricle (LV) involvement and the limited role of cardiac magnetic resonance (CMR) as the use of the late gadolinium enhancement technique for tissue characterization was not considered. In 2020, new diagnostic criteria (“the Padua criteria”) were proposed. The traditional organization in six categories of major/minor criteria was maintained. The criteria for identifying the right ventricular involvement were modified and a specific set of criteria for identifying LV involvement was created. Depending on the combination of criteria for right and LV involvement, a diagnosis of classic (right dominant) ACM, biventricular ACM or left-dominant ACM is then made. The article reviews the rationale of the Padua criteria, summarizes the main modifications compared to the previous 2010 ITF criteria and provides three examples of the application of the Padua criteria in clinical practice.

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