scholarly journals Acute myocardial infarction and arterial embolism in a patient with newly diagnosed renal mass: management dilemmas! A case report

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Benedikt Martin ◽  
Andreas Greinacher ◽  
Robin Bülow ◽  
Fabian Hammer ◽  
Andreas Hoene ◽  
...  
Keyword(s):  
Blood Vessels ◽  
Renal Tumors ◽  
Team Approach ◽  
Renal Lesion ◽  
Platelet Concentrates ◽  
Arterial Embolism ◽  
Case Presentation ◽  
Coronary Syndrome ◽  
Arterial Blood ◽  
Thrombotic Complications

Abstract Background Cancer is often associated with a hypercoagulable state and new thrombosis is often the first clinical manifestation of cancer. Surgical treatment of the primary tumor is crucial since it provides the only curative approach in most cases, but management of patients is highly complex, especially in the presence of new antiplatelet drugs and/or anticoagulants. Paraneoplastic syndromes (PNS) represent a frequent complication of renal cell carcinomas (RCC) and include different hematological symptoms in patients, whilst occlusion of arterial blood vessels displays a rare form of PNS accompanying renal tumors. Case presentation We report the case of a 62-year old man who was initially hospitalized due to acute coronary syndrome. He subsequently underwent coronary angioplasty treatment including multiple stenting and treatment with ticagrelor and aspirin. Post-interventional, acute arterial thrombotic emboli of several limb arteries required thrombectomy. By computer tomography we identified a renal lesion suspicious for an RCC and suspected a PNS as underlying cause of the thrombotic complications. Triple anticoagulant therapy was maintained with therapeutic dose low molecular weight heparin (LMWH), aspirin, and clopidogrel, by which we replaced ticagrelor. Surgery was postponed for 4 weeks. We paused LMWH, aspirin and clopidogrel only at the day of surgery and perioperatively restored hemostasis by transfusion of two platelet concentrates. Laparoscopic nephrectomy was uneventful. Pathology confirmed a clear cell RCC. The patient fully recovered whilst slowly reducing anticoagulation dose. Conclusions A multidisciplinary team approach of experts in urology, cardiology and hemostasis was key in managing this patient since a personalized thrombosis consult was needed to minimize the risk of reinfarction due to in-stent thrombosis. We report a therapeutic protocol that may be helpful for the management of similar cases. Furthermore, the finding of thrombotic arterial occlusions in larger blood vessels represents a novel complication of PNS in RCC and adds to the varied possible manifestations of this clinical chameleon.

Normal Vascular and Nerve Distribution of the Pes Region in Dogs: An Anatomical and Diagnostic Imaging

2020 ◽  
Keyword(s):  
Blood Vessels ◽  
Local Anesthesia ◽  
Clinical Importance ◽  
Venous Drainage ◽  
Distal Limb ◽  
Anatomical Dissection ◽  
Lateral Plantar Nerve ◽  
Arterial Blood ◽  
Red Lead ◽  
Arcuate Artery

To investigate the normal anatomical distribution of the arterial blood supply, venous drainage and innervation on both the dorsal and plantar aspects of pes region including the level of tarsal joint due to its clinical importance with a little data available. Methods: Ten hind paws of five adult apparently healthy domestic dogs of both sexes; six paws injected, through blood vessels with colored latex neoprene for anatomical dissection and the other four paws injected a contrast mixture of red lead oxide and turpentine oil for the radiographic investigation of blood vessels. In addition to five live dogs used to apply the distal limb local anesthesia with the aid of Needle-Guided Ultrasonography. Results: This investigation revealed that the dorsal and plantar aspects of dog pes region supplied by superficial and deep sets of arteries, veins and nerves. The three dorsal metatarsal arteries originated from the arcuate artery. The medial tarsal vein forming characteristic venous arcades. The 3rd plantar metatarsal artery divided into two axial arteries while the 2nd and 4th continued axially without division. The plantar common digital and metatarsal nerves II, III, IV communicated to give origins of the axial and abaxial plantar proper digital nerves except the abaxials of the 2nd and 5th digits which supplied by a branch from medial plantar nerve and lateral plantar nerve respectively. Conclusion: There were little differences between dogs and other carnivores in vascularization of hind paw with the recommendation of using Needle-Guided Ultrasonography in the distal limb local anesthesia to avoid vascular puncture or damage.

scholarly journals Solitary fibrous tumor of the greater omentum: case report and review of literature

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Karim M. Eltawil ◽  
Carly Whalen ◽  
Bryce Knapp
Keyword(s):  
Solitary Fibrous Tumor ◽  
Management Strategy ◽  
Abdominal Mass ◽  
Lower Abdominal Pain ◽  
Greater Omentum ◽  
Team Approach ◽  
Review Of Literature ◽  
Case Presentation ◽  
Multidisciplinary Team Approach ◽  
Fibrous Tumor

Abstract Background Solitary fibrous tumor (SFT) is a rare neoplasm of mesenchymal origin occurring most often in the visceral pleura, however, it has been described in almost every anatomic location of the human body. While most SFTs have a benign behavior, they can potentially be locally aggressive and demonstrate a malignant behavior. Case presentation A 63 year-old male patient presented with lower abdominal pain and nausea and was noted on CT to have a large, heterogeneous lower abdominal mass with no evidence of metastatic disease. A surgical resection was performed and the mass appeared to be connected to the greater omentum with a vascular pedicle. It was not invading any intra-abdominal or pelvic organs. Pathology revealed an SFT of omental origin. The mitotic count was less than 4 per 10 high-power fields and all pathologic characteristics did not meet the criteria for a malignant SFT. Conclusions We report an extremely rare case of SFT originating from the greater omentum. A multidisciplinary team approach was followed to plan the patient’s management strategy.

scholarly journals Renal angiomyoadenomatous tumor (RAT): a rare distinct entity with diagnostic challenges—a case report

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ankur Majumder ◽  
Ravi Hari Phulware ◽  
Arvind Ahuja ◽  
Anurag Singla ◽  
Pawan Kumar
Keyword(s):  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Close Association ◽  
Good Prognosis ◽  
Renal Tumors ◽  
Team Approach ◽  
Renal Neoplasm ◽  
Presenting Symptoms ◽  
Long Term Follow Up

Abstract Background Renal angiomyoadenomatous tumor (RAT) is a recently described rare renal neoplasm with variations in the presentation, gross, and microscopic findings, and having a benign course and good prognosis. It is characterized microscopically by the admixture of three components—epithelial cells arranged in tubules and nests, angiomyomatous stroma, and capillary-sized interconnecting vascular channels in close association with the epithelial cell clusters. Microscopically, these tumors can be confused with clear cell carcinoma, papillary carcinoma, mixed epithelial and stromal tumors, and angiomyolipoma. RAT differs from conventional clear cell carcinomas, which can rarely be associated with an identical leiomyomatosis stroma occasionally forming abortive vascular structures. RAT is a distinct morphologic entity, being different morphologically, immunohistochemically, and genetically from all renal tumors including conventional clear cell carcinoma and mixed epithelial and stromal tumor of the kidney. Case presentation Here, we report a case of a 21-year-old man with renal angiomyoadenomatous tumor, a rare neoplasm with only a few previous cases reported in the literature. Unlike our case, most tumors have been identified in middle-aged males; they present as well-circumscribed, encapsulated tan-brown masses with variably prominent cystic areas. Conclusion Diagnosis of RAT is challenging because of the rarity of the disease and common presenting symptoms to other renal pathology and is supplemented with histopathology and immunohistochemistry. A multidisciplinary team approach for diagnosis and management along with long-term follow-up are warranted.

scholarly journals Impact of oxygen therapy to ameliorate contrast-induced nephropathy in patients with acute coronary syndrome undergoing emergency angiography; a double-blinded clinical trial

2019 ◽  
Vol 8 (4) ◽  
pp. 283-288
Author(s):  
Tahere Zarouk Ahimahalle ◽  
Abdollah Amirfarhangi ◽  
Mosadegh Jabbari ◽  
Aria Jenabi ◽  
Hadia Bagherzadegan ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Acute Coronary Syndrome ◽  
Serum Creatinine ◽  
Oxygen Therapy ◽  
Female Gender ◽  
Contrast Induced Nephropathy ◽  
Coronary Syndrome ◽  
Arterial Blood ◽  
History Of ◽  
Double Blinded

Introduction: Contrast-induced nephropathy (CIN) is one of the major causes of acute kidney injury. Objectives: Regarding an increase in mortality and morbidity in patients with CIN, this study aimed to evaluate the effect of oxygen therapy in prevention of the CIN in individuals with acute coronary syndrome undergoing emergent angiography. Patients and Methods: This study was a double-blinded clinical trial with control group (parallel design), randomized, and with a sample size of 204 individuals conducted on male or female patients over 35 years old and suspected of coronary artery disease undergoing emergent angiography refereed to Rasoul Akram hospital in 2018. Participants were divided into 2 groups (supplementary oxygen and oxygen-free groups). The first group received two to three liters of oxygen per minute from 10 minutes before the start of the procedure until the end of the procedure, and the second group inhaled the oxygen in the room air. Arterial blood gas (ABG) was taken prior to receiving oxygen and at the end of the procedure. Serum creatinine level was tested for all individuals before and 48 hours after the procedure. Results: The mean age in intervention and control groups was 61.66 ± 14.64 years and 60.49 ± 11.59 years, respectively (P=0.54). Mean glomerular filtration rate (GFR) and serum creatinine before and after angiography was not significantly different (P>0.05). There was a significant difference between the two genders regarding the development of CIN (P=0.002), which was higher in women from that of men. Female gender was a strong risk factor and approximately increased four times the risk of CIN (OR = 4.1; (P=0.001). History of chronic kidney disease (CKD) and hypertension (HTN) also produced such a situation (OR = 22.37; P=0.007). Conclusion: According to the results, oxygen therapy has no effect on the occurrence of CIN. It is also found that female gender, history of CKD and hypertension are risk factors for CIN.

scholarly journals Premature atherosclerosis and acute coronary syndrome in a child with end-stage renal disease

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Tülay Becerir ◽  
Münevver Yılmaz ◽  
İlknur Girişgen ◽  
Neslihan Yılmaz ◽  
Dolunay Gürses ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Left Coronary Artery ◽  
Premature Atherosclerosis ◽  
Case Presentation ◽  
Coronary Syndrome ◽  
Life Saving ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Although acute coronary syndrome is rare in children, it is the most important cause of mortality in children with end-stage renal disease. Case presentation Here, a 16-year-old pediatric patient, who has been on dialysis since the age of 3, and who was diagnosed with acute coronary syndrome and placed an emergency percutaneous transcatheter stent in the left anterior descending branch of the left coronary artery is presented. It is important that the present patient does not have any electrocardiography findings in favor of cardiovascular disease and that he cannot fully explain the complaint of chest pain due to his mental retardation. Conclusions Early detection of acute coronary syndrome is life-saving, especially in children with chronic kidney disease.

scholarly journals Osteogenesis imperfecta and pregnancy: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Felix Chamunyonga ◽  
Kudzaishe Lloyd Masendeke ◽  
Bismark Mateveke
Keyword(s):  
Osteogenesis Imperfecta ◽  
Multidisciplinary Team ◽  
Connective Tissue Disorder ◽  
Delivery Mode ◽  
Team Approach ◽  
Baby Girl ◽  
Case Presentation ◽  
Increased Risk ◽  
Case Basis ◽  
Live Baby

Abstract Background Osteogenesis imperfecta is a rare connective tissue disorder of varying phenotypic presentations. In pregnancies complicated by osteogenesis imperfecta, there is an increased risk to both the mother and fetus. Case presentation We present a case of a 34-year-old, wheelchair-bound, primigravid African (Zimbabwean) patient with short stature and skeletal deformities. Her care, requiring a multidisciplinary team approach, resulted in the delivery of a live baby girl with a birth weight of 2100 g, also with osteogenesis imperfecta. Conclusion Good outcomes are reported when a multidisciplinary team is involved in the care of patients with osteogenesis imperfecta. Pregnancies can be carried to term but require close antenatal surveillance. Prenatal diagnosis is possible with ultrasound and genetic testing. Delivery should be carefully planned by a multidisciplinary team. Decisions on delivery mode should be made on a case-by-case basis.

scholarly journals Cytologic Features and Cellular Migration in the Cortex and Medulla of Thymus in the Young Adult Rat

Blood ◽  
1964 ◽  
Vol 23 (3) ◽  
pp. 275-299 ◽  
Author(s):  
G. SAINTE-MARIE ◽  
C. P. LEBLOND
Keyword(s):  
Blood Vessels ◽  
Transitional Cell ◽  
Cell Types ◽  
Cellular Migration ◽  
Male Rats ◽  
Adult Rat ◽  
Arterial Blood ◽  
Old Rats ◽  
Reticular Cells ◽  
Nuclear Processes

Abstract The cells of the cortex and medulla of thymus and their mitoses were described in 10-week old (200 Gm.) male rats. The four main cell types found in cortex (reticular cells, large, medium and small lymphocytes were related to each other by transitional cell types. The presence of numerous mitoses of the four cell types indicates rapid cell production. Since the thymus of 10-week old rats is not growing and, therefore, each cell population must be in a steady state, the mitotic production of new cells of a given type must be balanced by transformation into cells of another type or by emigration out of the cortex. Evidence is presented in support of the transformation of reticular cells into large lymphocytes; and of these into lesser and lesser sized lymphocytes. As for small lymphocytes, the evidence indicates that they migrate form cortex to medulla. The medulla contains numerous small lymphocytes, some reticular cells, and rare large and medium lymphocytes. The lymphocytes of the medulla (presumed to have migrated from the cortex) often show nuclear processes which are attributed to ameboid motion. The medulla of the rat thymus contains many blood vessels, most of which are enclosed within "perivascular channels." Diapedesis of lymphocytes, chiefly small ones, is frequently seen across the walls of both the perivascular channels and the blood vessels themselves. Furthermore, higher counts of lymphocytes in venous than in arterial blood of thymus indicate that these cells directly enter the blood circulation. In conclusion, cells of the lymphocytic series are produced by mitosis in the cortex of the thymus. The evidence indicates that lymphocytes arising in this region migrate into the medulla. Thence, these cells pass into perivascular channels and into the enclosed blood vessels to reach the circulation.

scholarly journals Analysis of associated diseases in patients with acute critical lower limb ischemia

2013 ◽  
Vol 66 (1-2) ◽  
pp. 41-45 ◽  
Author(s):  
Vladimir Manojlovic ◽  
Vladan Popovic ◽  
Dragan Nikolic ◽  
Djordje Milosevic ◽  
Janko Pasternak ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Lower Limb ◽  
Balloon Catheter ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Metabolic Decompensation ◽  
Arterial Embolism ◽  
Lower Limb Ischemia ◽  
Associated Diseases ◽  
Arterial Blood

Introduction. Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. Material and Methods. This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia. We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. Results and Discussion. Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number of arterial thrombosis demanded more complex ?inflow? and ?outflow? ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. Conclusion. Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.

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