scholarly journals Chemotherapy for Breast Cancer During Pregnancy: An 18-Year Experience From Five London Teaching Hospitals

2005 ◽  
Vol 23 (18) ◽  
pp. 4192-4197 ◽  
Author(s):  
Alistair E. Ring ◽  
Ian E. Smith ◽  
Alison Jones ◽  
Catherine Shannon ◽  
Eleni Galani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Palliative Chemotherapy ◽  
Case Series ◽  
First Trimester ◽  
Fetal Outcome ◽  
Teaching Hospitals ◽  
Published Data ◽  
Retrospective Case ◽  
Rare Association

Purpose The rare association between breast cancer and pregnancy means that few oncologists gain an expertise in this area. In particular, there are few published data concerning the use of chemotherapy for breast cancer during pregnancy. In this retrospective case series, we describe the experiences of five hospitals in London, United Kingdom, and how they manage this condition. Patients and Methods Retrospective searches were performed at five London hospitals in order to identify women who received chemotherapy for breast cancer while pregnant. Results Twenty-eight women were identified who had received chemotherapy for breast cancer during pregnancy. Twenty-four women received adjuvant or neoadjuvant chemotherapy for early breast cancer, and four women received palliative chemotherapy for metastatic disease. A total of 116 cycles of chemotherapy were administered during pregnancy. Sixteen women were treated with anthracycline-based chemotherapy and 12 received cyclophosphamide, methotrexate, and fluorouracil. All but one of the women were treated after the first trimester. One spontaneous abortion occurred in the woman treated during her first trimester; otherwise, there were no serious adverse consequences for the mothers or neonates. Conclusion These data provide evidence that in terms of peripartum complications and immediate fetal outcome, chemotherapy can be safely administered to women during the second and third trimesters of pregnancy.

scholarly journals Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

2021 ◽  
Author(s):  
Robert P Lennon ◽  
Theodore J Demetriou ◽  
M Fahad Khalid ◽  
Lauren Jodi Van Scoy ◽  
Erin L Miller ◽  
...  
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Military Medicine ◽  
Case Series ◽  
Outcome Data ◽  
Urban Environments ◽  
Urban Setting ◽  
Published Data ◽  
Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P < .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (>60U/L; 39.0% versus 5.9%, P < .001) and aspartate (>40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation <90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P < .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

scholarly journals Clozapine prescribing in COVID-19 positive medical inpatients: a case series

2020 ◽  
Vol 10 ◽  
pp. 204512532095956
Author(s):  
Matthew Butler ◽  
Felicity Bano ◽  
Marilia Calcia ◽  
Isabel McMullen ◽  
Chun Chiang Sin Fai Lam ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Case Series ◽  
Systemic Infection ◽  
Published Data ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Medical Inpatients ◽  
Medical Wards ◽  
Hospital Wards

There is both uncertainty regarding the safety of clozapine in COVID-19 patients owing to limited published data and a lack of consensus on continuing clozapine in patients with severe respiratory infections. COVID-19 is known to induce an acute immune response which can affect haematological parameters associated with clozapine monitoring, and systemic infection may reduce clozapine clearance. Clozapine, which has been associated with worse outcomes in some pneumonias, may in theory worsen outcomes in COVID-19. Despite these concerns, there are some data to indicate it is safe to continue clozapine in COVID-19 infection. In this retrospective case series, we describe our experiences of clozapine prescribing and disease progression of eight SARS-CoV-2 positive patients on medical wards in a major London teaching hospital. In four cases clozapine was stopped during the hospital admission. A COVID-19 pneumonia developed in four patients: three of these required intensive care unit admission for an average of 34 days. At the time of writing, three patients had died (two directly from COVID-19 pneumonia), two remained in general hospital wards, two were recovering in the community and one had been transferred to an inpatient psychiatric hospital. Follow-up length varied but in each case was not more than 104 days. Delirium was the most common adverse neuropsychiatric event, and in one case a relapse of psychosis occurred after cessation of clozapine. This retrospective case series illustrates the safe use of clozapine during COVID-19 infection. Our experiences suggest that consideration should be made to continuing clozapine even in those most unwell with COVID-19. We also identify areas which require larger scale hypothesis-testing research.

scholarly journals The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis

2018 ◽  
Vol 45 (12) ◽  
pp. 1651-1655 ◽  
Author(s):  
Mark Berman ◽  
Devy Zisman ◽  
Jonathan Wollman ◽  
David Levartovsky ◽  
Eli Rimon ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Postpartum Period ◽  
Case Series ◽  
First Trimester ◽  
Reproductive Age ◽  
Retrospective Case ◽  
Medical Centers ◽  
Stopping Treatment ◽  
Significant Change

Objective.To evaluate the effect of pregnancy on disease activity in psoriatic arthritis (PsA).Methods.This is a retrospective case series. Review of the medical files of all female patients followed at the PsA clinic of 2 medical centers identified those with at least 1 pregnancy during followup and 1 visit during or soon after pregnancy.Results.Twenty-five women with PsA (out of 107 women of reproductive age followed up in our PsA clinics) and 35 pregnancies were enrolled. Thirty-three pregnancies resulted in live healthy babies. In the whole group, there was no significant change in disease activity throughout pregnancy, while in 16 (48%) of pregnancies, patients worsened during the first postpartum year. In 15 out of 21 pregnancies, in which the women had been treated before conception with biologics, treatment was discontinued close to pregnancy or during the first trimester. Five of those 15 patients had been classified as having mild to severe PsA activity prior to pregnancy. That number increased to 8, 9, and 14 during the first and second trimesters and postpartum period, respectively. There was no significant change in degree of disease activity in 6 patients whose biologics were continued beyond the first trimester. Improvement in disease activity was observed during pregnancy among the nonbiologics-treated patients. Corticosteroids were initiated or the dosage was increased during 6 pregnancies, all involving patients whose biologics were stopped before pregnancy.Conclusion.Continuation of biologics therapy was associated with a low level of disease activity and a low probability of flare during pregnancy. Stopping treatment with biologics before pregnancy is associated with flare during pregnancy and the postpartum period.

scholarly journals The Use of a Kinetic Therapy Rotational Bed in Pediatric Acute Respiratory Distress Syndrome: A Case Series

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 303
Author(s):  
Daniel T. Cater ◽  
Aimee R. Ealy ◽  
Erin Kramer ◽  
Samer Abu-Sultaneh ◽  
Courtney M. Rowan
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Case Series ◽  
Published Data ◽  
Arterial Line ◽  
Prone Positioning ◽  
Retrospective Case ◽  
Oxygenation Indices

Patients with acute respiratory distress syndrome (ARDS) commonly have dependent atelectasis and heterogeneous lung disease. Due to the heterogenous lung volumes seen, the application of positive end expiratory pressure (PEEP) can have both beneficial and deleterious effects. Alternating supine and prone positioning may be beneficial in ARDS by providing more homogenous distribution of PEEP and decreasing intrapulmonary shunt. In pediatrics, the pediatric acute lung injury and consensus conference (PALICC) recommended to consider it in severe pediatric ARDS (PARDS). Manually prone positioning patients can be burdensome in larger patients. In adults, the use of rotational beds has eased care of these patients. There is little published data about rotational bed therapy in children. Therefore, we sought to describe the use of a rotational bed in children with PARDS. We performed a retrospective case series of children who utilized a rotational bed as an adjunctive therapy for their PARDS. Patient data were collected and analyzed. Descriptive statistical analyses were performed and reported. Oxygenation indices (OI) pre- and post-prone positioning were analyzed. Twelve patients with PARDS were treated with a rotational bed with minimal adverse events. There were no complications noted. Three patients had malfunctioning of their arterial line while on the rotational bed. Oxygenation indices improved over time in 11 of the 12 patients included in the study while on the rotational bed. Rotational beds can be safely utilized in pediatric patients. In larger children with PARDS, where it may be more difficult to perform a manual prone position, use of a rotational bed can be considered a safe alternative.

scholarly journals Skin Metastasis in Breast Cancer Patients; a Case Series

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Sara Rehman ◽  
Muhammad Atif Naveed
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Breast Conservation ◽  
Case Series ◽  
Recurrent Breast Cancer ◽  
Skin Lesions ◽  
Skin Metastasis ◽  
Research Centre ◽  
Breast Cancer Patients ◽  
Retrospective Case

Introduction: Breast cancer is the most common malignancy in women. It frequently metastasizes to bones, lungs and liver. Although rare, skin metastasis may also take place. It may also be the presenting feature of initial or recurrent breast cancer. The assessment of recurrent metastatic disease involving skin after mastectomy can be challenging because of the benign-appearing clinical presentation. The purpose of this caseseries was to explore the clinical and radiological presentation of skin metastasis in patients of breast cancer. Materials and Methods: This is a retrospective case series of breast cancer patients with skin lesions on chest and abdomen at the time of initial presentation, or post-treatment such as, after mastectomy or breast conservation therapy; who underwent various radiological investigations including mammography, ultrasoundscan, computed tomography (CT) scan and magnetic resonance imaging from 1 May 2018 to 30 September 2019 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan. Results: A total of eightcases were identified, out of which seven were females. The most common presentation consisted of the presence of metastatic nodules which were seen in 62.5% (five out of eight) of the patients. Other features consisted of erythematous or plaque-like skin thickening on clinical examination, increased density with indistinct margins seen on a mammogram and diffuse oedematous changes in the skin with small irregular mass or infiltration into subcutaneous tissues were visualised on ultrasound and CT studies. Conclusion: Skin metastasis from breast cancer most commonly presents as nodules, although rarely they may present as plaques or diffuse skin thickening. Awareness of diverse manifestations of skin metastasis is of utmost importance in early diagnosis and management.

Prognostic and predictive role of tumor-infiltrating lymphocytes in luminal b subtype breast cancer treated with neoadjuvant chemotherapy: A retrospective mono-institutional case series.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e12053-e12053
Author(s):  
Matteo Duca ◽  
Biagio Paolini ◽  
Ester Antelmi ◽  
Maria Luisa Carcangiu ◽  
Luigi Mariani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Case Series ◽  
Tumor Infiltrating Lymphocytes ◽  
Luminal B ◽  
Predictive Role ◽  
Infiltrating Lymphocytes

scholarly journals Outcomes from a Multi-disciplinary Uveitis Referral Clinic in Tasmania, Australia and adaptation during the COVID-19 pandemic

2021 ◽  
Author(s):  
Verlyn Yang
Keyword(s):  
Case Series ◽  
Developed Countries ◽  
Posterior Uveitis ◽  
Indigenous Populations ◽  
Published Data ◽  
Inflammatory Disorder ◽  
Intermediate Uveitis ◽  
Retrospective Case ◽  
Common Causes

Abstract Background: Uveitis is one of the most common causes of visual impairment, accounting for up to 25% of visual loss in the developing world and 10% in developed countries. There are marked regional differences within Australia, particularly in rural and Indigenous populations. There is no published data on uveitis in Tasmania. Methods: A 5-year retrospective case series review of medical records of all patients reviewed to the clinic was performed. Results: A total of 95 patients were referred to the clinic. Seventy-six (76) patients (123 eyes) had uveitis and were analysed in detail (see table 1). Nineteen (19) patients had a diagnosis other than uveitis or were on immunosuppressive therapy for another ocular inflammatory disorder (detailed in Table 2). The most common anatomical diagnosis was posterior uveitis (29%), followed by pan-uveitis (20%) and intermediate uveitis (17%). Average follow-up was 36.7 months. Conclusion: The most common anatomical diagnosis was posterior uveitis (29%), followed by pan-uveitis (20%) and intermediate uveitis (17%). Telemedicine is a modality that could have application in management of Uveitis in regional areas.

scholarly journals PREVALENCE OF CARDIAC DISEASES

2015 ◽  
Vol 22 (11) ◽  
pp. 1443-1448
Author(s):  
Lubna Latif ◽  
Usman Javed Iqbal
Keyword(s):  
Atrial Septal Defect ◽  
Cleft Lip ◽  
Septal Defect ◽  
Case Series ◽  
First Trimester ◽  
Fetal Outcome ◽  
Cardiac Diseases ◽  
Pregnant Females ◽  
Cardiology Department ◽  
Time Of Presentation

Objectives: The objective of this study was to find the prevalence of cardiacdisease among pregnant females and its impact on feto-maternal outcome. Study Design:Descriptive case series. Setting: Cardiology department Gulab Devi Chest Hospital LahoreDuration: April 2013 to April 2014. Patients & Methods: All pregnant females with cardiacdisease at any gestation with booked or un-booked statutes were included in this study. Patientswere admitted for thorough evaluation and investigations. Labor was monitored intensively. Dataregarding maternal outcomes were noted down on pre-formed questionnaire. Intra partum andpostpartum details were also noted down along with fetal outcome. The results were analyzedusing SPSS version 16.0.. Results: The total number of females presented with cardiac diseasewas 2650, out of which only 35 women were reported as pregnant. The duration of pregnancyat the time of presentation was as follows: 05 (14.2%) females presented in first trimester, 20(57.1%) in second trimester, 08 (22.8%) in third trimester and 02 (5.7%) patients presented inpostpartum period. There were 08 (22.8%) patients who had preterm labor. In terms of fetaloutcome 04 babies had birth weight of less than 1.5 kg, 12 had 1.5-2.0 kg, 15 were in rangeof 2-2.5 kg and 04 were more than 2.5 kg. 27 (77.1%) were term and 08 (22.8%) were pretermbabies. Cleft lip and atrial septal defect were the only two identified congenital anomalies.Conclusion: The overall prevalence of cardiac diseases during pregnancy was found to be1.3% in this study. Most common affected age group was of 20-25 years. Most common cardiacdisease found in our patient was mitral stenosis. 02 pregnancies ended in intrauterine fetaldeath. 08 babies were born preterm. Cleft lip and atrial septal defect were the only two identifiedcongenital anomalies in newborn delivered by our pregnant patients. Every effort should madeto create awareness regarding pre-pregnancy counseling, so that associated fetal and maternalmorbidity can be reduced.

scholarly journals Complete molar pregnancies with a coexisting fetus: Pregnancy outcomes and review of literature

2021 ◽  
Author(s):  
Roxanna A Irani ◽  
Kerry Holliman ◽  
Michelle Debbink ◽  
Lori Day ◽  
Krista Maree Mehlhaff ◽  
...  
Keyword(s):  
Data Transfer ◽  
Case Series ◽  
First Trimester ◽  
The United States ◽  
Obstetric Outcomes ◽  
Neoplastic Disease ◽  
Surveillance Period ◽  
Retrospective Case ◽  
Medicine Physician ◽  
Fetal Complications

To review obstetric outcomes of complete hydatidiform molar pregnancies with a coexisting fetus (CHMCF), a rare clinical entity, we performed a retrospective case series of pathology-confirmed HMCF. The cases were collected via a private Maternal-Fetal Medicine physician group on social media. Each contributing institution from across the United States obtained informed consent and institutional data transfer agreements as required, then transmitted the data using a HIPAA-compliant modality. Data collected included maternal, fetal/genetic, placental and delivery characteristics. Nine institutions contributed 14 cases. We found that the median gestational age at diagnosis was 12 weeks 2 days (9w0d - 19w4d), and over half were diagnosed in the first trimester. Sixty-four percent of CHMCF cases were a product of assisted reproductive technology. Placental mass size universally enlarged over the surveillance period. When invasive testing was performed, insufficient sample or no growth was noted in 40% of the sampled cases. Antenatal complications occurred in all delivered patients. Four patients developed gestational trophoblastic neoplasia. This is the largest reported series of obstetric outcomes for CHMCF, and highlights the need to counsel patients about the severe maternal and fetal complications in continuing pregnancies, including progression to gestational trophoblastic neoplastic disease.

scholarly journals Sarcoidosis and breast cancer: A retrospective case series

2020 ◽  
Vol 31 ◽  
pp. 101190
Author(s):  
Ilias C. Papanikolaou ◽  
Hidenobu Shigemitsu
Keyword(s):  
Breast Cancer ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series
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