scholarly journals Adrenocortical carcinoma and pregnancy: clinical and biological features and prognosis

2010 ◽  
Vol 163 (5) ◽  
pp. 793-800 ◽  
Author(s):  
Gwenaëlle Abiven-Lepage ◽  
Joël Coste ◽  
Frédérique Tissier ◽  
Lionel Groussin ◽  
Line Billaud ◽  
...  
Keyword(s):  
Adrenocortical Carcinoma ◽  
Clinical Presentation ◽  
Severe Disease ◽  
Pregnant Patient ◽  
Fetal Outcome ◽  
Poor Overall Survival ◽  
Biological Features ◽  
Hormonal Secretion ◽  
Observation Period

ObjectiveAdrenocortical carcinoma (ACC) is a rare, severe disease. Pregnancy-associated ACC has rarely been reported. We wished to evaluate the characteristics and prognosis of ACC diagnosed in patients during pregnancy or in thepostpartumperiod, comparing them with those for ACC diagnosed in nonpregnant women.DesignClinical presentation, hormonal secretion, staging, survival, and obstetric data are reported. Patients were included between 1963 and 2007. Mean follow-up was 48 months.Patients and methodsThis is a retrospective cohort study carried out at a referral center. All female patients aged 16–49 years diagnosed with ACC during the observation period were included (n=110). Twelve of these women were pregnant or in the first 6 months after delivery. Hormonal secretion, staging, obstetric data, and survival were analyzed. For the survival analysis, pregnant patients were compared with a subgroup of nonpregnant women matched for age, stage, and year of diagnosis (1 pregnant patient/2 controls).ResultsAdrenocortical tumors diagnosed during pregnancy or in thepostpartumperiod tend to be more often cortisol-secreting tumors (P=0.06) and to be discovered at a more advanced stage than those in nonpregnant women, although the differences were not significant. Fetal outcome was poor. Overall survival of the mother was worse than that of matched controls (hazard ratio of death: 3.98, confidence interval=1.34–11.85,P=0.013).ConclusionACC diagnosed during pregnancy or in thepostpartumperiod is associated with a poor fetal outcome and a poorer prognosis than ACC diagnosed in nonpregnant women.

scholarly journals Post-acute sequelae of COVID-19 in a non-hospitalized cohort: results from the Arizona CoVHORT

2021 ◽  
Author(s):  
Melanie L Bell ◽  
Collin J Catalfamo ◽  
Leslie V. Farland ◽  
Kacey C Ernst ◽  
Elizabeth T Jacobs ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Severe Disease ◽  
Median Number ◽  
Population Based ◽  
Diverse Population ◽  
Shortness Of Breath ◽  
Persistent Symptoms ◽  
Estimate Prevalence ◽  
Hispanic White

AbstractClinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as post-acute sequelae of SAR-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of various symptoms of PASC, defined as experiencing at least one symptom 30 days or longer. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95%CI 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.

scholarly journals Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254347
Author(s):  
Melanie L. Bell ◽  
Collin J. Catalfamo ◽  
Leslie V. Farland ◽  
Kacey C. Ernst ◽  
Elizabeth T. Jacobs ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Severe Disease ◽  
Median Number ◽  
Population Based ◽  
Diverse Population ◽  
Shortness Of Breath ◽  
Persistent Symptoms ◽  
Estimate Prevalence ◽  
Hispanic White

Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30–250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1–20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.

scholarly journals SAT-178 Incidence, Patterns of Clinical Presentation, and Outcomes of Patients with Brain Metastasis Due to Adrenocortical Carcinoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Larissa Costa Amorim ◽  
João Evangelista Bezerra Neto ◽  
Amanda Meneses Ferreira Lacombe ◽  
Helaine da Silva Charchar ◽  
Vânia Balderrama Brondani ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Median Time ◽  
Surgical Resection ◽  
Adrenocortical Carcinoma ◽  
Clinical Presentation ◽  
Advanced Disease ◽  
Systemic Treatments ◽  
Number Of Patients ◽  
The Brain

Abstract Background : Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy, with a heterogeneous but, frequently, dismal prognosis; patients with metastatic ACC have a five-year survival that ranges between 0 and 28%. Metastatic ACC may be present at diagnosis or during follow-up as disease recurrences. The most common sites of metastatic lesions include the liver, lungs, lymph nodes and bones. The brain has only rarely been reported as a site of metastasis in this neoplasia and, to the authors’ knowledge, little is known regarding the incidence, patterns of clinical presentation and disease progression, and outcomes. Objective : The aim of this report was to describe the clinical characteristics of adult patients with ACC who developed brain metastasis evaluated at a tertiary oncological center (ICESP) from Brazil. Methods : Retrospective analysis of medical records including evaluation of laboratory and imaging exams and pathologic data (in cases where surgical resection of the metastasis was performed). Results : In the last ten years (2009-2019), fifty-four patients have been treated for ACC at ICESP; all of them with advanced disease (locally advanced disease and metastatic disease). The median age at the time of diagnosis of ACC was 44 (range 24-61 yrs.). No patients presented metastasis at central nervous system (CNS) at the initial diagnosis; however, during follow-up, we identified brain metastasis in six patients (11.1%). The median time between ACC diagnosis and the detection of brain metastasis was 20.8 months (range 5-53 mo.). In all of these six cases, at least three other sites of metastatic involvement were already present when the brain involvement was diagnosed and, therefore, all of them had already been treated with mitotane in association with at least one line of cytotoxic chemotherapy. The number of brain metastasis in each of these six patients varied from one to eight and median size of lesion was 1.7 cm (range 0.5-4.0 cm). Secondary headache and seizure were the main symptoms of presentation and one or two of these symptoms occurred in all but in one patient, in which diagnosis was due to screening with brain MRI. In four patients with stable disease elsewhere, surgical resection of one or two brain metastases was performed. In these cases, SF1-positive immunohistochemistry confirmed the adrenocortical origin of the lesion. The median time between CNS metastasis detection and death was 3.8 months (range 0.4-59.6 mo.), and complications due to brain metastasis were the leading cause of death. Conclusions : In our institute, brain metastasis occurred in 11.1% of advanced ACC, a prevalence that is higher than previously reported in literature. Despite the relative small number of patients included in this study, we highlight the possibility of brain metastasis in patients with ACC, particularly in cases with a prolonged disease course and multiple systemic treatments.

scholarly journals Spontaneous Splenic Vein Rupture with Massive Hemoperitoneum during the Third Trimester of Pregnancy

2020 ◽  
Vol 4 (1) ◽  
pp. 1-5
Author(s):  
Marchi L ◽  
Cavaliere AF ◽  
Garraffo C ◽  
Vicini I ◽  
Giorgi L ◽  
...  
Keyword(s):  
Hypovolemic Shock ◽  
Splenic Vein ◽  
Fetal Distress ◽  
Pregnant Patient ◽  
Fetal Outcome ◽  
Maternal Survival ◽  
Causative Factors ◽  
Time In Literature ◽  
Risk Patients

We describe a case of spontaneous rupture of the splenic vein in a pregnant patient at 33 weeks gestation. For the first time in literature, we report follow-up investigations aimed at understanding the cause of the event. The woman was admitted to the emergency ward for hypovolemic shock. Maternal and fetal distress prompted an immediate cesarean section. The fetus was delivered stillborn, hemoperitoneum was present and two spontaneous splenic vein’s lacerations were found to be the source of the bleeding. The immediate splenectomy and aggressive correction of anemia and coagulopathy determined maternal survival. During the follow-up, no evidence of neither congenital nor acquired causative factors for a splenic vein rupture was found. The aim of reporting this case is to increase the awareness between clinicians of this condition since it is both rare and with an aspecific clinical picture. It presents itself in apparently low-risk patients and a good maternal-fetal outcome can only be achieved by early diagnosis and prompt treatment.

HRA Model for Hypercholesterolemia Based on a Longitudinal Health Database

1998 ◽  
Vol 37 (02) ◽  
pp. 130-133
Author(s):  
T. Kishimoto ◽  
Y. Iida ◽  
K. Yoshida ◽  
M. Miyakawa ◽  
H. Sugimori ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Model Analysis ◽  
Serum Total Cholesterol ◽  
Hazards Model ◽  
The Mean ◽  
Health Database ◽  
Observation Period

AbstractTo evaluate the risk factors for hypercholesterolemia, we examined 4,371 subjects (3,207 males and 1,164 females) who received medical checkups more than twice at an AMHTS in Tokyo during the period from 1976 through 1991; and whose serum total cholesterol was under 250 mg/dl. The mean follow-up duration was 6.6 years. A self-registering questionnaire was administered at the time of the health checkup. The endpoint of this study was the onset of hypercholesterolemia when the level of serum total cholesterol was 250 mg/dl and over. We compared two prognosis groups (normal and hypercholesterol) in terms of age, examination findings and lifestyle. After assessing each variable, we employed Cox's proportional hazards model analysis to determine the factors related to the occurrence of hypercholesterolemia. According to proportional hazards model analysis, total cholesterol, triglyceride and smoking at the beginning, and hypertension during the observation period were selected in males; and total cholesterol at the beginning and age were selected in females to determine the factors related to the occurrence of hypercholesterolemia.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Arterite de Takayasu em Gestante: Relato de Caso / Takayasu Arteritis in Pregnancy: Case Report

1970 ◽  
Vol 5 (4) ◽  
pp. 61-66
Author(s):  
Patrícia Resende Penido ◽  
Rhanna Junqueira Westin de Carvalho ◽  
Roger Willian Moraes Mendes
Keyword(s):  
Case Report ◽  
Takayasu Arteritis ◽  
Imaging Techniques ◽  
Unknown Origin ◽  
Pregnant Patient ◽  
Immunosuppressive Drugs ◽  
Clinical Treatment ◽  
Satisfactory Outcome

RESUMOIntrodução: A Arterite de Takayasu (AT) consiste em uma vasculopatia de origem indefinida, sendo de caráter crônico, que afeta a aorta e seus ramos principais. Em gestantes é uma condição complexa, em que o tratamento clínico é realizado com restrições. A utilização de corticoides tem sido favorável no controle inflamatório, principalmente naqueles casos em que antes da gravidez se fazia uso de imunossupressores. Casuística: Foi relatado um caso de uma gestante portadora de AT, através da análise de prontuário e de exames complementares, sendo realizado o pré-natal pelas equipes de Obstetrícia e Reumatologia, onde foi realizado tratamento clínico com corticoides, mostrando uma evolução satisfatória, ocorrendo apenas uma hospitalização que foi seguida de uma cesárea na trigésima sexta semana de gravidez, com recém nato saudável de 3.810g. Discussão: A AT pode estar associada a várias etiologias, sendo a gênese pouco conhecida. O diagnóstico na maioria das vezes é demorado, pela dificuldade da suspeita clínica, além de demandar o uso de técnicas de imagem mais sofisticadas. A gestação associada é fenômeno raro, já que as portadoras são orientadas a evitarem a gravidez. O controle clínico permitiu uma gestação sem grandes complicações e serviu como meio para levar a gestação até praticamente o fim do terceiro trimestre. Conclusão: Deve-se ressaltar o papel do acompanhamento clínico, especialmente com esta pan-arterite, mostrando os medicamentos que podem ser utilizados nesse grupo, especialmente quando se usava imunossupressores antes da gravidez. Palavras chave: Arterite de Takayasu, Gravidez, Vasculite. ABSTRACT:Introduction: Takayasu's arteritis (TA) consists of a vascular disease of unknown origin and chronic nature, which affects the aorta and its main branches. In pregnant women it is a complex condition, in which the clinical treatment is performed with restrictions. The use of corticosteroids has been favorable to control inflammation, especially in those cases when immunosuppressant had been used before pregnancy. Case Report: A case of a pregnant patient with TA has been reported through the analysis of medical records and laboratory tests. The Obstetrics and Rheumatology staff performed the prenatal care, and clinical treatment with corticosteroids was done showing a satisfactory outcome. There was only one hospitalization of the patient, which was followed by a cesarean in the thirty sixth week of pregnancy.  The newborn was a healthy one, weighing 3.810g. Discussion: TA may be associated with several etiologies, and the genesis is little known. The diagnosis most often takes time due to the difficulty of clinical suspicion, and requires the use of more sophisticated imaging techniques. The pregnancy is rare phenomenon, since the carriers are advised to avoid pregnancy. The clinical management allowed a pregnancy without major complications and served as a means to carry the pregnancy to almost the end of the third quarter. Conclusion: The role of the clinical follow-up should be noticed especially with this pan-arteritis, showing the drugs that can be used in this group, especially when there is use of immunosuppressive drugs before pregnancy. Keywords: Takayasu Arteritis, Pregnancy, Vasculitis.

Necrosis avascular

2020 ◽  
Vol 63 (2) ◽  
pp. 18-23
Author(s):  
Alejandro Jardón Gómez ◽  
Ana Cristina King ◽  
Carlos Pacheco Díaz
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Femoral Fracture ◽  
Open Fracture ◽  
Clinical Presentation ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Young Population ◽  
Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

scholarly journals When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula

2019 ◽  
Vol 30 (1) ◽  
pp. 146-148
Author(s):  
Lara Girelli ◽  
Elena Prisciandaro ◽  
Niccolò Filippi ◽  
Lorenzo Spaggiari
Keyword(s):  
Clinical Presentation ◽  
Clinical Status ◽  
High Morbidity ◽  
Conservative Approach ◽  
Chronic Fistula ◽  
Less Is More ◽  
Primary Surgery ◽  
History Of ◽  
Uncommon Complication

Abstract Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.

scholarly journals High risk groups for severe COVID-19 in a whole of population cohort in Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bette Liu ◽  
Paula Spokes ◽  
Wenqiang He ◽  
John Kaldor
Keyword(s):  
Socioeconomic Status ◽  
New South ◽  
Severe Disease ◽  
Risk Groups ◽  
Prevention Strategies ◽  
Complete Case ◽  
Relative Risks ◽  
South Wales ◽  
Hazard Ratios

Abstract Background Increasing age is the strongest known risk factor for severe COVID-19 disease but information on other factors is more limited. Methods All cases of COVID-19 diagnosed from January–October 2020 in New South Wales Australia were followed for COVID-19-related hospitalisations, intensive care unit (ICU) admissions and deaths through record linkage. Adjusted hazard ratios (aHR) for severe COVID-19 disease, measured by hospitalisation or death, or very severe COVID-19, measured by ICU admission or death according to age, sex, socioeconomic status and co-morbidities were estimated. Results Of 4054 confirmed cases, 468 (11.5%) were classified as having severe COVID-19 and 190 (4.7%) as having very severe disease. After adjusting for sex, socioeconomic status and comorbidities, increasing age led to the greatest risk of very severe disease. Compared to those 30–39 years, the aHR for ICU or death from COVID-19 was 4.45 in those 70–79 years; 8.43 in those 80–89 years; 16.19 in those 90+ years. After age, relative risks for very severe disease associated with other factors were more moderate: males vs females aHR 1.40 (95%CI 1.04–1.88); immunosuppressive conditions vs none aHR 2.20 (1.35–3.57); diabetes vs none aHR 1.88 (1.33–2.67); chronic lung disease vs none aHR 1.68 (1.18–2.38); obesity vs not obese aHR 1.52 (1.05–2.21). More comorbidities was associated with significantly greater risk; comparing those with 3+ comorbidities to those with none, aHR 5.34 (3.15–9.04). Conclusions In a setting with high COVID-19 case ascertainment and almost complete case follow-up, we found the risk of very severe disease varies by age, sex and presence of comorbidities. This variation should be considered in targeting prevention strategies.

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