scholarly journals A case of undifferentiated pleomorphic cardiac sarcoma

2021 ◽  
Vol 0 (Ahead of Print) ◽  
Author(s):  
Sergey Yakovlev ◽  
Anna Kalinskaya
Keyword(s):  
Abdominal Mass ◽  
Treatment Options ◽  
Interatrial Septum ◽  
Clinical Situation ◽  
Late Presentation ◽  
Pleomorphic Sarcoma ◽  
Progressive Dyspnea ◽  
Multiple Metastases ◽  
Primary Cardiac Sarcoma ◽  
Cardiac Masses

Primary cardiac sarcoma is known to have a poor prognosis due to late presentation, multiple metastases, and complications, challenging treatment options. We present a case of a 78-year-old female patient who was admitted to our hospital with progressive dyspnea and chest pain. Echocardiography revealed multiple masses of different shape and size in the left atrium, the left and right ventricles. Cardiac magnetic resonance confirmed multiple cardiac masses with signs of invasion in the myocardium and heterogeneous late gadolinium enhancement in all these masses. A biopsy of the abdominal mass revealed an undifferentiated pleomorphic sarcoma. We planned chemotherapy and supportive measures. Before the initiation of the chemotherapy, the clinical situation worsened dramatically. Despite the pericardiocentesis, the patient died due to cardiac tamponade. An autopsy revealed a massive tumor in the interatrial septum and multiple metastases in both ventricles, lungs, and abdomen.

scholarly journals Primary Cardiac Sarcoma: A Rare, Aggressive Malignancy with a High Propensity for Brain Metastases

Sarcoma ◽  
2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Brittany L. Siontis ◽  
Lili Zhao ◽  
Monika Leja ◽  
Jonathan B. McHugh ◽  
Maryann M. Shango ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Poor Prognosis ◽  
Late Presentation ◽  
University Of Michigan ◽  
Pleomorphic Sarcoma ◽  
High Propensity ◽  
Increased Risk ◽  
Primary Cardiac Sarcoma ◽  
The University ◽  
Systemic Therapies

Introduction. Primary cardiac sarcoma (PCS) has a poor prognosis compared to other sarcomas due to late presentation, challenging resection, incidence of metastases, and limited efficacy of systemic therapies. Methods. A medical record search engine was queried to identify patients diagnosed with PCS from 1992 to 2017 at the University of Michigan. Results. Thirty-nine patients with PCS had a median age of 41 years (range 2–77). Common histologies were angiosarcoma (AS, 14), high-grade undifferentiated pleomorphic sarcoma (UPS, 10), and leiomyosarcoma (LMS, 5). Sites of origin were left atrium (18), right atrium (16), and pericardium (5). AS was the most common right-sided tumor; UPS was more common on the left. Eighteen patients presented with metastases involving lung (10), bone (7), liver (5), and brain (4). Twenty-five patients underwent resection, achieving 3 R0 resections. Patients received a median of 2 (1–6) systemic therapies. Median overall survival (OS) was 12.1 months (range 0–79). Median OS was 14.0 months and 8.2 months in patients who did or did not undergo resection, respectively (p=0.018). Brain metastases occurred in 12 (31%) patients, 9 (75%) of whom had left heart tumors, at a median of 8.5 months (range 0–75) from diagnosis. Median OS was 5.6 months (range 0–30) after the diagnosis of brain metastases. Conclusions. PCS portends a poor prognosis, because of difficulty in obtaining complete resection of sarcoma, advanced stage at diagnosis, and high risk of brain metastases. Providers should be aware of the increased risk of brain metastases and consider brain imaging at diagnosis and follow-up.

scholarly journals Current treatment of patients with multiple brain metastases

2000 ◽  
Vol 9 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Steven D. Chang ◽  
John R. Adler
Keyword(s):  
Brain Metastases ◽  
Treatment Options ◽  
Whole Brain Radiotherapy ◽  
Mass Effect ◽  
Current Treatment ◽  
Rapid Reduction ◽  
Multiple Brain Metastases ◽  
Brain Radiotherapy ◽  
Multiple Metastases ◽  
Difficult Challenge

The management of patients with multiple brain metastases remains a difficult challenge for neurosurgeons. This patient population has a poor prognosis when compared with those harboring a solitary brain metastasis, and historically treatment has generally consisted of administering whole-brain radiotherapy once the diagnosis of multiple brain metastases is made. Resection can be useful in a subset of patients with multiple metastases in whom one or two of the lesions are symptomatic, as this may provide rapid reduction of mass effect and edema. Furthermore, the authors of recent studies have shown that stereotactic radiosurgery can be used in certain patients with multiple brain metastases as part of the treatment regimen. In this review the authors outline the treatment options and indications as well as a management strategy for the treatment of patients with multiple brain metastases.

scholarly journals Could we use cardiac MRIfor diagnosis of infective endocarditis

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
AE Elagha ◽  
YB Beniamin ◽  
WE El-Aroussy ◽  
MM Meshaal
Keyword(s):  
Infective Endocarditis ◽  
Tissue Characterization ◽  
Clinical Situation ◽  
Cardiac Complications ◽  
Wide Field ◽  
Imaging Tool ◽  
Low Sensitivity ◽  
Kappa Agreement ◽  
Cardiac Masses

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Echocardiography is a reliable imaging tool in diagnosing infective endocarditis (IE) according to "modified Dukes criteria"; however, it lacks tissue characterization of cardiac masses, and transthoracic echocardiography (TTE) has low sensitivity in detection of vegetations. Moreover, transesophageal echo (TEE) is considered semi-invasive and intolerable in some situations .On the other hand, cardiac magnetic resonance (CMR) is a powerful true 3D imaging tool with wide field of view, and superior capability of tissue characterization of cardiac masses; however, modest information is available about utility of CMR in diagnosing IE. Purpose To assess the feasibility of CMR to identify vegetations and complications of IE, and compare obtained findings with those obtained from echocardiography regarding: presence, number, size of vegetations, and detection of cardiac complications (e.g. aortic root abscess, periannular abscess, and shunts). Materials and Methods Eighty consecutive patients with suspected IE were enrolled in the study. All patients underwent TTE; only those with left-sided lesions underwent TEE.  When clinical situation allowed, CMR examination using 1.5 Tesla magnet were performed using the following sequences: Steady-state free precession (SSFP), T1W (± fat suppression) and T2W, first-pass perfusion, and delayed hyperenhancement. Moreover, chest and abdominal survey was done. Results Sixty-one patients (45 males and 16 females) were able to undergo and complete CMR study. Affection of tricuspid valve was seen in 39.3%, mitral 31.1%, aortic 24.6%, and pulmonary 4.9% of cases. All vegetations visualized by echocardiography were also clearly detected and confirmed by CMR. The sensitivity, specificity, accuracy and Kappa agreement of CMR with echocardiography in depicting >0.5cm vegetations were all 100%. By tissue characterization, vegetations resemble features of thrombi (with variation in signal intensity according to age of vegetation). However, in some cases, masses have a unique pattern that is different from vegetations of IE, and subsequently other diagnoses were suggested (e.g. fibroelastoma, Libman-Saks endocarditis). In 22 patients, CMR provided more information than echocardiography, and in 6 patients, CMR made a paradigm shift of diagnosis. Conclusion Cardiac MRI is a powerful imaging tool in diagnosis of IE and its complications. In comparison with echocardiography, CMR can identify the presence, numbers, and size of vegetations accurately. Moreover, with its unique ability of tissue characterization, CMR helps distinguish vegetations from other masses; therefore changes the diagnosis of IE and subsequent management in some patients.

Tooth autotransplantation part 4: Alternative treatment options

2020 ◽  
Vol 13 (2) ◽  
pp. 78-86
Author(s):  
Sophy Barber ◽  
Ahmed Al-Khayatt ◽  
Nadine Houghton
Keyword(s):  
Alternative Treatment ◽  
Clinical Relevance ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Clinical Situation ◽  
Treatment Choice ◽  
Tooth Replacement ◽  
Missing Teeth ◽  
Tooth Transplantation ◽  
Successful Technique

Tooth autotransplantation is a versatile and successful technique if used in suitable cases; however, it is not always the optimal treatment choice. This article will explore alternative treatment strategies for managing failing or missing teeth, including methods for managing the bone, orthodontic options and techniques for tooth replacement. These methods may be considered as an adjunct to tooth transplantation, or an alternative, if transplantation is not deemed appropriate. Indications for alternative treatments are discussed with illustrations from treated cases. CPD/Clinical Relevance: A number of approaches are available for managing failing or missing teeth and are dependent on the clinical situation. It is important for dental specialists to understand these options and to work collaboratively to determine the best option for patients on an individual basis.

scholarly journals Epidemiological Properties of Primary Open Angle Glaucoma in Nigeria

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Lawan Abdu
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
High Reliability ◽  
Treatment Options ◽  
Late Presentation ◽  
Open Angle ◽  
Long Term Effects ◽  
Eye Care

Background. Primary open angle glaucoma (POAG) is progressive chronic optic neuropathy in adults in which intraocular pressure (IOP) and other currently unknown factors contribute to damage. POAG is the second commonest cause of avoidable blindness in Nigeria.Pattern of Presentation. POAG is characterized by late presentation. Absence of pain which is a driving force for seeking medical help, inadequacy of trained eye care personnel, paucity of facilities, misdistribution of resources, lack of awareness, poor education, and poverty may all contribute to this. Medical and surgical treatment options available are challenging and tasking.Screening for Glaucoma. Screening is the presumptive identification of unrecognized disease (POAG) by applying test(s) which can be applied rapidly. Such test(s) should be of high reliability, validity, yield, acceptable, and cost effective. The test should ideally be sensitive, specific, and efficient. It is difficult to select a suitable test that meets these criteria. Intraocular pressure (IOP) appears to be the easiest option. But, high IOP is not diagnostic nor does normal value exclude the disease. Health education is a possible strategy in early case detection and management.Treatment of POAG. Glaucoma treatment can either be medical or surgical (this includes laser). Considering unavailability, potency, cost, and long-term effects of medication, surgery (trabeculectomy) could be a better option. Laser trabeculoplasty is available in a few centers. Viscocanalostomy is not routinely performed. Patient education is vital to success as management is for life.Conclusion. POAG remains a cause of avoidable blindness in Nigeria. There is need for long-term strategy to identify patients early and institute prompt management. Improvement in training of eye care personnel and provision of up to date equipment is essential in achieving this goal.

scholarly journals Total Plasma Exchange in Hypertriglyceridemia-Induced Pancreatitis: Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Harleen Dehal ◽  
Michael Adashek
Keyword(s):  
Plasma Exchange ◽  
Treatment Options ◽  
Clinical Status ◽  
Clinical Situation ◽  
Dramatic Improvement ◽  
Total Plasma ◽  
Rapid Fall ◽  
The Many ◽  
Total Plasma Exchange

Objective. To emphasize the role of apheresis in management of pancreatitis. Methods. The clinical course of a patient admitted for hypertriglyceridemia-induced pancreatitis (HTGP) complicated by multiorgan dysfunction is described, who demonstrated dramatic improvement in his clinical status after total plasma exchange (TPE). In addition, the current guidelines for TPE and the alternative treatment options for HTGP are also presented. Results. A patient presenting with pancreatitis associated with severe systemic inflammatory response was admitted to our hospital with an initial triglyceride level of 1181 mg/dL. Given the patient’s worsening clinical condition, he was started on TPE with a rapid fall in his serum TG levels, in turn leading to early clinical recovery. Conclusion. Though various therapeutic options for the treatment of HTGP are described in literature, there are no set guidelines available to tackle this difficult clinical situation. TPE, albeit not very well known in this context, is one of the many therapies available. Though it leads to a rapid, precipitous fall in the TG levels and early symptom resolution, the data about the long-term morbidity as well as the effectiveness of this therapy is still lacking.

scholarly journals Frequency of Retinoblastoma at Lady Reading Hospital, Peshawar, Pakistan

1970 ◽  
Vol 12 (3) ◽  
pp. 140-143
Author(s):  
Zafar Iqbal ◽  
Tariq Muhammad Saeed
Keyword(s):  
Demographic Data ◽  
Treatment Options ◽  
Late Presentation ◽  
Group V ◽  
Female Ratio ◽  
Fellow Eye ◽  
Bilateral Retinoblastoma ◽  
Male Preponderance ◽  
Age Range ◽  
Male To Female

Aim: To ascertain the demographics, clinical features, and treatment options for children with retinoblastoma. Methods: This was a hospital-based cohort study of all children with retinoblastoma presenting from 1 January 2008 to 31 December 2008. Demographic data, presenting features, family history, and findings identified during examination were recorded for each patient. The tumours were classified using the Reese- Ellsworth classification system. Documentation of the tumours included examination under anesthesia, ultrasound B- scan, and computed tomography scan as well as histopathological reporting of enucleated eyes.Results: Twenty seven new patients with retinoblastoma were identified and 36 eyes were affected, with a bilaterality rate of 33%. The frequency was 4.1, with a bimodal peak of presentation of younger than 1 yearand 4 years. The mean age at diagnosis was 3.2 years (SD, 2.5 years; range, 3 months to 8 years). Most of the patients were boys, (59%) and most were in the age range of 1 to 5 years (66%). There was a male preponderance (5:1) amongst patients younger than 1 year and the male to female ratio was equal (1:1) in the 1 to 5 years age range. Leukocoria was the main presentation in 38% of eyes and 19% presented with proptosis. Enucleation/exenteration was performed for 17 unilateral eyes (94%) and 5 bilateral eyes (27%) with group V disease. Groups I and II tumours (n = 1 and n = 7 for unilateral and bilateral eyes, respectively) were treated conservatively with cryotherapy or chemotherapy alone or in combination. The commonest treatment for bilateral disease was enucleation of 1 eye and chemotherapy for the fellow eye (22%). Radiotherapy was advised for patients with histopathological evidence of optic nerve involvement (25%).Conclusions: Retinoblastoma usually affects infants and children younger than 5 years, with no sexual or racial predilection. One-third of patients demonstrate bilaterality, with leukocoria as the commonest presenting feature and proptosis as a feature of late presentation. In bilateral retinoblastoma, primary enucleation of one eye with conservative chemotherapy and/or cryotherapy of the fellow eye is advocated.

scholarly journals Rhinosinusal mucormycosis: Literature review and some particular cases

2019 ◽  
Vol 9 (35) ◽  
pp. 129-137
Author(s):  
Carmen Badea ◽  
Codrut Sarafoleanu ◽  
Andreea Marza
Keyword(s):  
Treatment Options ◽  
Treatment Protocol ◽  
Complete Recovery ◽  
Late Presentation ◽  
Multiple Organ ◽  
Surgical Debridement ◽  
Cerebral Stroke ◽  
Significant Survival ◽  
Life Threatening ◽  
Underlying Risk

Abstract Rhinosinusal mucormycosis is a life-threatening disease caused by fungus of the order Mucorales, which commonly affects individuals with diabetes and those in immunocompromised states. It is the most common form of mucormycosis with a high mortality rate (50-80%). Treatment options include reversal of the underlying risk factors when it is possible, systemic antifungal medication and radical surgical debridement. Prognosis is reserved because of the high potential of invasiveness, so diagnosis and early treatment are essential. Herein, we make a review about the most important features of this pathology and we report two cases of rhinosinusal mucormycosis with similar presentations who followed the same treatment protocol – extended surgical debridement of the necrotic tissue combined with systemic antifungal treatment (Amphotericin B). Complete recovery was achieved in one patient, whereas in the other one, due to late presentation, massive extension and incomplete surgical debridement, the disease was complicated with multiple organ dysfunction and cerebral stroke. By presenting these cases, we would like to point out the importance of early diagnosis, appropriate medical and surgical therapy to obtain a significant survival rate in patients with this fatal disease.

scholarly journals Post-traumatic Late Presentation of Morel–Lavallée: Case Report and Review of Literature

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Mohammad O Boushnak ◽  
Hussein Rabah ◽  
Mohammad H Saleh ◽  
George Al Aaraj ◽  
Samer Hajjar ◽  
...  
Keyword(s):  
Case Report ◽  
Treatment Options ◽  
Subcutaneous Fat ◽  
Late Presentation ◽  
Deep Fascia ◽  
Incision And Drainage ◽  
Post Traumatic ◽  
Proximal Thigh ◽  
The Right ◽  
Incision Drainage

Introduction: Morel–Lavallée (MLL) is an uncommon entity that is missed by many physicians, it is the result of a shearing force that leads to degloving of the subcutaneous fat from the underlying deep fascia. Case Report: We present a case of a 15-year-old male patient who presented 3 months after the initial crush injury with a large MLL lesion at the lateral aspect of the right proximal thigh. He was treated with incision and drainage with compressive dressing and a negative pressure drain. Conclusion: Diagnosis of MLL is usually clinical and can be aided with radiological tools like MRI that is the gold standard of imaging in this lesion. Several treatment options are available, ranging from conservative treatment with compressive bandages to percutaneous drainage, injection of sclerotic agents, and surgical treatment with incision, drainage, and debridement. Diagnosis and treatment should be familiar to all caregivers to prevent further complications that could be life or organ-threatening. Keywords: Morel–Lavallée, thigh trauma, chronic Morel–Lavallée, thigh mass.

scholarly journals Sarcomatoid carcinoma of the gallbladder: A rare form of gallbladder cancer

2020 ◽  
Vol 8 ◽  
pp. 2050313X2090673
Author(s):  
Mehdi Siddiqui ◽  
Sheetal Hegde ◽  
Tung Nguyen ◽  
Scott DePaul
Keyword(s):  
Abdominal Pain ◽  
Hospice Care ◽  
Abdominal Mass ◽  
Treatment Options ◽  
Sarcomatoid Carcinoma ◽  
Stage Iv ◽  
Large Mass ◽  
Liver Lesions ◽  
Diffuse Abdominal Pain ◽  
Carcinoma Of The Gallbladder

Sarcomatoid carcinoma of the gallbladder or gallbladder carcinosarcoma is an exceedingly rare malignancy. Unfortunately, patients typically present with advanced disease at diagnosis. Symptoms may include abdominal pain, jaundice, anorexia, nausea, weight loss, and a palpable abdominal mass. This malignant tumor has a poor prognosis, and treatment options include surgical resection, radiation, and chemotherapy. We detail the case of a 57-year-old male who presented with diffuse abdominal pain and jaundice. Computed tomography scan of the abdomen and pelvis showed a large mass within the gallbladder, intrahepatic ductal dilation, gastrohepatic lymph node enlargement, and liver lesions concerning for metastatic disease. A core needle biopsy from one of the liver lesions revealed poorly differentiated sarcomatoid carcinoma of the gallbladder. He was assessed to have stage IV disease and deemed not to be a surgical candidate. Palliative chemotherapy was planned; however, treatment was never started due to the development of cholangitis with sepsis. The patient ultimately opted for hospice care and passed away shortly thereafter.

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