scholarly journals Fetal Presentation of Mediastinal Immature Teratoma: Ultrasound, Autopsy and Cytogenetic Findings

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1543
Author(s):  
Maria Paola Bonasoni ◽  
Giuseppina Comitini ◽  
Veronica Barbieri ◽  
Andrea Palicelli ◽  
Nunzio Salfi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Fetal Monitoring ◽  
Surgical Excision ◽  
Fetal Outcome ◽  
Anterior Mediastinum ◽  
Therapeutic Strategies ◽  
Cystic Mass ◽  
Immature Teratoma ◽  
Adequate Treatment ◽  
Mediastinal Teratoma

Teratomas are the most common congenital tumors, occurring along the midline or paraxial sites, or uncommonly, the mediastinum. Teratomas are classified as mature, containing only differentiated tissues from the three germinal layers; and immature, which also present with neuroectodermal elements, ependymal rosettes, and immature mesenchyme. Herein, we describe a new case of fetal mediastinal immature teratoma detected at 21 weeks of gestational age (wga) + 1 day with thorough cytogenetic analysis. Ultrasound (US) showed a solid and cystic mass located in the anterior mediastinum, measuring 1.8 × 1.3 cm with no signs of hydrops. At 22 wga, US showed a mass of 2.4 cm in diameter and moderate pericardial effusions. Although the prenatal risks and available therapeutic strategies were explained to the parents, they opted for termination of pregnancy. Histology showed an immature teratoma, Norris grade 2. Karyotype on the fetus and tumor exhibited a chromosomal asset of 46,XX. The fetal outcome in the case of mediastinal teratoma relies on the development of hydrops due to mass compression of vessels and heart failure. Prenatal US diagnosis and close fetal monitoring are paramount in planning adequate treatment, such as in utero surgery, ex utero intrapartum therapy (EXIT) procedure, and surgical excision after birth.

scholarly journals Ruptured mediastinal mature teratoma causing severe mediastinitis: report of a surgically resected case and a literature review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Eri Nakajima ◽  
Yujin Kudo ◽  
Sachio Maehara ◽  
Hideyuki Furumoto ◽  
Jun Matsubayashi ◽  
...  
Keyword(s):  
Literature Review ◽  
Surgical Resection ◽  
Mature Teratoma ◽  
Median Sternotomy ◽  
Surgical Margin ◽  
Emergency Admission ◽  
Anterior Mediastinum ◽  
Cystic Mass ◽  
Mediastinal Teratoma ◽  
The Right

Abstract Background Mediastinal teratomas occasionally rupture into the thoracic cavity, which induces mediastinitis or various other severe complications. Surgical treatment is crucial for ruptured teratomas; however, few literature reviews to date have addressed the characteristics of ruptured mediastinal teratomas. Case presentation We report a 29-year-old woman with severe mediastinitis owing to a mediastinal mature teratoma that ruptured into the mediastinum and right pleural cavity. Surgical resection by median sternotomy was performed within 24 hours after emergency admission. Intraoperative findings demonstrated the ruptured wall of the tumor with exposure of its white contents, which appeared similar to skin and fat, and necrotic tissue in the anterior mediastinum. The tumor was adhered to the right upper lobe, the ascending aorta, and pericardium. Owing to the severe adhesion of the tumor caused by inflammation in the surrounding tissues, a small portion of the tumor could not be removed, and hence complete resection with a sufficient surgical margin was not achieved. Pathologically, the tumor consisted of a solid mass and a cystic mass with severe adhesion to the resected portion of the lung, which included skin and lipid tissue. The tumor was concluded to be a mature teratoma as neither an immature component nor malignant transformation was observed. The patient had an uneventful postoperative course. Conclusions To our knowledge, this is the report of successful surgical resection of a ruptured mediastinal teratoma causing severe mediastinitis, with the first literature review of ruptured mediastinal teratomas. We also discuss relevant findings from reports in the literature.

Mediastinal teratoma in a second trimester fetus

2021 ◽  
Author(s):  
I.V. Novikova, E.I. Marakhovskaya, A.M. Sakharchuk et all
Keyword(s):  
Morphological Changes ◽  
Pregnancy Termination ◽  
Anterior Mediastinum ◽  
Immature Teratoma ◽  
Second Trimester ◽  
Solid Mass ◽  
Arterial Tree ◽  
Sonographic Examination ◽  
Mediastinal Teratoma ◽  
Pulmonary Arterial

А case of a large mediastinal teratoma in a fetus with a large pleural effusion at 21 weeks of gestation is presented. Detailed sonographic examination showed a large, complex cystic and solid mass posterior to the sternum, in the upper anterior mediastinum, measuring 35 31 22 mm. The lungs were visualized without morphological changes or pulmonary arterial tree abnormalities, but they were relatively small. The couple opted for pregnancy termination at 23 weeks of gestation. Histological examination revealed an encapsulated immature teratoma.

scholarly journals Mediastinal Mature Teratoma Revealed by Empyema

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Mohammed Raoufi ◽  
Laila Herrak ◽  
Anas Benali ◽  
Leila Achaachi ◽  
Mustapha El Ftouh ◽  
...  
Keyword(s):  
Chest Pain ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Left Lung ◽  
Needle Aspiration ◽  
Anterior Mediastinum ◽  
Cystic Tumor ◽  
Left Hemithorax ◽  
Adequate Treatment ◽  
Mediastinal Teratoma

Teratomas are germ cell tumors, manifested with a great variety of clinical features; the most common extragonadal site is the anterior mediastinum. In this case, we report the patient with a large mature mediastinal teratoma with several components of ectodermal and endothermal epithelium. A 24-year-old female patient presented with history of persistent chest pain and progressively aggravating dyspnea for the previous 3 months. A chest X-ray showed a large opacity of the entire left hemithorax. Transcutaneous needle aspiration revealed a purulent fluid. The tube thoracostomy was introduced and the effusion was evacuated. Some weeks later, patient was seen in emergency for persistent cough and lateral chest pain. CT scan revealed a mass of the left hemithorax. The mass showed heterogeneous density, without compressing mediastinum great vessels and left hilar structures. Lipase value was elevated in needle aspiration. The patient underwent a total resection of the mediastinum mass via a left posterolateral thoracotomy. Microscopy revealed a mature teratoma with cystic structures. The patient subsequently made a full recovery. This case provide benign mediastinal teratoma with total atelectasis of left lung and elevated lipase value in needle transcutaneous aspiration; this event is explained by pancreatic component in the cystic tumor. Total removal of the tumor is adequate treatment for this type of teratoma and the prognosis is excellent.

scholarly journals Overt and subclinical hypothyroidism among Bangladeshi pregnant women and its effect on fetomaternal outcome

2015 ◽  
Vol 40 (2) ◽  
pp. 52-57 ◽  
Author(s):  
M Sharmeen ◽  
PA Shamsunnahar ◽  
TR Laita ◽  
SB Chowdhury
Keyword(s):  
Adverse Effects ◽  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Perinatal Outcomes ◽  
Fetal Outcome ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Adequate Treatment ◽  
In Pregnancy

Objectives: Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from Bangladesh about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find out thyroid dysfunction (both overt and subclinical hypothyroidism) in pregnancy and its impact on obstetrical outcome.Methods: We studied the evaluation of 50 admitted pregnancies corresponding to 29 women with subclinical hypothyroidism and rest 21 was overt hypothyroidism. Detailed history and examination were performed. Apart from routine obstetrical investigations, Thyroid Stimulating Hormone (TSH) estimation was done. Their obstetrical and perinatal outcomes were noted.Results: Overt hypothyroidism was significantly (p<0.05) higher in 25 to 44 years age group. However two and three abortions were significantly (p<0.05) higher in overt hypothyroidism patients. In sub clinical hypothyroidism 86.2% conceived firstly within 2 years and 66.7% in overt hypothyroidism patients conceived firstly in between 3 to 5 years after marriage. Overt hypothyroids were prone to have pregnancy-induced hypertension 42.9%, intrauterine growth restriction (P=0.001) and gestational diabetes (38.1%) as compared to subclinical cases. Neonatal complications were significantly more in overt hypothyroidism group. Mean TSH level was significantly (p<0.05) higher in overt hypothyroidism patients but mean FT4 level was almost similar in both groups. Majority of the patient underwent caesarean section in both groups due to associated medical and obstetrical complications. None of the babies showed hypothyroidism by cord blood tests. In this analysis our results showed that overt hypothyroidism among Bangladeshi pregnant women are associated with more maternal complication & adverse parental outcome than subclinical hypothyroidism. The adequate treatment of hypothyroidism during gestation minimizes risks and generally, makes it possible for pregnancies to be carried to term without complications. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.Bangladesh Med Res Counc Bull 2014; 40 (2): 52-57

DESIGN OF A EUROPEAN SURVEY ON THE PHARMACOLOGICAL MANAGEMENT OF PAEDIATRIC HEART FAILURE

2015 ◽  
Vol 101 (1) ◽  
pp. e1.64-e1
Author(s):  
Cristina Castro Díez ◽  
Feras Khalil ◽  
Michiel Dalinghaus ◽  
Marijke van der Meulen ◽  
Saskia de Wildt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Drug Therapy ◽  
Survey Design ◽  
Therapeutic Strategies ◽  
Special Focus ◽  
The European Union ◽  
Converting Enzyme Inhibitors ◽  
Pharmacological Management ◽  
Survey Tool ◽  
Paediatric Cardiology

BackgroundLittle evidence is presently available to help clinicians guide decisions when tackling the pharmacological management of paediatric heart failure (HF). As a consequence, therapeutic strategies are largely supported by adults' data extrapolation and own expertise. The variability in drug treatment routines across Europe is expected to be high. Nevertheless, there are no epidemiological data that describe the current situation.AimTo develop a survey in the context of the LENA project to characterise the different therapeutic strategies for the management of paediatric HF that are currently practiced across Europe with special focus in the use of Angiotensin Converting Enzyme Inhibitors (ACE-I).MethodsItems to be included in the survey were selected through a thorough literature review and expert group discussions. European hospitals providing paediatric cardiology care were identified using websites of European and national paediatric cardiology associations as well as the ones of congresses and conferences related to the field. Standard recommendations for survey design were followed. The study protocol was approved by a data protection officer and an ethics committee. Web-survey tool EvaSys® was used. The survey was pre- and pilot-tested by a group of experts. A statistical analysis plan for the later processing and analysis of the data to be obtained was elaborated.ResultsA Europe-wide web-based survey was started in January 2015. 203 clinicians were invited via e-mail to participate. The questionnaire consisted of 23 questions addressing different aspects of drug therapy for HF in children. Use patterns of ACE-I (dosage by age group, effectiveness and toxicity assessment, use according to HF aetiology) and drug therapy for dilated cardiomyopathy where explored. Participants' demographic characteristics were also asked.ConclusionsThe procedure followed for the survey development should assure the quality of the tool. The results of this survey will provide an overview of the clinical treatment routine of paediatric heart failure across Europe.The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement n°602295 (LENA).The following authors will also be included in the later poster: Ingrid Klingmann (PHARMAPLEX BVBA, Germany), András Szatmári (GOTTSEGEN GYORGY ORSZAGOS KARDIOLOGIAI INTEZET, Hungary), László Ablonczy (GOTTSEGEN GYORGY ORSZAGOS KARDIOLOGIAI INTEZET, Hungary), Holger Schwender (HEINRICH-HEINE-UNIVERSITÄT DÜSSELDORF, GERMANY)

scholarly journals Pregnancy outcome in pre-gestational and gestational diabetic women: a prospective observational study

2021 ◽  
Vol 10 (8) ◽  
pp. 3040
Author(s):  
Mamta Mahajan ◽  
Amit Gupta ◽  
Anju Vij ◽  
Aanchal Gupta Sharma
Keyword(s):  
Disease Burden ◽  
Prospective Observational Study ◽  
Fetal Monitoring ◽  
Antenatal Clinic ◽  
Fetal Outcome ◽  
Maternal Complications ◽  
Missed Abortion ◽  
Patient Counselling ◽  
Medical College ◽  
Intrapartum Fetal Monitoring

Background: India is considered the world capital of diabetes, proper care and management of the same is the demand of society. The present study is carried out to identify the disease burden of GDM/ overt DM among antenatal cases. The main objective was to study the maternal and fetal outcome of diabetes complicating pregnancy.Methods: The present study was conducted at Dr. Rajendra Prasad Government Medical College at Tanda, District KangraHP from October 2015 to September 2016. All antenatal cases were screened for diabetes by OGTT 75 gm, 2-hour blood glucose level as per DIPSI guidelines and labelled as GDM/ overt DM. Those who fulfilled selection criteria were enrolled in the study. A total of 6452 cases who attended antenatal clinic during the study duration and were screened were selected for the study. 116 cases were found to have GDM / overt DM. Seventy-nine had GDM with OGTT>140 mg/dl (DIPSI guidelines) and 37 had overt DM with 2 hours PP >200 mg/dl (WHO criteria). Total 100 cases comprised of study group were followed till delivery to study maternal and fetal outcome.Results: The prevalence of diabetes in pregnancy was found to be low 1.79%. GDM was found to be more prevalent than overt diabetes in pregnant women (66% versus 34%). Among the antenatal maternal complications observed missed abortion (11.8% versus 1.55; p=0.026), polyhydraminos (26.4% versus 10.6%; p=0.04) and preterm labour (17.6% versus 4.5%; p=0.003) were significantly more common in overt diabetics than GDM cases. IUFD (8.8% versus 0; p=0.014) was also significantly more common in overt diabetics than GDM case. RDS was found significantly higher in neonates of overt diabetics as compared to GDM mothers (14.7 % versus 1.5%; p=0.009).Conclusions: Early detection and good glycemia control by MNT and insulin, regular antenatal check-ups, patient counselling and compliance, intrapartum fetal monitoring and early neonatal care are keys to improved outcome. 

scholarly journals The Value of Admission Serological Indicators for Predicting 28-Day Mortality in Intensive Care Patients With Acute Heart Failure: Construction and Validation of a Nomogram

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoyuan Wei ◽  
Yu Min ◽  
Jiangchuan Yu ◽  
Qianli Wang ◽  
Han Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Acute Heart Failure ◽  
Sofa Score ◽  
Medical Information ◽  
Troponin T ◽  
Adequate Treatment ◽  
Intensive Care Patients ◽  
Creatine Kinase Mb ◽  
Death Group

Background: Acute heart failure (AHF) is a severe clinical syndrome characterized as rapid onset or worsening of symptoms of chronic heart failure (CHF). Risk stratification for patients with AHF in the intensive care unit (ICU) may help clinicians to predict the 28-day mortality risk in this subpopulation and further raise the quality of care.Methods: We retrospectively reviewed and analyzed the demographic characteristics and serological indicators of patients with AHF in the Medical Information Mart for Intensive Care III (MIMIC III) (version 1.4) between June 2001 and October 2012 and our medical center between January 2019 and April 2021. The chi-squared test and the Fisher's exact test were used for comparison of qualitative variables among the AHF death group and non-death group. The clinical variables were selected by using the least absolute shrinkage and selection operator (LASSO) regression. A clinical nomogram for predicting the 28-day mortality was constructed based on the multivariate Cox proportional hazard regression analysis and further validated by the internal and external cohorts.Results: Age &gt; 65 years [hazard ratio (HR) = 2.47], the high Sequential Organ Failure Assessment (SOFA) score (≥3 and ≤8, HR = 2.21; ≥9 and ≤20, HR = 3.29), lactic acid (Lac) (&gt;2 mmol/l, HR = 1.40), bicarbonate (HCO3-) (&gt;28 mmol/l, HR = 1.59), blood urea nitrogen (BUN) (&gt;21 mg/dl, HR = 1.75), albumin (&lt;3.5 g/dl, HR = 2.02), troponin T (TnT) (&gt;0.04 ng/ml, HR = 4.02), and creatine kinase-MB (CK-MB) (&gt;5 ng/ml, HR = 1.64) were the independent risk factors for predicting 28-day mortality of intensive care patients with AHF (p &lt; 0.05). The novel nomogram was developed and validated with a promising C-index of 0.814 (95% CI: 0.754–0.882), 0.820 (95% CI: 0.721–0.897), and 0.828 (95% CI: 0.743–0.917), respectively.Conclusion: This study provides a new insight in early predicting the risk of 28-day mortality in intensive care patients with AHF. The age, the SOFA score, and serum TnT level are the leading three predictors in evaluating the short-term outcome of intensive care patients with AHF. Based on the nomogram, clinicians could better stratify patients with AHF at high risk and make adequate treatment plans.

scholarly journals Hepatic hydatid cyst: a masquerader

2020 ◽  
Vol 7 (5) ◽  
pp. 1688
Author(s):  
Krishan Kumar Kanhaiya ◽  
Bhimsi Kandoriya ◽  
Vineet Pandey ◽  
Viresh Kumar ◽  
Sushanto Neogi
Keyword(s):  
Differential Diagnosis ◽  
Hydatid Cyst ◽  
Surgical Excision ◽  
Hepatic Cyst ◽  
Cystic Mass ◽  
Hepatic Hydatid Cyst ◽  
Adrenal Cyst ◽  
Upper Abdominal ◽  
Hepatic Hydatid

Liver is the most common organ involved in echinococcosis. Organs affected by E granulosus are the liver (63%), lungs (25%) and muscles (5%). Rest of the organs are rarely affected.  Adrenal cysts are uncommon. Their size may range widely and the origin of large adrenal cysts is often difficult to distinguish from other organs, including the kidney, pancreas, spleen, and liver. A large right-sided adrenal cystic mass can rarely be mistaken for a hepatic cyst by imaging. In this report, authors have described an adrenal cyst in a 28 year old lady, who was diagnosed preoperatively to have a hepatic hydatid cyst but intraoperatively it was found to be of adrenal origin. The size of the adrenal cyst can vary from a few millimetres up to 50 cm in diameter. Majority of the adrenal cysts are unilateral, while 8-10% of those cysts have been noted to be present bilaterally. The majority of cases are diagnosed between the 3rd and 6th decades. Although uncommon, Adrenal cyst should be considered as one of the differential diagnosis of upper abdominal cysts. Surgical excision is advisable when the cysts are symptomatic, greater than 5 cm in diameter and in the case of suspecting malignancy. 

scholarly journals Transcanal Endoscopic Ear Surgery with Piezoelectric Device for External Auditory Canal Lesions

2021 ◽  
Vol 64 (7) ◽  
pp. 511-516
Author(s):  
Chan Young Lee ◽  
Seung Ho Kim ◽  
Jeong Hwan Choi
Keyword(s):  
External Auditory Canal ◽  
Cold Water ◽  
Surgical Excision ◽  
Cystic Mass ◽  
Surgical Removal ◽  
Ear Surgery ◽  
Dental Surgery ◽  
Piezoelectric Device ◽  
External Auditory Canal Cholesteatoma ◽  
Conductive Hearing

External auditory canal exostosis (EACE) is prone to occur in patients frequently exposed to cold water, which causes earwax impaction, recurrent otitis externa, and conductive hearing loss. The main treatment for symptomatic EACE is surgical excision. External auditory canal cholesteatoma (EACC) is a bone-destructive cystic mass caused by accumulation of plugs of desquamated keratin debris in the external auditory canal (EAC), which is also mainly treated with surgical removal. The main difficulties in the surgical removal of obstructive EACEs or EACCs are related to the adjacency of EAC skin, tympanic membrane, temporomandibular joint, and the blockage of the medial EAC landmarks during the operation. The piezoelectric device (PZD), which has long been used to cut bony structures in dental surgery, has clinical advantages here with regards to accurate exclusive bone cutting ability and minimal heat production. We report a series of cases that managed EAC lesions using PZD.

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