scholarly journals Microangiopathic Hemolytic Anemia in 57-year-old woman with Borderline Serous Tumor of the Ovary:Real-Time Management of Common Pathways of Hemostatic Failure

2012 ◽  
Vol 4 (1) ◽  
pp. e2012030
Author(s):  
Gloria Joan Morris
Keyword(s):  
Hemolytic Anemia ◽  
Time Management ◽  
Clinical Information ◽  
Coagulation System ◽  
Ovarian Mass ◽  
Common Pathway ◽  
Diagnostic Dilemma ◽  
Heparin Induced Thrombocytopenia ◽  
Strategic Approach ◽  
Serous Tumor

We present a case of a 57-year-old woman who underwent surgery for the removal of an ovarian mass but subsequently experienced microangioathic hemolytic anemia post-operatively, associated with fevers, renal insufficiency, hypertension, and hemolysis. While her clinical situations was initially suspicious for thrombotic thrombocytopenic purpura (TTP), further sorting of clinical information led to other explanations of these findings, including a systemic inflammatory response. Multiple triggers of the coagulation system which can lead to a common pathway of hemostatic failure were considered, and specific criteria seen in disseminated intravascular coagulation (DIC), TTP, heparin-induced thrombocytopenia (HIT), catastrophic antiphospholipid anitbody syndrom (APS), all of which can seem to overlap when a physician is faced with distinguishing the diagnosis clinically. We propose a chronologic and strategic approach for the clinician to consider when approaching this diagnostic dilemma.

Rhabdomyosarcoma in Ovary- Pathologist’s Diagnostic Dilemma

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
A C Srivastava ◽  
F Hussain ◽  
T Patel
Keyword(s):  
Soft Tissue ◽  
Ovarian Tumor ◽  
Ca 125 ◽  
Axillary Lymph ◽  
Ovarian Mass ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Epithelial Tumor ◽  
True Nature ◽  
Right Hand

Abstract Introduction/Objective Rhabdomyosarcoma is the most common pediatric soft tissue sarcoma. However, rhabdomyosarcoma in the ovary is exceptionally unusual and presents a diagnostic challenge. We report one such case and its clinical and pathological perspective. Methods/Case Report 16-year-old female presented with an enlarging pelvic mass, abdominal distension, and pain. Imaging revealed a heterogeneous left ovarian mass, right axillary lymphadenopathy, and right-hand soft tissue mass. CA-125 was 1833.0 U/ml. Patient underwent left salphingo-oophorectomy, omentectomy, peritoneal and mesenteric biopsy for ovarian staging, incidental appendectomy, and right axillary lymph node excision with suspicion of ovarian epithelial tumor. Pathological evaluation revealed a 16-cm intact ovary with multiple solid and cystic nodules with areas of hemorrhage and necrosis. Microscopic examination of ovarian tumor showed a high-grade malignant tumor consisting of sheets of small round blue cells with severe cytologic atypia, increased mitoses, and features suggestive of rhabdoid morphology. The other specimens were positive for metastases. The tumor cells were immunopositive for Myogenin and MyoD1 while immunonegative for Cytokeratin AE1/AE3, SF-1, PLAP, SALL4, MelanA, and S-100. INI-1 and BRG-1 demonstrated intact nuclear expression. FISH testing identified rearrangement of the FOX01 gene at 13q14. Based on these findings, diagnosis of alveolar rhabdomyosarcoma was rendered. Currently, the patient is receiving rhabdomyosarcoma chemotherapy treatment and has responded well. Results (if a Case Study enter NA) NA Conclusion In cases with complex and urgent clinical presentation, where the existence of a primary tumor is unknown and where symptoms attributable to primary ovarian tumor dominate the clinical picture, rhabdomyosarcoma is rarely proposed in the differential diagnoses of small round blue cell tumors of the ovary. At present, the right-hand mass is under evaluation; thus, the true nature of the ovarian mass, primary or metastatic is unknown. Our case illustrates the importance of exact diagnoses, as treatment of rhabdomyosarcoma, is different from other ovarian tumors.

scholarly journals True broad ligament fibroid mimicking ovarian mass in a postmenopausal woman

2019 ◽  
Vol 8 (7) ◽  
pp. 2910
Author(s):  
Lata Singh ◽  
Taru Gupta ◽  
Snigdha Kumari ◽  
Sangeeta Gupta
Keyword(s):  
Broad Ligament ◽  
Total Abdominal Hysterectomy ◽  
Large Mass ◽  
Abdominal Hysterectomy ◽  
Gravid Uterus ◽  
Ovarian Mass ◽  
Lower Abdomen ◽  
Diagnostic Dilemma ◽  
Co Morbidity ◽  
Smooth Muscle Tumors

Fibroids are benign smooth muscle tumors. Large fibroids are known to arise from the uterus, but occasionally from the broad ligament.  Here, we report a case of true broad ligament fibroid which is rare and difficult to diagnose in a 57 year old postmenopausal women with a large mass of 24 weeks size gravid uterus. Patient presented with pain lower abdomen and mass in abdomen with no other co-morbidity. This broad ligament fibroid was mimicking as ovarian tumor on ultrasonography and MRI as left ovary was not visualised separately, thus leading to diagnostic dilemma of ovarian malignancy. Mass resection with total abdominal hysterectomy and bilateral salpingo-oopherectomy was performed. No local or distant metastasis observed, and Histopathology showed true broad ligament fibroid of left side weighing 3.57 kilograms.

A two-cycle prospective audit of temporal bone computed tomography scan requests: improving the clinical applicability of radiology reports

2014 ◽  
Vol 128 (1) ◽  
pp. 49-52
Author(s):  
A Qureishi ◽  
G Garas ◽  
J Shah ◽  
J Birchall
Keyword(s):  
Computed Tomography ◽  
Temporal Bone ◽  
Time Management ◽  
Clinical Information ◽  
Computed Tomography Scan ◽  
Prospective Audit ◽  
National Guidelines ◽  
Clinical Value ◽  
Radiology Reports ◽  
Tomography Scan

AbstractBackground:Radiologists require accurate clinical information to formulate reports. This is particularly relevant to computed tomography of the temporal bone, in which previous surgery can mimic disease.Objectives:The information provided with temporal bone computed tomography scan requests was evaluated. The study aimed to minimise inappropriate requests and improve the clinical value of reports.Method:A two-cycle prospective audit was undertaken using a proforma designed on the basis of national guidelines. Following the first cycle (in which the requests and reports of 100 scans were evaluated), new guidelines and training were implemented. A follow-up audit (of 50 scans) was then performed.Results:Following intervention, the percentage of clinically relevant reports increased from 52 to 94 (p < 0.01), whilst unnecessary or inappropriate scan requests decreased from 11 to 2 per cent (p < 0.05).Conclusion:Optimising the clinical value of temporal bone computed tomography scan requests will have positive implications for patient care, time management and cost. The quality of the clinical information provided can have a significant impact on the clinical value of radiology reports, and can mean that unnecessary irradiation is avoided.

scholarly journals S2389 Gilbert’s Syndrome Coexisting With Congenital Hemolytic Anemia Presenting as Marked Indirect Hyperbilirubinemia: A Diagnostic Dilemma

2020 ◽  
Vol 115 (1) ◽  
pp. S1270-S1270
Author(s):  
Gurbir Sehmbey ◽  
Mustafa A. Alani ◽  
Keng-Yu Chuang ◽  
Sharad Bellapravalu
Keyword(s):  
Hemolytic Anemia ◽  
Diagnostic Dilemma ◽  
Gilbert’S Syndrome ◽  
Gilbert's Syndrome ◽  
Congenital Hemolytic Anemia

scholarly journals Coomb's negative autoimmune hemolytic anemia: A diagnostic dilemma for the hematologist

2008 ◽  
Vol 51 (4) ◽  
pp. 571 ◽  
Author(s):  
Ruchika Gupta ◽  
DeepakKumar Singh ◽  
Sompal Singh ◽  
Tejinder Singh
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Diagnostic Dilemma

Heparin Induced Thrombocytopenia; A Diagnostic Dilemma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4468-4468
Author(s):  
John L. Reagan ◽  
Samir Dalia ◽  
James N. Butera
Keyword(s):  
Conflicts Of Interest ◽  
Case Series ◽  
Serotonin Release ◽  
Pretest Probability ◽  
Thrombin Inhibitors ◽  
Bleeding Complications ◽  
Direct Thrombin Inhibitors ◽  
Retrospective Case ◽  
Diagnostic Dilemma ◽  
Heparin Induced Thrombocytopenia

Abstract Abstract 4468 Introduction The diagnosis of HIT can be challenging. Short of the serotonin release assay, which can be difficult to get in a timely manner, the 4T method developed by Lo et al., in conjunction with the HIT elisa assay (EIA), is the best established criteria for the rapid diagnosis of Heparin Induced Thrombocytopenia (HIT). We sought to determine how often the 4Ts were being applied at a large academic institution. In addition, we sought to understand the outcome of patients started on direct thrombin inhibitors (DTIs) who did not meet the 4T/EIA criteria for HIT. Methods A retrospective case series identified patients placed on DTI for HIT treatment from 10/2006 to 5/2008. The 4T pretest probability was then applied retrospectively. HIT EIA Ab testing, optical densities, duration of DTI treatment, and bleeding incidence were recorded. Liberal and modified conservative criteria from Lo et al.'s study were used to define patients with HIT. Overdiagnosis of HIT was then recorded based on the above criteria. Results 76 patients were included for analysis. The average age was 61.4 years. Based on the 4T pretest probability, 30 patients were classified as low risk, 37 intermediate risk, and 9 high risk for HIT. The average HIT OD for low, intermediate, and high pretest probability was 0.49, 1.17, and 2.05. 76% and 36% of patients treated with DTIs for HIT met the liberal and modified conservative HIT definitions, respectively. 18 patients (24%) did not meet liberal HIT criteria but remained on DTI treatment for 1 to 60 days. Cost of DTI overuse in this subset was $84,960. Cost of DTI use in patients who did not meet modified conservative criteria was $462,246. All 16 patients who developed bleeding complications fulfilled a liberal diagnosis of HIT while only 6 of these patients fulfilled the modified conservative definition of HIT. Conclusions 1) The 4T method for diagnosing HIT is not being applied to a large percentage of patients in a tertiary academic center. 2) There is an overdiagnosis of HIT regardless of definition criteria with 24% of patients treated for HIT not meeting the liberal definition while 64% of patients did not meet the modified conservative definition. This overdiagnosis has both a significant monetary and morbidity cost. Disclosures: No relevant conflicts of interest to declare.

A COMPARISON OF AMERICAN-BORN CHINESE AND TAIWANESE COLLEGE STUDENTS IN APPROACHES TO STUDYING

2018 ◽  
Vol 6 (2) ◽  
pp. 01-09
Author(s):  
Sherry Liang
Keyword(s):  
College Students ◽  
Time Management ◽  
Study Skills ◽  
Extrinsic Motivation ◽  
Chinese Students ◽  
Social Contexts ◽  
Learning Approaches ◽  
Approaches To Studying ◽  
Strategic Approach ◽  
Quasi Experimental

Purpose:The purpose of this study was designed to bracket both population’s culturally-related study skills in an attempt to know their similarities and dissimilarities. Methodology:The current study used a quasi-experimental quantitative researchto examine 62 American-born Chinese and 79 Taiwanese college students by using the Approaches to Studying Inventory to compare their learning study approaches. Results:Data analysis revealed three significant results: (a) American-born Chinesestudentsexpressed more interesting in ideas in deep approach and syllabus-boundness in surface approach than Taiwanese students. (b) Taiwanese students showed more in seeking meaning in deep approaches and time management in strategic approach than American-born Chinese students (c) American-born Chinese students displayed grater extrinsic motivation than their Taiwanese counterparts whereas Taiwanese students were more intrinsically motivated academically than American-Born Chinese students. Implications:Results suggest that American-born Chinese students’ learning approaches were influenced by their learning and social contexts.  Further studies could be conducted to identify the learning approaches in various generations of American-born Chinese to differentiate learning and social context influences.

Idiopathic Hemolytic Anemia of Pregnancy: A Diagnostic Dilemma

2014 ◽  
Vol 3 (4) ◽  
pp. 118-120 ◽  
Author(s):  
Monika Gupta ◽  
Mansi Kala ◽  
Sanjay Kumar ◽  
Gajender Singh ◽  
Sonia Chhabra ◽  
...  
Keyword(s):  
Hemolytic Anemia ◽  
Diagnostic Dilemma

Strategic Approach towards Clinical Information Security

2017 ◽  
pp. 1141-1171
Author(s):  
Sangseo Park ◽  
Jane Moon
Keyword(s):  
Information Security ◽  
Medical Information ◽  
Health Information System ◽  
Clinical Information ◽  
Technical Aspect ◽  
Point Of View ◽  
Security Requirements ◽  
Current Status ◽  
Disclosure Control ◽  
Strategic Approach

Information security in the health information system has been technology-centric and no strategy has been put forward to meet the demands of the rapid adoption of e-Health in the health industry. The implementation of security requires a good understanding of the stake holders involved and requires the technical aspect of clinical information security, including security requirements, access control and disclosure control. However, since technology-centric security is prone to failure, a stringent strategic approach is quintessential. This chapter discusses the ways to safeguard medical information assets from the strategy point of view. This study shows that most of the existing clinical information security literature and practice has been focused on tactical prevention at a technical level. This understanding of the current status of clinical information security not only suggests the need for a shift from the technical approach to the strategic approach but also raises the necessity for the employment of multiple strategies working in a harmonised way.

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