Clinics in diagnostic imaging (186). Atrial septal defect with pulmonary arterial hypertension

We report a case of a 61-year-old woman with a large atrial septal defect (ASD) that was detected incidentally on chest radiography and computed tomography when she presented with sepsis. Echocardiography confirmed a large secundum ASD with left-to-right shunt flow, right heart dilatation and severe pulmonary hypertension. The patient had a poor clinical outcome despite intensive care and eventually passed away. Haemodynamically significant ASDs have a known association with increased morbidity and mortality, and their early detection and closure cannot be understated. This article aimed to highlight the imaging features of ASD, with special emphasis on the routine chest radiograph. The pathophysiology and clinical manifestations of ASD are also briefly discussed.

Vinorelbine-cyclophosphamide compared to cyclophosphamide in peripheral blood stem cell mobilization for multiple myeloma

Background: High dose Cyclophosphamide [Cy] and Vinorelbine Cyclophosphamide [Vino-Cy] are stem cell [SC] mobilisation options for patients with multiple myeloma [MM]. We present a comparison of mobilisation outcomes using these regimens

Patients and methods: Vino-Cy patients received Vinorelbine 25 mg/m[2] on day 1, cyclophosphamide 1500 mg/m[2] on day 2, and pegylated GCSF on day 4 or GCSF 10 mcg/kg/day from day 4 onwards. Cy patients were given cyclophosphamide 4000 mg/m[2] on day 1 and GCSF10 mcg/kg/day from day 5 onwards. The target CD34 + SC collection was 5 * 10[6] per kg/BW

Results: 149 patients were included. SC collection was lower in the Vino-Cy group [8.20 * 10[6]/ Kg BW] compared to the Cy group [11.43 * 10[6]/Kg BW], with adjusted geometric mean ratio of 0.59 [95% CI 0.41 to 0.86, p = 0.006]. Time taken to achieve an adequate PB SC count was shorter for Vino-Cy [9 +/- 1 day compared to 12 +/- 2 days for Cy, adjusted absolute mean difference -3.95, 95% CI -4.85 to -3.06, P < .001]. Mobilisation related toxicities [in particular, neutropaenic fever] were greater for Cy

Conclusion: Vino-Cy is a potential alternative to Cy given the need for effective mobilisation protocols with acceptable toxicity

Cutaneous pseudolymphoma occurring after traumatic implantation of a foreign red pigment

Cutaneous pseudolymphoma is an uncommon, benign lymphoproliferative disorder of the skin. Although this condition is most commonly idiopathic, its occurrence has been associated with cosmetic tattoos. We report a unique case of cutaneous pseudolymphoma that occured after accidental, traumatic inoculation of a red pigment in a healthy 33-year-old woman.

Combined panel of serum human tissue kallikreins and CA-125 for the detection of epithelial ovarian cancer / 부인종양

OBJECTIVE: To determine the predictive accuracy of the combined panels of serum human tissue kallikreins (hKs) and CA-125 for the detection of epithelial ovarian cancer. METHODS: Serum specimens collected from 5 Indonesian centers and 1 Vietnamese center were analyzed for CA-125, hK6, and hK10 levels. A total of 375 specimens from patients presenting with ovarian tumors, which include 156 benign cysts, 172 epithelial ovarian cancers (stage I/II, n=72; stage III/IV, n=100), 36 germ cell tumors and 11 borderline tumors, were included in the study analysis. Receiver operating characteristic analysis were performed to determine the cutoffs for age, CA-125, hK6, and hK10. Sensitivity, specificity, negative, and positive predictive values were determined for various combinations of the biomarkers. RESULTS: The levels of hK6 and hK10 were significantly elevated in ovarian cancer cases compared to benign cysts. Combination of 3 markers, age/CA-125/hk6 or CA-125/hk6/hk10, showed improved specificity (100%) and positive predictive value (100%) for prediction of ovarian cancer, when compared to the performance of single markers having 80-92% specificity and 74-87% positive predictive value. Four-marker combination, age/CA-125/hK6/hK10 also showed 100% specificity and 100% positive predictive value, although it demonstrated low sensitivity (11.9%) and negative predictive value (52.8%). CONCLUSION: The combination of human tissue kallikreins and CA-125 showed potential for improving prediction of epithelial ovarian cancer in patients presenting with ovarian tumors.