Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 7 de 7
Filter
1.
Eur J Case Rep Intern Med ; 11(5): 004419, 2024.
Article in English | MEDLINE | ID: mdl-38715880

ABSTRACT

Case description: We describe a case of a patient treated with pembrolizumab (an immune checkpoint inhibitor) for metastatic scalp melanoma. He had a previous history of colorectal cancer, prostatic cancer and chronic polymyalgia rheumatica. The patient was known to have a stable ascending aortic aneurysm of 4.5 cm. However, he developed a rapid expansion of the ascending aortic aneurysm with the size crossing the threshold for surgery. The patient was referred to the cardiothoracic surgery service for intervention and he subsequently underwent surgery. The patient was electively admitted one week later for resection of aortic aneurysm, aortoplasty and external graft fixation. Pathologically, gross evidence of dissection was not identified; however, the histological analysis of the media showed laminar medial necrosis, multifocal in nature, with occasional clusters of histiocytic cells appreciated at their edge reminiscent of that seen in an inflammatory aortitis (granulomatous/giant cell type). Discussion: Immune checkpoint inhibitor-induced aortitis is becoming increasingly evident, and its presentation can vary. It has been discovered incidentally on surveillance imaging with the use of nivolumab. In other cases, patients have been symptomatic to severely symptomatic. Atezolizumab with carboplatin and etoposide has been reported to cause abdominal aortitis which was responsive to corticosteroids and subsequent discontinuation of atezolizumab. Pembrolizumab has been linked to a case of transverse aortic arch aortitis. In our case, the inflammatory aortitis due to pembrolizumab was the cause of the rapid expansion of the ascending aortic aneurysm. Conclusion: Patients with known aortic aneurysms should undergo careful surveillance when commencing immune-checkpoint inhibitor therapy. LEARNING POINTS: Immune checkpoint inhibitors are being increasingly used in the treatment of metastatic malignancy. However, they are a relatively new group of medications, and the side effect profile of each is yet to be fully recognised. Aortitis has occurred with several different immune checkpoint inhibitors.Patients with known aortic aneurysms should undergo careful surveillance when commencing immune checkpoint inhibitors.All interventional therapeutic options should be considered early in these patients on the development of aneurysmal expansion.

2.
Surgeon ; 21(3): 198-202, 2023 Jun.
Article in English | MEDLINE | ID: mdl-36307306

ABSTRACT

BACKGROUND: Surgical Hip Dislocation (SHD) is a powerful tool in the armamentarium of any surgeon treating conditions affecting the hips of children presenting with sequelae of a number of common conditions including Legg-CalvéPerthes disease (LCPD) and slipped capital femoral epiphysis (SCFE). Risks associated with the procedure are well described. We investigated to assess if SHD is associated with significant surgical risk and if it improved clinical outcomes for patients. METHODS: We conducted a prospective cohort study. We reviewed 18 (11 males and 7 females; mean age 13.7 years (6-17) with symptomatic hip pathology, secondary to femoroacetabular impingement (FAI) between 2017 and 2021. All patients underwent a surgical hip dislocation approach and femoral head-neck osteochondroplasty, Head Split osteotomy or both. Clinical improvement was assessed using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. The minimum follow-up was 6 months (mean, 22 months; range, 6-42 months). RESULTS: WOMAC scores improved at final follow-up from 10 to 3 for pain, 33 to 10 for function, and 4 to 2 for the stiffness subscales. All radiographic measures improved significantly of the postoperative X-rays. No patients developed osteonecrosis, implant failure, deep infection, or nonunion. CONCLUSION: Surgical Hip Dislocation, in the short term, we found improvement in WOMAC scores and radiographic indices with a low complication rate.


Subject(s)
Femoracetabular Impingement , Hip Dislocation , Slipped Capital Femoral Epiphyses , Male , Child , Female , Humans , Adolescent , Hip Dislocation/diagnostic imaging , Hip Dislocation/surgery , Hip Dislocation/complications , Prospective Studies , Treatment Outcome , Femoracetabular Impingement/diagnostic imaging , Femoracetabular Impingement/surgery , Femoracetabular Impingement/etiology , Radiography , Slipped Capital Femoral Epiphyses/diagnostic imaging , Slipped Capital Femoral Epiphyses/surgery , Retrospective Studies
4.
BJS Open ; 6(1)2022 01 06.
Article in English | MEDLINE | ID: mdl-35143631

ABSTRACT

BACKGROUND: Coronary artery anastomosis training and assessment are vital for patient safety and for conferring a prognostic benefit. A systematic review and meta-analysis were performed to analyse the impact of simulation on coronary anastomosis proficiency in terms of time taken and skill score. METHODS: This review was conducted in accordance with PRISMA guidelines, searching PubMed, Embase and Cochrane databases on 10 October 2020, using the terms 'Coronary anastomosis simulation' or 'vascular anastomosis simulation' and 'anastomosis simulation'. Studies included had objective measurement of scores of before and after simulation. Meta-analysis was performed using RevMan, version 5.4 (Cochrane Library). RESULTS: From a pool of 1687 articles, 12 articles evaluating the use of simulation in teaching coronary anastomosis were identified, with objective scores at baseline and after simulation. The 12 papers included 274 subjects. Data on 223 subjects could be extracted for analysis in performing coronary anastomosis in a simulated environment. Eight trials evaluated improvement in time and 12 trials evaluated performance using an objective evaluation score. In comparison with no formal simulation training, simulation was associated with improved skill in a five-point scale (standardized mean difference 1.68 (95 per cent c.i. 1.23 to 2.13; P < 0.001)) and time (mean difference 205.9 s (95 per cent c.i. 133.62 to 278.18; P < 0.001)) in trials included in the meta-analysis. Furthermore, novice cardiothoracic surgeons benefited more from simulation as regards time improvement compared with senior cardiothoracic surgeons (293 versus 120 s improvement; P = 0.003). Fidelity of simulator did not have a significant effect on rates of improvement. CONCLUSION: Simulation-based training in coronary anastomosis is associated with improved time efficiency and overall performance in comparison with no intervention. Further studies are necessary to determine the optimum timing of trainees progressing from simulation training to live operating.


Subject(s)
Clinical Competence , Simulation Training , Anastomosis, Surgical , Humans
5.
Ann Thorac Surg ; 112(4): e249-e251, 2021 10.
Article in English | MEDLINE | ID: mdl-33545149

ABSTRACT

Spontaneous regression is defined as the partial or complete resolution of a malignant neoplasm either with treatment that is perceived to be inadequate or in the absence of therapy. This report describes a case of spontaneous regression of a pulmonary metastasis of renal cell carcinoma secondary to metastasectomy in the contralateral lung.


Subject(s)
Carcinoma, Renal Cell/secondary , Lung Neoplasms/secondary , Lung Neoplasms/surgery , Metastasectomy , Neoplasm Regression, Spontaneous/pathology , Pneumonectomy , Aged , Carcinoma, Renal Cell/surgery , Humans , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Male , Nephrectomy
6.
J Card Surg ; 35(11): 3208-3210, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32789895

ABSTRACT

CASE: A 67-year-old female presented with an exceedingly rare cardiac neoplasm - papillary fibroelastoma. This is made rarer still as it occurred on the pulmonary valve. The patient complained of a prolonged history of chest discomfort. Magnetic resonance imaging and echocardiography revealed a pulmonary valve papillary fibroelastoma. Surgical excision proved curative and the patient remains asymptomatic to date. DISCUSSION: The literature surrounding papillary fibroelastomas is discussed. Primary cardiac tumours are uncommon. Papillary fibroelastomas occurring the right side of the heart comprise less than 0.05% of these. They have a characteristic macroscopic appearance which allow them to be easily identified with echocardiography and at surgical excision. They can present in a variety of ways including classical cardiac symptoms, embolic complications or as an incidental finding. Surgical excision is the definitive treatment.


Subject(s)
Cardiac Papillary Fibroelastoma/surgery , Heart Neoplasms/surgery , Pulmonary Valve/surgery , Aged , Cardiac Papillary Fibroelastoma/diagnostic imaging , Echocardiography , Female , Heart Neoplasms/diagnostic imaging , Humans , Magnetic Resonance Imaging , Pulmonary Valve/diagnostic imaging , Rare Diseases , Treatment Outcome
7.
IEEE Trans Vis Comput Graph ; 20(12): 1793-802, 2014 Dec.
Article in English | MEDLINE | ID: mdl-26356893

ABSTRACT

Searching a large document collection to learn about a broad subject involves the iterative process of figuring out what to ask, filtering the results, identifying useful documents, and deciding when one has covered enough material to stop searching. We are calling this activity "discoverage," discovery of relevant material and tracking coverage of that material. We built a visual analytic tool called Footprints that uses multiple coordinated visualizations to help users navigate through the discoverage process. To support discovery, Footprints displays topics extracted from documents that provide an overview of the search space and are used to construct searches visuospatially. Footprints allows users to triage their search results by assigning a status to each document (To Read, Read, Useful), and those status markings are shown on interactive histograms depicting the user's coverage through the documents across dates, sources, and topics. Coverage histograms help users notice biases in their search and fill any gaps in their analytic process. To create Footprints, we used a highly iterative, user-centered approach in which we conducted many evaluations during both the design and implementation stages and continually modified the design in response to feedback.

SELECTION OF CITATIONS
SEARCH DETAIL
...