A Complex Cardiac Mass Originating from Interatrial Septum in a Patient with History of Kidney Cancer: A Case Report and Literature Review.

Cardiac tumors are a rare phenomenon, and most cases are secondary to metastatic cancers rather than primary tumors. Renal cell carcinoma (RCC) is notorious for metastasis to cardiac tissue. Tumor thrombus migration to the renal vein and inferior vena cava happens in up to 10% of patients with RCC. Transitional cell carcinomas are another form of renal cancer, which may metastasize to the heart and are associated with widespread metastasis. Here, we report a patient with a past medical history of metastatic transitional cell cancer of renal pelvis under treatment with checkpoint inhibitor therapy presenting with shortness of breath. He had disseminated metastasis to bones, pleural space, lungs, and muscles. A large mass was found in the interatrial septum with invasion to the right and left atrium. The mass had a cystic component protruding into the left atrium. He passed away a few days after presentation.

A Patient Presenting with Cardiac Tamponade and the Challenges of Finding Its Cause: A Cardiac Angiosarcoma.

Primary malignancies of the heart are so rare that most of the available data come from case reports or large single-center-based studies, with the overall incidence of 0.02% in the United States. Diagnosis in case of an isolated pericardial effusion as presentation is challenging, and determining that an angiosarcoma is even more challenging. Here, we presented a rare case of pericardial angiosarcoma which presented to us with tamponade. The patient eventually was diagnosed through pericardiectomy. A multimodality approach was attempted to treat the cancer. The clinical details of such a unique disease entity inspired us to present it as a case report.

Burkholderia Aortic Aneurysm: A Case Report and Review of the Literature.

Melioidosis is a frequently fatal infection caused by the Gram-negative bacillus Burkholderia pseudomallei endemic to Southeast Asia and Northern Australia. It is a rare imported pathogen in the United States and is a potential bioterror agent. We report the case of an 82-year-old previously healthy man who presented with 2 weeks of fever and epigastric pain after he returned from the Philippines. A diagnosis of nondissecting mycotic aneurysm in the descending thoracic aorta was made with the help of CT angiogram and positive blood cultures. The patient completely recovered with a 6-month antibiotic therapy followed by surgical repair of the aneurysm. Given the slight increase in the number of melioidosis cases reported by CDC since 2008, melioidosis might be considered an emerging infectious disease in the United States. The purpose of this report is to raise awareness of the disease among clinicians as well as travelers.

Subclinical Hypothyroidism and Its Association with Increased Cardiovascular Mortality.

Thyroid hormones play an important role in regulating different metabolism functions and multiple organs' performance. Changes in the thyroid hormone axis can lead to profound effects on the stability of vital organs and systems, especially the cardiovascular system. Hypothyroidism is classified according to the clinical presentation as overt and subclinical. There is some evidence supporting the benefits of thyroxine hormone replacement for subclinical hypothyroidism on cardiovascular mortality outcomes. However, the clinical relevance of measuring and treating high thyroid-stimulating hormone (TSH) levels in newly diagnosed heart failure patients with preserved ejection fraction requires further study. In this report, we review the current evidence regarding the prognostic significance of subclinical hypothyroidism in heart failure patients with preserved ejection fraction.

Clot in Lung, Clot in Heart: A Case Report of Tumor-Like Thrombus in Right Atrium.

Tumor-like formation of thrombus in the right atrial cavity is rare. It may be mistaken for a myxoma. The exact pathophysiology of an isolated thrombus in the heart is still unclear. Management to prevent complications such as pulmonary thromboembolism depends on the clinical judgment of a cardiologist. This report describes a 76-year-old woman with right atrial thrombus causing subsequent pulmonary thromboembolism in right lung. She initially presented to us with pulmonary embolism, and later, an incidental finding of a mass in her right atrium revealed an association of thrombus in heart with thrombus in lung. The challenging management was to resect this thrombus which was fixed to atrial septum, and a trial of anticoagulation did not resolve it. Exact management of such incidental findings in right heart cavities is not well established. Some cases may benefit from resection of such formed fixed thrombus.

Epidemiologic survey of infantile cancer in Iran based on the data of the largest pediatric cancer referral center (Ali- Asghar Children Hospital), 1996-2005.

BACKGROUND: Cancer in infants younger than one year of age represents a unique problem with distinct epidemiological, clinical and genetic characteristics compared with older age groups. No report is yet available from Iran regarding epidemiological and survival rate of cancers diagnosed in this age group. MATERIALS AND METHODS: The population under study comprised of patients which were diagnosed and admitted to Ali-Asghar hospital between years 1996-2005. In total, 287 infants were included in the retrospective descriptive survey. Patient files were evaluated for age of patient at the time of diagnosis, sex, geographical residence, consanguinity of parents, histological diagnosis, site of cancer involvement, type of therapy, date of last follow-up and cause of death (if applicable). RESULTS: The average age at the time of diagnosis was 7.2 months old. The most frequent malignancy was retinoblastoma (44%), followed by leukemia (19%) and neuroblastoma (10%), with five-year overall survival rates of 77.7%, 41% and 90%, respectively Parents of 40 infants (13.9%) had consanguinity relationships. CONCLUSIONS: Although we cannot make any conclusions regarding the incidence of infant cancer subtypes based on this study, survival rates for major types were similar to the developed countries, which signifies strict adherence to standards of care in Ali-Asghar hospital, the main infant cancer care centre in Iran. A Childhood Cancer Registry with high-resolution data collection and also advanced genetic testing is advocated for in-depth analysis of variation in incidence and survival.

Perspectives of Iranian medical students about do-not-resuscitate orders.

OBJECTIVE: To study the attitudes of Iranian medical students towards the do-not-resuscitate (DNR) decision. METHODS: In this cross-sectional study, 220 medical students (110 interns and 110 residents) of Tehran University of medical sciences were selected. They asked to answer to the questionnaire which included two items: first item consisted of demographic questions (age, sex, and level of education); second item included questions about DNR Orders which derived from a previous study conducted by Hosaka et al. RESULTS: A total of 185 questionnaires returned (Response rate (RR=84%)). Ninety five were residents and ninety were interns. Seventy four percent of residents and 53% of interns felt that DNR order is sporadically necessary. Near 30% of interns and 40% of residents had participated in DNRs in their study period and the most case was the patient with terminal cancer. The most common person who decided DNR orders were physicians.Most participants believed that DNR cards are useful for establishing in clinical settings. CONCLUSION: As DNR is definitely a medical decision, it should be clearly discussed with patients and their families. So, it should be provided in standard format in medical situations.