High-grade B-cell lymphoma with MYC and BCL6 rearrangements presenting as a cervical mass.

Lymphoid malignancies represent 0. 008% of all cervical tumours. While uncommon, lymphoid malignancies of the gynaecological tract require careful diagnosis and classification to ensure appropriate treatment. We present a case of a 54-year-old woman with HIV who presented with urinary and faecal incontinence for 2 weeks, associated with the feeling of a mass in her vagina. A smooth flesh-coloured pelvic mass was seen on physical examination, and a transvaginal biopsy revealed infiltration of atypical lymphoid cells with fluorescence in situ hybridisation positive for MYC and BCL6, and negative for IGH/BCL2. Bone marrow and cerebral spinal fluid analysis also showed involvement by atypical lymphocytes. She was diagnosed with stage IV high-grade B-cells lymphoma (HGBLs) with MYC and BCL6 rearrangements. She was given R-CODOX-M plus IVAC with no evidence of disease at 4-month follow-up. To our knowledge, this is the first literature report of a HGBL with MYC and BCL6 rearrangement presenting as a cervical mass.

Mechanisms of Lead Failure by Recall Status and Manufacturer: Results From the Pacemaker and Implantable Defibrillator Leads Survival Study ("PAIDLESS").

OBJECTIVES: The aim of this study was to determine the differences in lead failure mechanisms across the major United States implantable defibrillator lead manufacturers (Boston Scientific, Medtronic, and St. Jude Medical), between all non-recalled and recalled leads, and between two recalled lead families (Medtronic Sprint Fidelis and the St. Jude Medical Riata and Riata ST). METHODS: This was a single-center, non-randomized, retrospective study analyzing 3802 patients with 4078 leads who underwent implantable defibrillator lead implantation between February 1, 1996 and December 31, 2011. Lead failure mechanisms were defined as lead fracture, insulation defect, and other. RESULTS: A total of 153 leads (3.8%) failed during the trial period. Failed Medtronic and St. Jude Medical leads presented predominantly as lead fractures (75.8% and 52.8%, respectively). Failed Boston Scientific leads displayed greater variability, although many also failed by fracture (44.4%). The majority of failed non-recalled and recalled leads presented as fractures (50.7% and 82.9%, respectively). The recalled Medtronic Sprint Fidelis and St. Jude Medical Riata/Riata ST leads primarily presented as fractures (89.3% and 65.0%, respectively). Patients whose lead failed via an insulation defect or other mechanism appeared to have a faster time to mortality following lead failure than patients whose lead failed via fracture (P<.01 and P=.02, respectively). CONCLUSIONS: Lead fracture is the most common form of lead failure regardless of the failure points previously identified in these leads. Patients who experienced a lead failure as a result of an insulation defect or other mechanism appeared to die faster than patients whose lead failed via fracture.

The Development of Innovative Handheld Devices to Augment Cardiopulmonary Resuscitation Therapy and External Cardioversion and Defibrillation.

Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) devices were conceived and invented by Drs. Todd Cohen and Keith Lurie to improve the low survival rates for conventional CPR. Active decompression creates greater chest recoil as compared with the passive decompression used in standard CPR, leading to increased preload and greater cardiac output. ACD CPR devices use a suction cup to adhere themselves to the patient's chest. Putting downward force onto the device allows for the operator to actively compress the chest. Active chest decompression is achieved by pulling up on the device (using its suction), which in turn pulls up on the patient's chest, enabling greater chest expansion. Animal and human studies have demonstrated an improvement in overall circulation when using ACD CPR versus standard CPR. The impedance threshold device (ITD) was created to enhance ACD CPR. This device connects to the patient's airway and prevents the influx of air during chest decompression. ACD CPR plus ITD improves myocardial and cerebral perfusion, increases survival rates, and is associated with more favorable neurological outcomes. CPR guidelines permit the use of the above two devices by properly trained personnel. Additionally, an insulated handheld compression device can be actively applied over a standard defibrillation patch to decrease transthoracic impedance. This methodology has been incorporated into a patented PrestoPush™ device (Nexus Control Systems LLC, Port Washington, NY, USA), which is a handheld external cardioversion/defibrillation augmenter. This paper reviews the development of these innovative devices to augment standard CPR and external cardioversion and defibrillation, including summaries of studies the authors consider to those that are most significant in ACD CPR development.