Spontaneous Isolated Superior Mesenteric Artery Dissection With Thrombosis: A Case Report of a Rare Presentation of Acute Abdominal Pain.

Spontaneous isolated superior mesenteric artery dissection is a very rare vascular disease that involves the superior mesenteric artery or its branches, with an incidence as low as 0.08%. The majority of cases occur in patients of Asian descent. Due to advances in imaging modalities, particularly abdominal computed tomography angiography, the diagnosis of this disease has been increasing. Herein, we present a rare case of spontaneous isolated superior mesenteric artery dissection with thrombosis in a young male patient with no past medical history. The importance of this disease as a differential diagnosis for acute abdominal pain is emphasized.

La dissection isolée spontanée de l'artère mésentérique supérieure est une maladie vasculaire très rare qui affecte l'artère mésentérique supérieure ou ses branches, et dont l'incidence s'élève à peine à 0,08 %. La majorité des cas surviennent chez des patients d'ascendance asiatique. En raison des progrès réalisés dans les modalités d'imagerie, et en particulier de l'angiographie abdominale par tomodensitométrie, le diagnostic de cette affection est en hausse. Nous présentons ici un rare cas de dissection isolée spontanée de l'artère mésentérique supérieure avec thrombose chez un jeune patient sans antécédents médicaux. L'importance de cette maladie dans le diagnostic différentiel de la douleur abdominale aiguë est mise en évidence.

Efficacy and Safety of Catheter Ablation vs Antiarrhythmic Drugs as Initial Therapy for Management of Symptomatic Paroxysmal Atrial Fibrillation: A Meta-Analysis.

BACKGROUND: Catheter ablation is an effective treatment for atrial fibrillation (AF), primarily performed in patients who fail antiarrhythmic drugs. Whether early catheter ablation, as first-line therapy, is associated with improved clinical outcomes remains unclear. METHODS: Electronic databases (PubMed, Scopus, Embase) were searched until March 28th, 2021. Randomized controlled trials (RCTs) compared catheter ablation vs antiarrhythmic drug therapy as first-line therapy were included. The primary outcome of interest was the first documented recurrence of any atrial tachyarrhythmia (symptomatic or asymptomatic; AF, atrial flutter, and atrial tachycardia). Secondary outcomes included symptomatic atrial tachyarrhythmia (AF, atrial flutter, and atrial tachycardia) and serious adverse events. Unadjusted risk ratios (RR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance considered if the confidence interval (CI) excludes one and p < 0.05. RESULTS: A total of six RCTs with 1212 patients (Ablation n = 609; Antiarrhythmic n = 603) were included. Follow- up period ranged from 1-2 years. Patients who underwent ablation were less likely to experience any recurrent atrial tachyarrhythmia when compared to patients receiving antiarrhythmic drugs (RR 0.63; 95% CI 0.55-0.73; p < 0.00001). Symptomatic atrial tachyarrhythmia was also lower in the ablation arm (RR 0.53; 95% CI 0.32-0.87; p = 0.01). No statistically significant differences were noted for overall any type of adverse events (RR 0.93; 95% CI 0.68-1.27; p = 0.64) and cardiovascular adverse events (RR 0.90; 95% CI 0.56-1.44; p = 0.65) respectively. CONCLUSIONS: Catheter ablation, as first-line therapy, was associated with a significantly lower rate of tachyarrhythmia recurrence compared to conventional antiarrhythmic drugs, with a similar adverse effect risk profile. These findings support a catheter ablation strategy as first-line therapy among patients with symptomatic paroxysmal atrial fibrillation.

Leptomeningeal Carcinomatosis of Metastatic Primary Prostate Cancer.

Leptomeningeal carcinomatosis (LC) is an uncommon complication of cancer in which the disease metastasizes to the meninges; it is estimated that this occurs in 5% of cancer patients and is most often terminal. LC has a median survival time of approximately 15.7 weeks [Leal et al., Curr Cancer Ther Rev. 2011;7(4):319-27]. Furthermore, metastasis from the prostate is exceptionally rare with only a few cases described in medical literature. Until recently, leptomeningeal disruption was very rare and cerebral involvement was irrelevant [Bubendorf et al., Hum Pathol. 2000;31(5):578-83; Schaller et al., Br J Cancer. 2000;77(12):2386-9]. With improved imaging, diagnostic modalities, and treatment with therapies that do not cross the blood-brain barrier, the incidence of LC has been on the rise [Batool and Kasi, StatPearls, https://www.ncbi.nlm.nih.gov/books/NBK499862/]. Diagnosis previously relied on biopsy, supported by lumbar puncture findings. We submit a case demonstrating progressive and consistent evidence of LC found on imaging, justifying its acceptance as a diagnostic modality.

Ruptured ectopic pregnancy after hysterectomy with copper intrauterine device in place: A case report.

INTRODUCTION: Ectopic pregnancy after hysterectomy is a rare event, with 72 cases being reported since 1895. Concomitant use of reliable contraception at the time of hysterectomy makes pregnancy extremely unlikely, but, as this case illustrates, does not completely rule out the possibility of post-hysterectomy ectopic pregnancy. CASE: A 30-year-old woman experienced a ruptured fallopian tube ectopic pregnancy four weeks after a laparoscopic-assisted vaginal hysterectomy and left salpingo-oophorectomy. At the time of her hysterectomy, a copper intrauterine device was in place. CONCLUSION: Women with ovaries who present with abdominal or pelvic pain should be evaluated for pregnancy regardless of contraceptive use or history of hysterectomy.