Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73‐year‐old woman

Pericardial effusion is commonly seen in patients with hypothyroidism, but a massive pericardial effusion with obvious diastolic right ventricular compression is uncommon. We herein report a case of 73‐year‐old woman seen in the ED with generalized weakness and hypotension. Echocardiography revealed a massive pericardial effusion with diastolic right ventricular compression, and thyroid function testing revealed marked hypothyroidism. The pericardial effusion resolved after the administration of thyroid replacement therapy. This case reveals the importance of including hypothyroidism in the differential diagnosis of pericardia effusion.     

Acute ST‐elevation myocardial infarction in a 24‐year‐old woman with atheromatous coronary artery disease

We report the case of a 24‐year‐old Torres Strait Islander woman who presented to a rural hospital ED with chest pain suspicious for myocardial ischaemia and was found to have an anterior ST‐elevation myocardial infarction. She was thrombolysed and transferred to a tertiary centre where subsequent angiography revealed atheromatous disease of the left anterior descending coronary artery. We believe this to be one of the youngest reported cases of myocardial infarction due to atheromatous coronary artery disease, and demonstrates important learning points regarding the demographics and risk factors of indigenous patients with chest pain.     

Apixaban used for the management of heparin‐induced thrombocytopenia in a 72‐year‐old woman with lung cancer

Heparin‐induced thrombocytopenia (HIT) is a serious adverse reaction to heparin treatment with a high risk of thrombosis. Heparin must be discontinued immediately and replaced with alternative anticoagulants that do not interact with HIT antibodies. In this case, a lung cancer patient, diagnosed with HIT was successfully treated with apixaban.     

Effects of blood‐flow‐restricted resistance training on muscle function in a 74‐year‐old male with sporadic inclusion body myositis: a case report

Sporadic inclusion body myositis (sIBM) is a systemic disease that is characterized by substantial skeletal muscle weakness and muscle inflammation, leading to impaired physical function. The objective was to investigate the effect of low‐load resistance exercise with concurrent partial blood flow restriction to the working muscles (blood‐flow‐restricted (BFR) training) in a patient with sIBM. The training consisted of 12 weeks of lower extremity BFR training with low training loads (~25‐RM). The patient was tested for mechanical muscle function and functional capacity before and after 6 and 12 weeks of training. Maximal horizontal gait speed increased by 19%, which was accompanied by 38–92% improvements in mechanical muscle function (maximal isometric strength, rate of force development and muscle power). In conclusion, BFR training was well tolerated by the patient with sIBM and led to substantial improvements in mechanical muscle function and gait speed.     

Ileocolocolic intussusception secondary to a submucosal lipoma: An unusual cause of intermittent abdominal pain in a 62‐year‐old woman

We present a case of subacute nonobstructing ileocolocolic intussusception secondary to a submucosal lipoma and a mobile cecum diagnosed sonographically in a 62‐year‐old woman. The patient was seen following a 2‐month history of nonspecific intermittent pain in the right and middle abdomen and weight loss. Sonography revealed ongoing intussusception involving distal ascending and transverse colon. Analysis of the distal intussusception end demonstrated a 3.0 × 2.5 cm echogenic polypoid lesion consistent with a lipoma serving as a lead point. The sonographic diagnosis was confirmed at surgery. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010.     

Laparoscopic repair of Bochdalek hernia with intrathoracic kidney in a 2‐year‐old child

Intrathoracic kidney with Bochdalek hernia is a very rare congenital anomaly. Some case reports have discussed repair by laparotomy or thoracotomy. We report a case in a child performed using a laparoscopic approach. A 2‐year‐old boy arrived at our hospital with gastric volvulus caused by a left‐sided Bochdalek hernia. CT also showed a left‐sided intrathoracic kidney. After conservative therapy for the volvulus, laparoscopic repair of the diaphragmatic hernia was performed. The key problem during the operation was the presence of the intrathoracic kidney. If direct closure of the hernia had been performed without the intrathoracic kidney having been relocated to the abdomen, a complete closure would have been impossible because of the renal vessels. After the intrathoracic kidney was relocated to the abdomen, the diaphragmatic defect was closed. The boy has been doing well without complications for 5 years, and CT reveals that the left‐sided kidney is almost normally positioned.     

Intravenous lobular capillary hemangioma occurring in the cephalic vein of a 39‐year‐old adult

Intravenous lobular capillary hemangiomas are extremely uncommon and mostly occur in the veins of the neck and upper extremities. Here, we report the clinical and sonographic features of an intravenous lobular capillary hemangioma localized in the right cephalic vein, and we discuss its pathologic findings and differential diagnoses. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :375–378, 2014     

Malignant peripheral nerve sheath tumor of the third eyelid in a 3‐year‐old Rhodesian Ridgeback

A 3‐year‐old Rhodesian Ridgeback was presented with conjunctivitis, enlargement of the third eyelid and a dorsotemporal deviation of the right eye. A mass within the third eyelid was detected and excised. The histopathologic examination showed a malignant peripheral nerve sheath tumor, which most likely is a neurofibrosarcoma based on immunohistochemistry.     

Incidental case finding of a 19‐year‐old woman with Tuberous Sclerosis Complex: A step‐wise Multidisciplinary approach

Radiological imaging plays a vital role in clinically diagnosing TSC. TSC prognosis is largely determined by the severity and the extent of the systems affected by it. TSC patients are symptomatically managed, since no cure is present. Healthcare professionals must frequently check‐up TSC patients who have a lifelong disorder.     

Measurement of maximal isometric torque and muscle quality of the knee extensors and flexors in healthy 50‐ to 70‐year‐old women

Muscle quality is defined as strength per unit muscle mass. The aim of this study was to measure the maximal voluntary isometric torque of the knee extensor and flexor muscle groups in healthy older women and to develop an index of muscle quality based on the combined knee extensor and flexor torque per unit lean tissue mass (LTM) of the upper leg. One hundred and thirty‐six healthy 50‐ to 70‐year‐old women completed an initial measurement of isometric peak torque of the knee extensors and flexors (Con‐Trex MJ; CMV AG, Dubendorf, Switzerland) that was repeated 7 days later. Subsequently, 131 women returned for whole‐ and regional‐body composition analysis (iDXA^?; GE Healthcare, Chalfont St Giles, Buckinghamshire, UK). Isometric peak torque demonstrated excellent within‐assessment reliability for both the knee extensors and flexors (ICC range: 0·991–1·000). Test–retest reliability was lower (ICC range: 0·777–0·828) with an observed mean increase of 5% in peak torque [6·2 (17·2) N m] on the second day of assessment (P<0·001). The relative mean decrease in combined isometric peak torque (?12·2%; P = 0·001) was double that of the relative, non‐significant, median difference in upper leg LTM (?5·3%; P = 0·102) between those in the 5th and 6th decade. The majority of difference in peak isometric torque came from the knee extensors (15·1 N m, P<0·001 versus 2·4 N m, P = 0·234). Isometric peak torque normalized for upper leg LTM (muscle quality) was 8% lower between decades (P = 0·029). These findings suggest strength per unit tissue may provide a better indication of age‐related differences in muscle quality prior to change in LTM.     

Plasma exchange in a 13‐year‐old male with acute intravascular hemolysis and acute kidney injury after placement of a ventricular assist device

Intravascular hemolysis and resulting plasma‐free hemoglobin elevation has been associated with acute kidney injury via several mechanisms. Proximal tubular injury due to iron compound deposition and nitric oxide sequestration with subsequent impairment of the microcirculation and hypoperfusion are specific adverse effects of intravascular hemolysis that may contribute to acute kidney injury. Therefore, removal of plasma‐free hemoglobin and restoration of normal nitric oxide vasodilatory mechanisms may play a beneficial role in treating acute kidney injury secondary to acute intravascular hemolysis. We report herein the case of a 13‐year‐old patient with severe intravascular hemolysis and acute kidney injury and describe the role of plasma exchange with plasma replacement in his successful recovery. J. Clin. Apheresis 27:274–277, © 2012 Wiley Periodicals, Inc.     

Peripheral blood stem cell recovery following early termination of apheresis due to hypotension in a 4.8‐kg infant

We report a case in which peripheral blood stem cells (PBSC) were successfully recovered following early termination of a collection procedure due to hypotension in a 7‐month‐old patient. The patient was diagnosed at 4 months of age with neuroblastoma stage IV‐S with favorable Shimada histology. She had completed two cycles of chemotherapy before the PBSC collection (PSCC). The procedure was performed on the Cobe Spectra in manual mode, and terminated after 35 min due to severe hypotension. Etiologies considered for the hypotensive episode included a transfusion reaction to the unit of red blood cells (RBC) used for priming the Spectra, citrate reaction, and hypovolemia due to blood drawn for laboratory testing and fluid shifts at the beginning of the procedure. Hypovolemia was ultimately determined to be the most likely etiology. A rinseback was performed into a transfer bag, and the cells were sent to the laboratory for analysis of CD34+ cell yield, volume reduction, and cryopreservation. An adequate number of PBSC were recovered to permit successful autologous transplantation. The ability to recover PBSC from the Spectra white blood cell collection set allowed the patient to avoid undergoing another PSCC. In procedures involving small children, the blood volume drawn for preprocedure testing should be limited to less than 10% of the patient's total blood volume, and the RBC prime should at a minimum replace the entire extracorporeal volume. If the procedure must be terminated early, sufficient PBSC may be recoverable from the blood in the apheresis instrument. J. Clin. Apheresis 2009. © 2009 Wiley‐Liss, Inc.     

Simultaneous quantification of myocardial perfusion,oxidative metabolism,cardiac efficiency and pump function at rest and during supine bicycle exercise using 1‐11C‐acetate PET – a pilot study

Background: PET using 1‐¹¹C‐acetate (ACE‐PET) applied at rest is used for measuring absolute myocardial blood flow (MBF) and oxidative metabolic rate (k_mono). We evaluated the feasibility of quantitative ACE‐PET during exercise. Methods: Five endurance athletes underwent dynamic PET scanning at rest and during supine bicycle stress. Exercise was maintained at a workload of 120 Watt for 17 min. The rate‐pressure product (RPP) was recorded repeatedly. MBF, k_mono in left (LV) and right (RV) ventricular wall, cardiac output (CO), cardiac efficiency and a lung uptake value reflecting left heart diastolic pressures were calculated from the PET data using previously validated models. Results: MBF increased from 0·71 ± 0·17 to 2·48 ± 0·25 ml min^?1 per ml, LV‐k_mono from 0·050 ± 0·005 to 0·146 ± 0·021 min^?1, RV‐k_mono from 0·023 + 0·006 to 0·087 + 0·014 min^‐1, RPP from 4·7 ± 0·8 to 13·2 ± 1·4 mmHg × min^?1 × 10³ and Cardiac Output from 5·2 ± 1·1 to 12·3 ± 1·2 l min ^?1 (all P < 0·001). Cardiac efficiency was unchanged (P = 0·99). Lung uptake decreased from 1·1 ± 0·2 to 0·6 ± 0·1 ml g^?1 (P < 0·001). Discussion: A number of important parameters related to cardiac function can be quantified non‐invasively and simultaneously with a short scanning protocol during steady state supine bicycling. This might open up new opportunities for studies of the integrated cardiac physiology in health and early asymptomatic disease.     

Use of the transabdominal approach to repair Morgagni hernia in a 28‐year‐old symptomatic female: A case report

Morgagni''s hernia is a congenital diaphragmatic hernia, which represents only 3% of all diaphragmatic hernias. Herein, we report a case of a 28‐year‐old symptomatic female patient with Morgagni''s hernia who underwent a transabdominal surgery for hernia repair and mesh placement.     

Isolated torsion of the fallopian tube associated with hydrosalpinx in a 17‐year‐old sexually inactive girl: A case report

Isolated tubal torsion is an unusual cause of acute abdominal pain in young sexually inactive patients. However, it should be still taken into account regarding the differential diagnosis of such conditions.     

Evaluation of the spectra optia apheresis system for mononuclear cell (MNC) collection in G‐CSF mobilized and nonmobilized healthy donors: Results of a multicenter study

The Spectra Optia apheresis system is a newer centrifugation‐based device that in comparison with the COBE Spectra includes features that enhance procedure automation and usability. In this FDA‐approved three‐center two‐arm observational study we characterized the performance of the Spectra Optia for collection of MNCs and CD34+ cells from nonmobilized and granulocyte‐colony stimulating factor (G‐CSF) mobilized healthy donors, respectively. There were a total of 15 evaluable subjects in each arm. Key performance indicators included collection efficiency of MNCs/CD34+ cells, product purity and cellular viability. For nonmobilized donors, median MNC collection efficiency, platelet collection efficiency, product hematocrit and granulocyte contamination were 57%, 12%, 4%, and 1.7%, respectively. For mobilized donors, median MNC collection efficiency, CD34+ cell collection efficiency, platelet collection efficiency, product hematocrit and granulocyte contamination were 61%, 77%, 19%, 4%, and 15%, respectively. Average WBC viability in the mobilized products was 99%. There was one severe (grade 3) adverse event related to citrate toxicity. This study demonstrates that the Spectra Optia can be used for safe and efficacious collection of MNCs, and results obtained are in line with expectations on collection efficiency and product characteristics. Adverse events were limited to those that are well documented in the stem‐cell mobilization and leukapheresis process. As of the time of this writing, FDA 510(k) approval for use of the Spectra Optia device for MNC collection was achieved in the US based partly on the results of this study. J. Clin. Apheresis 29:273–280, 2014. © 2014 Wiley Periodicals, Inc.     

Dynamic contrast‐enhanced computed tomography for the quantification of tumor response to vasoactive agents in a rat tumor model: preliminary results

Rationale and Objectives

The purpose of this pilot study was to establish the ability of dynamic contrast enhanced computed tomography (DCE‐CT) to detect changes in tumor blood flow (BF) and oxygenation induced by vasoactive substances in rats.

Materials and Methods

Under ultrasound guidance, a fiber‐optic probe was guided into thigh tumors in eight rats and attached to an oxygenation/blood flow‐sensing device. A DCE‐CT sequence was acquired at the oxygen‐sensing probe tip during injection of iodinated contrast media. Group 1 rats (n = 6) were administered a vasodilator (hydralazine, 5 mg/kg i.v.) and group 2 rats (n = 2) were given physiologic saline in a similar volume. DCE‐CT was repeated at the probe tip after 30 min. BF in the whole tumor and at the probe tip were estimated pre‐ and post‐drug administration and the percentage change was calculated.

Results

DCE‐CT defined significant differences between pre‐ and post‐drug BF in the whole tumor (p = 0.007) and at the probe tip (p = 0.03). Estimates of percentage change in BF in the whole tumor agreed with fiber‐optic measure of percentage change perfusion (r² = 0.60; p = 0.02) and pO₂ (r² = 0.65; p = 0.02). Estimates of percentage change in BF at the probe tip agreed with fiber‐optic measures of percentage change in perfusion (r² = 0.83; p = 0.001) and pO₂ (r² = 0.62; p = 0.02).

Conclusions

Preliminary results indicate that DCE‐CT is capable of identifying alterations in tumor BF in rats. The percentage change in BF agrees with a validated estimate of tumor perfusion and oxygenation. This research technique may prove useful for assessment of tumor BF during combined chemotherapeutic and radiation therapy to improve outcome. Copyright © 2010 John Wiley & Sons, Ltd.