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Thoracic vasculitis presenting as surgical problems.  Envoyer
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Thoracic vasculitis presenting as surgical problems.

Virchows Arch. 2010 Jan;456(1):91-6

Authors: Jansen M, Saleh S, Bolster M, O'Donnell A, Ahern T, Spence L, Sheppard MN, Burke L

We present four patients with vasculitis manifesting with unusual clinical or pathological features, generating surgical problems. Two cases presented with pulmonary hypertension, with investigations and radiological evidence prompting clinical suspicion of pulmonary thrombo-embolic disease. First case, with an antecedant history of Wegener's granulomatosis (WG), demonstrated following "embolectomy", WG involving the large pulmonary elastic arteries. The second case of inoperable "pulmonary thrombo-embolic disease" was subsequently found at limited post mortem to have giant cell arteritis, which affected widespread small peripheral pulmonary arterial vessels. The other two cases were of aortitis occurring in the background of immune-mediated disease, which had been treated with aggressive immunosuppression regimens. The first of these was a case of Cogan's syndrome complicated by descending aortitis, a rarely reported phenomenon, with co-existent acute endocarditis of the aortic valve leaflets. Most cases of endocarditis in this context occur secondary to and in continuity with ascending aortitis. That this case, and a case of ascending aortitis occurring in the context of relapsing polychondritis occurred in the face of aggressive immunosuppression with an apparent clinical response, underscores the need to not accept a clinical picture at face value. This has implications for clinical management, particularly in the follow-up of surgical prosthetic devices such as grafts which may be used in these cases. All four cases emphasise the continued importance of histology and the post-mortem examination in elucidating previously undetected or unsuspected disease.

PMID: 20012090 [PubMed - indexed for MEDLINE]

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Percutaneous osteoplasty for the management of a femoral head metastasis: a case report.  Envoyer
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Percutaneous osteoplasty for the management of a femoral head metastasis: a case report.

Korean J Radiol. 2009 Nov-Dec;10(6):641-4

Authors: Wang WG, Wu CG, Gu YF, Li MH

Percutaneous osteoplasty (POP) as a technical extension of percutaneous vertebroplasty (PVP) has been used to treat malignant disease that affects the skeletal system. POP has demonstrated good outcome for pain relief and functional improvement. Few studies have reported on the efficiency of POP to treat malignancies located in the femoral head. We designed a pilot study with the use of POP to treat intractable pain caused by a femoral head metastatic tumor in a 43-year-old man. During the follow-up period, the patient experienced sustained pain relief and improvement of quality of life that persisted for more than three months.

PMID: 19885322 [PubMed - indexed for MEDLINE]

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Fatal gemcitabine-induced pulmonary toxicity in metastatic gallbladder adenocarcinoma.  Envoyer
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Fatal gemcitabine-induced pulmonary toxicity in metastatic gallbladder adenocarcinoma.

Cancer Chemother Pharmacol. 2010 Feb;65(3):607-10

Authors: Galvão FH, Pestana JO, Capelozzi VL

Gemcitabine is a chemotherapy agent that may cause unpredictable side effects. In this report, we describe a fatal gemcitabine-induced pulmonary toxicity in a patient with gallbladder metastatic adenocarcinoma. A 72-year-old patient was submitted to an elective laparoscopic cholecystectomy, and a tubular adenocarcinoma in the gallbladder was incidentally diagnosed. CT scan and ultrasound before the surgery did not show any tumor. After the surgery a Pet scan was positive for a hot-spot in the left colon. The colonic lesion was conveniently removed and the histology evaluation confirmed the diagnosis of adenocarcinoma tubular. The patient was then submitted to three sections of 1,600 mg/m2 of gemcitabine with intervals of 1 week. Three weeks later he developed severe respiratory distress. A helicoidal CT scan showed diffuse and severe interstitial pneumonitis, and lung biopsy confirmed accelerated usual interstitial pneumonia consistent with drug-induced toxicity. The patient presented unfavorable evolution with progressive worsening of respiratory function, hypotension, and renal failure. He died 1 month later in spite of methylprednisolone pulse therapy, large spectrum antimicrobial therapy, and full support of respiratory, hemodynamic and renal systems. Gemcitabine-induced pulmonary toxicity is usually a dramatic condition. Physicians should suspect pulmonary toxicity in patients with respiratory distress after gemcitabine chemotherapy, mainly in elderly patients.

PMID: 19904536 [PubMed - indexed for MEDLINE]

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Non-Hodgkin's lymphoma presenting as an isolated soft-tissue chest wall mass [Images in cardio-thoracic surgery]  Envoyer
Author:Peters, P., Butler, N., Mundy, J., Shah, P.

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[Arterial and venous thrombosis in lung cancer]  Envoyer
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[Arterial and venous thrombosis in lung cancer]

Rev Mal Respir. 2009 Sep;26(7):783-7

Authors: Dres M, Ferré A, Marie Allain Y, Giraud F, Horellou MH, Gaudric J, Huchon G, Roche N

We report the case of a 61-year old man in whom a deep venous thrombosis was the presenting feature of disseminated lung carcinoma. A few days later, an arterial thrombosis occurred necessitating amputation. Within a few weeks, the lung cancer progressed dramatically and the patient died. While the association between venous thrombosis and cancer is well known, the relationship between cancer and arterial thrombosis has been less explored. This observation allows discussion of the pathophysiological and clinical aspects of this association, as well as the implications for patient care.

PMID: 19953022 [PubMed - indexed for MEDLINE]


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