Teratomas are the most common type of Germ Cell Tumors (GCTs). GCTs are classified as extragonadal, if there is no evidence of a primary tumor in neither the testicles, nor in the ovaries. Intracranial Mature Teratomas are tumors with a very low incidence, and clear male predominance. We present the case of a 21-year-old female patient, with a history of two seizures 15 days prior to admission, without any abnormalities upon physical examination. The Magnetic Resonance Imaging (MRI) performed at the admission evidenced an expansive, heterogeneous lesion in the frontal lobe, hypointense on T1-weighted images, hyperintense on T2-weighted images, and restriction on the diffusion imaging and ADC-mapping. The patient underwent microsurgical resection, and it was possible to achieve a near-total resection. During surgery, a welldefined capsule was identified, which was removed after adequate debulking. Tissues resembling hair were taken from inside the lesion. The patient recovered well, without any neurological deficits, and no further intervention was necessary. The authors aim to describe this rare pathology and their option for a surgical approach. Os teratomas são o tipo mais comum de Tumores de Células Germinativas (TCG). TGC são classificados como extragonadais, quando não há evidências de um tumor primário em nos testículos, ou nos ovários. Os Teratomas Maduros Intracranianas são tumores com uma incidência muito baixa, e com uma predileção pelo sexo masculino. Nós apresentamos o caso de uma paciente, feminina, 21 anos de idade, com história de dois episódios de convulsões tônico-clônicas generalizadas, 15 dias antes da admissão, sem nenhum déficit focal ao exame físico. A Ressonância Magnética realizada na chegada mostrou uma lesão sólida, expansiva, grande e heterogênea, hipointensa em T1, e hiperintensa em T2, com restrição a difusão e ADC-mapping. Foi realizado uma cirurgia, e foi possível obter uma ressecção quase total. Havia uma cápsula bem definida, a qual foi removida após adequada redução do volume tumoral. Dentro da lesão foi encontrado tecido semelhante a cabelo. A paciente se recuperou bem, e foi dado alta sem novos déficits neurológicos, não foi realizado mais nenhuma intervenção, e ela está sendo acompanhada regularmente. Os autores visam descrever essa patologia rara e sua opção por uma abordagem cirúrgica.
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In-hospital mortality after emergency coronary artery bypass grafting (CABG) remains an important issue that has needed considerable attention in recent years as the mortality rate is still high and prevention factors are not yet optimal. Our study presents the first largest cohort of emergency CABG from one large institution in Vietnam with the primary aim of comparing a large variety of pre-, intra-and postoperative parameters between in-hospital mortality patients and in-hospital survival patients and investigate risk factors of in-hospital mortality in patients undergoing emergency CABG. We conducted a retrospective evaluation of prospectively collected data in patients undergoing emergency CABG at the Hanoi Heart Hospital (Hanoi, Vietnam) from January 1, 2017, to December 31, 2019. Primary outcome variable was in-hospital mortality. A total of 71 patients were included in final analysis. The mean age of the cohort was 68.68 years (± 9.28, range 38–86). The mean weight, height and body mass index were 54.35 kg (± 9.17, range 37–77), 158.96 (±7.64, range 145–179) and 21.48 kg/m2 (±3.08, range 13.59–30.08), respectively. In-hospital mortality rate was 9.86%. Preoperative risk factors for in-hospital mortality included diabetes, decreased ejection fraction (EF), EF below 30%, cardiogenic shock, elevated systolic pulmonary artery pressure (PAP), elevated NT-ProBNP, and Euroscore II. Without grafting with left internal thoracic artery, and prolonged cardiopulmonary bypass (CPB) time were increased intraoperative factors for inhospital mortality risk. In-hospital mortality’s postoperative risk factors were found to be postextubation respiratory failure requiring mechanical ventilation, ventricular fibrillation, dialysis-requiring acute renal failure, pneumonia, bacterial sepsis, gastrointestinal bleeding, and prolonged mechanical ventilation time. Significant predictors determining in-hospital mortality were known as prolonged CPB time in surgery and postoperative ventricular fibrillation. Our hospital mortality rate after emergency CABG was relatively high. An optimal preventive strategy in emergency CABG management should target significant factors combined with other previously identified risk factors to reduce in-hospital mortality. |
In the article literary data and data of own supervision on one of actual problems of modern dermatology- lichen ruber planus (LRP) of a mucous membrane of oral cavity (MMOC) are cited. Lesion of the mucous membranes is a characteristic feature LRP and is one of the most frequent manifestations of dermatoses, and may be related carried to “great” attributes which is of important diagnostic value. According to supervision of the authors, lesion of the mucous membrane was marked in 69 (32,2%) of patients with LRP. The authors registered a significant variety of clinical forms and variants of LRP course of the mucous membranes. As it is known, skin and mucous membranes are the basic organs where numerous pathomorphologic pathological manifestations of LRP are developed. But existence of both endo and exogenous mechanisms, influence on intertissue and interorgan immune relations, homeostasis, and metabolic processes this cannot but affect clinical polymorphism of skin lesions and those of mucous membrane of the oral cavity in LRP. To the authors’ opinion, hereafter it would be perspective to detail and clear up what factors of LRP and in what way affect skin lesions and those of mucous membranes, as well as under what conditions they are realized.
It has been 4 years since the first, lon§-term (> 3 years) prospective comparison of adult-to-adult livin§ do- nor liver transplantation (A2ALLTx) to adult deceased donor liver transplantation (ADDLTx) was reported.1 In this follow up, prospective, IRB approved, 10-year comparison of A2ALLTx to ADDLTx we expand on our initial observations. This data includes: a§e, §ender, ethnicity, primary liver disease, waitin§ time, pretrans- plant CTP/YELD score, cold ischemia time (CIT), perioperative mortality, acute and chronic rejection, §raft and patient survival, char§es and post-transplant complications. In 10 years, 465 ADDLTx (81.3%) and 107 A2ALLTx (18.7%) were performed at VCUHS. Hepatitis C virus (HCV) was the most common reason for transplantation in both §roups (54.5% vs. 48.2%). Data re§ardin§ overall patient and §raft survival and retransplantation rates were similar. Comparison of patient/§raft survivals, retransplantation rates in patients with and without HCV were not statistically different. A2ALLTx patients had less acute rejection (9.6% vs. 21.7%) and more biliary complications (27.1% vs. 17.6%). In conclusion, A2ALLTx is as durable a liver replacement technique as the ADDLTx. Patients with A2ALLTx were youn§er, had lower YELD scores, less acute rejection and similar histolo§ical HCV recurrence. Biliary complications were more common in A2ALLTx but were not associated with increased §raft loss compared to ADDLTx.
Rectal bleeding is a common symptom experienced by pregnant women. Although the majority of cases are attributable to benign conditions such as haemorrhoids and anal fissures, other more serious diagnoses such as inflammatory bowel disease and malignancy should not be overlooked. Most investigations are safe during pregnancy and these should not be withheld as significant implications on both foetal and maternal morbidity may result. In these cases, a multidisciplinary team approach is essential. This review explores the differential diagnosis, investigation and management of rectal bleeding during pregnancy