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Pulmonary embolization as primary manifestation of hepatocellular carcinoma with intracardiac penetration: A case report

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World Journal of Gastroenterology 2005年第15期11卷 2357-2359页

作者： Elod Papp Zsuzsanna Keszthelyi Nagy Karoly Kalmar Lajos Papp Csaba Weninger tamas Tornoczky Endre Kalman Kalman Toth tamas habon 1st Department of Medicine Department of Surgery Heart Institute Department of Radiology Department of Pathology

Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.

关键词： Hepatocellular carcinoma Intracardiac penetration Pulmonary embolization

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From hypertension to heart failure

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World Journal of Hypertension 2015年第2期5卷 85-92页

作者： Klara Magyar Roland Gal Adam Riba tamas habon Robert Halmosi Kalman Toth 1st Department of Medicine University of PecsMedical School

Hypertension is an increasing health problem worldwide especially among the *** therapeutical importance is indicated by the caused organ damages like hypertensive heart disease(HHD) and heart failure with the subsequent higher morbidity and mortality in the *** HHD ventricular hypertrophy develops as a compensatory mechanism for pressure overload but as the left ventricular compliance decreases,the process can transform into heart failure with firstly preserved and then into reduced ejection fraction(HFp EF,HFr EF).The main characteristics of underlying mechanisms involve cardiomyocyte growth,vessel changes,increased collagen production in all of which several mechanical stress induced neurohumoral agents,signal transduction pathways are *** to the new ESC and AHA guidelines five main groups of antihypertensive agents can be applied for decreasing blood pressure and for the prevention of organ ***,patients are not able to tolerate antihypertensive medication because of side effects,drug intolerance or interactions thus it is more difficult to reach the target blood pressure *** there are several efforts to complete the existing therapeutical possibilities against the development of organ damages like inhibition of Rho/ROCK pathway(e.g.,statins),regulation of ROS formation,influence on mitochondrial biogenesis and enhancing recombinant adenovirus hepatocyte growth factor *** induced oxidative stress causes DNA breaks producing the activation of nuclear poly(ADP-ribose) polymerase-1(PARP) enzyme that leads to energy depletion and unfavorable modulation of different kinase *** activation promotes the development of HHD,and its transition to heart *** inhibition of PARP-enzyme offers another new therapeutical approach among hypertensive *** purpose of this review is to give a comprehensive summary about the most significant mechanisms in HHD and an insight into

关键词： Hypertension Hypertensive heart disease HfpEF Organ damage PARP-inhibition

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