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Spontaneous Heparin-Induced Thrombocytopenia Presenting as Concomitant Bilateral Cerebrovascular Infarction and Acute Coronary Syndrome

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Cardiovascular Innovations and Applications 2023年第1期7卷 44-48页

作者： Jong Kun Park Ilan Vavilin Jacob Zaemes Araba Ofosu-Somuah Raghav Gattani Camila Sahebi Alexander G.Truesdell The University of Texas Health Science Center at Houston HoustonTXUSA MedStar Georgetown University hospital Washington D.C.USA inova Heart and Vascular Institute Falls ChurchVAUSA inova fairfax hospital department of hematology and oncology Falls ChurchVAUSA

Background:Spontaneous heparin-induced thrombocytopenia is a pro-thrombotic syndrome in which anti-heparin antibodies develop without heparin *** presentation:A 78-year-old man who underwent a successful lumbar laminectomy presented to the hospital 5 days after discharge for stroke-like symptoms and was found to have acute infarcts of the bilateral frontal *** patient was found to be severely thrombocytopenic and was incidentally found to have an inferior wall myocardial *** investigation led to the diagnosis of bilateral lower extremity deep vein *** overall clinical presentation prompted a detailed hematologic workup that indicated positivity for heparin-induced thrombocy-topenia despite no previous exposure to heparin ***:This case illustrates a patient with no prior lifetime heparin exposure who underwent laminectomy with subsequent development of acute infarcts of the bilateral frontal lobes,an inferior wall myocardial infarction,and bilateral lower extremity deep vein thromboses,with concern for sequelae of spontaneous heparin-induced thrombo-cytopenia.

关键词： Acute coronary syndrome deep vein thrombosis myocardial infarction cerebrovascular infarction spontaneous heparin-induced thrombocytopenia

Distinct Placenta Increta and Percreta in the Setting of Dichorionic Diamniotic Twin Gestation: A Unique Histological Finding

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Open Journal of Obstetrics and Gynecology 2022年第7期12卷 610-615页

作者： Conway Xu Cassandra Presti Sebastian Nasrallah Saeid Movahedi-Lankarani John C. Elkas Alfred Khoury Ankit Shah department of Obstetrics and Gynecology Inova Fairfax Hospital Falls Church VA USA Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Inova Fairfax Hospital Falls Church VA USA department of Pathology Inova Fairfax Hospital Falls Church VA USA Mid Atlantic Gynecologic oncology and Pelvic Surgery Associates Fairfax VA USA Perinatal Associates of Northern Virginia Fairfax VA USA

Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple gestation placentas. To our knowledge, there have been no reports of PAS in dichorionic placentas with different degrees of invasion. Here, we report dichorionic diamniotic placentas with two different degrees of invasion, one increta and another percreta.

关键词： Placenta Accreta Spectrum Increta Percreta Differential Placental Invasion Twin

Low Dose Total Skin Electron Beam Radiation in Cutaneous T-Cell Lymphoma: Review

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Journal of Cancer Therapy 2014年第14期5卷 1372-1379页

作者： Misty Gamble Elizabeth Tocci Jennifer A. DeSimone department of Melanoma and Cutaneous oncology MedStar Washington Hospital Center Washington DC USA department of Dermatology MedStar Georgetown University Hospital Washington DC USA University of Massachusetts Medical School Worcester USA Melanoma and Skin oncology INOVA Fairfax Hospital Fairfax USA

The treatment of advanced stage MF is especially challenging as single agent overall response rates are in the 35% range and chronic recurrence is the rule. The treatment of CTCL across all stages of disease is aimed at the goal of achieving and sustaining remission. Increasingly, low dose total skin electron beam therapy (TSEBT) is being utilized as a skin directed component in combination therapy for advanced stage CTCL. Researchers are seeking to better define the utility of low dose TSEBT as a method of debulking skin disease while simultaneously treating other disease compartments and in combination with sustained maintenance therapies of both the skin directed and systemic varieties. Data exists showing the efficacy of low dose TSEBT in early and advanced disease. There is also data documenting prolonged treatment responses with TSEBT plus adjuvant skin directed therapies such as PUVA and topical nitrogen mustard. Emerging data examining the role of low dose TSEBT in the prestem cell transplant preparation is also promising. This brief review summarizes the utility of low dose TSEBT in multiagent treatment regimens in CTCL.

关键词： Cutaneous T-Cell Lymphoma Mycosis Fungoides Total Skin Electron Beam Therapy Hematopoietic Stem Cell Transplantation

Advanced Undifferentiated Endometrial Carcinoma with No Evidence of Disease after Neoadjuvant Chemotherapy: A Case Report

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Open Journal of Obstetrics and Gynecology 2020年第11期10卷 1573-1579页

作者： Cassandra L. Presti Payam Katebi Kashi Christopher M. Tarney Ruchi Garg Division of Gynecologic oncology Department of Obstetrics and Gynecology Inova Fairfax Women’s Hospital Falls Church VA USA Walter Reed National Military Medical Center Department of Obstetrics and Gynecology Division of Gynecologic Oncology Bethesda MD USA Mid Atlantic Gynecologic oncology and Pelvic Surgery Associates Fairfax Virginia USA

Background: Neoadjuvant chemotherapy is used in gynecologic malignancies as primary treatment for advanced disease and has demonstrated improvement in survival rates. However, the data for use in endometrial cancer is limited. Case: This is a case of stage IV endometrial undifferentiated carcinoma with complete response to four cycles of neoadjuvant chemotherapy (carboplatin/paclitaxel) and no evidence of disease during the interval debulking surgery (robotic-assisted total laparoscopic hysterectomy with bilateral salpingoophorectomy, pelvic and paraaortic lymph node dissection, and cystoscopy). Conclusion: Complete response to neoadjuvant chemotherapy prior to interval debulking surgery is only reported in a limited number of cases, and even less common in advanced stage high-grade endometrial cancers. The use of neoadjuvant chemotherapy may reduce tumor burden, increase opportunities for optimal debulking, and have an impact on survival. Further research is needed to understand the potential for neoadjuvant chemotherapy in these patients.

关键词： Neoadjuvant Chemotherapy Undifferentiated Endometrial Carcinoma

Vaginal Cellular Angiofibroma with Heavy Bleeding: A Case Report

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Open Journal of Obstetrics and Gynecology 2020年第11期10卷 1609-1615页

作者： Anh Q. Nguyen Cassandra L. Presti Graham Nelsen Francine McLeod department of Obstetrics and Gynecology Inova Fairfax Hospital Falls Church VA USA department Obstetrics and Gynecology School of Medicine University of Virginia Inova Campus Falls Church VA USA

Cellular angiofibroma is a rare mesenchymal tumor that most commonly presents as an asymptomatic well-circumscribed mass in the vulva. Very few cases have been found in the vagina and even fewer presented with vaginal bleeding. A 54-year-old female presented to the emergency department with five months of vaginal bleeding and symptomatic anemia requiring blood transfusion. Upon physical examination, she was found to have a firm 4 cm posterior vaginal mass, distinctly distal to the cervix. The mass was resected and diagnosed as a vaginal cellular angiofibroma on pathologic evaluation. The patient did well post-operatively with recommended follow-up every six months. The common differential diagnosis for a bleeding vaginal mass includes leiomyoma, angiofibroblastoma, aggressive angiomyxoma, squamous cell carcinoma, and adenocarcinoma. In this case, cellular angiofibroma presented as a vaginal mass with heavy bleeding leading to severe anemia. Early involvement of gynecologic oncology can help to optimize patients’ evaluation and management.

关键词： Vaginal Cellular Angiofibroma Vaginal Tumor Vaginal Bleeding

Fibrin sealant for esophageal anastomosis:A phase II study

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World Journal of Gastrointestinal oncology 2020年第6期12卷 651-662页

作者： Yao-Bin Lin Jian-Hua Fu Yan Huang Yi-Huai Hu Kong-Jia Luo Ke-Xi Wang AmosÉla Bella Dong-Rong Situ Ji-Yang Chen Ting Lin Xavier B D’Journo Nuria M Novoa Alessandro Brunelli Hiran C Fernando Robert J Cerfolio Mahmoud Ismail Hong Yang 无 department of Thoracic Surgery State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangdong Esophageal Cancer InstituteSun Yat-sen University Cancer CenterGuangzhou 510060Guangdong ProvinceChina department of Thoracic Surgery Avicenne HospitalBobigny 93000France department of Surgery and Specialties Faculty of Medicine and Biomedical SciencesUniversity of YaoundéIYaoundéCameroon department of Surgery Royal Darwin HospitalNorthern Territory 0811Australia department of Thoracic Surgery and Diseases of Esophagus Aix-Marseille UniversityHôpital NordMarseille 13915France Thoracic Surgery Service University Hospital of SalamancaSalamanca 37007Spain department of Thoracic Surgery St James's University HospitalLeeds LS97TFUnited Kingdom Section of Thoracic Surgery Inova Fairfax Medical CenterInova Schar Cancer InstituteFalls ChurchVA 22042United States department of Cardiothoracic Surgery New York University Langone HealthNew YorkNY 10016United States department of Thoracic Surgery Academic Hospital of the Charité–UniversitätsmedizinHumboldt University BerlinBerlin 10117Germany the AME Thoracic Surgery Collaborative Group

BACKGROUND Esophagectomy is a pivotal curative modality for localized esophageal or esophagogastric junction cancer(EC or EJC).Postoperative anastomotic leakage(AL)remains *** use of fibrin sealant(FS)may improve the strength of esophageal anastomosis and reduce the incidence of *** To assess the efficacy and safety of applying FS to prevent AL in patients with EC or *** In this single-arm,phase II trial(*** identifier:NCT03529266),we recruited patients aged 18-80 years with resectable EC or EJC clinically staged as *** open or minimally invasive McKeown esophagectomy was performed with a circular stapled *** performing the anastomosis,2.5 mL of porcine FS was applied *** primary endpoint was the proportion of patients with AL within 3 *** From June 4,2018,to December 29,2018,57 patients were *** the data cutoff date(June 30,2019),three(5.3%)of the 57 patients had developed AL,including two(3.5%)with esophagogastric AL and one(1.8%)with gastric *** incidence of anastomotic stricture and other major postoperative complications was 1.8%and 17.5%,*** median time needed to resume oral feeding after operation was 8 d(Interquartile range:7.0-9.0 d).No adverse events related to FS were *** deaths occurred within 90 d after *** Perioperative sealing with porcine FS appears safe and may prevent AL after esophagectomy in patients with resectable EC or *** phase III studies are warranted.

关键词： Esophageal cancer McKeown esophagectomy Fibrin sealant Anastomotic leakage Postoperative complications Prevention