Large thoracic tumour without superior vena cava syndrome

A 62-year-old male with long-standing smoking history presented with haemoptysis. Plain chest X-ray showed abnormal findings proximate to the right pulmonary hilum. Bronchoscopy revealed a fragile exophytic tumour of the right wall of the lower third of the trachea, infiltrating the right main bronchus (75% stenosis) and the right upper lobar bronchus (near total occlusion). Contrast-enhanced chest computed tomography demonstrated a 7.2 × 4.9 cm tumour contiguous to the above-mentioned structures, mediastinal lymph node pathology, and a vessel coursing inferiorly to the left of the aortic arch and anterior to the left hilum. Despite the tumour constricting the right superior vena cava (SVC), no signs of SVC syndrome were present. In this case, the patient does not present with SVC syndrome, as expected due to the constriction of the (right) SVC caused by the tumour, since head and neck veins drain through the persistent left superior vena cava (PLSVC). PLSVC is the most common thoracic venous anomaly with an incidence of 0.3% to 0.5% of the general population and it is a congenital anomaly caused by the failure of the left anterior cardinal vein to regress and to consequently form the ligament of Marshall during foetal development. It is associated with absence of the left brachiocephalic vein and in 10% to 20% of cases the right SVC is absent. Two potential draining points of the PLSVC have been previously reported. In the majority of cases PLSVC drains directly into the coronary sinus, but less frequently it drains into the left atrium or the left superior pulmonary vein (LSPV). In cases where the PLSVC drains into the coronary sinus, congenital heart defects are rare. The patient usually remains asymptomatic and PLSVC is an incidental finding during radiographic imaging or medical procedures. When the PLSVC drains into the left atrium or the LSPV, a right-to-left shunt is formed; a condition usually asymptomatic. In some reported cases this PLSVC variant presents with persistent, unexplained hypoxia or cyanosis and embolisation causing recurrent transient ischaemic attacks and/or cerebral abscesses. This PLSVC variant is more often associated with absence of the right SVC and congenital heart abnormalities.

Cell cyclins: triggering elements of cancer or not?

Cyclins are indispensable elements of the cell cycle and derangement of their function can lead to cancer formation. Recent studies have also revealed more mechanisms through which cyclins can express their oncogenic potential. This review focuses on the aberrant expression of G1/S cyclins and especially cyclin D and cyclin E; the pathways through which they lead to tumour formation and their involvement in different types of cancer. These elements indicate the mechanisms that could act as targets for cancer therapy

Renal resistive index as a predictive factor of delayed graft function: A meta-analysis

Background: Delayed graft function represents a major complication of kidney transplantation, leading to high rates of short and long-term morbidity. The aim of the present meta-analysis is to assess the role of renal resistive index measurement in the post-transplant period and evaluate its efficacy in the prediction of delayed graft function. Methods: Medline, Scopus, Cochrane Central Register of Controlled Trials CENTRAL, Clinicaltrials.gov and Google Scholar databases were systematically searched. Statistical analysis was performed with Review Manager 5.3, R 3.4.3 and Open Meta-Analyst software. Results: Fourteen studies were included with a total of 2741 kidney recipients. Patients with delayed graft function presented significantly higher rates of elevated renal resistive index (Odds Ratio: 1.96, 95% CI: [1.37, 2.81]). Also, renal resistive index values were significantly higher in patients with delayed graft function compared both to those with slow (Mean Difference: 0.04, 95% CI: [0.01, 0.07]) and immediate (Mean Difference: 0.10, 95% CI: [0.07, 0.12]) graft function. The pooled sensitivity for the detection of delayed graft function was estimated at 47.2% (95% CI: [30.9, 64.2]), the specificity at 69.3% (95% CI: [54.1, 81.2]) and the area under the curve at 0.613. Conclusions: The present meta-analysis suggests the promising role of renal resistive index evaluation early after kidney transplantation, since its high values were significantly associated with higher incidence of delayed graft function. Future large-scale studies should define the most appropriate cut-off value and should incorporate renal resistive index in combined models in order to achieve optimal predictive accuracy. © 2019 Elsevier Inc

Renal resistive index as predictor of acute kidney injury after major surgery: A systematic review and meta-analysis

Purpose: To determine the efficacy of Doppler renal resistive index in the prediction of acute kidney injury after major surgery. Methods: A systematic review and meta-analysis of cohort studies was conducted. Medline (1966–2018), Scopus (2004–2018), Clinicaltrials.gov (2008–2018) and Google Scholar (2004–2018) databases were systematically searched. Prospective studies that examined the diagnostic accuracy of renal resistive index in postoperative acute kidney injury were included. Results: The meta-analysis was based on 10 studies, including a total number of 911 patients. Patients who developed acute kidney injury presented higher renal resistive index values preoperatively (MD: 0.02, 95% CI: [0.00–0.03]), immediately after surgery (MD: 0.07, 95% CI: [0.04–0.11]) and 24 hours postoperatively (MD: 0.07, 95% CI: [0.04–0.09]). The pooled sensitivity was 81.8%, the specificity 77.6% and the area under the curve 0.866. Fagan's nomogram indicated that the post-test probability was increased to 60.6% (positive test) and decreased to 9.5% (negative test), when the pre-test probability was 30%. Conclusions: Renal resistive index represents a useful marker with fair performance in the prediction of postoperative acute kidney injury. Future cohorts should establish the optimal timing of measurement and evaluate the most appropriate cut-off value that should be used in the clinical setting. © 2018 Elsevier Inc

Predictors of tolvaptan short-term response in patients with refractory ascites: A meta-analysis

Background and Aim: Tolvaptan represents an oral V2-receptor antagonist, which has been suggested as a promising add-on diuretic treatment for refractory ascites. The present meta-analysis aims to accumulate current evidence and identify which clinical and laboratory factors are linked to short-term response to tolvaptan therapy. Methods: Medline, Scopus, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and Google Scholar databases were searched from inception. All observational studies reporting the correlation of patients' characteristics with tolvaptan response were selected. Results: Tolvaptan response was associated with significantly higher baseline body weight (mean difference: 4.59 kg, 95% confidence interval [CI]: [3.58, 5.61]), presence of hepatitis C (odds ratio: 1.59 95% CI: [1.18, 2.14]), lower blood urea nitrogen (BUN) (mean difference: −6.88 mg/dL, 95% CI: [−8.13, −5.63]), lower serum creatinine (mean difference: −0.17 mg/dL, 95% CI: [−0.30, −0.05]), lower C-reactive protein (mean difference: −1.43 mg/dL, 95% CI: [−2.52, −0.35]), and higher sodium levels (mean difference: 1.00 mEq/L, 95% CI: [0.45, 1.55]). The outcomes of bodyweight, hepatitis C, BUN, and C-reactive protein remain significant independently of response definition and risk of bias. Conclusions: The present findings suggest bodyweight, BUN, C-reactive protein, and hepatitis C as potential predictive factors of tolvaptan short-term response in patients with refractory ascites. Future studies are needed to introduce cut-off values and construct an optimal combined screening model. © 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Lt

Markers of endothelial dysfunction and arterial stiffness in patients with early-stage autosomal dominant polycystic kidney disease: A meta-analysis

Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is characterised by increased rates of cardiovascular complications leading to significant morbidity and mortality. This meta-analysis aims to evaluate whether the disease is linked to endothelial dysfunction and arterial stiffness during its early stages. Methods: Medline, Scopus, CENTRAL, Web of Science, Clinicaltrials.gov and Google Scholar databases comparing ADPKD patients with preserved renal function to healthy controls were included. The outcomes of interest were brachial flow-mediated dilatation, carotid-femoral pulse wave velocity, augmentation index, carotid intima-media thickness and central systolic blood pressure, plasma ADMA or homocysteine levels. Standardised mean differences (SMDs) were estimated by a random-effects model in R-3.6.3. Results: A total of 27 studies were included, comprising 1967 individuals. ADPKD was linked to significantly lower flow-mediated dilatation (SMD: −1.44, 95% CI: [−2.35, −0.53]) and higher pulse wave velocity (SMD: 1.44, 95% CI: [0.22, 2.66]) and carotid intima-media thickness (SMD: 1.02, 95% CI: [0.57, 1.47]). No significant associations were noted regarding augmentation index (SMD: 0.62, 95% CI: [−0.19, 1.43]) and central systolic blood pressure (SMD: 1.84, 95% CI: [−0.12, 3.80]). Plasma homocysteine was significantly higher in ADPKD (SMD: 0.81, 95% CI: [0.16, 1.45]), while no difference was calculated for ADMA levels (SMD: 1.14, 95% CI: [−0.25, 2.53]). Conclusions: Early-stage ADPKD patients present increased vascular stiffness and endothelial dysfunction, as reflected by low flow-mediated dilatation and elevated values of pulse wave velocity, carotid intima-media thickness and plasma homocysteine. The exact effects of early arterial stiffness on long-term outcomes remain to be elucidated. © 2020 John Wiley & Sons Lt

Jaundice-Should "yellow" be a red code?

Objective: Jaundice is the clinical manifestation, of hyperbilirubinemia. It is considered as a sign of either a liver disease or, less often, of a hemolytic disorder. It can be divided into obstructive and non obstructive type, involving increase of indirect (non-conjugated) bilirubin or increase of direct (conjugated) bilirubin, respectively, but it can be also manifested as mixed type. Methods: This article updates the current knoweledge concerning the jaundice's etiology, pathophysiological mechanisms, and complications ant treatment by reviewing of the latest medical literature. It also presents an approach of jaundice's treatment and pathogenesis, in special populations as in neonates and pregnant women. Results: The treatment is consistent in the management of the subjective diseases responsible for the jaundice and its complications.The clinical prognosis of the jaundice depends on the etiology. Surgical treatment of jaundiced patients is associated with high mortality and morbidity rates. Studies have shown that the severity of jaundice and the presence of malignant disease are importan risk factors for post-operative mortality. Conclusions: Early detection of jaundice is of vital importance because of its involvement in malignancy or in other benign conditions requiring immediate treatment in order to avoid further complications