Cervical adenocarcinoma presenting as a cardiac tamponade in a 57-year-old woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pericardial effusion as a complication of malignant gynecological disorders is rare. Few cases of endometrial cancer, squamous cell carcinoma of the cervix, ovarian cancer and uterine carcinosarcoma have been previously reported. We report the first case of cardiac tamponade secondary to a cervical adenocarcinoma.</p> <p>Case presentation</p> <p>A 54-year-old Caucasian woman, without any relevant medical history and no gynecological aftercare, was admitted to our hospital emergency room with severe dyspnea. Echocardiography revealed severe pericardial effusion with a swinging heart. An emergency pericardial drainage was performed through a pericardial window, which permitted the draining of 700 mL of bloody fluid and a pericardial biopsy. Cytological examination of the fluid revealed atypical cells, and the biopsy specimen showed tumor emboli suggestive of adenocarcinoma. Magnetic resonance imaging showed a 35 mm cervical lesion indicative of an endocervical tumor. Exploratory laparoscopy revealed diffuse peritoneal lesions and histological examination of cervical curettage showed a poorly differentiated micropapillary adenocarcinoma of the cervix.</p> <p>Conclusion</p> <p>Carcinomatous pericarditis as the first symptom of a malignant gynecological adenocarcinoma has not, to the best of our knowledge, been documented before. This case highlights the extreme severity of pericardial effusion secondary to cervical adenocarcinoma, a sign of advanced disease. Gynecological malignancies have to be considered in cases of neoplastic pericardial effusion.</p

Understanding and Optimizing Persistent Memory Allocation

The proliferation of fast, dense, byte-addressable nonvolatile memory suggests that data might be kept in pointer-rich "in-memory" format across program runs and even process and system crashes. For full generality, such data requires dynamic memory allocation, and while the allocator could in principle be "rolled into" each data structure, it is desirable to make it a separate abstraction. Toward this end, we introduce recoverability, a correctness criterion for persistent allocators, together with a nonblocking allocator, Ralloc, that satisfies this criterion. Ralloc is based on the LRMalloc of Leite and Rocha, with three key innovations. First, we persist just enough information during normal operation to permit correct reconstruction of the heap after a full-system crash. Our reconstruction mechanism performs garbage collection (GC) to identify and remedy any failure-induced memory leaks. Second, we introduce the notion of filter functions, which identify the locations of pointers within persistent blocks to mitigate the limitations of conservative GC. Third, to allow persistent regions to be mapped at an arbitrary address, we employ position-independent (offset-based) pointers for both data and metadata. Experiments show Ralloc to be performance-competitive with both Makalu, the state-of-the-art lock-based persistent allocator, and such transient allocators as LRMalloc and JEMalloc. In particular, reliance on GC and offline metadata reconstruction allows Ralloc to pay almost nothing for persistence during normal operation