Fatal outcome of congenital aortopulmonary window with patent ductus arteriosus complicating pregnancy

Aortopulmonary window (APW) is a rare congenital heart defect with abnormal communication between the ascending aorta and the pulmonary trunk with two separate semilunar valves. We present an autopsy case report wherein a young primigravida woman presented with progressive breathlessness and central cyanosis at 21 weeks of gestation. Echocardiography performed in the emergency room revealed elevated right-sided cardiac pressures suggestive of severe pulmonary hypertension; however, no structural cardiac defect was discernible. The patient succumbed to congestive cardiac failure and progressive hypoxia within 5 days of hospitalization. The autopsy revealed a Type I aortopulmonary window (2 cm) with patent ductus arteriosus. The lungs showed changes of severe pulmonary hypertension with superadded bronchopneumonia. This report underscores a rare presentation of APW, undiagnosed until pregnancy, leading to the Eisenmenger syndrome and death

Identification of diagnostic serum protein profiles of glioblastoma patients

Diagnosis of a glioblastoma (GBM) is triggered by the onset of symptoms and is based on cerebral imaging and histological examination. Serum-based biomarkers may support detection of GBM. Here, we explored serum protein concentrations of GBM patients and used data mining to explore profiles of biomarkers and determine whether these are associated with the clinical status of the patients. Gene and protein expression data for astrocytoma and GBM were used to identify secreted proteins differently expressed in tumors and in normal brain tissues. Tumor expression and serum concentrations of 14 candidate proteins were analyzed for 23 GBM patients and nine healthy subjects. Data-mining methods involving all 14 proteins were used as an initial evaluation step to find clinically informative profiles. Data mining identified a serum protein profile formed by BMP2, HSP70, and CXCL10 that enabled correct assignment to the GBM group with specificity and sensitivity of 89 and 96%, respectively (p < 0.0001, Fischer’s exact test). Survival for more than 15 months after tumor resection was associated with a profile formed by TSP1, HSP70, and IGFBP3, enabling correct assignment in all cases (p < 0.0001, Fischer’s exact test). No correlation was found with tumor size or age of the patient. This study shows that robust serum profiles for GBM may be identified by data mining on the basis of a relatively small study cohort. Profiles of more than one biomarker enable more specific assignment to the GBM and survival group than those based on single proteins, confirming earlier attempts to correlate single markers with cancer. These conceptual findings will be a basis for validation in a larger sample size

Granulomatous prostatitis - an infrequent diagnosis

Granulomatous prostatitis is a rare disorder of pros-tate. We encountered 10 cases of′grmudomatous prosta-titis consisting of 5 cases of non-specific granulomatous prostatitis, 2 cases of xanthogranulomatous prostatitis, I case of tuberculous prostatitis, I case of malakoplakia prostate and I case of granulomatous prostatitis associ-ated with adenocarcinoma prostate. The diagnosis was made by histopathologic examination of trucut biopsy, TURP chips or retropubic prostatectomy specimen. In all the cases, granulomatous prostatitis was an incidental find-ing

Nonamyloid tumoral light-chain-deposition disease (aggregoma) of the paraspinal region.

Aggregomas are rare localized masses of monoclonal nonamyloid immunoglobulin light-chain deposits. To date, there have been only a few reports of isolated aggregomas, with the majority detailing renal, lymph node and brain deposition. We present a rare case of paraspinal aggregoma in a 67-year-old female who presented with a complaint of cough and chest pain. Imaging demonstrated a left-sided paravertebral mass extending from T7-T10. Pathological analysis showed lamellar deposition of extracellular eosinophilic material with an associated lymphoplasmacytic nonamyloid infiltrate. To our knowledge, this is the first report of a paraspinal aggregoma. While exceedingly rare, this tumor can be included in the radiologic differential diagnosis of paravertebral soft tissue tumors in adults. The observation of our case adds to the limited understanding of the etiology, pathogenesis, natural history, and treatment of nonamyloid light-chain depositions

Indications for Inferior Vena Cava Filter Placement: Do Physicians Comply with Guidelines?

Purpose: Inferior vena cava (IVC) filter placement has increased significantly over the past few decades, but indications for filter placement vary widely depending on which professional society recommendations are followed, and it is uncertain how compliant physicians are in adhering to guidelines. This study assessed documented indications for IVC filter placement and evaluated compliance with standards set by the American College of Chest Physicians (ACCP) and the Society of Interventional Radiology (SIR). Materials and Methods: A single-center, retrospective medical record review in a metropolitan, 652-bed, acute care, teaching hospital. Inpatient filter placement over a 26-month period was reviewed. The study measured compliance with established guidelines, relationship of medical specialty to filter placement, and evaluation of self-referral patterns among physicians. Results: Compliance with established ACCP guidelines was poor regardless of whether the IVC filter insertion was performed by interventional radiology (IR; 43.5%), vascular surgery (VS; 39.9%), or interventional cardiology (IC; 33.3%) staff. Compliance with the less restrictive SIR guidelines was better (77.5%, 77.1%, and 80% for IR, VS, and IC, respectively). There was a greater degree of guideline compliance when filter placement was recommended by internal medicine (IM)-trained physicians than by non-IM-trained physicians: 46.3% of IR-placed filters requested by IM physicians met ACCP criteria whereas only 24.0% of filters recommended by non-IM specialties were compliant with criteria (P = .03). In the VS group, these compliance rates were 45.8% and 31.5%, respectively (P = .03). Among IR-placed filters, 84.0% of IM-recommended filter placements were compliant with SIR guidelines, versus only 48.0% of non IM-recommended placements (P <= .001). In the VS group, these compliance rates were 87.8% and 69.6%, respectively (P <= .001). Conclusions: There is poor physician compliance with guidelines for IVC filter placement. Most filter indications meeting SIR guidelines are for patients classified as "falls risks," failures of anticoagulation, patients with limited cardiopulmonary reserve and patients non compliant with anticoagulation medications. This single-center study suggests a need for harmonization of current guidelines espoused by professional societies

Idiopathic pulmonary haemosiderosis with mineralizing pulmonary elastosis: A case report

<p>Abstract</p> <p>Introduction</p> <p>Idiopathic pulmonary haemosiderosis characterized by repeated episodes of intra-alveolar haemorrhage is rare in adults and has a relatively benign course compared to cases seen in children.</p> <p>Case Presentation</p> <p>The case presented here is of an adult man with idiopathic pulmonary haemosiderosis with mineralizing pulmonary elastosis.</p> <p>Conclusion</p> <p>Pathologists are generally not familiar with this histologic reaction pattern associated with iron encrustation of pulmonary elastic tissue.</p