Transcatheter Patch Occlusion of the Left Atrial Appendage Using Surgical Adhesives in High-Risk Patients With Atrial Fibrillation

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Right Ventricular Outflow Tract Obstruction in a Middle Aged Man with Right-Sided Aortic Arch

Congenital diseases causing an obstruction of the right ventricular outflow tract are difficult to precisely diagnose, especially in elderly patients. We report a case of a 49-year-old man who presented to our hospital with longstanding shortness of breath on exertion. He was finally diagnosed as right ventricular outflow tract obstruction and referred for surgical correction. The patient had a history of descending aorta dissection which was treated by thoracic stent grafting. By that time right-sided aortic arch was diagnosed. The coexistence of right ventricular outflow tract obstraction and right sided aortic arch in the same patient is very rare, to the best of our knowledge

Sinus node disease in subjects with type 1 ECG pattern of Brugada syndrome

AbstractBackgroundThe spectrum of phenotypes related to mutations of the SCN5A gene include Brugada syndrome (BS), long QT syndrome, progressive cardiac conduction defect, and sinus node disease (SND). The present study investigated the incidence of SND in subjects with type 1 electrocardiogram (ECG) pattern of BS.Methods and resultsThe study population consisted of 68 individuals (55 males, mean age 44.8±12.8 years) with spontaneous (n=27) or drug-induced (n=41) type 1 ECG pattern of BS. Twenty-eight subjects were symptomatic with a history of syncope (41.2%). SND was observed in 6 symptomatic subjects (8.8%), and was mainly attributed to sino-atrial block with sinus pauses. Two patients were initially diagnosed with SND, and received a pacemaker. Patients with SND displayed an increased P-wave duration in leads II and V2, PR interval in leads II and V2, QRS duration in leads II and V2, and increased QTc interval in lead V2 (p<0.05). AH and HV intervals as well as corrected sinus node recovery time (cSNRT) were significantly prolonged in subjects with SND (p<0.05). During a mean follow-up period of 5.0±3.6 years, five subjects with a history of syncope suffered appropriate implantable cardioverter defibrillator (ICD) discharges due to ventricular arrhythmias (7.4%). None of those diagnosed with SND suffered syncope or ICD therapies.ConclusionSND is not an uncommon finding in subjects with type 1 ECG pattern of BS. The occurrence of SND in relatively young patients may deserve meticulous investigation including sodium channel blocking test

Phenotypic diversity of circulating tumour cells in patients with metastatic castration‐resistant prostate cancer

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139087/1/bju13631_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139087/2/bju13631.pd

Primary Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction: The Experience of "Evagelismos" General Hospital of Athens

BACKROUND: Primary percutaneous coronary intervention (PCI) has been shown to be a better reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI) compared with thrombolysis, particularly when applied early. The objective of the present study was to report our experience from treating patients presenting to the emergency room of our hospital with STEMI with primary PCI. PATIENTS AND METHODS: The population of the study included 100 patients who presented to our hospital with STEMI and underwent primary PCI over a 12-month period. Patients’ clinical and angiographic data were retrospectively collected and patients were followed up for 9 months. Technical details of the primary PCI, including stent implantation, and use of drug eluting stents, thrombus aspiration catheter, or platelet glycoprotein IIb/ΙΙΙa inhibitors were recorded and correlated to clinical and angiographic patient data. RESULTS: Of 196 patients who presented o the emergency room with STEMI during the study period, 100 (51%) patients (85 men and 15 women) underwent primary PCI. PCI was successful with TIMI 3 flow of the infarct-related coronary artery in 79 (79%) patients. Six (6%) patients died during hospitalization and another 4 (4.3%) patients died during the 9-month follow up period. Twenty one (22%) patients required rehospitalization for acute coronary syndrome, of whom 17 needed a repeat PCI and 4 patients were submitted to coronary artery bypass grafting. Left ventricular ejection fraction (LVEF) was &lt;50% in 54 (54%) patients. In 52 patients primary PCI was performed in less than 4 hours from onset of symptoms. In his cohort, 19 patients were thrombolyzed before arriving to the catheterization laboratory. Antithrombotic therapy with platelet glycoprotein IIb/IIIa inhibitors was used in 48 (48%) patients. Univariate analysis showed that the odds of achieving TIMI 3 flow were higher after using IIb/ΙΙΙa inhibitors (odds ratio-OR 6.4) or if the LVEF ≥50% (vs LVEF &lt; 50%) at the beginning of the PCI (OR 6.4). If the time from the onset of symptoms to PCI was &gt;4 hours, the odds of achieving TIMI 3 flow were reduced by 23.4% compared to time from symptoms to PCI &lt;4 hours. The presence of TIMI 3 flow of the infarct-related artery reduced the odds of death by 10.2% compared to the absence of TIMI 3 flow of the infarct-related coronary artery. CONCLUSION: Our results are in keeping with those published by other groups performing primary PCI. We demonstrated the importance of time interval from onset of symptoms until PCI is started. We found that the use of GP IIb/IIIa inhibitors was beneficial and emphasized the predictive value of LVEF &gt;50% and the importance of achieving TIMI 3 flow in the IRA at the end of the procedure

With the Tsunami of Immunotherapy, Will Soft Tissue Sarcoma Remain an Immune Desert?

Soft tissue sarcomas (STSs) are rare, aggressive and heterogeneous malignancies with poor outcomes. They include more than 50 different histologic subtypes with variable molecular and cytogenetic profiles responsible for the heterogeneity of these tumors. Radical surgery, chemotherapy and radiation therapy are still the mainstay of treatment with limited therapeutic options in case of metastatic and locally advanced unresectable disease. The current available cytotoxic and targeted therapies are only offering short living disease control. In the era of immunotherapy, STSs were affected by this ‘tsunami’ with very promising results, but larger randomized trials are still needed to prove their benefit in terms of survival and efficacy. They are not included yet in the standard of care. In this review of the literature, we are developing the active immunotherapeutic strategies (vaccines), as well as the passive strategies (adoptive cell therapy) and the checkpoint inhibitors emphasizing on the most recent results and on the limitation of the immunotherapy in this heterogenic media.info:eu-repo/semantics/publishe

56 years-old, an old age for pure seminomatous germ cell tumor: Case report and Review of the literature

Germ cell tumors primarily affect adolescents and young adult men. They occur much less commonly in older patients. The definition of elder age in this kind of tumors, as the detailed clinical and treatment characteristics in this age group are lacking. According to the literature, germ cell tumors are infrequent in men aged more than 50 years old, and there is a predominance of seminomatous histologic subtype. Here we report the case of a 56 years old male patient who was initially diagnosed with pure testicular seminoma at the age of 55. He underwent a right orchiectomy and didn’t receive an adjuvant treatment for a pure seminomatous germ cell tumor, staged pT1 with rete testis invasion. Unfortunately, he suffered from a retroperitoneal relapse of his disease 9 months after the surgery. He received a first line chemotherapy consisting of 4 cycles of Etoposide and Cisplatin. He tolerated very well the treatment with an excellent response and without developing any related toxicity. He is currently in complete remission on regular follow up. This case report and review of the literature are to emphasize on germ cell tumors diagnosed after the age of 50 years old. This category of patients should be treated with full curative surgical and cytotoxic treatments, as it is done in the younger population, in order to achieve a good overall response rate. However, they require careful observation and increased supportive care for better treatment tolerability and thus better outcome.info:eu-repo/semantics/publishe

Paratesticular liposarcoma, an unsual presentation of testicular mass

info:eu-repo/semantics/publishe

Checkpoint inhibitors in bladder and renal cancers: Results and perspectives

The field of immunotherapy in urinary malignancy is expanding in several directions and checkpoint inhibitors are leading the way. The aim of this report is to highlight the efficacy and safety profile of the two classes of molecules, anti-cytotoxic T-lymphocyte antigen-4 and anti-programmed death receptor-1/programmed death ligand type 1, that are under investigation and represent potential candidates to be used in the near future for the management of bladder and renal cell cancer. The preliminary results as well as the future perspectives of this novel immunotherapy are analyzed. Novel immune checkpoint targets are reviewed as well.SCOPUS: re.jinfo:eu-repo/semantics/publishe

MicroRNA-675-5p Overexpression Is an Independent Prognostic Molecular Biomarker of Short-Term Relapse and Poor Overall Survival in Colorectal Cancer

Colorectal cancer (CRC) is the main cause of cancer-related deaths globally, highlighting the importance of accurate biomarkers for early detection and accurate prognosis. MicroRNAs (miRNAs) have emerged as effective cancer biomarkers. The aim of this study was to investigate the prognostic potential of miR-675-5p as a molecular prognostic biomarker in CRC. For this reason, a quantitative PCR assay was developed and applied to determine miR-675-5p expression in cDNAs from 218 primary CRC and 90 paired normal colorectal tissue samples. To assess the significance of miR-675-5p expression and its association with patient outcome, extensive biostatistical analysis was performed. miR-675-5p expression was found to be significantly downregulated in CRC tissue samples compared to that in adjacent normal colorectal tissues. Moreover, high miR-675-5p expression was associated with shorter disease-free (DFS) and overall survival (OS) in CRC patients, while it maintained its unfavorable prognostic value independently of other established prognostic factors. Furthermore, TNM stage stratification demonstrated that higher miR-675-5p levels were associated with shorter DFS and OS intervals, particularly in patients with CRC of TNM stage II or III. In conclusion, our findings suggest that miR-675-5p overexpression constitutes a promising molecular biomarker of unfavorable prognosis in CRC, independent of other established prognostic factors, including TNM staging