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Cancer
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Elyce Cardonick, Charlotte Maggen, Puja Patel
Non-Hodgkin's lymphoma (NHL) is rarely reported during pregnancy as this generally occurs in an older age group (mean age at diagnosis is 42 years). NHL refers to a group of lymphoproliferative diseases (ranging from indolent to aggressive) among which, diffuse large B cell lymphoma is the most commonly reported, and often diagnosed at advanced stages [66]. Pregnant women present with an aggressive histology, but the response to treatment, failure, and progression rates are reported to be similar to non-pregnant patients [66–68]. Women with NHL in one study was shown to be at an increased risk for pre-eclampsia, cesarean-section, preterm births, and postpartum blood transfusions [69]. Symptoms can vary widely, with many complaints and presentations such as ovarian masses can be similar to symptoms in normal pregnancy, which can lead to a delay in diagnosis of NHL in pregnancy. Superior vena cava syndrome can occur in which the patient will complain of swelling in upper extremity and face after a long duration of elevation of the arms.
Superior Vena Cava Syndrome
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Superior vena cava syndrome has been recognized as a clinical entity for over 200 years. Over 70% of cases are due to lung cancer, especially the right-sided tumours. Metastatic disease and lymphomas account for the majority of the remaining 30%. Occasionally tuberculous disease may be a causative factor. Onset of symptoms is generally insidious, most patients experiencing some symptoms for 2-6 weeks prior to admission. Symptoms or signs include painless swelling of the face and neck, cough, increasing dyspnoea, dizziness, headache, visual disturbance with the sensation of fullness in the ears.
The heart
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
The route of blood flow through the heart begins with the venae cavae, which return blood from the peripheral tissues to the right side of the heart (see Figure 7.1). The superior vena cava returns blood from the head and arms to the heart and the inferior vena cava returns blood from the truck of the body and the legs to the heart. Blood in the vena cavae has already passed through the tissues of the body and is low in oxygen. This deoxygenated blood first enters the right atrium and flows into the right ventricle. Contraction of the right ventricle propels this blood to the lungs through the pulmonary circulation by way of the pulmonary artery. As it flows through the lungs, the blood becomes enriched with oxygen and eliminates carbon dioxide to the atmosphere. Blood then returns to the heart through the pulmonary veins. The oxygenated blood enters the left atrium and then the left ventricle. Contraction of the left ventricle propels the oxygen-rich blood back to the peripheral tissues through the systemic circulation, passing first through the aorta, the largest arterial vessel.
Anatomy-based characteristics of far-field SVC electrograms in right superior pulmonary veins after isolation
Published in Scandinavian Cardiovascular Journal, 2022
Wentao Gu, Weizhuo Liu, Jian Li, Jun Shen, Jiawei Pan, Bangwei Wu, Haiming Shi, Xinping Luo, Nanqing Xiong
It is universally agreed that complete pulmonary vein (PV) isolation is the cornerstone of catheter ablation in patients with atrial fibrillation (AF) [1,2]. Careful evaluation of PV isolation, including differentiating near-field from far-field electrograms originating from adjacent extra-PV structures by using mapping and pacing maneuvers, can help avoid futile ablation [3,4]. Superior vena cava (SVC) is one of the contributing sources of far-field signals appearing commonly in anterior aspects of right superior pulmonary veins (RSPVs) for their close anatomical relationship [5–7]. According to an early study, SVC potentials, recorded with circular mapping catheter with the help of venography, appeared in RSPVs in 23% patients during sinus rhythm right after successful PV isolation [8]. However, the anatomical difference accounted for the presence or absence of SVC potentials has not been clearly described. Currently, PV isolation is routinely performed with the assistance of a high-density 3-dimensional (3 D) mapping system, and computed tomography (CT) scan is widely used as pre-procedural guidance for understanding the procedural-related anatomy. In this study, we analyzed the detailed characteristics of far-field-SVC potentials in RSPV after PV isolation using 3 D mapping system and studied the relationship between the CT-based local anatomy and the presence of far-field-SVC electrograms.
Pembrolizumab in the treatment of refractory primary mediastinal large B-cell lymphoma: safety and efficacy
Published in Expert Review of Anticancer Therapy, 2021
Vincent Camus, Camille Bigenwald, Vincent Ribrag, Julien Lazarovici, Fabrice Jardin, Clémentine Sarkozy
At the clinical level, PMBL can occur at all ages but is diagnosed more frequently in young adults, between 25 and 40 years (average age of 37 years at diagnosis), with a male (M)/female (F) sex ratio of 1:2. The disease most often develops as large tumor masses (often larger than 10 cm in diameter and referred as ‘bulky’) in the anterior mediastinum with a rapidly progressing evolution pattern. In 1998, the Adult Lymphoma Study Group (GELA) reported a large cohort [23] of PMBL showing a majority of young women with good performance status, elevated LDH, predominance of localized stage, rare extra-nodal (3% versus 17% in DLBCL), and bone marrow invasion, but frequent contiguous regional organs involvement (pleura, pericardium, lung). Thrombotic complications of superior vena cava obstruction are common due to bulky mediastinal masses and may affect 30–40% of patients at diagnosis [24]. This complication impairs survival, justifying usage of antithrombotic prophylaxis in case of bulky disease. In conclusion, the clinical presentation of PMBL is closely related to NS-cHL. Numerous biological data (described below) also underline the genetic proximity between cHL and PMBL.
Tetralogy of Fallot with isolated levocardia in a young female
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Zeeshan Sattar, Hafez Muhammad Abdullah, Sohaib Roomi, Waqas Ullah, Adnan Khan, Ali Ghani, Asrar Ahmad
Preoperative echocardiography revealed the anatomy of levocardia, a large subpulmonary ventricular septal defect (VSD), and severe subvalvular pulmonic stenosis with a gradient of 80 mmHg. It also revealed atrioventricular (AV) discordance with right anterior aorta arising from morphologically left sided right ventricle and left posterior pulmonary artery arising more than 60% from morphologically left sided right ventricle. There was associated congenitally corrected transposition of the great arteries and a double outlet right ventricle (DORV). The morphologically left sided right ventricle was also hypertrophied. There was a single left sided superior vena cava and an inferior vena cava that drained into right atrium. The interatrial septum was intact. Other findings included a left aortic arch and an intact interatrial septum.