Adenocarcinoma of the urinary bladder with inferior vena cava thrombus

alkiviadis.1961 shared this article with you from Inoreader Message: Harkirat Singh Talwar and Vikas Kumar Panwar Author affiliations Urology, All India Institute of Medical Sciences—Rishikesh, Rishikesh, India Correspondence to Dr Vikas Kumar Panwar; vikaspanwar.dr@gmail.com http://dx.doi.org/10.1136/bcr-2020-237772 Statistics from Altmetric.com Request Permissions Description Adenocarcinoma of the bladder is an unusual malignancy arising most commonly from the dome and posterior wall of the bladder. It has a male predominance seen during the sixth and seventh decade.1 It arises from the urothelium although has a pure glandular histology.2 Haematuria is the most common presenting symptom and various cystoscopic morphologies exist like solid, papillary, sessile or ulcerated. Notable risk factors for adenocarcinoma include schistosomiasis, chronic irritation, cystocoele and exstrophy bladder. Adenocarcinoma of the bladder may be primary in origin or may be secondary to involvement by adjacent organs. Urachal adenocarcinoma although a separate entity is frequently grouped with bladder adenocarcinoma. No case has been ever reported in the literature of a bladder carcinoma with inferior vena cava (IVC) thrombus. This is a first case of its kind to be reported with tumour extending through the iliac veins into the IVC. A 60-year-old man presented with haematuria and history of transurethral resection of bladder mass done elsewhere. General and physical examination revealed no positive findings and he had a poor performance status. Histopathology was suggestive of adenocarcinoma of the urinary bladder with tumour infiltrating the deep muscle. Contrast enhanced CT scan revealed 7.2×6.5 cm mass arising from the dome and the right posterolateral wall of the urinary bladder and extending into right ureter for a length of 3.5 cm causing gross hydroureteronephrosis (figure 1). The mass was seen extending into the small bowel mesentery and the mesorectal fascia and seminal vesicles. An enhancing tumour thrombus was also seen for a length of 5.2 cm in the distal IVC extending into bilateral common iliac veins and the right internal and external iliac veins. Metastatic work up revealed extensive lesions in the lungs and the skeleton (figure 2). Creatinine clearance of the patient improved to 70 mL/m in post insertion of the nephrostomy tube. The patient was started on low-molecular weight heparin and also received palliative chemotherapy. The patient succumbed to illness 3 months after presentation. Figure 1 Download figure Open in new tab Download powerpoint Figure 1 Coronal sections showing the bladder mass and the inferior vena cava thrombus (A) and the upstream right hydroureteronephrosis as a result of the bladder mass and right ureteric extension (B). Figure 2 Download figure Open in new tab Download powerpoint Figure 2 Axial section of the thorax revealing multiple parenchymal pulmonary metastatic deposits. Prevention of pulmonary embolism is of utmost priority in such patients with anticoagulation and IVC filter being the mainstay.3 Although low-molecular weight heparin is preferred with total/near total tumour thrombus or those with a bland thrombus, IVC filter may be required in patients when anticoagulation fails or is contraindicated. Treatment of the malignancy according to standard guidelines is mandated thereafter.4 Radical cystectomy and pelvic lymph node dissection remains the standard of care for localised disease as chemotherapy has not shown to improve outcomes in adenocarcinoma of bladder. Platinum-based chemotherapy regimens used against urothelial carcinoma are not effective against adenocarcinoma. Majority of patients have muscle invasive disease at presentation and prognosis remains poor with adenocarcinoma of urinary bladder having a poorer stage by stage survival outcome as compared with its urothelial counterpart. Learning points Primary adenocarcinomas of the urinary bladder are rare tumours and are usually detected at an advanced stage and thus have poor prognosis. Bladder cancers can present with inferior vena cava (IVC) thrombus with a possible route being through the internal and common iliac veins. This is the first case to be reported of a bladder carcinoma with IVC thrombus. Anticoagulation and prevention of pulmonary embolism remains the top priority in such cases followed by stage-based management following standard guidelines. References ↵Dadhania V, Czerniak B, Guo CC. Adenocarcinoma of the urinary bladder. Am J Clin Exp Urol 2015;3:51–63.pmid:http://www.ncbi.nlm.nih.gov/pubmed/26309895PubMedGoogle Scholar ↵Grignon DJ, Ro JY, Ayala AG, et al. Primary adenocarcinoma of the urinary bladder. A clinicopathologic analysis of 72 cases. Cancer 1991;67:2165–72.doi:10.1002/1097-0142(19910415)67:8<2165::AID-CNCR2820670827>3.0.CO;2-Mpmid:http://www.ncbi.nlm.nih.gov/pubmed/1706216CrossRefPubMedWeb of ScienceGoogle Scholar ↵Pandhi MB, Desai KR, Ryu RK, et al. The role of inferior vena cava filters in cancer patients. Semin Intervent Radiol 2016;33:071–4.doi:10.1055/s-0036-1581090pmid:http://www.ncbi.nlm.nih.gov/pubmed/27247473PubMedGoogle Scholar ↵Black PC, Brown GA, Dinney CPN. The impact of variant histology on the outcome of bladder cancer treated with curative intent. Urol Oncol 2009;27:3–7.doi:10.1016/j.urolonc.2007.07.010pmid:http://www.ncbi.nlm.nih.gov/pubmed/18367107PubMedGoogle Scholar Adenocarcinoma of the urinary bladder with inferior vena cava thrombus Via BMJ Case Reports Last 6 Issues View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extended pulsed radiofrequency as a part of multimodal pain management in a refractory case of Bernhardt-Roth syndrome

alkiviadis.1961 shared this article with you from Inoreader Extended pulsed radiofrequency as a part of multimodal pain management in a refractory case of Bernhardt-Roth syndrome Via BMJ Case Reports Last 6 Issues Bernhardt-Roth syndrome (BRS) is a neurological condition characterised by pain, burning or numbness in anterolateral thigh due to entrapment of the lateral femoral cutaneous nerve (LFCN). The possible aetiologies can be mechanical, iatrogenic, neuropathic or idiopathic. After consent for possible publication, we are discussing a case of pain management in a 38-year-old patient with BRS secondary to diabetes. The coherent history, uncontrolled glycaemic status and reduced nerve conduction velocity for LFCN helped reach the diagnosis. Initial treatment with pharmacotherapy, steroid LFCN block and conventional pulsed radiofrequency (PRF) provided moderate temporary pain relief. Extended PRF over 8 min provided significant analgesia without any complications. Physical therapy, adequate glycaemic control and extended PRF provided complete pain relief and improved function over 6 months of follow-up duration. Hence, a cautious multifaceted approach targeting the basic aetiology with extended PRF helped achieve significant analgesia in our refractory case of BRS. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Haemolymphatic cancer among children

alkiviadis.1961 shared this article with you from Inoreader Haemolymphatic cancer among children in Sardinia, Italy: 1974-2003 incidence Via BMJ Open Current Issue Objectives To explore the time trend and geographical distribution of childhood leukaemia incidence over the territory of the Italian region of Sardinia. Setting All hospitals departments, diagnostic centres and social security agencies in Sardinia were regularly screened in 1974–2003 to identify, register and review the diagnoses of incident cases of haematological malignancies (HM). Participants The whole child population aged 0–14 resident in Sardinia. Primary and secondary outcome measures Incidence and time trend of childhood HM and childhood acute lymphoblastic leukaemia (ALL) over the study period, and use of Bayesian methods to plot the probability of areas with excess incidence on the regional map. Results Overall, 675 HM cases, including 378 ALL cases, occurred among children aged 0–14 years resident in Sardinia in 1974–2003, with an incidence rate of 6.97x10-5 (95% CI 6.47 to 7.51) and 3.85x10-5 (95% CI 3.48 to 4.26), respectively. Incidence of HM and ALL showed an upward trend along the study period especially among females. Three communes out of the 356 existing in 1974, namely Ittiri, Villa San Pietro and Carbonia, stand out as areas with excess incidence of HM and ALL in particular and another, Carloforte, for ALL only. Conclusions Our results might serve as convincing arguments for extending the coverage of routine cancer registration over the whole Sardinian population, while prompting further research on the genetic and environmental determinants in the areas at risk. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD)

alkiviadis.1961 shared this article with you from Inoreader Tranexamic ACid during PancereaticoDuodenectomy (TAC-PD): study protocol for a multicentre randomised, blind, placebo-controlled trial Via BMJ Open Current Issue Introduction Pancreaticoduodenectomy (PD) is a major gastroenterological surgery that results in a substantial amount of blood loss. Several studies have demonstrated that major blood loss during PD is associated with both short-term and long-term poor outcomes. Administration of perioperative tranexamic acid (TXA) has been reported to reduce intraoperative blood loss in various surgeries, including cardiovascular surgery and orthopaedic surgery. Nevertheless, the effect of perioperative TXA use in patients undergoing PD has not been investigated. This study aims to investigate the effect of TXA on blood loss during PD. Methods and analysis A multicentre (six hospitals), randomised, blind (patient-blinded, surgeon-blinded, anaesthesiologist-blinded, monitor-blinded), placebo-controlled trial of TXA during PD was started in September 2019. Patients undergoing PD for biliary, duodenal or pancreatic diseases are randomly assigned to the TXA or placebo group. The stratification factors are the institutions and preoperative clinical diagnosis. Before skin incision, the participants in TXA group are administrated 1 g TXA as a loading infusion followed by a maintenance infusion of 125 mg/hour TXA until the end of surgery or 8 hours from the incision. Participants in the placebo group are administrated the same volume of saline that is indistinguishable from the TXA. The primary outcome is blood loss during PD. The secondary outcomes are intraoperative and postoperative (up to day 2) blood transfusions, operation time, anaesthesia time, postoperative laboratory variables, length of hospital stay, in-hospital and 90-day morta lity and postoperative complications occurring within 28 days of surgery or requiring readmission. To date, 115 patients of a planned 220 have been enrolled in the study. Ethics and dissemination This protocol was approved by the Nagoya University Clinical Research Review Board and is registered with Japan Registry of Clinical Trials on 15 August 2019. The results of this trial will be disseminated through peer-reviewed journals. Trial registration number jRCTs041190062. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of SARS-CoV-2 (COVID-19) on pregnancy

alkiviadis.1961 shared this article with you from Inoreader Impact of SARS-CoV-2 (COVID-19) on pregnancy: a systematic review and meta-analysis protocol Via BMJ Open Current Issue Introduction The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has been growing at an accelerating rate, and has become a public health emergency. Pregnant women and their fetuses are susceptible to viral infection, and outcomes in this population need to be investigated. Methods and analysis PubMed, Web of Science, Embase, CINAHAL, Latin American and Caribbean Health Sciences Literature, clinicaltrials.gov, SCOPUS, Google Scholar and Cochrane Central Controlled Trials Registry will be searched for observational studies (cohort and control cases) published from December 2019 to present. This systematic review and meta-analysis will include studies of pregnant women at any gestational stage diagnosed with COVID-19. The primary outcomes will be maternal and foetal morbidity and mortality. Three independent reviewers will select the studies and extract data from the original publications. The risk of bias will be assessed using the Newcastle-Ottawa Scale for observational studies. To evaluate the strength of evidence from the included data, we will use Grading of Recommendation Assessment, Development, and Evaluation method. Data synthesis will be performed using Review Manager software V.5.2.3. To assess heterogeneity, we will compute the I2 statistics. Additi onally, a quantitative synthesis will be performed if the included studies are sufficiently homogenous. Ethics and dissemination This study will be a review of the published data, and thus it is not necessary to obtain ethical approval. The findings of this systematic review will be published in a peer-reviewed journal. PROSPERO registration number PROSPERO 2020: CRD42020181519. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

End-stage renal disease as a risk factor for epiglottitis

alkiviadis.1961 shared this article with you from Inoreader End-stage renal disease as a risk factor for epiglottitis: a population-based cohort study in Taiwan Via BMJ Open Current Issue Objectives Patients with uremia are prone to infection; however, end-stage renal disease (ESRD) as a risk factor for acute epiglottitis warrants study. We investigated the risk of severe epiglottitis requiring hospitalisation in patients with ESRD. Setting We conducted a retrospective matched cohort study by using the claims data of Taiwan's National Health Insurance Research Database. Participants We identified an ESRD cohort with 87 908 patients newly diagnosed in 2000–2013 and underwent dialysis. The non-ESRD cohort comprised patients who had not received a diagnosis of ESRD, and they were matches to the ESRD cohort (1:1) by sex, age, residence urbanisation level, monthly income, and diabetes and hypertension status. Primary and secondary outcome measures The cumulative incidence of epiglottitis at the end of 2013 was analysed with Kaplan-Meier methods and log-rank tests. The HR of epiglottitis was calculated using the Cox proportional hazards model after adjustment for confounding factors. Results The overall epiglottitis incidence rate was 94% greater in the ESRD cohort than in the non-ESRD cohort (10.3 vs 5.3 cases per 100 000 person-years, p=0.002), with an adjusted HR of 1.89 (95% CI: 1.23 to 2.91, p=0.004). In the log-rank analysis, compared with the non-ESRD group, the epiglottitis cumulative incidence was significantly higher in the ESRD group (p=0.003). Epiglottitis did not exhibit an association with higher rates of airway interventions, intensive care unit admissions or longer hospitalisation in patients with ESRD than in controls. Conclusions This nationwide matched cohort study indicated that ESRD patients should be monitored for the risk of severe epiglottitis requiring hospitalisation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparable human reconstitution following Cesium-137 versus X-ray irradiation preconditioning in immunodeficient NOG mice

als.fakia shared this article with you from Inoreader Comparable human reconstitution following Cesium-137 versus X-ray irradiation preconditioning in immunodeficient NOG mice Via PLOS ONE Alerts: New Articles by Anna Halling Folkmar Andersen, Stine Sofie Frank Nielsen, Rikke Olesen, Jakob Le Fèvre Harslund, Ole Schmeltz Søgaard, Lars Østergaard, Paul W. Denton, Martin Tolstrup Humanized mouse models are used extensively in research involving human pathogens and diseases. However, most of these models require preconditioning. Radio-active sources have been used routinely for this purpose but safety issues have motivated researchers to transition to chemical or X-ray based preconditioning. In this study, we directly compare 350 kV X-ray and Cs-137 low-dose precondition of NOG mice before human stem cell transplantation. Based on flow cytometry data, we found that engraftment of human cells into the mouse bone marrow was similar between radiation sources. Likewise, human engraftment in the peripheral blood was comparable between Cs-137 and three different X-ray doses with equal chimerization kinetics. In primary lymphoid organs such as the thymus and lymph nodes, and spleen, liver and lung, human-to-mouse chimerization was also comparable between irradiation sources. Development of different CD4 and CD8 T cells as well as these cells' maturation stages, i.e . from naïve to effector and memory subsets were generally analogous. Based on our results, we conclude that there are no discernable differences between the two sources in the low-dose spectrum investigated. However, while we encourage the transition to X-ray-based sources, we recommend all research groups to consider technical specifications and dose-finding studies. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.