Preoperative embolization in surgical treatment of a primary hemangiopericytoma of the rib: a case report

Primary hemangiopericytoma of the rib is extremely rare and only a few cases have been reported. A 62-yr-old man presented with an aching chest pain and dyspnea. Thoracic computed tomography revealed a homogenous mass expanding the right seventh rib. A diagnosis of hemangiopericytoma was established by percutaneous needle biopsy. Preoperative embolization of the feeding vessels of the tumor was performed in order to prevent perioperative bleeding. There was no significant bleeding during the surgery, where complete resection of the tumor with 7th to 9th ribs with a surgical margin of 5 cm was performed. Postoperative course was uneventful and there has been no recurrence for thirteen months. To our knowledge, there has been no report to apply a preoperative embolization of a primary hemangiopericytoma of the rib.     

Persistent extramural vascular invasion positivity on magnetic resonance imaging after neoadjuvant chemoradiotherapy predicts poor outcome in rectal cancer

BackgroundIn rectal cancer, extramural vascular invasion (EMVI) is the presence of tumour cells in blood vessels outside the muscular layer, which is associated with poor prognosis. Regression of EMVI on MRI following neoadjuvant chemoradiotherapy or its persistence may have prognostic implications.MethodsThis retrospective study included 52 patients with rectal cancer who underwent total mesorectal excision following long-course neoadjuvant chemoradiotherapy (CRT). EMVI assessments were done on previous pelvic MRIs obtained before neoadjuvant CRT and eight weeks after the completion of neoadjuvant chemoradiotherapy in initially EMVI positive cases.ResultsPersistently EMVI positive patients had worse overall survival and disease-free survival compared to initially EMVI negative patients and patients who returned to negative (p < 0.001 for both). Multivariate analysis identified persistent EMVI positivity after neoadjuvant treatment (HR, 102.9; p = 0.003) as significant independent predictor of worse overall survival; and persistent EMVI positivity (HR, 17.0; p = 0.002), mesorectal fascia involvement after neoadjuvant treatment (HR, 8.0; p = 0.017), and poor differentiation (HR, 10.3, p = 0.012) as significant independent predictors of worse disease-free survival.ConclusionPersistent EMVI positivity after neoadjuvant therapy appears to be an independent factor for poor overall survival; and persistent EMVI positivity as well as mesorectal fascia involvement on post neoadjuvant therapy MRI and poor differentiation appears to be important predictors of poor disease-free survival in rectal cancer patients.     

Correlation of serum IgE levels with severity of acute pulmonary thromboembolism

We aimed to investigate whether there is a direct correlation of serum IgE concentration with severity of acute pulmonary thromboembolism (PTE). DESIGN: Prospective study. SETTINGS: University medical center. Forty-six patients (27 female, 19 male) who were diagnosed as acute PTE in our clinic between 01 October 2000 and 30 November 2001 comprised the study group. Mean age was 55 (range was 20-82). The study group was divided into three groups according to severity of PTE: Group A, submassive PTE without pulmonary infarction (20 patients); group B, submassive PTE with pulmonary infarction (15 patients); and group C, massive PTE (11 patients). Serum IgE concentrations were measured by ELISA method at 1st, 5th, 15th, 30th, 60th, 90th days, and 120th days, if needed, after the diagnosis. Statistical analysis was made by Post hoc Tukey test. First day serum IgE levels were highest in group B (mean 507.7) followed by group C (mean 324.2), and were lowest in group A (mean 117.2). The differences between group B and group C, between group B and group A, and also between group C and A were all statistically significant (p< 0.5, p< 0.0001, p< 0.015, respectively). 5th day and 15th day results showed statistically significant differences between group B and A, and between group C and A (at 5th day: p<0.0001, p< 0.015 respectively, and at 15th day: p< 0.0001, p< 0.012 respectively). At 30th, 60th, and 90th days of diagnosis serum IgE concentrations were higher in group B than in group A which were statistically significant (p< 0.0001, p< 0.0001, p< 0.019 respectively). Patients with submassive PTE and pulmonary infarction had the highest serum IgE concentrations and the longest duration of high levels of IgE.     

Traditional risk factors are predictive on segmental localization of coronary artery disease

The aim of this study was to investigate the relationship between established risk factors and segmental localization of coronary artery disease. A total of 2760 patients who underwent coronary angiography were enrolled into the study. Coronary angiographic segmental evaluation was performed according to the scheme of American Heart Association. Patients were classified into 2 groups (group 1: normal coronary artery segments, group 2: coronary artery segments with coronary artery disease). Smoking was highly related with left main coronary artery disease (odds ratio = 7.5; P = .005). Diabetes mellitus and male sex increased the risk of atherosclerosis in all coronary vasculature (odds ratio = 2.7-2.2; P < .001-P < .001). Hypertension was correlated with distal coronary artery (odds ratio = 1.4; P < .001) and family history with distal circumflex lesions (odds ratio = 4.5; P = .005) High triglyceride levels were associated with right coronary artery lesions (odds ratio = 1.00; P =.03). The effect of advanced age was small (odds ratio = 1.08; P < .001). Risk factors may be predictive for segmental localization.