RESUMEN
Floating right heart thrombus, also known as "emboli in transit" is a potentially fatal condition, of varying etiology and usually coexisting with massive pulmonary embolism. Although the mortality rate is as high as 40%, there are no established therapeutic guidelines. A case is presented of an 84 year old female with a history of colon cancer and coronary artery disease who presented with sudden onset unresponsiveness. She was intubated in the ED and started on intravenous pressor support. A free floating large right ventricular thrombus and dilated right ventricle were noted on transthoracic echocardiogram (TTE). She was managed medically with good short term outcome. Floating right heart thrombus is a rare occurrence. Recognition of signs and symptoms along with early TTE is critical for diagnosis and consideration of treatment modality. The existing literature does not offer a clear consensus for management of pulmonary embolism with co-existing mobile intra-cardiac thrombus. Choice of treatment is crucial and should be considered on a case-by-case basis after careful assessment of indications, contraindications, risks and benefits.
Asunto(s)
Cardiopatías/tratamiento farmacológico , Terapia Trombolítica , Trombosis/tratamiento farmacológico , Anciano de 80 o más Años , Ecocardiografía , Femenino , Cardiopatías/diagnóstico por imagen , Cardiopatías/cirugía , Humanos , Trombosis/diagnóstico por imagen , Trombosis/cirugíaRESUMEN
BACKGROUND: A phase II study was conducted using concurrent paclitaxel, carboplatin, and external beam radiotherapy (RT) in patients with advanced head and neck cancer. METHODS: Forty-three patients (stage III, n = 12; stage IV, n = 31) were treated with 8 cycles of weekly paclitaxel (60 mg/m(2)), carboplatin (area under the curve [AUC] = 1), and RT (1.8 Gy daily; total dose, 66-72 Gy). Patients with initially palpable lymph nodes underwent neck dissection. RESULTS: The overall clinical response rate was 91% (65% complete, 26% partial). Severe mucositis occurred in 37 (90%) patients, necessitating hospitalization in 13 (31%) patients. With a median follow-up of 49 months, the locoregional and distant failure rates were 26% and 21%, respectively. CONCLUSIONS: Concurrent paclitaxel, carboplatin, and RT for advanced head and neck cancer results in high complete response rates. Long-term follow-up has revealed the curative potential of this regimen, though the doses used resulted in unacceptable toxicity.