RESUMEN

Giant cell arteritis (GCA) is an immune-mediated systemic vasculitis usually seen in the older population. We describe a case of a 75-year-old woman who presented with jaw claudication and temporal headache. A colour duplex ultrasonography and later biopsy of the temporal arteries confirmed GCA and she was commenced on oral steroids. She was subsequently readmitted with a new worsening vision of both eyes and confusion. Her brain images revealed acute bilateral vertebral artery thrombus with haemorrhagic transformation. She was loaded on intravenous steroids. The next day she developed vomiting, bilateral visual loss and a cardiac arrest from ventricular fibrillation. Following the return of spontaneous circulation, she was taken to the cardiac catheterisation laboratory for a coronary angiogram, which showed diffuse thrombus at the apical left anterior descending artery. A bedside echocardiogram revealed a sizable left ventricular thrombus. She was managed with heparin and antiplatelet therapy. This case presented a complex diagnostic dilemma to the medical team as vasculitis, atherosclerosis, and cardiac emboli could have contributed to her stroke and visual loss. This patient also had some vascular risk factors for occlusive cerebrovascular disease, potentially suggesting a clinical event with multiple aetiologies. Stroke and visual loss are rare but serious complications of GCA, which require a high index of suspicion and early treatment with corticosteroids to improve prognosis. Although a temporal artery biopsy remains to be the definitive diagnostic modality for GCA, the use of radiological investigations in the diagnosis of GCA is increasingly common. A non-invasive colour duplex ultrasonography of the temporary arteries could be used to assess GCA in highly suspected patients. Echocardiograms and contrast-enhanced body imaging should be performed in patients with suspected or established GCA to assess for secondary thromboembolic and vascular complications.

RESUMEN

BACKGROUND AND PURPOSE: Intracranial aneurysms are a known but rare complication of radiotherapy (RT). We reviewed the angiographic and clinical outcomes of intracranial aneurysms following RT in patients with nasopharyngeal carcinoma (NPC), a malignancy endemic in Hong Kong. MATERIALS AND METHODS: The clinical, angiographic and laboratory data was collected for nine NPC patients harboring fifteen intracranial aneurysms following RT, diagnosed between 1st January 2000 and 31st December 2012. RESULTS: The median age at aneurysm diagnosis was 56 years with a male predilection (67%). The median latent period to diagnosis was nine years (0.3-30). Eight patients (89%) presented with aneurysmal subarachnoid hemorrhage. Nine aneurysms were located at the anterior circulation, and 14 were saccular in morphology. Of the treated aneurysms, eight underwent endovascular intervention and two were surgically clipped. Within a year, 50% of the treated aneurysms had recurred. Poor neurological outcome was noted. At two-year follow-up, the median score for modified Rankin score and Glasgow Outcome score was 5 and 2 respectively. The two-year mortality rate of patients with treated ruptured intracranial aneurysms was 50%. CONCLUSION: Compared to previous studies, our irradiated NPC patients had higher mortality and morbidity rates after aneurysm rupture and a higher angiographic recurrence rate following treatment. Greater vigilance is required in the detection of post-treatment recurrence of these aneurysms due to the higher risk of rupture. The authors recommend dedicated screening of intracranial aneurysms by active surveillance in routine CT protocols or the addition of three-dimensional time-of-flight magnetic resonance angiography in MR protocols.

Asunto(s)

Carcinoma/radioterapia , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Neoplasias Nasofaríngeas/radioterapia , Radioterapia/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares , Femenino , Humanos , Aneurisma Intracraneal/etiología , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/diagnóstico por imagen , Resultado del Tratamiento

RESUMEN

Lung cancer is a major cause of mortality and morbidity in Malaysia and worldwide. This paper reviews all research and publications on lung cancer in Malaysia published between 2000-2015. 89 papers were identified, of which 64 papers were selected and reviewed on the basis of their relevance to the review. The epidemiology, risk factors, cell types, clinical presentation, diagnosis, treatment, outcomes, prevention, and the social impact of lung cancer in the country are reviewed and summarized. The clinical relevance of the studies done in the country are discussed along with recommendations for future research.

Asunto(s)

Neoplasias Pulmonares

RESUMEN

OBJECTIVE: Several modalities are available for volumetric measurement of the intracranial aneurysm. We discuss the challenges involved in manual segmentation, and analyze the application of alternative methods using automatic segmentation and geometric formulae in measurement of aneurysm volumes and coil packing density. METHODS: The volumes and morphology of 38 aneurysms treated with endovascular coiling at a single center were measured using three-dimensional rotational angiography (3DRA) reconstruction software using automatic segmentation. Aneurysm volumes were also calculated from their height, width, depth, size of neck, and assumed shape in 3DRA images using simple geometric formulae. The aneurysm volumes were dichotomized as "small" or "large" using the median volume of the studied population (54 mm(3)) measured by automatic segmentation as the cut-off value for further statistical analysis. RESULTS: A greater proportion of aneurysms were categorized as being "small" when geometric formulae were applied. The median aneurysm volumes obtained were 54.5 mm(3) by 3DRA software, and 30.6 mm(3) using mathematical equations. An underestimation of aneurysm volume with a resultant overestimation in the calculated coil packing density (p = 0.002) was observed. CONCLUSION: Caution must be exercised in the application of simple geometric formulae in the management of intracranial aneurysms as volumes may potentially be underestimated and packing densities falsely elevated. Future research should focus on validation of automatic segmentation in volumetric measurement and improving its accuracy to enhance its application in clinical practice.