RESUMEN
Primary myeloid sarcoma is a rare extramedullary manifestation of acute myeloid leukemia (AML). Typically, myeloid sarcoma presents after a diagnosis of AML or other myeloproliferative disorder. However, primary myeloid sarcoma may present without any preexisting condition, thereby making it extremely difficult to diagnose. We discuss a case of a 22-year-old female who was misdiagnosed initially with acute appendicitis and underwent an appendectomy. Postoperatively, she continued to be symptomatic and eventually developed small bowel obstruction. Diagnostic laparoscopy revealed multiple small bowel masses as well as diffuse abdominal and pelvic lymphadenopathy. After extensive pathological review and additional workup consisting of immunohistochemistry and molecular studies, the correct diagnosis of myeloid sarcoma was made. This review will discuss the presentation, diagnosis, management, and prognosis of primary myeloid sarcoma.
Asunto(s)
Apendicitis/diagnóstico , Errores Diagnósticos , Neoplasias del Íleon/diagnóstico , Íleon/patología , Obstrucción Intestinal/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Sarcoma Mieloide/diagnóstico , Procedimientos Innecesarios , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Apendicectomía , Apendicitis/cirugía , Colonoscopía , Femenino , Trasplante de Células Madre Hematopoyéticas , Humanos , Neoplasias del Íleon/complicaciones , Neoplasias del Íleon/terapia , Íleon/diagnóstico por imagen , Íleon/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Neoplasias Primarias Múltiples/complicaciones , Neoplasias Primarias Múltiples/terapia , Radiografía , Sarcoma Mieloide/complicaciones , Sarcoma Mieloide/terapia , Adulto JovenAsunto(s)
Neoplasias de la Mama/cirugía , Tumor Filoide/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Métodos , Persona de Mediana EdadRESUMEN
We have used the superior approach through the dome of the left atrium to repair cardiac lesions in the left atrium in 15 children ranging from 3 months to 17 years old. The single hospital death occurred in a 16-month-old infant with levo (L) transposition of the great arteries, Ebstein's malformation of the left atrioventricular valve, and ventricular septal defect. Exposure of the intraatrial structures was excellent, injury to adjacent cardiac structures did not occur, and hemorrhage from the left atrial suture line was not a problem. Though a few transient arrhythmias were seen, all survivors are in sinus rhythm without evidence of sick sinus syndrome, except 1 patient in whom atrial flutter associated with cardiomyopathy developed 1 year after operation. The excellent surgical exposure obtained of the interior of the left atrium and the absence of important complications related to the incision cause us to recommend this approach in children.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cardiopatías Congénitas/cirugía , Adolescente , Arritmias Cardíacas/etiología , Procedimientos Quirúrgicos Cardíacos/mortalidad , Niño , Preescolar , Femenino , Atrios Cardíacos/anomalías , Atrios Cardíacos/cirugía , Humanos , Lactante , Masculino , Complicaciones Posoperatorias/etiologíaRESUMEN
A simple thermodilution technique is described for determining systemic blood flow with right atrial and left atrial catheters and a pulmonary arterial thermistor probe. Injections of cold water into the atrial catheters provide computer display readings that permit direct calculation of systemic blood flow. The method is convenient for determining systemic blood flow in postoperative patients with a residual left-to-right shunt.
Asunto(s)
Circulación Sanguínea , Gasto Cardíaco , Defectos del Tabique Interventricular/fisiopatología , Arteria Pulmonar , Computadores , Humanos , Lactante , Complicaciones Posoperatorias , Tetralogía de Fallot/fisiopatología , Termodilución/métodosRESUMEN
Forty patients have been treated with recurrent operable breast cancer after having undergone procedures less extensive than modified radical mastectomy as a treatment of the primary, with or without radiation therapy. Initial pathology was invasive cancer in 21 patients, and treatment (excision or simple mastectomy, with or without radiation therapy) has been offered as the treatment of choice. Completion of radical mastectomy was done here in 30 patients, extended radical mastectomy in 3, and local excision in 7. Eleven received postoperative radiation therapy. The overall 5-year survival rate from the time of treatment, free of disease, was 40 per cent, and the 10-year survival rate was 20 per cent. If initial treatment included radiation therapy, survival was improved (12/25 vs 4/15 having no radiation therapy). Axillary nodal involvement was extensive, with 13 patients having positive level III nodes. Such patients should be followed closely in order to detect recurrence earlier. Adjuvant radiation therapy and chemotherapy trials post mastectomy should be evaluated in the hope of improving survival.