RESUMEN
A positive seatbelt sign following a motor vehicle accident is associated with an increased risk of intra-abdominal injury and hemoperitoneum. Injury to the uterus in reproductive-age women can also occur. In this report, we describe a 29-year-old nulligravida female who presented to the emergency room following a motor vehicle accident at freeway speeds. A positive seatbelt sign was noted, and a focused assessment with sonography for trauma revealed hemoperitoneum with an incidental finding of uterine leiomyomata. Upon exploratory laparotomy, a free-floating intraperitoneal mass was identified as an avulsed uterine leiomyoma. A uterine laceration containing a subserosal leiomyoma was also identified. The gynecological team was consulted, and a myomectomy of the subserosal leiomyoma followed by a closure of the uterine laceration was performed. The patient was transfused with a total of three units of packed red blood cells and two units of fresh frozen plasma. The postoperative course was without major complication. A positive seatbelt sign and hemoperitoneum in a reproductive-age woman with leiomyomata should increase the clinical suspicion for uterine injury and decrease the threshold for obtaining a gynecological consultation.
RESUMEN
INTRODUCTION: Recent analyses have identified cardiac dose as an important predictor of overall survival (OS) after chemoradiation for locally advanced non-small-cell lung cancer (NSCLC). However, the survival influence of the cardiac dose after stereotactic body radiotherapy (SBRT) is unknown. We performed a dose-volume histogram (DVH) analysis of patients treated with SBRT for early stage NSCLC to examine survival and cardiac toxicity. MATERIALS AND METHODS: We reviewed the medical records of patients who had undergone SBRT for early-stage NSCLC from June 2007 to June 2015 and documented the cardiac DVH parameters, including the maximum and mean dose and percentage of volume receiving >5, >10, >20, and >30 Gy (V5, V10, V20, and V30, respectively). The biologically effective doses and 2-Gy equivalent doses were also calculated. The DVH parameters were assessed as predictors of OS using Cox regression analysis. RESULTS: We identified 102 patients with 118 treated tumors. At a median follow-up period of 27.2 months (range, 9.8-72.5 months), the 2-year OS estimate was 70.4%. The cardiac DVH parameters were as follows: maximum dose, median, 14.2 Gy (range, 0.3-77.8 Gy); mean dose, median, 1.6 Gy (range, 0-12.6 Gy); and V5, median, 8.7% (range, 0%-96.4%). We identified no correlation between OS and any cardiac dose parameter. No patient developed acute (within 3 months) cardiac toxicity. Four patients died of cardiac causes; all had had preexisting heart disease. CONCLUSION: In our cohort, cardiac dose was not a predictor of OS after lung SBRT, despite a subset of patients receiving high maximum cardiac doses. The findings from our limited cohort showed that high doses to small volumes of the heart appear safe. Analyses of larger patient cohorts with longer follow-up durations are needed to better delineate the safe cardiac DVH constraints for SBRT.