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Review of Hematology-Oncology Emergencies for Internal Medicine Residents.

The prevalence of cancer continues to grow globally every year. With therapeutic advances over the recent decades, the prevalence of individuals living with cancer continues to increase. Internal medicine residents can see patients admitted to the hospital for cancer-related emergencies. Early identification and appropriate management of these emergencies have been shown to improve mortality and morbidity. In this article, we aim to review the recent updates in the management of commonly encountered oncologic emergencies in the practice of internal medicine residents. This review will cover sp

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… Hemodynamically unstable patients require emergency pericardiocentesis.​ Pericardiocentesis under echocardiographic guidance is recommended in nonemergent cases. The recurrence rate is decreased in pericardiocentesis with extended catheter drainage or balloon pericardiotomy. …

Diagnosis of very long chain acyl-dehydrogenase deficiency from an infant's newborn screening card.

Very long chain fatty acid dehydrogenase (VLCAD) deficiency is a rare but treatable cause of cardiomyopathy, fatty liver, skeletal myopathy, … ding. At 3 months, he presented with cardiorespiratory failure and pericardial effusions, requiring pericardiocentesis, tracheostomy, and prolonged mechanical ventilation. Plasma free-fatty acid and acylcarnitine profiles demonstrated small but significant elevations of C14:2, C14:1, C16, and C18:1 acylcarnitine species, findings consistent with a biochemical diagno …

Diagnosis, Treatment, and Prevention of Cardiovascular Toxicity Related to Anti-Cancer Treatment in Clinical Practice: An Opinion Paper from the Working Group on Cardio-Oncology of the Korean Society of Echocardiography.

Cardiovascular (CV) toxicity associated with anti-cancer treatment is commonly encountered and raises critical problems that often result in serious morbidity or mortality. Most cardiac toxicities are related to the cumulative dose of chemotherapy; however, the type of chemotherapy, concomitant agents, and/or conventional CV risk factors have been frequently implicated in CV toxicity. Approximately half of the patients exhibiting CV toxicity receive an anthracycline-based regimen. Therefore, serologic biomarkers or cardiac imagings are important during anti-cancer treatment for early detection

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… Each specific management strategy follows general treatment principles. 200) Aspirin or non-steroidal anti-inflammatory drugs are the mainstays of therapy for acute pericarditis and colchicine is recommended to reduce inflammation and to prevent recurrence. 201) Pericardiocentesis should be considered … in patients with hemodynamically unstable pericardial effusion, and it may be considered to relieve symptoms and establish a diagnosis in patients with extensive pericardial effusion. 202) Pericardiotomy can be considered if pericardiocentesis cannot be performed. 203) Surgical pericardiectomy is rarely …

Thoracic amebiasis.

Pleuropulmonary amebiasis is the common and pericardial amebiasis the rare form of thoracic amebiasis. Low socioeconomic conditions, malnutr … dial cavity. Patients should be cared for in the ICU and ambecides should be started without delay. Pericardiocentesis usually confirms the diagnosis and improves the general condition of the patient. Aspiration of the accumulated fluid should be performed urgently in cardiac tamponade; repeated aspiration may be needed. Surgical drainage should be done if needed. A …

Posterior Reversible Encephalopathy Syndrome: A Case Report With Contemporary Literature Review and Neuropathological Evidence From Autopsy.

Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological condition characterized by vasogenic edema in the parieto-occipital brain regions. Although typically reversible, some cases result in irreversible damage, particularly with delayed treatment. This study reviews 12 autopsy-confirmed cases and presents a novel case, emphasizing neuropathological findings that challenge the assumption of reversibility. Common pathological features include white matter edema, axonal swelling, and fibrinoid necrosis. Risk factors for PRES include hypertension (HTN), autoimmune diseases, re

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… Pericardiocentesis was performed, and she was discharged to rehab on colchicine, metoprolol, and prednisolone. Her condition deteriorated, and she began experiencing dyspnea on exertion and palpitations, leading to the creation of a pericardial window. …

Intrathoracic manifestations of hematologic malignancies: a narrative review.

BACKGROUND AND OBJECTIVE: Although the global incidence of hematologic malignancies is decreasing, the risk of developing these cancers is increasing due to increased lifespan and modern treatments including targeted therapy, chemotherapy, and radiation. Intrathoracic manifestations of hematologic malignancies may be the presenting sign leading to diagnosis or result from various treatment toxicity. The most common respiratory manifestation of hematologic malignancies is infectious, but up to half of pulmonary findings are from non-infectious etiologies. We aim to summarize the current literat

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… Clinically significant pericardial effusions may be treated with pericardiocentesis followed by placement of a pericardial drain. … In addition to treatment of the underlying disease, recurrent malignant pericardial effusions can be managed with repeated pericardiocentesis or surgical pericardial windows, but optimal management is unclear ( 20 ). …

Cardio-oncology: conflicting priorities of anticancer treatment and cardiovascular outcome.

BackgroundThis article about the emerging field of cardio-oncology highlights typical side effects of oncological therapies in the cardiovascular system, cardiovascular complications of malignancies itself, and potential preventive or therapeutic modalities.MethodsWe performed a selective literature search in PubMed until September 2016.ResultsCardiovascular events in cancer patients can be frequently attributed to oncological therapies or to the underlying malignancy itself. Furthermore, many patients with cancer have pre-existing cardiovascular diseases that can be aggravated by the malignan

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… If cardiac tamponade is imminent, pericardiocentesis should be performed promptly. Pericardial effusions often re-occur in these patients and are difficult to manage. Radiotherapy might likely lead to a reduction of the associated pericardial effusion in the presence of radiation sensitive tumors. … Bishiniotis TS Antoniadou S Katseas G Mouratidou D Litos AG Balamoutsos N Malignant cardiac tamponade in women with breast cancer treated by pericardiocentesis and intrapericardial administration of triethylenethiophosphoramide (thiotepa) Am J Cardiol 2000 86 3 362 364 10.1016/S0002-9149(00)00937-1 10922456 …

Heart failure with preserved ejection fraction in cancer patients and survivors. A scientific statement of the Heart Failure Association of the ESC and the ESC Council of Cardio-Oncology.

Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized in cancer patients and survivors, yet it remains underdiagnosed and its epidemiology largely unknown. This statement underscores the imperative need to include HFpEF in the cardiotoxicities identified during or after anticancer treatments. It also highlights the prognostic value of pre-existing HFpEF for periprocedural and cardiotoxicity risk and it discusses the challenges in the diagnosis and treatment of HFpEF in cancer patients. It also explores the aetiologic role of anticancer therapies (chemotherapy, targe

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… Outcomes of cancer patients undergoing percutaneous pericardiocentesis for pericardial effusion . J Am Coll Cardiol 2015 ; 66 : 1119 – 1128 . 10.1016/j.jacc.2015.06.1332 26337990 PMC4560839 134 Labbé C , Tremblay L , Lacasse Y . … Pericardiocentesis versus pericardiotomy for malignant pericardial effusion: A retrospective comparison . Curr Oncol 2015 ; 22 : 412 – 416 . 10.3747/co.22.2698 26715874 PMC4687662 135 Janus SE , Heisler AC , Al Jammal M , Chahine N , Chami T , Hajjari J , et al . …

Cardiovascular Disease After Hematopoietic Stem Cell Transplantation in Adults: JACC: CardioOncology State-of-the-Art Review.

The use of hematopoietic cell transplantation (HCT) has expanded in the last 4 decades to include an older and more comorbid population. These patients face an increased risk of cardiovascular disease after HCT. The risk varies depending on several factors, including the type of transplant (autologous or allogeneic). Many therapies used in HCT have the potential to be cardiotoxic. Cardiovascular complications after HCT include atrial arrhythmias, heart failure, myocardial infarction, and pericardial effusions. Before HCT, patients should undergo a comprehensive cardiovascular assessment, with

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… . • The proportion of patients who develop tamponade alongside the effusion ranges from 8% to 83%; however, in case series, the mortality rate is low because of timely intervention with pericardiocentesis. 26 , 106 Ventricular arrhythmias | | • Ventricular arrhythmias are uncommon across both transplantation … effusion has resolved. • The optimal time interval for repeat scanning is unclear, but general guidance suggests repeating the echocardiogram 7-14 days after the index echocardiogram in small to medium effusions (>4 to ≤20 mm), with a repeat scan in 4 to 6 weeks if the effusion is resolving. 19 • If pericardiocentesis …

A Phase I Study of Carfilzomib with Cyclophosphamide and Etoposide in Relapsed and Refractory Leukemia and Solid Tumors.

BackgroundNovel therapies are needed for children, adolescents, and young adults with relapse/refractory leukemia or solid tumors. The proteasome inhibitor carfilzomib has demonstrated pre-clinical activity against several pediatric malignancies when used alone or in combination. Therefore, a multicenter dose-escalation phase 1 study of carfilzomib administered in combination with cyclophosphamide and etoposide was conducted.MethodsStudy eligibility included an age of 6 months to 2/day, etoposide 100 mg/m2/day, and carfilzomib was administered every 28 days with growth factor support. The carf

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… It was also unclear if pericarditis was due to carfilzomib as a pericardiocentesis revealed T-cell leukemia cells in the patient’s pericardial fluid, leading to our decision to enroll additional patients until a third DLT occurred. …

Review of oncological emergencies in small animal patients.

Oncological emergencies can occur at any time during the course of a malignancy and need to be recognized promptly to maximize successful outcomes. Emergencies are characterized as chemotherapy-induced, paraneoplastic syndromes, or directly related to the neoplasm. Prompt identification with treatment of these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. This review aims to educate the reader on the pathophysiology, clinical presentation and treatment of some of these emergencies, and to review the current veterinary literature to help

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… Primary treatment involves removal of the fluid via pericardiocentesis. Arrhythmias, particularly ventricular arrhythmias, are the most common complication and occur in approximately 10% of dogs within one hour of the procedure and in 15% within forty‐eight hours (Humm et al . 2009 ). … New England Journal of Medicine 364 , 1844 – 1854 . 21561350 10.1056/NEJMra0904569 PMC3437249 Humm K.R. , Keenaghan‐Clark E.A. & Boag A.K. ( 2009 ) Adverse events associated with pericardiocentesis in dogs: 85 cases (1999‐2006) . …

Current Data and Future Perspectives on Patients with Atrial Fibrillation and Cancer

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… The incidence of the 30-day and 180-day readmission outcomes, as well as the composite in-hospital outcome rate (in-hospital death, ischemic stroke/transient ischemic attack, systemic embolism, bleeding requiring blood transfusion, pericardial effusion/cardiac tamponade treated with pericardiocentesis …

Emergency Care

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Best of JACC: Case Reports From ACC.23.

This dedicated issue of JACC: Case Reports highlights the top ranked Complex Clinical Cases from the ACC 2023 Scientific Sessions. These cases were reviewed and selected by a committee of peers in the months leading up to the annual meeting. These reviewers were ACC members with no affiliation to the JACC: Case Reports Editorial Board. While the cases were presented at the meeting and included in the formal Abstract Book from ACC, they have not been published elsewhere. These cases illustrate how the ACC can be a place for cardiovascular professionals to come together to learn, grow, and share

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… She underwent ultrasound-guided pericardiocentesis with the removal of 950 milliliters of serosanguineous fluid. Follow-up echocardiogram showed re-accumulation of fluid. Due to the rapid onset of PEff, she underwent a pericardial window and bilateral chest tube placement. …

Poster Presentation

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… Echocardiography guided pericardiocentesis was performed in this case which presented with shortness of breath and features of right heart compromise. …

A review of chemotherapeutic drugs-induced arrhythmia and potential intervention with traditional Chinese medicines.

Significant advances in chemotherapy drugs have reduced mortality in patients with malignant tumors. However, chemotherapy-related cardiotoxicity increases the morbidity and mortality of patients, and has become the second leading cause of death after tumor recurrence, which has received more and more attention in recent years. Arrhythmia is one of the common types of chemotherapy-induced cardiotoxicity, and has become a new risk related to chemotherapy treatment, which seriously affects the therapeutic outcome in patients. Traditional Chinese medicine has experienced thousands of years of cli

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… Intrapericardial cisplatin administration after pericardiocentesis in patients with lung adenocarcinoma and malignant cardiac tamponade. Hell. J. Cardiol. 46 (5), 324–329. Brouty-Boye D., Kolonias D., Lampidis T. J. (1995). …

Cardio-oncology in Austria: cardiotoxicity and surveillance of anti-cancer therapies : Position paper of the Heart Failure Working Group of the Austrian Society of Cardiology.

Survival in cancer is continuously improving due to evolving oncological treatment. Therefore, cardiovascular short-term and long-term side effects gain crucial importance for overall outcome. Cardiotoxicity not only presents as heart failure, but also as treatment-resistant hypertension, acute coronary ischemia with plaque rupture or vasospasm, thromboembolism, arrhythmia, pulmonary hypertension, diastolic dysfunction, acute myocarditis and others. Recent recommendations have proposed baseline cardiac risk assessment and surveillance strategies. Major challenges are the availability of monito

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… Pericardiocentesis may be required in hemodynamic compromise, followed by surgical pericardial windowing if needed. Chronic thickening and constrictive pericarditis may develop after high-dose radiotherapy [ 136 , 144 ]. …

Abstract

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Standard Poster Abstracts for the 17th Asia Pacific Heart Rhythm Society (APHRS) Scientific Sessions

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Brazilian Position Statement on the Use Of Multimodality Imaging in Cardio-Oncology - 2021.

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