Marked Compression Research Articles

Angioedema Turned Aortic Dissection

Introduction: Angiotensin-converting enzyme inhibitor (ACE-I)-induced angioedema accounts for many emergency department visits. Clinicians may anchor on this diagnosis when patients present for facial swelling. However, facial swelling can have many causes ranging from an allergic reaction to superior vena cava syndrome (SVCS). Case Description: A 61-year old African-American male presented with facial swelling. He reported a history of hypertension and was prescribed lisinopril. Suspicion for ACE-I-associated angioedema was high; the initial plan was to stop that medication and monitor the patient to ensure that his swelling did not worsen. However, the patient revealed he also had chest pain. Tests were ordered to assess for acute coronary syndrome. Most were unremarkable, but the chest radiograph showed a widened mediastinum. A bedside ultrasound showed a large ascending aortic aneurysm with an associated proximal aortic dissection; a dissection flap was clearly visualized. After consulting with cardiothoracic surgery, a CT angiogram of the chest was obtained which showed a 7.7 cm dissecting aneurysm involving the ascending aorta and proximal aortic arch. The radiologist also noted there was marked compression of the superior vena cava due to the large aneurysm of the ascending aorta. The patient was taken emergently to the operating room where a 6.5-hour complex operation ensued. Although the patient was transferred to recovery in stable condition, multiple complications, including worsening SVCS, prolonged his intensive care unit stay. Life support was ultimately terminated after a five-week hospital stay. Discussion: Superior vena cava syndrome is most commonly caused by advanced stages of lung cancer. Today, only 5% to 22% of all cases of SVCS in developed countries are not caused by cancer, and most of these are caused by thrombosis due to central venous catheters and pacemakers. Thoracic aortic aneurysm, which itself is reported to have a prevalence of 0.16%, is a rare cause of SVCS, with only a few previously documented cases. Furthermore, patients may remain asymptomatic for a long time and the clinical signs of SVCS are often nonspecific. Especially in nonmalignant cases of SVCS, all of these factors can misdirect the correct diagnosis, as it did for us. Thus, it is important to keep the differential diagnosis for any symptom broad, even when the diagnosis seems obvious.

Atypical magnetic resonance imaging findings of a vertebral melanotic melanoma in a dog

AbstractAn 8‐year‐8‐month‐old whippet was investigated by magnetic resonance imaging for acute thoracolumbar discomfort and pelvic limb stiffness, which had progressed to severe ambulatory paraparesis and proprioceptive ataxia of the pelvic limbs in the 24 hours before presentation. An aggressive, extradural T10 vertebral mass‐like lesion was identified, with resultant marked compression of the spinal cord. The lesion was heterogeneously T2‐weighted hyperintense and moderately T1‐weighted hyperintense relative to the adjacent vertebrae and paravertebral musculature. Cytological analysis of the lesion was consistent with a melanotic melanoma, which was confirmed by histopathological analysis and immunohistochemistry. The vertebral column is an uncommon location for either primary or metastatic melanomas in both humans and veterinary species. This lesion was particularly unusual in that its imaging characteristics were not typical for melanotic melanoma. This case report illustrates the unusual anatomical and imaging features of this tumour and outlines the diagnostic considerations pertinent to this case.

Sarcoidosis with esophageal involvement: an uncommon clinical enigma.

We present the case of a 46-year-old male, a former smoker, with a medical history significant for morbid obesity grade III, hypothyroidism, hyperuricemia, and dyslipidemia. Four months ago, he was diagnosed with sarcoidosis involving mediastinal lymph nodes and is currently undergoing treatment with corticosteroids. The patient presented to the emergency department with persistent epigastric and thoracic pain lasting one week, accompanied by dysphagia and odynophagia intermittently. Laboratory tests showed elevated acute-phase reactants, with no other notable abnormalities. Chest X-ray revealed pre-existing mediastinal adenopathy. Despite an abdominal CT scan with contrast showing no significant findings, esophagogastroduodenoscopy revealed marked extrinsic compression of the esophagus between 25 and 32 cm from the dental arch, with less intensity distally. Although passage of the endoscope through this area caused significant pain, it did not hinder its advancement. A chest CT scan with oral contrast demonstrated filamentous narrowing of the esophagus in the middle third, along with concentric thickening of its walls and multiple paratracheal, parahilar, and periesophageal lymphadenopathies. Following a tapering regimen of corticosteroids, the patient was discharged with a clinical diagnosis of sarcoidosis with mediastinal and esophageal involvement secondary to extrinsic compression. Due to clinical improvement with the prescribed treatment, endoscopic ultrasound and biopsies to assess esophageal wall involvement were deemed unnecessary.

Anesthetic Management of a Pediatric Patient with Midline Neck Mass Causing Significant Tracheal Compression in Stridor for Resection of Tumor

Abstract A 1-year-old female child weighing 10 kg, with a mass over the lower part of the neck presented with stridor. Computed tomography showed a solid enhancing lesion in the lower neck causing marked tracheal compression with complete apposition of the anterior and posterior walls of the trachea causing almost complete obliteration of the tracheal lumen. The child was posted for resection of the tumor under general anesthesia. She was induced with sevoflurane 8% in oxygen and intubated following a flexible bronchoscopic assessment with a 4.0 mm cuffed endotracheal tube using C-MAC videolaryngoscope. After positioning, she developed airway compression, and using a fiber-optic bronchoscope, ETT tip was repositioned distal to the area of tracheal compression. There were repeated episodes of airway compression with desaturation intraoperatively. Postoperatively, the child was ventilated. Due to tracheomalacia and bilateral vocal cord palsy, the extubation trials failed, and she was eventually tracheostomized on the 5th postoperative day to maintain airway.

FRI343 A Case Of Postpartum Adrenal Crisis Secondary To Empty Sella

Abstract Disclosure: A. Alzenaidi: None. Empty sella occurs when the pituitary gland appears shrunken or invisible and CSF fills the sella turcica space. It is commonly defined in the radiology literature as an incidental finding of no clinical significance, but an association with sequalae of lymphocytic hypophysitis (LH) was observed in a mouse model of the disease. However, patient data on the development of empty sella are scant and present later in life.To our knowledge, this is the second case of postpartum empty sella with clinically suspected LH and early presentation within 2 yr postpartum. A 31-year-old woman presented to our endocrine clinic for pituitary evaluation. She was 16 months post-spontaneous vaginal delivery with no history of excessive bleeding or blood transfusion. Her pregnancy was uneventful except for headache without visual changes after the thirty-fifth week, which improved with nasal steroid spray. Four to six weeks postpartum, she presented to her primary care physician with palpitations, fatigue and weight loss. Labs showed TSH, 0.001 mIU/mL (0.3-4.2); free T4, 30.98 pmol/L (9-19); free T3, 23.04 pmol/L (2.6-5.7); and thyroid peroxidase antibodies, 512.6 IU/mL (<5.6). Thyroid function tests improved after a short course of carbimazole, although without significant improvement of her symptoms. At 10 months postpartum, she presented to the ED with worsening fatigue, weight loss, vomiting and dizziness. Further history revealed oligomenorrhea and an inability to lactate since delivery. On exam, her heart rate was 100 b/m, respiratory rate was 20 b/m, BP was 90/50 mmHg, and temperature was 38.8 C. Labs showed WBC, 4.26 x 103/µL (4-11); Hb, 9.9 g/dL (11.8-14.8); PLT, 181 x 103/µL (150-450); Na, 136 mEq/L (135-145); K, 3.6 mEq/L (3.5-5.1); HCO3, 20 mmol/L (22-29); creatinine, 62 µmol/L (49-90); lactate, 0.82 mmol/L (0.5-2.2); FSH, 6.16 IU/L; prolactin, < 12.6 mIU/L (110-564) (prolactin prepregnancy was 233 mIU/L); TSH, 6.7 (0.3-4.2); free T4, <5.15 pmol/L (9-19); ACTH, 0.22 pmol/L (1.03-10.73); cortisol, 50.3 nmol/L (1.82 µg/dl); and peak cortisol after 250 mcg ACTH stimulation test, 223.5 nmol/L (8.1 µg/dl). She was treated with intravenous fluids and hydrocortisone. Pituitary MRI showed marked compression of the pituitary tissue with concave superior margins due to partially empty sella. She was maintained only on hydrocortisone replacement. During follow-up, her menstrual cycle resumed regularly, and fatigue and thyroid function improved (TSH, 2.65 µIU/ml; free T4, 12.13 pmol/L). Our patient had autoimmune thyroiditis with positive TPO antibodies, and it is possible that she had coexistent LH. LH typically presents as a pituitary mass; however, our patient had empty sella.In conclusion, the development of empty sella in this case suggests that postpartum atrophy of the pituitary gland can be life threatening if associated with hypopituitarism. Early recognition could prevent serious consequences. Presentation: Friday, June 16, 2023

Computed tomographic features of double aortic arch in six dogs.

Double aortic arch (DAA) is a rare, congenital anomaly in small animals, resulting in a complete vascular ring encircling the esophagus and trachea, and subsequent compression of these organs. Few studies have reported utilizing CT angiography (CTA) for diagnosing DAA in dogs; thus, the imaging features are currently lacking in the literature. The objectives of this retrospective, multicenter, descriptive case series were to report the clinical and CTA characteristics of DAA in surgically treated cases. Medical records and CTA images were reviewed. Six juvenile dogs met the inclusion criteria (median age: 4.2 months; range: 2-5 months). The most common clinical signs included chronic regurgitation (100%), decreased body condition (67%), and coughing (50%). Common CTA features of DAA included a dominant left aortic arch (median diameter: 8.1mm) and minor right aortic arch (median diameter: 4.3mm; 83%), an aberrant right subclavian artery arising directly from the right aortic arch (83%), segmental esophageal constriction (100%), and variable degrees of dilation cranial to the heart base, and marked tracheal luminal compression (median percent change: -55%; 100%) and leftward curvature of the trachea at the level of the bifurcation of the aortic arches (100%). All dogs underwent successful surgical correction with only minor postoperative complications. Due to the similarity of clinical and imaging characteristics described to that of other forms of vascular ring anomalies (VRA), CTA is vital for the specific diagnosis of DAA in dogs.

Anaesthetic Management for A Patient Presenting for Caesarean Delivery with A giant Thymoma – A Case Report

Presentation of a thymoma during pregnancy means that safe delivery becomes more challenging. We present a 33-year-old pregnant woman who was diagnosed with a large thymoma causing marked compression of the tracheobronchial tree and right atrium. After various multidisciplinary meetings she presented for elective caesarean section delivery at 31 weeks of gestation. A combined spinalepidural anaesthesia was performed, along with colloid pre- and co-loading, and vasopressor support. The delivery was uneventful. The possibility of catastrophic complications was foreseen. Therefore, all requirements for the possibility of airway or haemodynamic collapse were planned carefully, including the possibility of emergent cardiopulmonary bypass.

Reversible Pisa syndrome caused by chronic subdural hematoma in a patient with Parkinson’s disease: a case report

BackgroundPisa syndrome (PS), characterized by lateral trunk flexion, is quite common in patients with Parkinson’s disease (PD). Patients with PS are older and have a significantly longer disease duration, more severe motor phenotype, ongoing combined treatment with levodopa and dopamine agonists, and higher levodopa equivalent daily dose. We describe here, to the best of our knowledge, the first case of a woman with PD who developed acute-onset PS caused by chronic subdural hematoma (CSDH).Case presentationA 70-year-old woman developed acute-onset lateral flexion of her trunk to the left side while standing, and she was admitted to our hospital. One month before, she had a mild head trauma with loss of consciousness. At 65 years of age, she noticed difficulty with walking and clumsiness with her hands. She was diagnosed as having PD (Hoehn and Yahr stage 2) and levodopa was initiated. Her symptoms were markedly improved. At 67 years of age, she developed orthostatic hypotension and was treated sequentially with fluids, compression stockings, and midodrine. Urgently performed brain computed tomography (CT) showed a CSDH in the right hemisphere resulting in a marked compression of the hemisphere. After surgical evacuation, her PS disappeared. She has fully recovered to her preoperative level of function.ConclusionThe present case provides a valuable insight, that is, the mesial frontal lobe and its connections from the posterior parietal cortex play crucial roles in maintaining the body schema and in the pathophysiology of PS. This case suggests that CSDH should be considered when clinicians examine acute-onset PS, even in patients with neurodegenerative disorders such as PD. Appropriate patient triage and timely neurosurgical intervention should be considered.

Cervical cord reperfusion injury: a rare complication of spine surgery

BackgroundAnterior cervical discectomy and fusion procedure has been considered the surgical procedure of choice for the management of degenerative cervical myelopathy. Postoperative paresis is one of the most serious and concerning complications. The occurrence of such complications without any clear anatomic explanation (e.g., epidural hematoma) is unusual.Case presentationA 62-year-old man underwent cervical spine decompression via the anterior approach for marked central canal stenosis and spinal cord compression due to degenerative changes. The operation was performed under neuromonitoring, and a complete discectomy for the levels C3/C4, C5/C6, and C6/C7 was performed. Fluoroscopy confirmed the correct placement of the inserted plates and screws. No motor or sensory deficits were evident after postoperative recovery. However, 1 day later, the patient experienced progressive weakness in his both upper and lower extremities. A whole spine MRI study was performed to exclude epidural hematoma as the possible etiology. Although no localized fluid collection or hematoma was observed, the study demonstrated abnormal signal intensity in the spinal cord on T2-weighted images at the levels C5 to C7. Such findings were consistent with changes in cord reperfusion syndrome. The patient was administered intravenous methylprednisolone therapy. Gradual improvement in the muscle power in his both extremities was noted, and the patient was discharged with a satisfactory outcome. One month later, the MRI study was repeated and showed regression of the previously seen high T2 signal intensity in the cervical spine.ConclusionCervical cord reperfusion injury is an extremely rare etiology of neurological deterioration following spinal cord decompressive surgeries. Clinicians need to maintain a high index of suspicion for this complication and should be familiar with its imaging appearance.

Challenges of Diagnosis and Treatment Choice in Riedel‘s Fibrosing Thyroiditis: Clinical Case Examples

Background. Clinically distinct Riedel’s fibrosing thyroiditis is extremely rare, accounting for only 0.05 % of histologically verified thyroiditis cases, as follows from the real clinical practice and literature. Classic Riedel’s thyroiditis is typified by a marked compression syndrome, which may lack at initial disease stages. A problematic verification often conduces to a diagnostic and, especially, therapeutic malpractice, as illustrated by the two hereby analysed clinical cases.Materials and methods. The article presents two clinical cases of fibrosing thyroiditis, specifying the diagnosis and treatment choice in patients with this pathology. Diagnosis verification and therapy correction facilitated a favourable outcome.Results and discussion. Riedel’s fibrosing thyroiditis can be reluctant to diagnosis due to asymptomatic thyroid dysfunction, the lack of strict radiological diagnostic criteria and rarity in clinical practice. This provokes diagnostic and later therapeutic malpractices, which correction permitted a favourable outcome.Conclusion. Since treatment for compression syndrome-aggravated Riedel’s fibrosing thyroiditis is exclusively surgical, it continues posing a challenge as associated with likely severe complications. Essentially, the first treatment stage was inadequate in both cases. In the first case, the patient withdrew a thyroid hormone therapy already in 4 days, which precluded serious iatrogenic complications, while in the second case, the long-term drug misuse had conduced to cardiovascular pathology.

Schiff‐Sherrington syndromein a 7‐year‐old zebra mare (Equus quagga)

SummaryA 7‐year‐old plains zebra(Equus quagga)mare was presented to the Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Germany as an emergency. The owner reported that the mare was unable to stand after a suspected traumatic episode at the home yard. The mare was transported in lateral recumbency in a trailer. Clinical examination revealed tachycardia (up to 102 beats/min), tachypnoea (28 breaths/min), mild fever (38.7°C) and clinical dehydration with elastic skin and dry and red mucous membranes. Neurological examination showed paraplegia with complete loss of nociception of the mid‐thoracic region and caudal to it. In contrast, examination of the thoracic limbs revealed marked extensor rigidity and hyperaesthesia resulting in an enhanced acute response to minimal touch of the neck and shoulder region. Lateral radiographs of the thoracic vertebral column led to the diagnosis of a complete fracture of the vertebral body of the 7th thoracic (T) vertebra with suspected traumatic compression of the spinal cord. Post‐mortem examination confirmed the diagnosis. Gross pathology revealed a complete comminuted fracture of T7 with marked compression of the spinal cord. This is the first report describing the clinical, radiological and pathological findings of a fracture of a thoracic vertebra leading to aSchiff‐Sherrington syndromein a zebra(Equus quagga).

Sudden bilateral lower limb paralysis with dural ectasia in Neurofibromatosis type 1

Abstract Introduction: Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder characterized by pigmented lesions (café-au-lait macules, skinfold freckling, and Lisch nodules), and dermal neurofibromas. In some subjects, NF-1 presents with complications such as brain tumors, skeletal abnormalities, peripheral nerve tumors, and behavioral abnormalities. Patient concerns: We report the case of a 30-year-old man who presented with sudden bilateral lower limb paralysis and acute-onset lower back pain following a fall while rising from a seated position. He denied a history of back pain or muscle weakness before the index event. On examination, the patella and Achilles tendon reflexes were absent bilaterally. The patient presented with a power grade of 0 in all lower limb muscle groups and normal muscle bulk. Diagnosis: Bilateral lower limb paralysis was associated with sensory loss in the T11 dermatome. X-ray, computed tomography, and magnetic resonance imaging (MRI) showed vertebral canal enlargement (dural ectasia) at multiple levels suggestive of a lateral meningocele associated with neurofibromatosis. After repeated MRI studies, herniation of nerve root sleeves was noted, with marked compression of the traversing nerve roots. Notably, there was no evidence of cord compression on either the computed tomography or MRI. The cerebrospinal fluid studies were unremarkable. Interventions: No particular intervention was performed to address specific NF symptoms. In the hospital, the patient received analgesics and antibiotics (gentamicin and cefuroxime) for a urinary tract infection, lactulose for constipation and enoxaparin as anticoagulant prophylaxis. Outcomes: The patient experienced a clinical decline unrelated to his initial symptoms and succumbed to sepsis 6 weeks after admission. The cause of death was not directly linked with NF-1. Conclusion: We report a case of NF-1 with dural ectasia presenting with sudden bilateral lower limb paralysis and lower back pain following mild trauma. Although 70% of dural ectasia cases are associated with NF-1, there are few reports of NF-1 patients with dural ectasia and associated orthopedic complications. Here, we note that dystrophic changes in NF-1 may lead to rapidly aggravating neurological symptoms even after trivial trauma.

Ewing's Sarcoma of the Pancreas

A 23-year-old previously healthy woman presented with a 2-day history of progressively worsening left upper quadrant abdominal pain with associated abdominal distention, nausea, and bloating. Computed tomography of the abdomen revealed a 14 × 12.5 × 11 cm multilobulated mass inferior to the stomach causing marked extrinsic compression of the stomach and encasing the splenic artery and celiac axis (Figure A). Magnetic resonance imaging of the abdomen confirmed the previously described abdominal mass emanating from the pancreatic body and tail demonstrating diffuse restricted diffusion with heterogeneous enhancement.

Transdural reduction of a bone fragment protruding into the spinal canal during surgical treatment of lumbar burst fracture: A case report.

Background: There have been many reports on the clinical, radiographic, and surgical management of thoracolumbar burst fractures attributed to high-energy trauma. Interestingly, few reports have described how to extract bone fragments associated with these injuries protruding into the spinal canal contributing to significant neurological deficits.Methods: An 18-year-old male presented with a severe L3-level paraparesis (i.e., loss of motor/sensory function below L3 lower extremity hyporeflexia, and sphincter dysfunction: American Spinal Injury Association [ASIA] Impairment Scale B) following a high-speed crash. The computed tomography and magnetic resonance studies revealed a L3 burst fracture with bone fragments protruding into the spinal canal causing marked cauda equina compression. Following a L3-L4 laminectomy, and opening of the dorsal dura, the bone fragments were ventrally impacted into the fractured L3 vertebral body a pedicle/screw L1-L5 fusion was then completed.Results: One month later, the patient recovered to an ASIA Scale of C, (i.e., residual proximal 3/5 and distal 2/5 motor deficits, with partial sensory sparing).Conclusion: Transdural ventral impaction of protruded bone fragments attributed to high speed lumbar burst fractures contributing to significant cauda equina compression can be safely/effectively accomplished.

Spinal ataxia in a 2‐year‐old colt caused by a compressive primary vertebral osteosarcoma

SummaryNeoplasia is a rare cause of ataxia in horses. This report describes a 2‐year‐old colt presented with sudden‐onset ataxia in which a cervical vertebral osteosarcoma causing severe compression of the spinal cord was diagnosed. Radiological changes included a large osteolytic lesion in the vertebral body, the vertebral arch, the right cranial articular process and the right transverse process of C4, interrupting the borders of the vertebral foramen and the right transverse foramen. Myelography revealed a marked spinal cord compression. Necropsy confirmed the presence of a well‐demarcated, invasive and firm mass protruding from the fourth cervical vertebral body that led to severe compression of the spinal cord. In spite of its strongly pleomorphic nature, the detection of osteoid confirmed the diagnosis of a central osteosarcoma of the combined type. To the best of our knowledge, a primary single vertebral osteosarcoma causing ataxia in a juvenile horse has not previously been reported, and findings of this case report could help in the diagnostic work‐up of similar cases.

Thymoma and Not Just Thymic Carcinoid Can Be Associated With Multiple Endocrine Neoplasia Type 1

Background: Multiple endocrine neoplasia type 1 (MEN1) is an inherited tumor syndrome with autosomal dominant inheritance. Thymic neuroendocrine tumors (NETs) are known manifestations of MEN1 occurring in 2-8% of patients. However, thymomas, a type of thymic epithelial tumors, have only been described in rare case reports. They markedly differ from thymic NETs in their natural history, morphology, prognosis, and therapeutic options. Here we present a case of an aggressive, recurrent thymoma associated with MEN1. Case Report: A 58-year-old Caucasian female with a family history of MEN1 was diagnosed with a prolactinoma at age 15 when she presented with irregular menses, galactorrhea, headaches and visual field defects. She was referred to our institution for further evaluation where genetic testing confirmed the diagnosis of MEN1. Throughout the years, she developed primary hyperparathyroidism, non-functional pancreatic neuroendocrine tumors, Zollinger-Ellison syndrome, bilateral adrenal hyperplasia, and bronchial carcinoid. At the age of 49, magnetic resonance imaging (MRI) and computed tomography (CT) scan of the chest incidentally demonstrated a 2.5 x 6 x 10-cm anterior mediastinal mass, with marked compression of the left brachiocephalic vein and encasement of the superior vena cava. Biopsy was consistent for malignant cells of thymic epithelial origin. A median sternotomy with en bloc resection with SVC resection and reconstruction, mediastinal lymph node dissection and placation of the right hemidiaphragm were performed. Pathology revealed WHO type B3 thymoma extending into the pulmonary parenchyma with positive tissue margins but negative lymph node involvement. Following surgery, she underwent adjuvant radiation therapy with a total dose of 59 Gy. Annual screening showed disease remission. However, nine years after initial presentation, surveillance CT scans revealed a pleural base mass with mass effect on the superior portion of the IVC, as well as hypoattenuated masses within the liver. Positron emission tomography with fluorodeoxyglucose (18FDG PET-CT) confirmed multiple metastatic lesions involving thorax and abdomen. Biopsy of the retrocaval soft tissue subxiphoid mass revealed epithelioid cells in a background of lymphocytes consistent with recurrent thymoma. She was subsequently staged as IV B thymoma and was recommended to start systemic chemotherapy. Conclusion: We described a case of an aggressive thymoma in a patient with MEN1 syndrome demonstrating that their association exists and the clinical presentation can be aggressive. Thus, it is important for practitioners to screen for thymic tumors routinely in patients with MEN1 for early detection as they can be a major cause of mortality. Although further studies are needed, improving the detection of these tumors could significantly contribute to reducing MEN1-related deaths.

Traumatic atlantoaxial subluxation associated with congenital aplasia of the odontoid process of the axis in an English Springer Spaniel

AbstractWe describe a three‐year‐old English Springer Spaniel presented with peracute and traumatic onset of cervical spinal cord signs of non‐ambulatory tetraparesis and bilateral Horner's syndrome. MRI and CT revealed aplasia of the odontoid process, dramatic dorsal displacement of the axis and marked compression of the spinal cord with changes consistent with oedema and inflammation. Surgical reduction of the vertebrae and atlantoaxial arthrodesis was successful, with recovery of ambulation over six weeks. A follow‐up CT six weeks later confirmed stability of the implants. The dog is clinically stable 19 months on. Traumatic atlantoaxial subluxation associated with congenital dysplasia of the odontoid process is rarely reported in medium breed dogs.

Research and Application of a Multidimensional Association Rules Mining Method Based on OLAP

As to the problems of low data mining efficiency, less dimensionality, and low accuracy of traditional multidimensional association rules in the university big data environment, an OLAP-based multi-dimensional association rule mining method is proposed, which combines hash function and marked transaction compression technology to solve the problem of excessive or redundant candidate sets in the Apriori algorithm, and uses On Line Analytical Processing to manage the intermediate data in the association mining process , in order to reduce the time overhead caused by repeated calculations. To verify the validity of the proposed method, a learning situation analysis system is constructed in the field of colleges and universities. The multi-dimensional association rules mining method is used to analyze more than 21,000 desensitized real data, in order to mine the key factors affecting students' academic performance. The experimental results show that the proposed multi-dimensional mining model has good mining results and significantly improves the time performance.

Somatosensory evoked potentials in Hirayama disease: A Brazilian study.

Background: Hirayama’s disease (HD) is characterized by an insidious onset asymmetric weakness and atrophy of the forearm and hand. Taking as a premise, the etiopathogenesis of the disease is attributed to forward displacement of posterior wall of lower cervical dural canal in neck flexion causing marked compression and flattening of lower spinal cord. This may result in compression of the posterior column of the spinal cord and seems likely to result in somatosensory evoked potentials (SSEPs) abnormalities. In the present study, we studied the possible involvement of the lemniscal dorsal pathway in patients with HD.Methods: SSEPs in upper and lower extremities were prospectively performed in eight patients with HD. All the patients were recruited from the outpatient clinic of a neuromuscular disorder center from South Brazil. SSEPs were obtained by transcutaneous electrical stimulation of the median and posterior tibial nerves, on both sides. We collected the amplitude and the latency of the different components obtained in each channel. The interpretation was based on Brazilian study standards.Results: We evaluated seven men and one woman (mean age 27). The data obtained were compared to a control group consisting of eight patients with spondylotic cervical myelopathy, 6 men and 2 women with mean age of 59 years. The measurements of obtained by the SSEP were also compared between the groups and no significant difference was found for any of them.Conclusion: SSEP did not turn out to be an electrophysiological marker in our HD patients.

PRIMARY MEDIASTINAL B CELL NON-HODGKIN’S LYMPHOMA PRESENTING AS SUPERIOR VENA CAVA SYNDROME AND PERICARDIAL EFFUSION IN TAMPONADE IN A 28-YEAR-OLD FEMALE: A CASE REPORT

SESSION TITLE: Fellows Lung Cancer Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Mediastinal infiltration due to lymphoma occurs as a systemic dissemination of the disease in the majority of patients but can occur as a primary tumor in up to 10% of cases. Among primary mediastinal lymphomas, only less than 3% of all Non Hodgkin's lymphoma cases correspond to a rare subtype of lymphoma known as primary diffuse large B cell mediastinal lymphoma. CASE PRESENTATION: This is a case of a 28 year old female with no hypertension, diabetes, asthma or history of pulmonary tuberculosis treatment. She is a non smoker presenting with two week history of productive cough. Consult was done with diagnosis of upper respiratory tract infection with cefuroxime and ambroxol given. Subseqent onset of facial puffiness was noted with no dyspnea or dysphagia. Physical examination findings showed facial puffiness,engorged neck veins,indistinct heart sounds and vesicular breath sounds.No lymphadenopathy noted.Chest X-ray revealed a right superoanterior mediastinal soft tissue density and 2D echo showed moderate pericardial effusion with tamponade physiology. Insertion of pericardiostomy catheter was performed and pericardial fluid sent for analysis revealing negative results for Tuberculosis gene Xpert. Chest CT scan with contrast revealed a large, noncalcified heterogenously enhancing mass measuring 7.5 x 12.5 x 9.0 cm with marked compression of the left brachiocephalic vein and superior vena cava. IV dexamethasone initiated with referral to Interventional Radiology for CT scan guided core needle biopsy which showed histologic findings of Non Hodgkin’s B cell lymphoma. Referral to Oncology ensued and chemotherapy was done with vincristine, doxorubicin, cyclophophamide and prednisone with radiotherapy. Patient had resolution of symptoms and repeat chest CT scan after four months showed interval decrease in size of the anterior mediastinal mass. DISCUSSION: Primary mediastinal large B-cell lymphoma (PMLBCL) was first described by Van Heerdemn and collaborators in 1970. It is an aggressive lymphoma with diffuse proliferation of large B-cells occurring in young females.Our patient's presentation is typical of PMBCL which is almost always associated with superior vena cava syndrome responsive to IV steroids. 50% of patients have systemic B signs (fever, night sweats, and weight loss), pleural, or as seen in this case, pericardial effusion. Following pathologic confirmation of PMBCL, the decision was made to treat with CHOP therapy and radiotherapy which was well tolerated. Repeat imaging showed significant regression of the mediastinal mass with resolution of cough and SVC. CONCLUSIONS: PMLBCL lymphoma is a rare tumor with atypical behaviour given the tendency for secondary invasion to the pleura, pericardium,thoracic wall and lung resulting in superior vena cava syndrome and pericardial effusion. Prompt histologic diagnosis leads to timely intervention with radiotherapy and chemotherapy. Reference #1: Juanpere S, Cañete N, Ortuño P, et al. A diagnostic approach to the mediastinal masses. Insights Imag. 2013; 29-52. Reference #2: Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005;128:2893-909. Reference #3: Van Heerden JA, Harrison EGJ, Bernatz PE, et al. Mediastinal malignant lymphoma. Chest. 1970;57:518-29. DISCLOSURES: No relevant relationships by Eden Castro, source=Web Response