Non-neoplastic Cause Research Articles

Abstract 15108: Systematic Review to Explore Differential Frequencies of Coronary Artery Disease in Survivors of Different Cancers

Introduction: The leading non-neoplastic cause of morbidity and mortality in cancer survivors is cardiovascular disease, of which coronary artery disease (CAD) is emerging as a significant burden. Inherent in screening is an understanding of pre-test risk, and the association of CAD with particular cancers is not well-defined. Hypothesis: To develop a systematic review to explore differential frequencies of CAD in survivors of different cancers. Methods: We searched MEDLINE and EMBASE (2006-2021) for studies of CAD in survivors. For studies without a control population, we utilized a community prevalence for CAD from the 2021 US. National Centre of Health Statistics; 0.5% for 18-44 years, 4.7% for 45-64 years, 11% for 65-74 years and 19.5% for >75 years. A random-effects model was used to compare CAD prevalence in survivors and controls. Results: Twenty studies (736,956 survivors) involved 17 types of cancer (bladder, breast, colorectal, hematologic, head and neck, kidney, liver, lung, melanoma, ovarian, pancreatic, prostate, renal, stomach, testicular, thyroid, uterus). Survivors overall were associated with an increased risk of CAD compared to controls (risk difference = 0.11, 95% CI: 0.07-0.15, p=0.0, I2=99.93%). Eight cancer types (breast, hematologic, head and neck, kidney, liver, pancreatic, stomach, and testicular) resulted in a significantly higher CAD compared to other cancer types (Figure). Conclusions: Cancer survivors are at an increased risk of CAD compared to general population, but certain cancer types associate with a significantly higher CAD risk.

Multidetector computed tomography evaluation of obstructive jaundice: a cross-sectional study from a tertiary hospital of Nepal

Background: The utilization of advanced multidetector computed tomography (MDCT) technology along with postprocessing reconstruction techniques has significantly enhanced the clarity of visualization of the hepato-biliary tree. Therefore, this study was conducted to evaluate the diagnostic statistics of MDCT and its associated features in the evaluation of obstructive jaundice, with respect to surgical or histopathological diagnoses. Methods and methodology: The authors conducted a cross-sectional study among 30 participants with obstructive jaundice using purposive sampling. The authors calculated the diagnostic statistics of non-neoplastic and neoplastic types, along with specific etiologies of obstructive jaundice identified through MDCT using a statistical package for social sciences (SPSS) v21 and MedCalc v12.3.0. The ethical clearance was obtained from the institutional review committee of BPKIHS, Nepal (Ref no: Acd/291/075/076-IRC). Results: The sensitivity and the negative predictive value of MDCT for non-neoplastic cause to detect obstructive jaundice were 100% (95% CI: 79.41–100.00) and 100% (95% CI: 75.29–100.00), while the specificity and the positive predictive value for neoplastic cause to detect obstructive jaundice were 100% (95% CI: 79.41–100.00) and 100% (95% CI: 75.29–100.00), respectively. Similarly, the accuracy for either non-neoplastic or neoplastic cause was 96.67% (95% CI: 82.78–99.92). The most common cause of obstructive jaundice was choledocholithiasis (33.34%) followed by cholangiocarcinoma (20%), ampullary carcinoma (13.33%), and choledochal cyst (13.33%). The diagnostic accuracy of the individual etiology of common causes of obstructive jaundice ranged from 82.78 to 100%. Biliary obstruction was most frequently observed in the periampullary region (83.33%), followed by the proximal common bile duct (6.67%), hilar region (6.67%), and intrahepatic region (3.33%). Conclusion: The MDCT could serve as the initial and time-efficient excellent imaging modality for diagnosing various causes of obstructive jaundice with greater accuracy. It can differentiate non-neoplastic from neoplastic causes of obstructive jaundice.

Common neoplastic causes of paediatric and adolescent back pain.

Neoplasm of the spinal column in children is rare, but can involve either benign or malignant tumours. Early detection of malignant tumours is key to successful clinical outcome and long-term prognosis. In such cases, back pain is a common presenting symptom, but often has a non-neoplastic cause. Therefore, it is important for GPs and trainees who encounter paediatric patients to be aware of the clinical entity to be able to thoroughly assess them in clinical practice. This article discusses the types of paediatric spinal neoplasms, anatomical-based classification, clinical red flags, imaging modalities and outlines brief management options.

Role of computerized tomography scan in identifying non-neoplastic cause of seizure disorders in children

Role of computerized tomography scan in identifying non-neoplastic cause of seizure disorders in children

Aettiiollogy off Hoarrseness iin Pattiientts above 40 Yearrs off Age (Across Secttiionall Sttudy)

Objectives: this study is designed to determine the most common causes of hoarseness in patients above 40 years of age and the relationship between hoarseness causes and its duration.
 Patient and Methods: the study is cross sectional study. It considers 80 patients with hoarseness who were assessed between april 2011 and December 2011 at E.N.T. outpatient clinic ;department of otolaryngology in AL Diwaniya Teaching hospitalIn AL Diwaniya city. Ira
 Results :out of the 80 patients ,57 had hoarseness because of non-neoplastic causes giving an incidence of 71,25% (infective laryngitis n= 23,28.75% ,acid laryngitis n =17,21.25%, allergic laryngitis n =13,16.25,%, vocal cord palsy n =2, 2.5,%, psychogenic n =2,2.5%, ) while hoarseness occured in the remaining 23 patients as aresult of neoplastic causes, giving an incidence of 28, 75% (laryngea carcinoma n = 12, 15 % vocal cord polyp n =6, 7.5 %,voca c. nodule n = 3, 375%,laryngeal cyst n =1 1. 25% granuoma n = 1,1.25%, benign tumor n = 00 %) we also found that hoarse patients for aduration of more than one month were; likely to have aneoplastc cause more than non-neoplastic cause Conclusionsthe incidence of non neoplaic causes of hoarseness in patents more than 40 year d are more common han neoplastic causes. Moreover hoarse patients who have alonger duraton of hoarseness have amore chance to have neoplasic cause than non- neoplastic cause

AORTIC VALVE SURGERY IN PATIENTS WITH PREVIOUS MEDIASTINAL RADIATION THERAPY

Cardiac diseases are the main non-neoplastic cause of late mortality and morbidity in patients previously exposed to mediastinal radiation therapy (MRT). The potential perioperative risks for conventional aortic valve surgery in patients after MRT remain underweighted in traditional risk scores. The aim of this study was to examine perioperative mortality and morbidity in these patients, as well as mid-term outcomes.

The Pathology of Aging 129S6/SvEvTac Mice.

The 129 mouse strain is commonly used for the generation of genetically engineered mice. Genetic drift or accidental contamination during outcrossing has resulted in several 129 substrains. Comprehensive data on spontaneous age-related pathology exist for the 129S4/SvJae substrain, whereas only limited information is available for other 129 substrains. This longitudinal aging study describes the life span and spontaneous lesions of 44 male and 18 female mice of the 129S6/SvEvTac substrain. Median survival time was 778 and 770 days for males and females, respectively. Tumors of lung and Harderian gland were the most common neoplasms in both sexes. Hepatocellular tumors occurred mainly in males. Hematopoietic tumors were observed at low frequency. Suppurative and ulcerative blepharoconjunctivitis was the most common nonneoplastic condition in both sexes. Corynebacteria (primarily Corynebacterium urealyticum and C. pseudodiphtheriticum) were isolated from animals with blepharoconjunctivitis and in some cases from unaffected mice, although a clear causal association between corynebacterial infections and blepharoconjunctivitis could not be inferred. Polyarteritis occurred only in males and was identified as the most common nonneoplastic contributory cause of death. Eosinophilic crystalline pneumonia occurred in both sexes and was a relevant cause of death or comorbidity. Epithelial hyalinosis at extrapulmonary sites was noted at higher frequency in females. This study contributes important data on the spontaneous age-related pathology of the 129S6/SvEvTac mouse substrain and is a valuable reference for evaluation of the phenotype in genetically engineered mice obtained with this 129 substrain.

Characteristics of bone fractures and usefulness of micro-computed tomography for fracture detection in rabbits: 210 cases (2007-2013).

To characterize bone fractures and the usefulness of micro-CT for imaging fractures in pet rabbits. Retrospective case series. 210 client-owned rabbits with bone fractures. Medical records of rabbits evaluated for bone fractures from 2007 through 2013 were examined. Information was collected on signalment and nature of fractures, and radiographic and micro-CT images of fractures were reviewed. Almost half (n = 95 [47.7%]) of fractures were in rabbits < 3 years old. Accidental fall was the most common cause. Vertebral fracture was the most common type of fracture with a nonneoplastic cause (n = 46 [23.2%]) and was most common in the L4-L7 region. The tibia was the most common site for limb fracture among all fractures with a nonneoplastic cause (45 [22.7%]). Twelve (5.7%) fractures had a neoplastic cause, and 7 of these were associated with metastatic uterine adenocarcinoma. Females were significantly more likely to have a fracture caused by neoplasia than were males. Compared with radiography, micro-CT provided more detailed fracture information, particularly for complicated fractures or structures (eg, skull, pelvic, vertebral, and comminuted limb fractures). Findings were useful for understanding the nature of fractures in pet rabbits and supported the use of micro-CT versus radiography for fracture detection and evaluation.

Use of multidetector computed tomography in the assessment of dogs with pericardial effusion.

BackgroundContrast‐enhanced multidetector computed tomography (MDCT) allows high spatial and temporal resolution imaging of cardiac, thoracic, and abdominal structures. Accurate determination of the cause of pericardial effusion (PE) is essential to providing appropriate treatment and prognosis. Echocardiography and pericardial fluid analysis may not differentiate between causes of PE and cannot identify extracardiac metastasis.Hypothesis/ObjectivesDescribe the thoracic and abdominal MDCT findings and evaluate the utility of MDCT to differentiate between neoplastic and nonneoplastic causes of PE in dogs.AnimalsEleven client‐owned dogs with PE diagnosed by echocardiography.MethodsProspective observational study. Transthoracic echocardiography (TTE), 3‐view thoracic radiography, and contrast‐enhanced thoracic and abdominal MDCT images were evaluated for the presence of cardiac masses, pulmonary metastases, and abdominal masses. Histopathology in 5 dogs and survival analysis in all dogs were evaluated.ResultsA neoplastic cause was identified in 6/11 dogs and a nonneoplastic cause was identified in 5/11. Cardiac MDCT findings were consistent with TTE findings in all dogs with right atrial (5/5) and heart base masses (1/1). Pulmonary metastases were identified in 1/11 dogs by thoracic radiography and in 2/11 dogs by MDCT. MDCT identified splenic or hepatic lesions consistent with neoplasia in 6/11 and 5/11 dogs, respectively. Focal MDCT pericardial changes at the pericardiocentesis site were noted in 3/11 dogs.Conclusions and Clinical ImportanceMultidetector computed tomography did not improve the detection of cardiac masses in dogs with PE over echocardiography. The benefit of MDCT was primarily in the detection of pulmonary metastases and extracardiac lesions using a single imaging modality.

Sleep pattern changes in patients with liver cirrhosis

BackgroundLiver cirrhosis is considered as a major cause of mortality worldwide and is the most common non-neoplastic cause of death among hepatobiliary and digestive diseases. One of the least studied complications of liver cirrhosis is the disturbed sleep pattern, which is being increasingly recognized as a major health problem affecting the quality of life. MethodsThis study included two groups; the first group consisted of 30 patients diagnosed as liver cirrhosis based on abdominal ultrasound and liver biopsy and the second group consisted of 10 healthy subjects served as controls. ESS was calculated for every patient and all patients were subjected to complete overnight polysomnography to detect sleep disturbances among all participants. ResultsOur results showed that cirrhotic patients had ESS, AHI and OSA significantly higher than the control group [16.4±2.6 vs 11.1±1.8, P=0.0001; 10.9±8.5 vs 2.4±1.6, P=0.005 and 3.1±3.1 vs 1.1±0.9, P=0.03, respectively]. The percentage of sleep efficiency was significantly lower in cirrhotic patients than the control group [61.9±12.9 vs 73.1±7.6 (P=0.02)]. Also, the percentages of S1, S3–S4 and REM sleep in relation to the total sleep time were significantly higher in the cirrhotic patients than the control group (P=0.01, 0.02 and 0.06, respectively) while the percentage of S2 was significantly lower (P=0.02). Cirrhotic patients of Child class C had ESS, AHI and OSA significantly higher and sleep efficiency significantly lower than cirrhotic patients of classes A and B (P=0.001 for all). Cirrhotic patients with tense ascites had ESS, AHI and OSA significantly higher and sleep efficiency lower than patients with mild, moderate, or no ascites. ConclusionThis study revealed that cirrhotic patients had disturbed sleep pattern, correlating with the degree of cirrhosis.

Primary intraocular lymphoma in a patient with systemic lupus erythematosus

Dear Editor, Establishment of an intraocular lymphoma may form a diagnostic challenge, especially when biopsy is contraindicated due to the anatomic site of the lesion. In recent years, vitreous IL-10 levels above 400 pg/mL (sensitivity 80 %, specificity 99 %) and a vitreous IL-10 to IL-6 ratio greater than 1.0 (sensitivity 74 %, specificity 75 %) were found to be associated with the presence of an intraocular lymphoma [1, 2]. We present a case where retinal biopsy was not possible. A 45-year-old female with a history of lupus nephritis class V presented with panuveitis of her right eye and loss of visual acuity of both eyes. During fundoscopy, a slightly elevated lesion was observed (Fig. 1a). As there was no systemic activity of her lupus erythematosus and the patient was immunocompromised due to chronic use of azathioprine and prednisolone, opportunistic infections were considered. No Herpes Simplex Virus, Varicella Zoster Virus, Cytomegalovirus, Epstein–Barr virus, toxoplasmosis, borreliosis, syphilis, or tuberculosis were found. Vitrectomy, however, revealed a rapidly growing lesion involving the macula lutea (Fig. 1b–c). Vitreous fluid analysis showed atypical lymphocytes and an interleukin-10 to interleukin-6 ratio of 14.8 (3,700 and 250 pg/mL, respectively), indicative of lymphoma rather than a non-neoplastic cause of uveitis. Brain magnetic resonance imaging, bone marrow, and spinal fluid analysis showed no abnormalities. Histology of the primary tumor could not be obtained as biopsy of this area would result in blindness. The patient was diagnosed with a solitary intraocular lymphoma and was treated with 2 cycles of intravenous methotrexate (3 g/m2, days 1 and 15); BCNU (100 mg/m2, day 4); teniposide (100 mg/m2, days 2–3); prednisolone (60 mg/m2, days 1–5); and intrathecal methotrexate, cytarabine, and hydrocortisone (15 mg, 40 mg, and 25 mg, respectively, days 1 and 15). The visual acuity of both eyes improved during treatment, suggesting a shrinking mass in both eyes. As there were no visible lesions in the left eye, only the right eye was irradiated (30 Gy). Six months later, the patient developed a lesion consistent with an intraocular lymphoma in the left eye, and at this time, radiotherapy was initiated for the left eye. Up-to-date, almost 2 years later, fundoscopy only shows flat scars, and the patient has no signs of ocular, cerebral, or systemic relapse (Fig. 1d). Fig. 1 Fundoscopic images of the right eye of a 45-year-old female. a Uveitis and an underlying whitish, slightly elevated lesion. b Lesion after vitrectomy, 12 weeks later. c Autofluorescent image postvitrectomy. d Flat scar without signs of relapse, ... Although high IL-10 levels are not pathognomonic for an intraocular lymphoma, patients with suspect lesions in regions which are essential for vision may benefit from vitreous interleukin measurement. If, in this way, a retinal biopsy can be avoided, eyesight can be retained. Furthermore, in patients presenting with a unilateral intraocular lymphoma, irradiation of the contralateral eye should be considered as up to 80 % actually have bilateral disease [3].

An unsuspected case of cerebral toxoplasmosis: case report and literature review

Toxoplasmosis caused by Toxoplasma gondii is one the most frequent opportunistic infections among the immunocompromised patients and commonly affects the brain of those individuals with advanced human immunodeficiency virus (HIV) infection with acquired immune deficiency syndrome (AIDS). Cerebral toxoplas-mosis can be a challenging histopathological diagnosis when it presents as the early sequela of clinically unsuspected immuno-suppression. We report a case with problematic histopathological diagnosis of cerebral toxoplasmosis because of the patient’s unsuspected HIV status, the clinico-radiological impression of metastatic malignancy, and the compounded difficulty of identifying the typical T. gondii organisms in frozen section material. However, this case highlights the need to always contemplate a non-neoplastic infective cause as the basis for observed necrosis in brain biopsies, regardless of the clinical suspicion under which the histopatholo-gical examination has been requested.

Prognostic Implications of Periodic Epileptiform Discharges

Periodic epileptiform discharges (PEDs) are an abnormal finding on electroencephalograms (EEGs), the significance of which is uncertain. To investigate long-term outcome in patients with PEDs. We retrospectively analyzed the outcomes of patients who had PEDs diagnosed during a 7-year period. We abstracted and tabulated clinical parameters from the time of EEG, imaging findings, EEG measurements, and subsequent clinical outcome from medical records. We used descriptive, inferential, and logistic regression analysis to determine the factors associated with clinical outcomes in patients with PEDs. We divided PEDs into the following subgroups: periodic lateralized epileptiform discharges (PLEDs), generalized PEDs, and bilateral PEDs and analyzed these subgroups individually. University-affiliated teaching hospital. Subjects One hundred sixty-two patients with PEDs. We obtained complete clinical, neuroimaging, neurophysiologic, and long-term outcome data in 118 patients. In the subgroup of patients with PLEDs, absence of seizures at onset (odds ratio, 0.21 per point; 95% confidence interval, 0.04-0.97) and an acute etiology for the PLEDs (odds ratio, 0.14 per point; 95% confidence interval, 0.03-0.72) were associated with death. A nonneoplastic cause for PLEDs was associated with independent functionality (odds ratio, 0.45 per point; 95% confidence interval, 0.3-0.67). In patients with PLEDs, the absence of clinical seizures at the time of detection and presumed acute etiology are associated with death, whereas a nonneoplastic etiology was associated with a good clinical outcome.

Adverse events associated with pericardiocentesis in dogs: 85 cases (1999-2006).

To quantify the frequency of adverse events occurring during or post pericardiocentesis and to determine if adverse events are related to the cause of the pericardial effusion or frequency of pericardiocentesis. Retrospective study. Referral hospital. ANIMALS, INTERVENTION AND MEASUREMENTS: Medical records of 85 dogs that underwent 112 episodes of pericardiocentesis were reviewed. Any adverse events during pericardiocentesis and in the 48 hours post pericardiocentesis were noted. The frequency of adverse events was compared between dogs with a suspected neoplastic cause and a suspected nonneoplastic cause of their pericardial effusion and also between the first and subsequent pericardiocenteses. The incidence of adverse events was 10.7% within 1 hour of pericardiocentesis and 15.2% within 48 hours. There was no significant difference in the frequency of adverse events between the groups. Most adverse events identified were dysrhythmias. Forty-one percent of those dogs with adverse events were euthanized or died within 48 hours. The incidence of adverse events seen within 48 hours of pericardiocentesis was 15.2%.

Oxyntic mucosa pseudopolyps: a presentation of atrophic autoimmune gastritis.

Gastric polyps are often present in the setting of atrophic gastritis. Although the majority of these polyps are nonneoplastic, such as hyperplastic polyps, neoplastic polyps may be present. We discuss nine cases that illustrate an additional nonneoplastic cause of polyps in atrophic gastritis. Specifically, preserved islands of relatively normal oxyntic mucosa in a background of gastric atrophy may appear polypoid endoscopically. The patients (seven women, two men, mean age 64 years) presented with nonspecific abdominal or reflux symptoms (n = 8) and diarrhea (n = 1). Five of five patients tested were confirmed to have hypergastrinemia, and three of three patients tested had antiparietal cell antibodies. Biopsies from the gastric body or fundus of our nine patients showed fragments of atrophic mucosa and separate fragments of preserved oxyntic mucosa. Based upon the histologic characteristics of the atrophic fundic and relatively normal antral biopsies, the gastric atrophy appeared to be of autoimmune-type. The relatively preserved oxyntic glands showed parietal cell hypertrophy and focal mild chronic inflammation. The number of polyps observed endoscopically ranged from less than five to multiple/diffuse. Three patients had persistent nodularities in their stomachs for 1, 3, and 7 years of their follow-up. Our study shows that some patients with atrophic gastritis, autoimmune-type, may present with gastric polyps/nodules that represent relatively preserved oxyntic mucosa. This presentation may be more common than is presently recognized because biopsies of the polyps alone will not show histologic features of atrophic gastritis or reveal the etiology of the polyp itself. Although a limited number of previous studies have suggested this type of polypoid presentation may represent "early" atrophic gastritis, its persistence in three of our patients argues against this hypothesis.

The value of necropsy in oncology

The effectiveness of diagnostic procedures in cancer patients was evaluated by comparing clinical with necropsy findings. Necropsy and clinical records of 102 patients were reviewed for primary site and histology of tumour, metastatic sites, presence of second neoplasms, associated non-neoplastic diseases, terminal illness and cause of death. Major discordances between clinical and postmortem findings were found in 34 (33%) cases: in 10 of these a correct clinical definition of site and histology of the primary tumour would have resulted in a change of management and prognosis; in 4 cases in which a major non-neoplastic pathology had been responsible for death, correct diagnosis might have resulted in prolongation of survival. Spread of disease was generally underestimated, even for metastases in clinically accessible organs. Even more disappointing were the clinical data related to terminal illness and cause of death (43% overall concordance).

Lymphocytic Adenohypophysitis: Clinical, Radiological, and Magnetic Resonance Imaging Characterization

Lymphocytic adenohypophysitis is a rare nonneoplastic cause of a pituitary mass. We report the case of an 18-year-old woman who presented with complaints of headaches and visual disturbances after an otherwise uncomplicated pregnancy and delivery. She had an elevated serum prolactin level and a pituitary mass visualized by magnetic resonance imaging (MRI). The tissue removed by transsphenoidal resection was an inflammatory mass composed of lymphocytes, plasma cells, and moderate fibrosis surrounding islands of hyperplastic lactotrophs. This is the first case of lymphocytic adenohypophysitis visualized by MRI. As in this case, lymphocytic adenohypophysitis is frequently confused with a prolactin-secreting pituitary tumor before operation and pathological examination of the tissue. The clinical characteristics and radiological features of and an approach to managing patients with lymphocytic adenohypophysitis are reviewed and discussed.

Update of a mortality study of workers in petroleum refineries.

A large cohort of petroleum refinery workers with long duration of employment, long latency, and relatively young age at hire had its vital status updated through Dec. 31, 1980. The standardized mortality ratio (SMR) for all causes was 78. Each nonneoplastic cause had an SMR below 100, including SMRs of 63 for emphysema and for all diseases of the genitourinary system and of 73 for chronic nephritis. The SMR for all cancers was 87. SMRs for specific neoplasms included digestive system, 90; lung, 85; kidney, 68; brain, 89; leukemia, 101; multiple myeloma, 123; unspecified lymphoma, 112; polycythemia vera (four deaths), 455; myelofibrosis (three deaths), 201; and benign and unspecified brain neoplasms, 108. There were nine deaths from mesothelioma; all nine employees had more than 20 years of employment, with an SMR of 241.

EXTREME EOSINOPHILIA WITH IODIDE HYPERSENSITIVITY. REPORT OF A CASE WITH OBSERVATIONS ON THE CELLULAR COMPOSITION OF INFLAMMATORY EXUDATES.

THE differentiation of leukemoid reactions from leukemia, although frequently difficult, can be especially so when involving eosinophilic granulocytes. In cases of extreme leukocytosis the presence of neutrophils with toxic granulation, Dohle bodies or vacuolation1 strongly suggests a non-neoplastic cause of the reaction. With eosinophilic granulocytes, however, these aids are lacking, therefore preventing morphologic differentiation of eosinophilic leukemia from a variety of hypersensitivity syndromes manifesting eosinophilia. In addition, neutrophilic leukemoid reactions associated with septic or necrotic processes are generally brief, permitting early retrospective diagnosis. In contrast, prolonged eosinophilia occurs with many chronic allergic syndromes, compounding further the difficulties in differential diagnosis. . . .