Year-old Female Research Articles

A Case of Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia Using Transseptal Approach, Guided by Electro-Anatomical Mapping System

A 65 year-old female was admitted to our hospital because of syncope. She has been previously diagnosed with dilated cardiomyopathy. Twelve-lead electrocardiogram (ECG) presented narrow QRS tachycardia. Electrophysiological study and radiofrequency catheter ablation was performed. Under isoproterenol infusion, supraventricular tachycardia (SVT) was easily induced followed by critical AH interval. The mechanism of SVT was diagnosed with slow-fast atrioventricular nodal reentrant tachycardia (AVNRT). We tried slow-pathway ablation from venous approach targeted at the triangle of Koch using electrogram guide and anatomical approach. Slow-pathway conduction was not eliminated, however, and SVT still could be easily induced. Therefore we delivered radiofrequency (RF) from the left atrial (LA) septum by transseptal approach using an electro-anatomical mapping (EAM) system. After RF application at mid-septum from the LA, the slow-pathway conduction was modified and SVT could not be induced.

Rotational Collapse of Trachea after Percutaneous Dilatational Tracheostomy

This article describes a patient whose trachea became obstructed during head rotation after Percutaneous Dilatational Tracheostomy (PDT). A 26 year-old female was admitted into the Intensive Care Unit (ICU) because of relapse of Myastenia Gravis (MG). During the therapy, the patient underwent PDT. During her ICU stay, the patient experienced sepsis. After two months, she complained of suffering from dyspnea and occasionally showed stridor and signs of obstruction. These signs occurred during the rotation of her head. Bronchoscopy and multi-slice CT scan imaging were carried out and no airway pathology or obstruction and other signs of MG relapse were observed. Pulmonary Function Tests were normal, but the patient complained from dyspnea during rotation of the head which improved immediately after rotating head to normal position. Repositioning of tracheostomy tube did not improve the symptoms. The general opinion is that it may be a complication of PDT that refers to irritation of the posterior wall of the trachea secondary to the chronic irritation by the tracheostomy canula, which causes an intermittent obstruction of the trachea, and Polderman suggested the acronym TWISTED (tracheal wall injury with intermittent stoppage of the tracheostomy and episodes of dyspnea).1 This problem was termed as the Rotational Collapse of trachea, because the signs of airway obstruction were completely improved with normal positioning of the head. In PDT, the airway was manipulated, therefore, patient selection, technique of procedure and the skill of intensivist play an essential role in perioperative complications. Thus currently, with the routine use of PDT in ICUs, new complications are reported and it is crucial to know the ways to manage such problems.

A Case of Orbital Apex Syndrome Related to Sphenoid Fungal Sinusitis

Orbital apex syndrome (OAS) has been described previously as a syndrome involving damage to the oculomotor nerve, trochlear nerve, abducens nerve, and ophthalmic branch of the trigeminal nerve in association with optic nerve dysfunction. The conditions and symptoms of OAS are characterized by blindness, fixed dilated pupils, proptosis, ptosis of the eye and ophthalmoplegia. Infectious diseases involving the central nervous system, paranasal sinuses, and periorbital structures may lead to an OAS. We recently experienced a rare case of sphenoidal aspergillosis, which damaged the adjacent cavernous sinus structures and led to the definite symptom of OAS in a 75 year-old female. We present this rare case with a brief review of these disease’s entities. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:644-7

The association of unusual site of an idiopathic deep vein thrombosis and chylothorax in an adult

Deep vein thrombosis (DVT) usually presents with pain, swelling, and tenderness, but very uncommonly does it occur in the left cervical region. The association of a DVT with chylothorax as a complication in adults is very uncommon. We present a 53 yearold female that complained of a progressive painful left lower neck swelling and redness for 2 days. These symptoms were preceded by transient painful and erythematous swelling in her left axillary region one week prior to admission. Physical exam was remarkable for tender erythematous swelling around left lower cervical and supraclavicular regions, and peripheral venous dilatations of left upper chest wall and proximal left upper extremity. Work-up with x-ray and CT scan of the chest revealed mildto-moderate sized right-sided pleural effusion without mediastinal abnormalities. Thoracentesis revealed findings consistent with chylothorax. An inconclusive mammogram lead to additional imaging with ultrasound that yielded an unusual site of thrombosis in the left subclavian and external jugular veins. Especially in adults, this site of DVT is very uncommon, and more so, was the associated complication of chylothorax, with an unremarkable history and an unyielding work-up, etiology of such an unusual site of DVT was not found. Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or United States government. The authors are employees of the U.S. government. No grant funding was received for this study.

Asymptomatic Familial Factor XI Deficiency.

Abstract 4449 BackgroundFactor XI deficiency (known as Rosenthal syndrome or hemophilia C) is an autosomal disorder affecting both sexes which results in a bleeding disorder of variable severity. This condition is very uncommon among the non-Jewish population and consists mostly of sporadic cases, although an occasional familial cluster has been described (Bolton-Maggs et al. J Thromb Haemost 2004 Jun;2(6):918-24). We present two asymptomatic siblings with coagulation Factor XI deficiency. Case ReportIn February 2004 a healthy 33 year-old non-Jewish white female without personal or family medical history presented with an elevated partial thromboplastin time (PTT) incidentally found during a routine pre-operative evaluation. Her prothrombin time (PT) was normal. Her PTT was 45 seconds (reference interval 23-37 seconds), and normalized with 1:1 mixing studies of patient and normal plasma. Preliminary laboratory evaluation included negative tests for the presence of a Lupus Anticoagulant, a normal serum albumin level, and a normal urinalysis. Additional laboratory testing of coagulation and included FXI and XII activities, measured by means of a one stage APTT-based clotting assay using APTT reagent (Automated APTT, Trinity Biotech, Bray Ireland), congenitally depleted deficient plasma (HRF, Inc, Raleigh NC) using the MDA II Trinity Biotech, Bray Ireland). FXI was 46% (reference range 60-150) and FXII was 42% (reference range 50-150). In March 2004, a repeated the laboratory evaluation showed a FXI of 41% and a FXII of 46%. In April 2006, FXI was 49%, and FXII was 40%. Is to be noted that the patient never had abnormal bleeding episodes despite abdominal and breast surgical procedures. In 2009, her only brother (aged 29 and otherwise healthy) underwent hematological evaluation that showed normal levels of PT, PTT, platelet count, fibrinogen, and factor XII (88% activity). His factor XI was 51% (decreased activity). ConclusionAlthough modern laboratory methods are able to identify unusual coagulation defects, their clinical significance requires additional investigation. Disclosures:No relevant conflicts of interest to declare.

Cerebellopontine angle arachnoid cyst containing ectopic choroid plexus—case report

We present a rare and interesting case of a cerebellopontine angle cyst containing ectopic choroid plexus tissue in a 26 year-old female. Surgical resection was performed, and histological examination confirmed the presence of choroid plexus in the cyst wall. This is the first reported case of ectopic choroid plexus at the cerebellopontine angle in an adult. We present the case and review the literature.

Les réadmissions pour asthme en France, 2002-2005

Most hospital admissions with asthma are avoidable. The objective of the analysis was to describe hospital readmissions for asthma. Using data from the French hospital information system, admissions for asthma or for acute respiratory failure associated with asthma that occurred in 2-44 years-old patients between 2002 and 2005 in France (excluding French overseas departments) were analysed. Readmission rates at 7 days and at 1 year were estimated using the Kaplan-Meier method. The risk of readmission at 1 year was 15.0%. It varied according to age (higher in 2-4 year and 35-44 years-old patients) and sex (higher in 10-34 years-old females) and increased with the length of stay of the index admission. The risk of readmission at 7 days was 1.1% and was higher for the shortest lengths of stay. Readmissions for asthma are pertinent indicators for the monitoring of asthma, especially the clinical management of the disease. Using data from an increasing number of years, together with linkage of hospital admissions and asthma drug reimbursement data, should allow a better understanding of severe asthma in France.

Epiploic Appendagitis in a Female Patient with Situs Ambiguous Abnormality

We report the case of a 23 year-old obese female, with previously diagnosed situs inversus below the diaphragm, who presented with severe left upper quadrant abdominal pain. The patient was believed to have a surgical indication, possibly appendicitis or diverticulitis, and had an emergent abdominal Computed Tomography (CT) scan. The CT was interpreted as epiploic appendagitis with no signs of appendicitis. Epiploic appendagitis is a rare cause of acute abdominal pain, which involves the torsion and eventual necrosis of one of the epiploic appendages. This case was complicated by the fact that the patient had situs inversus below the diaphragm, which made it difficult to relate her localized abdominal pain to the correct anatomic area. The diagnosis allowed the patient to avoid invasive surgery and instead opt for conservative medical management. The utilization of radiologic imaging is of utmost importance in diagnosing this condition, which has characteristic findings on CT, US, and MR, all of which is discussed in this article.

Linfoma primario de tiroides: Reporte de cuatro casos

Primary thyroid lymphoma is uncommon and usually of non-Hodgkin type. We report four female patients with thyroid lymphoma. An 81 year-old patient that was operated and received three cycles of chemotherapy and was lost from follow up. A 16 year-old patient that is operated and received full chemotherapy and was discharged free of disease. A 80 year-old patient that was operated and died due to a multiple organ failure, 50 days after hospital admission and a 54 year-old female that was operated but rejected chemotherapy and was lost from follow up.

Diffuse unilateral subacute neuroretinitis masquerading as a white-dot syndrome

A 19 year-old Caucasian female was referred with a 3-month history of unilateral, progressively worsening vision accompanied by flashes and floaters. She denied any associated pain on eye movements, headaches...

Hemangiopericytoma and antiangiogenic therapy: clinical benefit of antiangiogenic therapy (sorafenib and sunitinib) in relapsed Malignant Haemangioperyctoma /Solitary Fibrous Tumour

Soft tissue sarcomas are a highly heterogeneous group of tumors. Recently, different molecular abnormalities were identified and in some cases corresponding molecular targeted therapies led to significant clinical benefits. Malignant tumors of blood vessels are classified as sarcomas and are uncommon. They encompass angiosarcoma, hemangioendotheliomas, and hemangiopericytomas. The term hemangiopericytoma (HMP) was coined in 1942 by Stout and Murray for soft tissue tumours thought to originate from cell encircling blood vessels (pericytes)[1]. Over the years the concept of HMP has gradually evolved. It was namely shown that this term has been used for a wide variety of benign and malignant soft tissue tumours which share common morphologic features but correspond to different entities. It is now obvious that some conventional HMP correspond in fact to the spectrum of solitary fibrous tumour (SFT). SFT of the soft tissue (or extrapleural SFT) have an unpredictable behaviour, 10 to 15 % of them showing an aggressive evolution with either local recurrences and/or metastases. SFT located in the mediastinum, peritoneum, retroperitoneum and pelvis tend to be more aggressive than those in other locations. The most common sites of metastasis are the lung, bone, and liver. There is no standard treatment for patients with advanced disease with the exception of anthracyclins largely used in first chemotherapy line. Here, we describe a patient with a hemangioperictoma who achieved a partial response while on sorafenib therapy, and a second case with the same clinical outcome while on sunitinib. First patient was a 59 year-old female was referred to our center for a multi-relapsed hemangiopericytoma. The tumor was diagnosed in 1982 as a pre-sacral hemangiopericytoma and surgery was performed. The patient experienced multiple relapses: lung metastases in 1994 and pancreatic metastases in 1996 were completely resected. In 2000, she relapsed in the lung for the third time and first-line chemotherapy was administered with an anthracyclin-based regimen (cisplatin, epirubicin and ifosfamide). After 6 cycles, the CT-scan showed stable disease and surgery was performed. In 2003, due to further pulmonary progression, the patient was included in a phase II with trabectedin (Yondelis®) but therapy was discontinued because of hepatic toxicity. Invest New Drugs (2010) 28:199–202 DOI 10.1007/s10637-009-9249-1

Vaginal fibroleiomyoma in a cow: a case report

: This paper describes a case of fibroleiomyoma seen in the vagina of a cow, diagnosed on the basis of macroscopic, microscopic and immunohistochemical findings. A five year-old female, Simmental and Brown Swiss crossbreed cow presented with six neoplastic masses located on the vaginal wall. The masses were surgically removed through the vaginal route and were firm and well demarcated. Microscopic examination showed that the non-encapsulated neoplastic nodules consisted of the admixture of smooth muscle and connective tissue. Immunohistochemical examination revealed strong focal positive reactions for smooth muscle actin and vimentin, but no positive reaction for CD 68. The tumour reported here was considered benign because of the lack of clear pleomorphism, invasivness, multinuclear giant cells and atypia, and low mitotic activity.

A laryngeal presentation of Churg--Strauss syndrome in childhood

A 10- year-old female, known to have bronchial asthma, presented with an unusual laryngeal lesion, eventually diagnosed as Churg-Strauss syndrome (CSS). She was referred to our hospital with history of recurrent stridor. On endoscopyhe, the larynx showed signs similar to recurrent respiratory papillomatosis (RRP). CSS is a systemic disorder and is now defined as one of the ANCA (antineutrophil cytoplasmic antibodies)-associated vasculitides. CSS is a systemic disease that may involve unusual sites like the larynx. Such an unusual presenatation of CSS should be kept in mind, especially in patients with history of asthma.

Spontaneous Subdural Hematoma at Thoracolumbar spine - A Case Report -

A 63 year-old female was brought to our hospital with severe lower back pain. She received antihypertensive drugs for 2 years but her blood pressure was normal upon arrival. She could not stand up or even walk. The MRI showed a subdural hematoma at the thoracolumbar region, which was extremely rare. The treatment applied was decompression through a spinal tap without surgery. After this, her pain subsided considerably. Two weeks later, MRI confirmed that there was no hematoma in the same region. She was discharged and has enjoyed her daily activities free of pain. A spontaneous subdural hematoma is an extremely rare disease. The condition was treated successfully in a conservative manner.

A Case of Multiple Discrete Fungus Balls of the Bilateral Paranasal Sinuses

Fungus balls of the paranasal sinuses are usually found in only one sinus, most frequently in the maxillary sinus. Multisinus involvement was found only in 6.4% of the largest review of this disease entity. Though fungus ball could be involved in multiple sinuses, these sinuses were mostly contiguous. In addition, bilateral involvement is rare in the literature：only one case of triple discrete fungus balls in a patient has been reported. We recently experienced a rare case of multifocal discrete fungus ball involving the bilateral maxillary sinus and left sphenoid sinus in a 58 year-old female. Therefore, we present this rare case with a brief review of this disease entity. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:457-60)

Primary calvarial meningioma

A rare case of a diffuse calvarial meningioma in a sixty year-old female is reported. The patient presented with headache and disorientation. Imaging showed thickening of the frontoparietal calvarium on left side. In relationship to the thickened bone, there was an enhancing en-plaque meningioma. Following wide surgical resection, the histological examination revealed an intraosseous meningioma . The origin of primary intraosseous meningioma are discussed and the relevant literature is briefly reviewed.

Combined Coagulation Factor XI and Factor XII Deficiency in An Asymptomatic Female

Background: Multiple combined coagulation factor deficiencies have been reported, although the genetic defects associated with these conditions remain largely unknown. We present an asymptomatic female with a persistent deficiency of both coagulation Factor XI (FXI) and Factor XII (FXII). To our knowledge, this particular combination of coagulation factor deficiency has not been previously reported.Case Report: In February 2004 a healthy 33 year-old white female without personal or family medical history presented with an elevated partial thromboplastin time (PTT) incidentally found during a routine pre-operative evaluation. Her prothrombin time (PT) was normal. Her PTT was 45 seconds (reference interval 23–37 seconds), and normalized with 1:1 mixing studies of patient and normal plasma. Preliminary laboratory evaluation included negative tests for the presence of a Lupus Anticoagulant, a normal serum albumin level, and a normal urinalysis. Additional laboratory testing of coagulation and included FXI and XII activities, measured by means of a one stage APTT-based clotting assay using APTT reagent (Automated APTT, Trinity Biotech, Bray Ireland), congenitally depleted deficient plasma (HRF, Inc, Raleigh NC) using the MDA II Trinity Biotech, Bray Ireland). FXI was 46% (reference range 60–150) and FXII was 42% (reference range 50–150). In March 2004, a repeated the laboratory evaluation showed a FXI of 41% and a FXII of 46%. In April 2006, FXI was 49%, and FXII was 40%. Is to be noted that the patient has never had a documented thromboembolic episode or excessive bleeding, despite the exposure, respectively, to estrogen supplementation for seven years, to a full-term pregnancy, and to an abdominal surgical event.Conclusion: Although modern laboratory methods are able to identify novel combinations of coagulation defects, their clinical significance requires additional investigation.

Male aggression during mating: evidence for sexual coercion in a female dominant primate?

In this article we document male sexual coercion of a Lemur catta female on St. Catherines Island (SCI), USA. Data presented in this paper were collected on one free-ranging L. catta group during October-November 2002 using all-occurrences sampling for agonism and reproductive behavior. We observed a male forcefully attempting to mate with a year-old estrous female. Despite the fact that we observed this female to present to the male during her estrus, throughout the episode the male employed the use of force, and achieved penile intromission on at least one occasion while the female struggled and resisted. We interpret his behavior as sexual coercion. As measured by sexual presents, the female appeared to more strongly prefer two other males as mates, yet each of these males gained fewer mounts and less cumulative time spent in mounts than the coercive male. The coercive male was one of two group males with the lowest observed mating success, suggesting that coercion might be a strategy used by males who are not highly sexually preferred. Females undergo early sexual maturation at this site owing to provisioning, and can therefore enter estrus before fully attaining dominance over males. As such, these data suggest that one consequence of provisioning a wild L. catta population (or of maintaining L. catta in captivity) may be that young females can be the targets of sexual coercion if they reach sexual maturity before fully achieving social dominance over males. In conclusion, male sexual coercion can occur in L. catta despite the female dominance characteristic of this species, and can constrain the mating behavior of females.

Rarely seen cardiotoxicity of lithium overdose: Complete heart block

Introduction Serious cardiac toxicity due to lithium toxicity is uncommon and generally only occurs in individuals with underlying heart disease. Cardiac impairment may result in dysrhythmias, including sinus bradycardia, sinoatrial block, and first-degree atrioventricular block. This paper describes a patient with complete AV block in the course of chronic lithium treatment. Case report Fifty-seven year-old female was brought into the emergency department (ED) due to altered mental status and malaise by ambulance from hospice. She had hypertension, type-II diabetes mellitus, and depression. The caregivers told that she had been fine yesterday, had taken regular medications (lysinopril, furosemid, acetyl salicylic acid, oral antidiabetic tablets and lithium (300 mg tb/day)). Her vital signs were; blood pressure: 70/45 mmHg, pulse: 37 bpm, respiratory rate: 22 bpm, and oxygen saturation 86%. She was confused and unresponsive to verbal stimulation. Her EKG revealed total atrioventricular block. Initial biochemical results were unremarkable except for a lithium level of 2.2 mmol/l (therapeutic range 0.5–0.8 mmol/l) and an increased creatinine of 2.11 mg/dl. A transvenous pacing electrode was introduced into the right ventricle, which allowed rapid restoration of haemodynamic and neurological status. Her neurologic examination was completely normal in the follow-up period and she was discharged without sequelae. Conclusion In conclusion, emergency physicians should bear in mind that complete AV block can ensue in the course of lithium toxicity and it is an entity that should be included in the differential diagnosis.

Bilateral carotid body tumor: The role of fine‐needle aspiration biopsy in the preoperative diagnosis

Carotid body (CB) is a round to ovoid or flattened structure situated within the adventitia of the common carotid artery bifurcation on both sides of the neck. CB contains two basic types of cells: chief cells (or glomus type 1) and sustentacular cells (glomus type 2). Carotid body tumor (CBT) or paraganglioma arises from the chief cells of the carotid body. The diagnosis of CBT is typically made with radiological studies. Fine needle aspiration biopsy (FNAB) is seldom requested for this purpose due to rare but dreadful reported complications such as hemorrhage and damage to the carotid artery. In this report we discuss the cytological findings of a malignant CBT diagnosed by FNAB in a 22 year-old female.