Background Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential. Case report We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered ECG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed. Conclusions Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS.
Dermal sarcomas represent a group or rare malignancies of mesenchymal origin. Although surgical excision with wide margins can be curative, in the advanced/metastatic setting, treatment options are limited and the benefit from anthracycline-based chemotherapy or targeted agents is usually short-lived. Tumor mutational burden and PD-L1 expression scores can be used as predictive biomarker for response to immunotherapy in some metastatic cancers. The role of immune-checkpoint blockade for sarcoma patients remains investigational. Here we present three cases of dermal sarcomas with high TMB and PD-L1 expression and responses to anti-PD1 agents in two of them.
Background: Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential. Case report: We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered ECG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed. Conclusion: Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS.
RESUMOIntrodução: A leucemia mieloide crônica (LMC) é uma patologia marcada pela síntese de uma tirosina quinase BCR-ABL constitucionalmente ativa. Com o surgimento dos inibidores da tirosina quinase houve uma grande melhora no prognóstico dos pacientes com o tratamento da LMC. A ocorrência de derrame pleural e pericárdico é mais descrita com o uso do dasatinibe, sendo rara com o uso do imatinibe e nilotinibe. Devido à raridade do caso, iremos apresentar um relato de uma paciente de 19 anos em uso de imatinib, a qual apresentou efusões pleural e pericárdica relacionadas à terapia. Relato: Paciente do sexo feminino, 19 anos, apresenta-se ao Pronto Atendimento do Hospital de Clínicas da UFPR em julho de 2012 com queixa de dispneia e dor torácica ventilatório-dependente, com piora nos últimos cinco dias. Ao exame, observou-se murmúrio vesicular diminuído bilateralmente em bases, bulhas cardíacas hipofonéticas, abdome ascítico e edema de membros inferiores abaixo dos joelhos. Foram solicitados exames complementares que demonstraram derrame pericárdico importante associado a tamponamento cardíaco, necessitando de janela pericárdica. Seis dias após o ocorrido a paciente foi reavaliada e internada, sendo submetida à drenagem torácica fechada, com drenagem de 2450 ml no total de 9 dias de internamento. A paciente tinha o diagnostico de LMC t(9,22) desde 2008, tendo sido iniciado o tratamento com Gleevec® 400 mg/dia em março de 2009, tendo sido acompanhada e tendo apresentado apenas efeitos colaterais aceitáveis; a dose da medicação fora mantida até novembro de 2011 quando se optou por aumentar a dose para 600 mg/dia graças a uma resposta molecular subótima. Após a resolução e investigação do quadro, outras causas foram excluídas e optou-se pela introdução do nilotinibe para controle da doença. Conclusão: Este relato ressalta a relevância dos efeitos adversos relacionados ao uso do imatinib no tratamento da LMC.Palavras-chave: fibrose cística, tuberculose, Chopin.
Background: Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential. Case report: We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered EKG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed. Conclusion: considering that community clinicians might be unfamiliar with TTS, this condition is likely to be underdiagnosed. Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS.
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