Ovarian vein thrombosis (OVT) is a rare serious diagnosis especially if extending to inferior vein cava (IVC). We present a case of 36-year- old female who was diagnosed with right OVT reaching the inferior vein cava following a supra-cervical hysterectomy that was performed in the postpartum period due to excessive bleeding from uterine fibroids. Using the new generation anti-coagulant "rivaroxaban" for six months followed by maintenance regimen of aspirin and sulodexide, complete resolution of the clot was noticed without any adverse event while using this regimen. This is the first OVT case which is completely treated with rivaroxaban without any adjunct invasive modality.

BACKGROUND The 2010 revised Task Force criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) provided guidance for the classification of patients as definitive, borderline or possible ARVC. However, many patients with clinical suspicion for ARVC have isolated RV dyskinetic segments only and partly meet cardiac magnetic resonance (CMR) imaging criteria. This subgroup of patients and the implication of this imaging finding remain not well defined. METHODS There were 65 consecutive patients with clinical suspicion for ARVC who were referred for CMR between 2015 and 2017. The presence of fatty infiltration and fibrosis were assessed using T2 imaging and myocardial delayed enhancement sequences, respectively. RV wall motions, volumes and ejection fraction (EF) of all patients were re-analysed and quantified. Available data on family history, Holter findings, and electrocardiograms were also reviewed. RESULTS There were 5 patients (7.7%) that fulfilled major CMR criteria for ARVC: 4 were classified as having definitive ARVC; and 1/5 as borderline. There were 33 patients with no RV dyskinetic segments: none were classified as having definitive or borderline ARVC; 4/33 were classified as possible ARVC, leaving 29/33 as normal or no ARVC. Finally, there were 27 remaining patients (41.5%) with isolated RV dyskinetic segments: 1/27 was classified as definitive ARVC; 4/27 as borderline; 8/27 as possible; leaving 15/27 as indeterminate. Compared to control, those with isolated RV dyskinesia (including the subgroup labelled as indeterminate 15/27) had more abnormal RVEF, larger RV end-diastolic volume index (82 ± 12 mL/m 2 vs. 72 ± 12 mL/m 2 , p-value 0.0127), and a trend for higher odds of dilated RV (odds ratio 3.0 [0.81–11], p-value 0.09). CONCLUSIONS Among patients with a clinical suspicion for ARVC, almost 40% had isolated focal RV dyskinetic segments with the majority remaining unclassified. This cohort had more RV dilation and abnormal EF compared to control.

Background Numerous studies have demonstrated that radioembolization of the liver with yttrium-90 microspheres provides a survival advantage for patients with unresectable primary or secondary tumors of the liver. The goal of this study was to provide results of the real-world experience of a single center in Lebanon with the use of radioembolization to treat liver-only or liver-dominant tumors. Methods Patients were included in this retrospective review if they were evaluated for radioembolization between January 2015 and June 2017 and had a lung shunt fraction of 20% or less. Tumor responses were determined using the Response Evaluation Criteria In Solid Tumors. Results Of the 23 patients treated with radioembolization, 8 had hepatocellular carcinoma, 4 had cholangiocellular carcinoma, and 11 had liver-only or liver-dominant metastases from other primary cancers. All were Middle Eastern, with a median age of 64 years (range 36-87 years), and 14 were men. A majority (n=19) had an initial tumor volume of 49% or less. Most (n=17) had multifocal lesions, and 8 had a history of branched or main portal vein thrombosis. Eighteen patients required arterial coil occlusion. Two patients had their cystic artery occluded, and one of these patients developed cholecystitis, which was successfully treated with antibiotics and supportive care. Only one other patient developed a postradioembolization complication, which was a peptic ulcer and was not thought to be due to arterial reflux of microspheres because both the gastroduodenal and right gastric arteries were occluded. Median time to progression was 7 months (range 3-36 months), and median overall survival from radioembolization was 12 months (range 3-40 months). Tumor responses include complete response for 5 patients and partial response for 13 patients. One patient had stable disease and 4 had progressive disease. Conclusion While avoiding prophylactic coiling, we had a positive experience with coiling of the gastroduodenal artery and middle hepatic artery for consolidation of radiotherapy. Performing radioembolization in a nonreferral, private center in Lebanon resulted in good patient outcomes with a low rate of complications.

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Purpose: We aim to provide results of the real-world experience of a single center in Lebanon on the use of radioembolization to treat liver-only or liver-dominant tumors.Methods: This retrospective review included patients who were evaluated for radioembolization between January 2015 and June 2017 and who had a lung shunt fraction of 20% or less. Tumor responses were determined using the response evaluation criteria in solid tumors (RECIST).Results: Of the 23 Arab patients with a median age of 64 years (range, 36-87 years), eight had hepatocellular carcinoma, four had cholangiocarcinoma, and 11 had liver-only or liverdominant metastases from other primary cancers. Most (n=17) had multifocal lesions, and 13 had a history of branched (n=8) or main (n=5) portal vein thrombosis. When appropriate, the gastroduodenal artery and middle hepatic artery were embolized for consolidation of radiotherapy; 18 patients required arterial coil occlusion, two had their cystic artery occluded, and one developed cholecystitis, which was successfully treated with antibiotics and supportive care. Another patient developed a post-radioembolization complication-a peptic ulcer unrelated to arterial reflux of microspheres because both the gastroduodenal and right gastric arteries were occluded. The median time to progression was seven months (range, 3-36 months), and median overall survival from radioembolization was 12 months (range, 3-40 months). Tumor responses included five complete responses, 13 partial responses, one stable disease, and four cases of progressive disease.Conclusion: Performing radioembolization in a non-referral, private center in Lebanon resulted in good patient outcomes with few complications.

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