The objective of the present study is to characterize genitourinary tumors (GU) metastatic to the head and neck and to determine long-term prognoses. Using a retrospective chart review of 734 patients treated between January 1995 and May 2005 with an ICD-9 code pertaining to a metastatic head and neck cancer, we found 37 patients with primary GU tumors. There were 24 cases of prostate cancer, 10 cases of renal cell carcinoma, and 4 cases of transitional cell carcinoma. Sixteen of 24 patients (67%) with prostate cancer had a cranial metastasis while 6 of 9 (67%) patients with renal cell carcinoma had cerebral metastasis. We concluded that prolonged survival is possible in prostate cancer patients treated aggressively with radiation and chemotherapy, indicating that early detection and aggressive screening are important in these patients.
Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT) occurs due to concurrent antegrade conduction over fast and slow atrioventricular nodal pathways and is treated by slow pathway modification. We describe a unique case of a patient with cardiac sarcoidosis who received inappropriate ICD shocks for DAVNNT. Atrial and ventricular device electrograms satisfied both rate and V>A criteria for ventricular tachycardia. We postulate that alterations in refractoriness and conduction as is seen in cardiac sarcoidosis (CS) may have contributed to occurrence of DAVNNT.
Performing afib ablation combined with the placement of the Watchman
device for LAA occlusion has been evaluated before, with results showing
evidence of safety and ability to perform (6). This can save time and
materials allowing patients to have two procedures simultaneously,
preventing repeating exposure to possible risks that come with general
anesthesia and transseptal puncture, and decreasing the total length of
hospital stay (7-8). In this case, especially we proceeded with the
combined procedure due to difficulty in obtaining access associated with
total interruption of IVC and the obligation to use alternative
non-conventional ways as the transhepatic access that may lead to higher
risk upon repeating.
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