Austrian syndrome consists of a triad of endocarditis, meningitis, and pneumonia caused by Streptococcus pneumoniae. With the arrival of many antibiotic therapies, the disease remains rare, however, it can be overlooked due to the lack of awareness. We present a case of Austrian syndrome in an immunocompromised patient complicated by multiorgan failure.
Methods: 33 patients underwent a valve-in-valve procedure, with the implantation of 34 percutaneous implantable valves; one patient underwent the implantation of both, a mitral and an aortic valve device during the same pracedure. Both, the Edwards-Sapien and the CoreValve devices were used. Outcomes were evaluated using the VARC 2 criteria. Results: Valve-in-Valve in the aortic position (N¼23): mean age of patients was 81.4 AE 5.9 years. The CoreValve and the Edwards-Sapien valve devices were used in 91.3% and 8.7% of patients, respectively. The CoreValve device was implanted via the trans-axillar route in 3 cases and via trans-femoral route in 18 cases. The transapical route was used in both Edwards-Sapien implantations. Procedural success was achieved in 100% of cases. One month and one year survival rates were 100% and 90%; respectively. At one month follow up, 95.7% of patients were in NYHA I/II. Valve-in-Valve in the mitral position (N¼10): mean age of patients was 73.6 AE 15 years. All the procedures were performed with the Edwards-Sapien device via the trans-apical route. Procedural success was achieved in 100% of cases. One month and one year survival rates were 90% and 80%; respectively. At one month follow up, 100% of patients were in NYHA I/II. Valve-in-Valve in the tricuspid position (N¼1):A 78 year-old patient NYHA IV, was treated with the successful trans-femoral vein implantation of an Edwards-Sapien 29mm valve within a severely stenotic bioprosthetic Handcock 31mm valve. The procedure went uneventful. At one month follow up the patient was in NYHA II. Pre-and post-peak and mean trans-valvular gradients were 26/16 and 6/3 mmHg, respectively. Conclusions: In our experience, the Valve-in-Valve procedure for the treatment of failed bio-prosthetic valves, using multiple access techniques and available devices, led to significant symptomatic improvement, low peri-procedural morbidity and low mortality rates.Background: Elevated levels of natriuretic peptides are associated with adverse outcome across a wide spectrum of cardiovascular diseases. However, cut-off values differ according to age, gender, and body weight. We studied the prognostic value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP)-ratio, which is independent of individual cut-off levels, in predicting mortality in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: Out of 350 consecutive TAVR patients, 244 patients with pre-procedural NT-proBNP levels were included in the analysis, and the predictive value of NT-proBNP-ratio (measured NT-proBNP/maximal normal NT-proBNP values specific for age and gender) on all-cause-mortality was assessed in a multivariate model. Results: Median BNP-ratio was 4.2 [interquartile range 1.8-9.7). All-cause mortality was 7.8% at 30 days, and 16.9% at 1 year, respectively. All-cause mortality at 30 days was 3.4% in patients with less than median NT-proBNP-ratio, and 14.0% in patients with more than median NT-proBNP-ratio (p¼0.02). All-cause mortality at 1 year was 7.0% i...
Anaplastic Thyroid Carcinoma (ATC) is one of the most lethal tumours in humans, extremely rare in occurrence and very aggressive in nature. We hereby present a rare case of ATC with airway compromise. A 66-year-old male, presented complaining of a non-tender anterior neck mass rapidly increasing in size associated with dry cough, hoarseness and voice changes. Imaging studies revealed a large heterogeneous centrally necrotic lobulated left thyroid mass with metastatic lymph nodes and rightward tracheal deviation. Core biopsy and immunohistochemistry stains revealed a profile consistent with ATC. Patient's airway was compromised. Options for treatment and prognosis were discussed. Patient was discharged home with home hospice. A high index of suspicion for ATC is necessary in patients presenting with a rapidly enlarging neck mass. A prompt cytologic evaluation with metastatic work up is important to establish diagnosis. Due to its poor prognosis, an honest discussion regarding end-of-life issues must be initiated at diagnosis. Novel therapies toward genetic and epigenetic pathways have been developed, which is the basis of current clinical trials that are intended to improve clinical outcomes in the coming years.
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