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INTRODUCTION
Hypertension (HTN) is the most common non-communicable disease in Nigeria. The crude prevalence rate for females is 11.2%, while the age-adjusted rate is 9.3%. HTN is also the most common medical disorder of pregnancy worldwide. It has been estimated that 5-10% of all pregnancies are complicated by HTN.
Angiosarcoma of the scalp is a rare and deadly malignant tumor classically found in elderly Caucasian males. It was first described by Livingston and Klemperer in 1926, when they reported a tumor of the scalp in a 38-year-old white male who later died from uncontrolled hemorrhage from the tumor. E. Wilson Jones, 38 years after the first case was published, described a series of nine cases occurring on the face and scalp of elderly patients.
- In: Cancer
- Tags: angiosarcoma cancer, head and neck, I black, scalp
CASE REPORT
A 50-year-old African-American man related a nine-month history of a scalp “knot” that measured about 1 cm x 0.5 cm. He scratched the lesion repeatedly, leaving him with an enlarging ulcer. Three weeks later, he presented to his primary care physician because of the foul smelling nature of the lesion. He was initially treated with antibiotics for seven days but with no resolution. He was again seen about two weeks later and was prescribed another regimen of antibiotics for 14 days. The lesion continued to increase in size associated with fluctuance and pruritus. The patient returned a third time and was given a 21-day course of antibiotics along with instruction to clean the lesion four times daily. By this time, the lesion had become an ulcerated mass. He was eventually referred to a dermatologist eight months after the lesion was first noticed. A biopsy of the lesion revealed atypical vascular proliferation that resembled granulation tissue but with focal atypical features including papillary formation and dissection in between the reticular collagen bundles. A few nonatypical mitotic figures were also noted associated with a marked mixed inflammation. Given the age and race of the patient in conjunction with the history, the dermatopathologist favored pyogenic granuloma as the top differential. Others on the differential included deep fungal infection, granulomatous inflammation, squamous cell carcinoma, and basal cell carcinoma. The patient was then referred for surgical evaluation. On physical exam, a fluctuant fungating and foul-smelling mass measuring 3.7 cm x 5.3 cm was noted in the right occipitoparietal area with purulent drainage. No cervical or posterior auricular lymph nodes were palpable, and the rest of the physical exam was otherwise unremarkable. Nine months after the patient first noticed the “knot”, the mass was excised with primary closure (Figure 1). The excised tissue was submitted for surgical pathology consultation.
- In: Cancer
- Tags: angiosarcoma cancer, head and neck, I black, scalp
Angiosarcoma of the of Scalp with Calvarium
19 Jan2010
INTRODUCTION
Angiosarcoma is an extremely malignant soft tissue sarcoma of endothelial origin. Because of its ambiguous presentation that usually mimics common benign dermatologic conditions, it is often diagnosed late. These sarcomas account for about 1% of all sarcomas and less than 0.1 % of all head and neck cancers. Therefore, the rarity of angiosarcoma may impede early diagnosis. Radiation and chronic lymphedema have been implicated in the development of some cutaneous angiosarcomas. Angiosarcoma is usually found in elderly Caucasian men in their 70s. Angiosarcoma has the highest rate of lymph node metastases of all soft-tissue sarcomas of the head and neck, and distant metastasis may occur in up to 50%, with the lung being the most common site. Prognosis is dismal regardless of histologic type and therapy. Age, patient’s sex, location, and clinical appearance have no effect on prognosis. However, tumor size has been found to correlate with favorable outcome, hence, the need for early diagnosis and aggressive management. The overall five-year survival rate is less than 30%.
- In: Cancer
- Tags: angiosarcoma cancer, head and neck, I black, scalp
In conjunction with an echocardiogram, BNP may become the gold standard for diagnosing diastolic dysfunction. As a screening test, BNP for HF may be more diagnostically helpful than the far-more-utilized prostate-specific antigen (PSA), Papanicolaou smears, or mammography used to screen for the corresponding prostate, cervical, and breast cancers. It has a high negative predictive value, meaning if the BNP value is low, this essentially rules out the presence of significant LVD. Therefore, it may preclude the need for an echocardiogram in patients with a very low value unless the test is necessary for other reasons. The potential diagnostic importance of the BNP in symptomatic patients presenting to the ED was recently published. This has significance because 80% of CHF emergency room visits yearly result in hospitalization. A test that assists with correct triaging of HF patients would be beneficial. In Maisal’s study, 1,586 patients presenting to the emergency department with dyspnea were evaluated in the usual manner. In addition, a BNP level was drawn with the ED doctors blinded to the results. Later, two cardiologists reassessed the patients’ records. They had access to all information: the ED records, results of diagnostic tests, such as echocardiograms, and data on hospital course, including response to treatment. The cardiologists then divided the patients into three groups: No HF, LVD without congestion, and LVD with congestion (CHF). The BNP levels were then unblinded. The results in Figure 4 demonstrate that BNP was able to significantly differentiate the patients in the three groups. Therefore, the ED physicians’ diagnostic accuracy can be enhanced by the availability of BNP measurements. In other studies, BNP is able to distinguish between those patients with dyspnea secondary to chronic obstructive pulmonary disease versus HF. And in the patients presenting with edema, a cardinal symptom of HF, BNP could make a distinction between those with and without CHF.
- In: Disease
- Tags: BioZ, diagnosis, heart failure, impedance cardiography
The pulmonary artery catheter (РАС), in use for over 30 years and placed in about one million patients yearly, is still the gold standard for obtain ing similar hemodynamic values. But there is little information from large, multicenter randomized trials showing value and improved patient outcome. The potential complications are well documented. They include pulmonary artery (PA) rupture, PA thrombus, infection, and right atrial/ventricular perforation, catheter entrapment that may lead to rupture of the chordae, and tricuspid valve. A large multicenter trial is underway to evaluate effectiveness of PAC’s in CHF—the Escape Trial. When comparing the РАС to the BioZ, some advantages of the BioZ are obvious. It is noninvasive, requires minimal skill to perform, can be conducted in the critical care units, stepdown units, perioperative areas, emergency departments, or the outpatient clinics for a one-time measurement or continuous monitoring.
- In: Disease
- Tags: BioZ, diagnosis, heart failure, impedance cardiography
Valuable cardiac information can be obtained from the echocardiogram. The size, shape, and function of the ventricles along with regional wall motion can be attained. The presence of thrombus can often be identified depending on its size and location in these patients who have a high risk for the development of thrombotic events. Identification of valvular abnormality, especially mitral regurgitation (MR), aortic stenosis (AS), and aortic regurgitation (AR) is important and can impact treatment options, preventing HF for those at high risk. Mitral valvuloplasty in severe MR and aortic replacement in significant AS or AR may improve left ventricular function and HF symptoms if correct timing of surgery is achieved. Other information that can be obtained from a routine echocardiogram include estimate of pulmonary pressures, presence and severity of diastolic dysfunction, and left ventricular hypertrophy. Presence of significant pericardial efftision can also be assessed.
- In: Disease
- Tags: BioZ, diagnosis, heart failure, impedance cardiography