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Orbital Plasmacytoma, An Uncommon Presentation of Advanced Multiple Myeloma
Get PDFIntroduction: Extramedullary plasmacytomas are present in 13% of multiple myeloma (MM) patients. Less than 5% of MM cases are non-secretory. The orbital location is uncommon and a minority of orbital tumours are plasmacytomas.
Description: The patient was a 71-year-old man, with right proptosis, retro-ocular pain and epistaxis with visual acuity 2/10, limitation of upper eye movement and scattered ecchymosis. Blood tests revealed severe anaemia, coagulopathy, increased serum creatinine, LDH and C-RP without improvement after antimicrobial treatment. Peripheral immunophenotyping showed 9.4% of plasma cells with intracytoplasmic clonal κ chains. IgG and λ chains were decreased with normal plasma and urine immunofixation. Orbital CT: retro-orbital superomedial tumour with bone destruction. Histology of the tumour and bone biopsy was consistent with plasmacytoma. The patient was deceased in 2 weeks.
Discussion: MM accounts for 10% of haematopoietic tumours; 7% of cases present with plasmacytomas at diagnosis. Orbital locations are rarely reported (frequently in the temporal region). Proptosis, ptosis and reduced visual acuity are common symptoms. However, orbital pain is less frequent. Most cases of MM demonstrate hypergammaglobulinaemia. Only 5% of MM cases are non-secretory.
The uncommon location, topography, symptom peculiarities and absence of monoclonality led to the diagnostic challenge of this fatal case of MM
Ruptured Sinus of Valsalva Aneurysm Causing Aorto–Atrial Fistula and Acute Heart Failure: A Rare Encounter
Get PDFA ruptured sinus of Valsalva aneurysm as a cause of aorto–atrial fistula is very rare. We present the case of a 53-year-old female who presented with symptoms of acute heart failure and suspicion of an aorto–atrial fistula found on a transthoracic echocardiogram, which was confirmed on transesophageal echocardiography. A coronary angiogram showed normal coronary arteries but confirmed the right aorto–atrial fistula on aortogram. She underwent successful surgical repair of the fistula. Her postoperative echocardiogram showed a normal right atrium and right ventricle with no shunt. A ruptured sinus of Valsalva aneurysm is a devastating event and presents as acute heart failure. Prompt diagnosis and surgical repair is necessary to prevent mortality
Abdominal Pain: A Real Challenge in Novel COVID-19 Infection
Get PDFCOVID-19 (coronavirus disease 19) is an infectious disease caused by coronavirus SARS-CoV-2. Since its detection in China at the end of 2019, the novel coronavirus has rapidly spread throughout the world and has caused an international public health emergency. The most common manifestation is flu-like symptoms. Mild infections usually improve within a few days, but COVID-19 can cause severe pneumonia with acute respiratory distress syndrome and death. Gastrointestinal symptoms are less common but possible and more difficult to recognize as part of a COVID-19 syndrome. In line with the current opinion of the WHO, we strongly believe that preventive measures and early diagnosis of COVID-19 are crucial to interrupt virus spread and avoid local outbreaks. We report the cases of COVID-19 patients admitted to our Emergency Department who complained of gastrointestinal symptoms at admission
Epigastric Pain and Weight Loss – A Case of Wilkie’s Syndrome
Get PDFSuperior mesenteric artery syndrome (SMA syndrome) or Wilkie’s syndrome is a rare etiology of duodenal obstruction due to compression of the third portion of the duodenum between the superior mesenteric artery and the aorta. Physical and laboratory findings are often non-specific but imaging methods are useful for diagnosing the condition. A 46-year-old female patient presented to the outpatient clinic of our internal medicine department with a 2-year history of epigastric pain, nausea, early satiety and weight loss of 15 kg. Previous studies were inconclusive. The patient underwent computed tomography enterography and its findings were consistent with SMA syndrome. Currently the patient is being followed by General Surgery and Nutrition and is under nutritional measures in order to optimize her body mass index to decrease possible surgical complications.This case report emphasizes the importance of clinical suspicion and careful investigation when considering less common etiologies for frequent gastrointestinal symptoms
Two Cases of Cardiac Implantable Electronic Device Placement via Persistent Left Superior Vena Cava
Get PDFPersistent left superior vena cava (PLSVC) is the most common variation of anomalous venous return to the heart and present in 0.1–0.5% of the general population. The left anterior cardinal veins typically obliterate during early cardiac development but failure of involution results in PLSVC. It is an asymptomatic congenital anomaly, usually discovered while performing interventions through the left subclavian vein or during cardiovascular imaging. PLSVC can be associated with cardiac arrhythmias and congenital heart disease. We present two cases of PLSVC: first, a 68-year-old male who presented with complete heart block, for which a temporary pacemaker was initially inserted followed by a permanent pacemaker; second, a 53-year-old female with a history of hypertension and ischemic cardiomyopathy with a left ventricular ejection fraction of 25%, and a survivor of sudden cardiac death, who underwent an implantable cardioverter-defibrillator (ICD) for secondary prevention.
Both cases of PLSVC were detected incidentally during the transvenous approach to the heart. PLSVC was suspected by the unusually left medial position of the lead, while cineflouroscopy showed the venous trajectory toward the coronary sinus and drainage into the right atrium. It is technically difficult to cross the wire through the tricuspid valve when coming from the PLSVC and coronary sinus without making a loop in the right atrium, which is known as a wide loop technique.
PLSVC is an uncommon anomalous anatomical variant and should be recognized appropriately by specialists who frequently carry out procedures through the left subclavian vein, such as implantation of permanent pacemaker, ICD and cardiac resynchronization therapy. It should also be recognized that wide loop formation of the right ventricular lead in the right atrium is helpful to cross the tricuspid valve and to affix the lead in the right ventricle
Proceedings of Eighth International Symposium “Monitoring of Mediterranean Coastal Areas. Problems and Measurement Techniques”
Get PDFThe 8th International Symposium "Monitoring of Mediterranean Coastal Areas. Problems and Measurements Techniques" was organized by CNR-IBE in collaboration with FCS Foundation, and Natural History Museum of the Mediterranean and under the patronage of University of Florence, Accademia dei Geogofili, Tuscany Region and Livorno Province. It is the occasion in which scholars can illustrate and exchange their activities and innovative proposals, with common aims to promote actions to preserve coastal marine environment. Considering Symposium interdisciplinary nature, the Scientific Committee, underlining this holistic view of Nature, decided to celebrate Alexander von Humboldt; a nature scholar that proposed the organic and inorganic nature’s aspects as a single system. It represents a sign of continuity considering that in-presence Symposium could not be carried out due to the COVID-19 pandemic restrictions. Subjects are related to coastal topics: morphology; flora and fauna; energy production; management and integrated protection; geography and landscape, cultural heritage and environmental assets, legal and economic aspects
HBIM data management in historical and archaeological buildings
Get PDFRecent technological evolutions in the acquisition and management of building data are offering new opportunities for digital reconstruction. At the same time, the BIM (Building Information Modeling) methodology, based on the implementation of libraries composed of parametric objects provided by the IFC (Industry Foundation Classes) standard, allows the design and management of data of existing buildings, and, in particular, historical and archaeological buildings. In the latter case, the great variety of Cultural Heritage (CH) distributed over the European territory, and the ability of BIM to cover the life of buildings or/and other artefacts from a geometric, descriptive, physical and static point of view, have stimulated the development of the HBIM (Historic BIM) modelling. The HBIM approach should consider the complexity of historical or archaeological buildings or artefacts, with particular attention to possible fragmentation or incompleteness of parts. In this work, different approaches regarding the survey, restitution and data management will be described, finalised to the construction of an HBIM model, considering different possible variables, emerging from different study cases
Use of Cherenkov light in TOF-PET
No full textThe time-of-flight resolution of PET scanners is limited by the timing spread due to delayed scintillation emission. By using prompt Cherenkov photons instead, the coincidence timing resolution can be improved. The improvement is limited by the photon travel time spread in the crystals. By segmenting the crystals, the remaining contribution is due to the intrinsic time resolution of the photosensors. In this contribution, we evaluate the feasibility of using lead fluoride in Cherenkov-light–based PET scanner with silicon photomultipliers. Due to a significantly lower price of lead fluoride compared to an L(Y)SO scintillator, such a scanner is a competitive option already with the use of current silicon photomultipliers which have a single photon time spread of around 100 ps
Exotic states in BSM physics: The 331 model, a case of study
No full textWe present the relevant phenomenology of the so-called 331 model. The gauge group of this model is SU(3)c×SU(3)L ×U(1)X, implying the presence of extra vector and scalar bosons as well as fermions. We also discuss some interesting
theoretical aspects of the model, the most important being connected with the cancellation of anomalies
Ultra-fast deep learning algorithms on FPGA for the phase-II level-0 trigger of the ATLAS experiment
No full textThe LHC accelerator will face, during the following years, a complete upgrade with the main purpose of rising up the instantaneous luminosity by a factor of almost five. Though this will permit to collect an incredible amount of data, the complexity of each event will greatly intensifies going from an average number of interactions per bunch crossing of 40 to an average of 200. To cope with this problem and be able to handle this large amount of information, both the detectors and the trigger algorithms of the ATLAS experiment will be updated. A machine learning approach for the level-0 trigger algorithm is presented