Browsing by Author "Norton, Melanie (57206175387)"

Secondary metastatic deposits in the heart are generally rarely diagnosed antemortem. Malignant tumors of gynecologic origin commonly spread to the bones, lungs, local cervical region and the supra-clavicular lymph nodes, while gynecologic metastases to the thoracic region are rarely seen in clinical practice. We present a case of squamous cervical carcinoma that metastasized to the heart in 35-year old patient. The patient was admitted to cardiology department with complaints of retrosternal pain, dyspnea, fatigue, and cough. She informed the physicians that she had bilateral adnexectomy three years prior to admission. On physical examination patient was pale, febrile (38 °C), adynamic, with diminished breath sounds. Trans-thoracic echocardiogram showed aforeign mass of 42x64 mm extracardially proximal to the right atrium. Biopsy showed characteristics of metastatic deposits of squamous differentiation. These were the only metastases in this case. © 2018 EDIZIONI MINERVA MEDICA.

Objective Cerebral small vessel disease (SVD) is associated with late-onset depression and increases the risk for depression after stroke. We aimed to investigate baseline predictors of depression after long-term follow-up in patients with SVD, initially presenting with first-ever lacunar stroke, free of depression and cognitive impairment. Methods A total of 294 patients with SVD were evaluated 3-5 years after the qualifying event. We analyzed baseline demographic data, vascular risk factors, functional status expressed as a score on modified Rankin Scale (mRS), cognitive status, presence of depression, total number of lacunar infarcts and severity of white matter hyperintensities (WMH) on MRI with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores. Results On follow-up, depression was registered in 117 (39.8%) SVD patients. At the baseline, patients with depression compared with non-depressed were older (64.4 vs 60.9 years; p = 0.007), had higher mRS score (2.8 ± 0.7 vs 1.5 ± 0.7; p < 0.0001) and had more severe lesions on MRI scales (p < 0.0001 for all parameters). On follow-up, depressed patients more frequently exhibited cognitive decline (75.2% depressed vs 56.5% non-depressed; p = 0.003). No difference was detected in risk factor frequency between groups. Multivariate Cox regression analysis adjusted by age and gender revealed independent predictors of depression: baseline mRS >2 (HR 2.17, 95%CI 1.74-2.72; p < 0.0001) and tARWMC (HR 1.05, 95%CI 1.02-1.09; p = 0.005), and cognitive decline on follow-up (HR 1.80, 95%CI 1.12-2.89; p = 0.015). Conclusions Baseline functional status and severity of WMH and development of cognitive decline predict the occurence of late-onset depression in patients with SVD. Copyright © 2015 John Wiley & Sons, Ltd.