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Pooniya S, McKinnie A, Taylor T, Will M, Wallace W. Classic biphasic pulmonary blastoma (CBPB): a rare primary pulmonary malignancy. BMJ Case Rep 2021; 14:e244151. [PMID: 34376421 PMCID: PMC8356168 DOI: 10.1136/bcr-2021-244151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/04/2022] Open
Abstract
Classic biphasic pulmonary blastoma (CBPB) is a very rare primary pulmonary malignancy with distinctive clinical and pathological features. Usually CBPB presents with either non specific symptoms or is diagnosed incidentally. Histologically CBPB is composed of a mixture of malignant epithelial and stromal cells resembling fetal lung tissue. Surgical resection is the mainstay of treatment with further chemotherapy or radiotherapy on a case-by-case basis. However, due to its rarity, no definite treatment guidelines are available. CBPB overall has a very poor prognosis with a 5-year survival rate of only 15%. Our patient presented with cough and haemoptysis. Her chest radiograph demonstrated a large right-sided lung mass. Further investigations included CT, CT-guided biopsy and PET CT which were discussed at multidisciplinary team meetings. The patient then underwent complete surgical excision. We report this rare malignancy with radiological and pathological features, comparing them with previously reported cases.
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Affiliation(s)
- Shashank Pooniya
- Clinical Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Angela McKinnie
- Clinical Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Thomas Taylor
- Clinical Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Malcolm Will
- Consultant Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William Wallace
- Professor Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
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Mohan M, Al-Talabany S, McKinnie A, Mordi IR, Singh JSS, Gandy SJ, Baig F, Hussain MS, Bhalraam U, Khan F, Choy AM, Matthew S, Houston JG, Struthers AD, George J, Lang CC. A randomized controlled trial of metformin on left ventricular hypertrophy in patients with coronary artery disease without diabetes: the MET-REMODEL trial. Eur Heart J 2020; 40:3409-3417. [PMID: 30993313 PMCID: PMC6823615 DOI: 10.1093/eurheartj/ehz203] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/01/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022] Open
Abstract
Aim We tested the hypothesis that metformin may regress left ventricular hypertrophy (LVH) in patients who have coronary artery disease (CAD), with insulin resistance (IR) and/or pre-diabetes. Methods and results We randomly assigned 68 patients (mean age 65 ± 8 years) without diabetes who have CAD with IR and/or pre-diabetes to receive either metformin XL (2000 mg daily dose) or placebo for 12 months. Primary endpoint was change in left ventricular mass indexed to height1.7 (LVMI), assessed by magnetic resonance imaging. In the modified intention-to-treat analysis (n = 63), metformin treatment significantly reduced LVMI compared with placebo group (absolute mean difference −1.37 (95% confidence interval: −2.63 to −0.12, P = 0.033). Metformin also significantly reduced other secondary study endpoints such as: LVM (P = 0.032), body weight (P = 0.001), subcutaneous adipose tissue (P = 0.024), office systolic blood pressure (BP, P = 0.022) and concentration of thiobarbituric acid reactive substances, a biomarker for oxidative stress (P = 0.04). The glycated haemoglobin A1C concentration and fasting IR index did not differ between study groups at the end of the study. Conclusion Metformin treatment significantly reduced LVMI, LVM, office systolic BP, body weight, and oxidative stress. Although LVH is a good surrogate marker of cardiovascular (CV) outcome, conclusive evidence for the cardio-protective role of metformin is required from large CV outcomes trials. ![]()
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Affiliation(s)
- Mohapradeep Mohan
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Shaween Al-Talabany
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Angela McKinnie
- NHS Tayside Clinical Radiology, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Jagdeep S S Singh
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Stephen J Gandy
- Department of Medical Physics, NHS Tayside, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Fatima Baig
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Muhammad S Hussain
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - U Bhalraam
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Faisel Khan
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Anna-Maria Choy
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Shona Matthew
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - John Graeme Houston
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Jacob George
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
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Bowness J, Seeley J, Varsou O, McKinnie A, Zealley I, McLeod G, Grant C. Arterial Anatomy of the Anterior Abdominal Wall: Evidence-Based Safe Sites for Instrumentation Based on Radiological Analysis of 100 Patients. Clin Anat 2019; 33:350-354. [PMID: 31444816 DOI: 10.1002/ca.23463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/19/2019] [Accepted: 08/01/2019] [Indexed: 11/08/2022]
Abstract
Multiple medical interventions require percutaneous instrumentation of the anterior abdominal wall, all of which carry a potential for vascular trauma. We assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries to determine the safest site with respect to vascular anatomy of the rectus sheath. In a review of 100 arterial phase, contrast-enhanced abdominal computed tomography scans, anterior abdominal wall arteries were assessed bilaterally at three axial planes: transpyloric, umbilicus, and anterior superior iliac spine (ASIS). The mean age of patients was 69.2 years (SD ± 15), with 62 male and 38 female. An artery was visible least frequently at the transpyloric plane (5%), compared with the umbilicus (72-79%) and ASIS (93-96%), on the left (χ2 (4) = 207.272; P < 0.001) and right (χ2 (4) = 198.553; P < 0.001), with a moderate strength association (Cramer's V = 0.588 (left) and 0.575 (right)). The arteries were most commonly observed within the rectus abdominis muscle at the level of the umbilicus and ASIS on both sides (62-68%). The inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it travelled superiorly. These data suggest that the safest site to instrument the rectus sheath, with respect to vascular anatomy, is at the transpyloric plane. This information on anatomical variation of the anterior abdominal wall vasculature may be of particular interest to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion. Clin. Anat. 33:350-354, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- James Bowness
- Institute of Academic Anaesthesia, University of Dundee, Dundee, United Kingdom.,Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
| | - Jonathan Seeley
- Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
| | - Ourania Varsou
- Anatomy Facility, School of Life Sciences, University of Glasgow, United Kingdom
| | - Angela McKinnie
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
| | - Graeme McLeod
- Institute of Academic Anaesthesia, University of Dundee, Dundee, United Kingdom.,Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
| | - Calum Grant
- Department of Anaesthesia, Ninewells Hospital, Dundee, United Kingdom
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Mohan M, Al-Talabany S, McKinnie A, Mordi I, Singh JSS, Gandy S, Khan F, Choy AM, Houston JG, George J, Struthers AD, Lang CC. 2358Metformin regresses left ventricular hypertrophy in normotensive patients with coronary artery disease without type 2 diabetes mellitus - The MET-REMODEL trialM. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Mohan
- University of Dundee, Division of Molecular & Clinical Medicine, Dundee, United Kingdom
| | - S Al-Talabany
- University of Dundee, Division of Molecular & Clinical Medicine, Dundee, United Kingdom
| | - A McKinnie
- NHS Tayside, Department of Radiology, Dundee, United Kingdom
| | - I Mordi
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - J S S Singh
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - S Gandy
- NHS Tayside, Department of Medical Physics, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - F Khan
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - A M Choy
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - J G Houston
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - J George
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - A D Struthers
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - C C Lang
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
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