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Roberts CS, Hassan MH, Hasson L, Guileyardo JM, Roberts WC. Fatal Acute Myocardial Infarction With Normal Epicardial Coronary Arteries Shortly Following COVID-19 Vaccination. Am J Cardiol 2024; 218:68-71. [PMID: 38428710 DOI: 10.1016/j.amjcard.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/26/2024] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
Myocarditis and acute myocardial infarction (AMI) have been reported after COVID-19 messenger ribonucleic acid vaccination. Nearly all reported patients with myocarditis or AMI after COVID-19 vaccination have survived and become asymptomatic. Described herein is a previously healthy man who developed severe heart decompensation shortly after receiving a COVID-19 vaccination and died approximately 40 hours later. An autopsy disclosed massive AMI.
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Affiliation(s)
- Charles S Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Murad H Hassan
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Lena Hasson
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Joseph M Guileyardo
- Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
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2
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Abstract
ABSTRACT Cavernous sinus thrombosis is a rare and often fatal condition, usually associated with infections in the head and neck region. Clinical presentation includes fever, headache, and periorbital swelling. Mortality can be high; however, prompt treatment can reduce the probability of death. We present a case of a cavernous sinus thrombosis associated with methamphetamine injection into the face.
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Affiliation(s)
- Varsha Podduturi
- From the Department of Pathology, Harris County Institute of Forensic Sciences
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3
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Roberts WC, Jeong M, Guileyardo JM. Fatal mitral stenosis secondary to massive mitral annular calcium. Proc AMIA Symp 2022; 35:697-699. [DOI: 10.1080/08998280.2022.2076522] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- William C. Roberts
- Baylor Scott & White Heart and Vascular Institute, Dallas, Texas
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Minseob Jeong
- Baylor Scott & White Heart and Vascular Institute, Dallas, Texas
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4
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Smith AL, Santa Ana CA, Fordtran JS, Guileyardo JM. Unsuitability of sump tubes for delivery of enteral nutrition and medications to intensive care unit patients. Proc (Bayl Univ Med Cent) 2021; 34:560-565. [PMID: 34456473 DOI: 10.1080/08998280.2021.1930487] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
16 Fr Salem Sump™ tubes have special features to facilitate suction drainage of the stomach, including a second lumen for air venting. These tubes are also commonly used to deliver enteral nutrition and medications to intensive care unit (ICU) patients, but we found no previous research to justify this practice. Because of the unused air vent, these tubes have a large external diameter and a small bore infusion channel (no larger than that of a single lumen 12 Fr feeding tube). The causes of 16 Fr Salem Sump tube obstructions in 17 ICU patients included clogged medications (8 cases) and precipitation of feeding formula (7 cases), each of which would be promoted by a narrow bore. Because of multiple drainage holes at their distal end, these tubes cannot be thoroughly cleansed by standard water flushing; moreover, their drainage holes mandate a deeper length of tube insertion beyond the gastroesophageal junction, which increases the likelihood of intestinal or pulmonary perforation. For these reasons, we conclude that 16 Fr Salem Sump tubes are inferior to standard feeding tubes for delivery of enteral nutrition and medications to patients in medical ICUs.
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Affiliation(s)
- Avery L Smith
- Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas
| | - Carol A Santa Ana
- Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas
| | - John S Fordtran
- Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas
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5
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Sovic WR, Arunthamakun J, Lemieux A, Guileyardo JM. Papillary fibroelastoma in the left ventricle. Proc (Bayl Univ Med Cent) 2021; 34:623-624. [PMID: 34456493 DOI: 10.1080/08998280.2021.1914454] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
We present a 61-year-old woman with a recent transient ischemic attack who presented with presyncope and was ultimately found to have a papillary fibroelastoma at the apex of her left ventricle. She underwent minimally invasive excision of the tumor.
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Affiliation(s)
- William R Sovic
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Justin Arunthamakun
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Ariane Lemieux
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
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6
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Sovic WR, Ngo Q, Patlolla S, Guileyardo JM, Roberts WC. Isolated mitral valve endocarditis with ring abscess and pericarditis in end-stage renal disease. Proc (Bayl Univ Med Cent) 2021; 34:403-404. [PMID: 33953478 DOI: 10.1080/08998280.2021.1879567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Described herein is a 68-year-old man with end-stage renal disease on hemodialysis who was found to have methicillin-sensitive Staphylococcus aureus endocarditis with an associated ring abscess that extended into the left atrioventricular sulcus and ruptured into the pericardial space causing pericardial effusion. In contrast to the frequency of infective endocarditis involving the aortic valve, ring abscess associated with infection of the mitral valve is uncommon.
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Affiliation(s)
- William Ryan Sovic
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Quynh Ngo
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Srikant Patlolla
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | | | - William C Roberts
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.,Department of Pathology, Baylor University Medical Center, Dallas, Texas.,Baylor Heart and Vascular Institute, Dallas, Texas
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Sohn AJ, Guileyardo JM, Moore AJ, Ausloos KA, Naik CA. Rapidly progressive fatal hypoxia in a young woman. Proc (Bayl Univ Med Cent) 2021; 34:407-408. [PMID: 33953480 DOI: 10.1080/08998280.2020.1871279] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
We present a rare cause of pulmonary arterial hypertension in a 29-year-old woman with rapidly progressive and fatal hypoxia. Subsequent workup revealed classic radiological findings and pathologic confirmation of pulmonary veno-occlusive disease.
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Affiliation(s)
- Aaron J Sohn
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | | | - Alastair J Moore
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Kenneth A Ausloos
- Center for Advanced Lung Diseases, Baylor University Medical Center, Dallas, Texas
| | - Chetan A Naik
- Center for Advanced Lung Diseases, Baylor University Medical Center, Dallas, Texas
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8
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Salam YM, Guileyardo JM, Roberts WC. Relation of the quantity of coronary calcium to the quantity of aortic calcium determined from radiographs at necropsy. Proc (Bayl Univ Med Cent) 2020; 34:247-249. [PMID: 33678957 DOI: 10.1080/08998280.2020.1847948] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Described herein are radiographs of the heart and aorta at necropsy after "cleaning" these structures of extraneous tissue. As a consequence, the quantity of calcium is far more discernible than by computed tomography or magnetic resonance or ultrasonic imaging during life or before extraneous tissues are removed at necropsy. We illustrate these radiographic images at necropsy in three patients to show that the relative amount of calcific deposits in the coronary arteries and aorta may be subjectively similar or one of these structures may have far more calcium in the arterial walls than the other. The reasons for these differences are unclear.
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Affiliation(s)
- Yusuf M Salam
- Baylor Scott & White Heart and Vascular Institute, Dallas, Texas.,University of Texas Health School of Public Health, Dallas, Texas
| | | | - William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Dallas, Texas.,Department of Pathology, Baylor University Medical Center, Dallas, Texas.,Department of Internal Medicine (Cardiology), Baylor University Medical Center, Dallas, Texas
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Naik CA, Mathai SK, Sandkovsky US, Ausloos KA, Guileyardo JM, Schwartz G, Mason DP, Gottlieb R, Grazia TJ. Acute myocardial infarction secondary to mucormycosis after lung transplantation. IDCases 2020; 23:e01019. [PMID: 33376674 PMCID: PMC7758357 DOI: 10.1016/j.idcr.2020.e01019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022] Open
Abstract
We present a case of a 57-year-old man who underwent bilateral lung transplantation for idiopathic pulmonary fibrosis. His immediately post-operative course was complicated by fever and cardiac arrest. Despite supportive care and broad-spectrum antibiotics, he experienced continued clinical decline. Autopsy results indicated angioinvasive mucormycosis and coronary arteritis resulting in acute myocardial infarction as the cause of death.
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Affiliation(s)
- Chetan A Naik
- Center for Advanced Heart & Lung Diseases, Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Susan K Mathai
- Center for Advanced Heart & Lung Diseases, Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Uriel S Sandkovsky
- Division of Infectious Diseases, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Kenneth A Ausloos
- Center for Advanced Heart & Lung Diseases, Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Joseph M Guileyardo
- Department of Pathology, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Gary Schwartz
- Department of Surgery, Thoracic Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - David P Mason
- Department of Surgery, Thoracic Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Robert Gottlieb
- Center for Advanced Heart & Lung Diseases, Division of Cardiology, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Todd J Grazia
- Center for Advanced Heart & Lung Diseases, Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, TX, USA
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10
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Roberts WC, Ather N, Guileyardo JM. Examining Hearts Containing Left Ventricular Assist Devices at Necropsy. Am J Cardiol 2020; 125:244-250. [PMID: 31753314 DOI: 10.1016/j.amjcard.2019.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
There are no publications describing hearts at necropsy containing left ventricular assist devices (LVADs). The purpose was to study the relation of the LVAD cannula to the left ventricular (LV) cavity and wall. We studied the hearts at necropsy of 15 adults who had an LVAD inserted from 4 to 1,423 days (median 60) earlier. In 13 patients, the cannula had been inserted at an angle to the major longitudinal axis of the LV chamber, and in 11 patients, the orifice margin of the cannulas contacted the LV mural endocardium. In 3 patients, the LVAD cannula was inserted into the posterior wall, and, in another into the anterior wall. In the remaining 11 patients, the cannula had been inserted into the LV apex. Despite the insertion of the cannulas into the LV apex, the direction of the insertion was not into the longitudinal axis of the LV cavity in 9 patients. These unusual insertions in some patients may have altered flow into the orifice of the cannula; in others, based on their long postoperative survival, physiologic consequences were almost certainly absent. The presence of considerable quantities of subepicardial adipose tissue and pericardial adhesions from previous cardiac procedures (mainly coronary bypass) potentially interfered with achieving proper alignment of the LVAD cannula during its insertion. Misalignment of the cannulas of the LVAD in the LV cavity appears to be rather frequent.
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Roberts WC, Kale IP, Guileyardo JM. Potential cardiac consequences of thrombocytopenia and thrombocytosis. Cardiovasc Pathol 2018; 37:34-38. [PMID: 30290370 DOI: 10.1016/j.carpath.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022] Open
Abstract
This report illustrates the heart in three patients with cardiac hemorrhages associated with extreme thrombocytopenia, and the hearts in three patients with rocks speculated to result at least in part from organization of thrombi possibly related to thrombocytosis in one or more cardiac chambers.
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Affiliation(s)
- William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX; Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX.
| | - Ishani P Kale
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX; Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX.
| | - Joseph M Guileyardo
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX; Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX
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12
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Smith AL, Santa Ana CA, Fordtran JS, Guileyardo JM. Deaths associated with insertion of nasogastric tubes for enteral nutrition in the medical intensive care unit: Clinical and autopsy findings. Proc (Bayl Univ Med Cent) 2018; 31:310-316. [PMID: 29904295 DOI: 10.1080/08998280.2018.1459400] [Citation(s) in RCA: 5] [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: 11/17/2017] [Revised: 03/09/2018] [Accepted: 03/19/2018] [Indexed: 10/16/2022] Open
Abstract
It is generally assumed that blind insertion of nasogastric tubes for enteral nutrition in patients admitted to medical intensive care units is safe; that is, does not result in life-threatening injury. If death occurs in temporal association with insertion of a nasogastric tube, caregivers typically attribute it to underlying diseases, with little or no consideration of iatrogenic death due to tube insertion. The clinical and autopsy results in three recent cases at Baylor University Medical Center challenge the validity of these notions.
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Affiliation(s)
- Avery L Smith
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Carol A Santa Ana
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - John S Fordtran
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
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13
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Roberts WC, Kondapalli N, Guileyardo JM. Morphologic Findings in Donor (Transplanted) Hearts at Necropsy Early and Late After Orthotopic Heart Transplantation. Am J Cardiol 2018; 121:217-240. [PMID: 29197470 DOI: 10.1016/j.amjcard.2017.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/04/2017] [Indexed: 11/16/2022]
Abstract
Little necropsy information is available on donor hearts in place in recipients for varying periods. Necropsy studies were performed in 79 patients who had survived from 1 day to 17 years after orthotopic heart transplantation (OHT). At OHT, the 79 patients ranged in age from 3 to 70 years (mean 51), and at death, from 20 to 76 years (mean 54). The native hearts tended to be larger than the donor hearts in the 22 patients surviving ≤60 days and the donor hearts tended to be larger in the 57 patients surviving >60 days, suggesting that the donor hearts increased in weight with time. Cardiac adiposity increased with time. Grossly visible myocardial lesions were seen in 24 (30%) of the 79 cases: necrosis only in 20; fibrosis only in 2, and both in 2. One or more epicardial coronary arteries were narrowed >75% in cross-sectional area in 25 (32%), 1 of whom was in the group surviving ≤60 days. The right ventricular cavity was dilated in 73 cases (92%) and the left ventricular cavity in 39 cases. Evidence of graft rejection (lymphocytic infiltrates) was found in 50 patients (63%); in 8 (36%) of the 22 patients surviving ≤60 days, and in 42 (74%) of the 57 surviving >60 days. The lymphocytic infiltrates were largest in the subepicardial adipose tissue, next in myocardium, and least in endocardium. The quantity of the cellular infiltrates varied considerably among the patients. In conclusion, with time, the donor hearts tended to increase in weight, in the quantity of adipose tissue, in the amounts of coronary narrowing, in the frequency of ventricular cavity dilatation (particularly the right ventricle), and in the frequency of lymphocytic infiltrates (evidence of rejection).
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Affiliation(s)
- William C Roberts
- Baylor Heart and Vascular Institute, the Departments of Pathology and Internal Medicine (Division of Cardiology), Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Nitin Kondapalli
- Baylor Heart and Vascular Institute, the Departments of Pathology and Internal Medicine (Division of Cardiology), Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Joseph M Guileyardo
- Baylor Heart and Vascular Institute, the Departments of Pathology and Internal Medicine (Division of Cardiology), Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
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Zhang J, Guileyardo JM, Roberts WC. Origin of the left subclavian artery as the first branch and origin of the right subclavian artery as the fourth branch of the aortic arch with crisscrossing posterior to the common carotid arteries. Proc (Bayl Univ Med Cent) 2017; 29:423. [PMID: 27695185 DOI: 10.1080/08998280.2016.11929497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We describe an aortic arch anomaly consisting of the origin of the left subclavian artery as the fourth branch and the right subclavian artery as the first branch off the aortic arch with crisscrossing of these two arteries anterior to the trachea without clinical consequences. This anomaly, to our knowledge, has not been reported previously.
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Affiliation(s)
- Junlin Zhang
- Baylor Heart and Vascular Institute (Zhang, Roberts) and the Departments of Pathology (Guileyardo, Roberts) and Internal Medicine, Division of Cardiology (Roberts), Baylor University Medical Center at Dallas, Texas. Dr. Zhang is now with the Department of Physical Therapy, Arkansas State University
| | - Joseph M Guileyardo
- Baylor Heart and Vascular Institute (Zhang, Roberts) and the Departments of Pathology (Guileyardo, Roberts) and Internal Medicine, Division of Cardiology (Roberts), Baylor University Medical Center at Dallas, Texas. Dr. Zhang is now with the Department of Physical Therapy, Arkansas State University
| | - William C Roberts
- Baylor Heart and Vascular Institute (Zhang, Roberts) and the Departments of Pathology (Guileyardo, Roberts) and Internal Medicine, Division of Cardiology (Roberts), Baylor University Medical Center at Dallas, Texas. Dr. Zhang is now with the Department of Physical Therapy, Arkansas State University
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16
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Roberts WC, Sing AC, Guileyardo JM. Combined atresia of one left-sided and one right-sided cardiac valve in a premature newborn. Proc (Bayl Univ Med Cent) 2017; 30:437-438. [PMID: 28966456 DOI: 10.1080/08998280.2017.11930219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Described herein is the heart of a 2-day-old newborn, the product of a 25-week gestation, with atresia of two cardiac valves, one on the right side and one on the left side, apparently a previously undescribed entity.
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Affiliation(s)
- William C Roberts
- Baylor Heart and Vascular Institute (Roberts) and the Departments of Pathology (Roberts, Guileyardo) and Internal Medicine (Division of Cardiology) (Roberts), Baylor University Medical Center at Dallas; and the Department of Pediatric Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas (Sing)
| | - Alan C Sing
- Baylor Heart and Vascular Institute (Roberts) and the Departments of Pathology (Roberts, Guileyardo) and Internal Medicine (Division of Cardiology) (Roberts), Baylor University Medical Center at Dallas; and the Department of Pediatric Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas (Sing)
| | - Joseph M Guileyardo
- Baylor Heart and Vascular Institute (Roberts) and the Departments of Pathology (Roberts, Guileyardo) and Internal Medicine (Division of Cardiology) (Roberts), Baylor University Medical Center at Dallas; and the Department of Pediatric Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas (Sing)
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Roberts WC, Grayburn PA, Guileyardo JM, Stoler RC. Full Development of Consequences of Congenital Pulmonic Stenosis in Eighty-Four Years. Am J Cardiol 2017; 119:1284-1287. [PMID: 28256252 DOI: 10.1016/j.amjcard.2016.11.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 11/29/2022]
Abstract
Described herein is an 84-year-old woman, the oldest reported, with severe pulmonic stenosis who underwent a highly successful pulmonic valvotomy at age 77 and highly unsuccessfully attempted percutaneous pulmonic valve implantation at age 84. During the 84 years she developed nearly all clinical and morphologic consequences of pulmonic stenosis, including heavy calcification of the pulmonic valve, heavy calcification of the tricuspid valve annulus, severe right ventricular wall thickening without ventricular cavity dilation, aneurysm of the pulmonary truck, multiple focal ventricular wall scars without narrowing of the epicardial coronary arteries, wall thickening and luminal narrowing of the intramural coronary arteries, and extremely low 12-lead QRS electrocardiographic voltage.
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Affiliation(s)
- William C Roberts
- Baylor Heart and Vascular Institute, the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas.
| | - Paul A Grayburn
- Baylor Heart and Vascular Institute, the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas
| | - Joseph M Guileyardo
- Baylor Heart and Vascular Institute, the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas
| | - Robert C Stoler
- Baylor Heart and Vascular Institute, the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas
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Roberts WC, Kapoor P, Main ML, Guileyardo JM. Acute Aortic Dissection With Intussusception of the Partition Between the True and False Channels Leading to Near Total Aortic Occlusion (True Aortic Stenosis). Am J Cardiol 2017; 119:340-344. [PMID: 27865483 DOI: 10.1016/j.amjcard.2016.09.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/22/2016] [Accepted: 09/22/2016] [Indexed: 11/26/2022]
Abstract
Described herein are 2 patients with fatal acute aortic dissection resulting in a circumferential intimal-medial tear causing the partition between the true and false channels to roll up and propagate forward as an intra-aortic intussusception (a receiving within).
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Zhrebker L, Cherni I, Gross LM, Hinshelwood MM, Reese M, Aldrich J, Guileyardo JM, Roberts WC, Craig D, Von Hoff DD, Mennel RG, Carpten JD. Case report: whole exome sequencing of primary cardiac angiosarcoma highlights potential for targeted therapies. BMC Cancer 2017; 17:17. [PMID: 28056866 PMCID: PMC5217318 DOI: 10.1186/s12885-016-3000-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 12/14/2016] [Indexed: 02/03/2023] Open
Abstract
Background Primary cardiac angiosarcomas are rare, but they are the most aggressive type of primary cardiac neoplasms. When patients do present, it is with advanced pulmonary and/or cardiac symptoms. Therefore, many times the correct diagnosis is not made at the time of initial presentation. These patients have metastatic disease and the vast majority of these patients die within a few months after diagnosis. Currently the treatment choices are limited and there are no targeted therapies available. Case presentation A 56-year-old male presented with shortness of breath, night sweats, and productive cough for a month. Workup revealed pericardial effusion and multiple bilateral pulmonary nodules suspicious for metastatic disease. Transthoracic echocardiogram showed a large pericardial effusion and a large mass in the base of the right atrium. Results of biopsy of bilateral lung nodules established a diagnosis of primary cardiac angiosarcoma. Aggressive pulmonary disease caused rapid deterioration; the patient went on hospice and subsequently died. Whole exome sequencing of the patient’s postmortem tumor revealed a novel KDR (G681R) mutation, and focal high-level amplification at chromosome 1q encompassing MDM4, a negative regulator of TP53. Conclusion Mutations in KDR have been reported previously in angiosarcomas. Previous studies also demonstrated that KDR mutants with constitutive KDR activation could be inhibited with specific KDR inhibitors in vitro. Thus, patients harboring activating KDR mutations could be candidates for treatment with KDR-specific inhibitors. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-3000-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leah Zhrebker
- Baylor Charles A. Sammons Cancer Center at Dallas, Baylor University Medical Center at Dallas, 3410 Worth Street, Dallas, TX, 75246, USA. .,Department of Internal Medicine, Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX, 75246, USA.
| | - Irene Cherni
- Integrative Cancer Genomics, Translational Genomics Research Institute, 445N 5th Street, Phoenix, AZ, 85004, USA
| | - Lara M Gross
- Department of Internal Medicine, Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX, 75246, USA
| | - Margaret M Hinshelwood
- Baylor Charles A. Sammons Cancer Center at Dallas, Baylor University Medical Center at Dallas, 3410 Worth Street, Dallas, TX, 75246, USA
| | - Merrick Reese
- Baylor Charles A. Sammons Cancer Center at Dallas, Baylor University Medical Center at Dallas, 3410 Worth Street, Dallas, TX, 75246, USA.,Texas Oncology/US Oncology, 3410 Worth Street, Dallas, TX, 75246, USA
| | - Jessica Aldrich
- Integrative Cancer Genomics, Translational Genomics Research Institute, 445N 5th Street, Phoenix, AZ, 85004, USA
| | - Joseph M Guileyardo
- Anatomic Pathology and Clinical Pathology, Baylor University Medical Center at Dallas, 3600 Gaston Ave, Dallas, TX, 75246, USA
| | - William C Roberts
- Department of Internal Medicine, Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX, 75246, USA.,Anatomic Pathology and Clinical Pathology, Baylor University Medical Center at Dallas, 3600 Gaston Ave, Dallas, TX, 75246, USA
| | - David Craig
- Integrative Cancer Genomics, Translational Genomics Research Institute, 445N 5th Street, Phoenix, AZ, 85004, USA
| | - Daniel D Von Hoff
- Clinical Translational Research Division Translational Genomics Research Institute, 445N 5th Street, Phoenix, AZ, 85004, USA
| | - Robert G Mennel
- Baylor Charles A. Sammons Cancer Center at Dallas, Baylor University Medical Center at Dallas, 3410 Worth Street, Dallas, TX, 75246, USA.,Texas Oncology/US Oncology, 3410 Worth Street, Dallas, TX, 75246, USA.,College of Medicine, Texas A&M Health Sciences Center, 3410 Worth Street, Dallas, TX, 75246, USA
| | - John D Carpten
- Integrative Cancer Genomics, Translational Genomics Research Institute, 445N 5th Street, Phoenix, AZ, 85004, USA
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Roberts WC, Won VS, Vasudevan A, Guileyardo JM. Characteristics of Hearts at Necropsy in Patients Treated Chronically With Prednisone (The Corticosteroid Heart). Am J Cardiol 2016; 118:1935-1940. [PMID: 28314425 DOI: 10.1016/j.amjcard.2016.08.090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/04/2016] [Accepted: 08/04/2016] [Indexed: 11/17/2022]
Abstract
It is known that long-term corticosteroid therapy increases fatty deposits in several human tissues. To quantify the quantity of fatty deposits in the heart in patients on prednisone, we examined the heart at necropsy in 37 patients who had received long-term corticosteroid therapy (prednisone in 34) and compared certain findings in them to those in 194 (steroid-naïve) patients also studied at necropsy at Baylor University Medical Center, Dallas, in a 3-year period (2013, 2014, and 2015). Significant differences between the 2 groups were found in age, gender, and frequency of coronary artery disease but not in body mass index, frequency of massive cardiac adiposity, heart weight, or frequency of systemic hypertension or diabetes mellitus. Furthermore, no significant differences were observed in the patients taking ≤20 mg versus those taking >20 mg daily of prednisone. In conclusion, this study observed no significant differences in body mass index, frequency of cardiac adiposity (floating heart), heart weight, or frequencies of systemic hypertension or diabetes mellitus in the patients receiving or not receiving prednisone for a long term, but the prednisone-treated patients were younger, more often women, and had a lower frequency of severe narrowing of ≥1 major coronary arteries.
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Affiliation(s)
- William C Roberts
- Baylor Heart and Vascular Institute, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.
| | - Vera S Won
- Baylor Heart and Vascular Institute, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Anupama Vasudevan
- Baylor Heart and Vascular Institute, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Joseph M Guileyardo
- Baylor Heart and Vascular Institute, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
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21
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Roberts WC, Won VS, Vasudevan A, Guileyardo JM. Causes of Death and Heart Weights in Adults at Necropsy in a Tertiary Texas Hospital, 2013-2015. Am J Cardiol 2016; 118:1758-1768. [PMID: 27743575 DOI: 10.1016/j.amjcard.2016.08.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/15/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
The causes of death and heart weights at death appear to be quite different in the USA today than in the first few decades of the last century. We determined the causes of death and heart weights at necropsy in 231 adults and compared the heart weights to those reported in several studies in the first half of the 20th century. Of the 231 patients, 91 (39%) died of a cardiovascular (CV) condition, and 140 (61%), of a non-CV condition. Of the 91 fatal CV disease cases, 48 had fatal coronary artery disease (CAD); of the remaining 183 cases without fatal CAD, 25 had narrowing >75% of 1 or more major epicardial coronary arteries. Thus, 73 of the 231 (32%) patients at necropsy had severe CAD. Comparison between the fatal CV and fatal non-CV cases disclosed variable age (mean 64 years vs mean 57 years) and heart weight (529 g vs 449 g) to be significantly different. Heart weight was found to be the only significantly variable between men and women. Comparison of the heart weights in this study to those recorded as "normal" hearts 75 to 115 years earlier showed that today's "average" heart is much larger than those reported earlier. In contrast to the earlier studies, heart weight presently appears to increase with age and with an increase in body mass index. In conclusion, early studies in heart weight did not take into account today's longer survival and therefore a high prevalence of systemic hypertension, diabetes mellitus, obesity (and cardiac adiposity), and the presence of atherosclerotic CAD. Additionally, the cause of death (CV vs non-CV) was rarely considered in the early studies of heart weight.
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22
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Zhang J, Guileyardo JM, Roberts WC. Frequency and potential consequences of origin of the left vertebral artery (or the arteria thryoidea ima) directly from the aortic arch. Proc (Bayl Univ Med Cent) 2016; 29:424-425. [PMID: 27695186 DOI: 10.1080/08998280.2016.11929498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Described herein are findings in a 58-year-old man in whom necropsy disclosed origin of the left vertebral artery (or the arteria thryoidea ima) directly from the aortic arch. No functional consequences resulted. Study of previous publications disclosed the frequency of this anomaly in adults to be approximately 3.5%. Dissection has been reported to be more frequent in the left vertebral artery when it arises directly from the aorta than when it arises from the left subclavian artery.
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Affiliation(s)
- Junlin Zhang
- Baylor Heart and Vascular Institute (Zhang, Roberts) and the Departments of Pathology (Guileyardo, Roberts) and Internal Medicine, Division of Cardiology (Roberts), Baylor University Medical Center at Dallas, Texas. Dr. Zhang is now with the Department of Physical Therapy, Arkansas State University
| | - Joseph M Guileyardo
- Baylor Heart and Vascular Institute (Zhang, Roberts) and the Departments of Pathology (Guileyardo, Roberts) and Internal Medicine, Division of Cardiology (Roberts), Baylor University Medical Center at Dallas, Texas. Dr. Zhang is now with the Department of Physical Therapy, Arkansas State University
| | - William C Roberts
- Baylor Heart and Vascular Institute (Zhang, Roberts) and the Departments of Pathology (Guileyardo, Roberts) and Internal Medicine, Division of Cardiology (Roberts), Baylor University Medical Center at Dallas, Texas. Dr. Zhang is now with the Department of Physical Therapy, Arkansas State University
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23
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Roberts WC, Won VS, Vasudevan A, Ko JM, Guileyardo JM. Frequency of Massive Cardiac Adiposity (Floating Heart) at Necropsy and Comparison of Clinical and Morphologic Variables With Cases With Nonmassive Cardiac Adiposity at a Single Texas Hospital, 2013 to 2014. Am J Cardiol 2016; 117:1006-13. [PMID: 26800773 DOI: 10.1016/j.amjcard.2015.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 01/28/2023]
Abstract
Body weight continues to increase worldwide primarily because of the increase in body fat. This study analyzes the frequency of massive adiposity at autopsy determined by the ability of the heart to float in a container of 10% formaldehyde (because adipose tissue is lighter than myocardium) and compares certain findings in the patients with floating to those with nonfloating hearts. The hearts studied at necropsy during a 2-year period (2013 to 2014) at Baylor University Medical Center were carefully "cleaned" and weighed by the same person and tested as to their ability to float in a container of formaldehyde, an indication of severe cardiac adiposity. Of the 146 hearts studied, 76 (52%) floated in a container of formaldehyde and 70 (48%) did not. Comparison of the 76 patients with floating hearts with the 70 with nonfloating hearts showed significant differences in ages (62 ± 13 vs 58 ± 14 years). No significant differences between the 2 groups were found in gender, body mass index, frequency of systemic hypertension or diabetes mellitus, either acute or healed myocardial infarction, or whether death was due to a coronary or a noncoronary condition. A weak correlation was found between body mass index and heart weight in both men and women and in both floating and nonfloating hearts. The massive quantity of cardiac adipose tissue (floating heart) appears to have increased enormously in recent decades in the United States.
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Affiliation(s)
- William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.
| | - Vera S Won
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
| | - Anupama Vasudevan
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
| | - Jong Mi Ko
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
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24
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Abstract
Ventricular septal defect (VSD) is the most common congenital heart malformation and can be detected during the prenatal and postnatal period, in childhood, and in adulthood. Spontaneous closure of VSD can be determined through a variety of methods-echocardiography, Doppler color flow imaging, angiography, auscultation, and cardiac catheterization-and can be proven by pathological evidence at necropsy. There are two major types of VSD, membranous and muscular, as well as the perimembranous variety, which comprises variable portions of the adjacent muscular septum but lacks the membranous septum. VSD appears either as an isolated cardiac defect without other abnormalities or with several complex malformations. It has long been recognized that VSD can close spontaneously, but the incidence of spontaneous VSD closure is still uncertain. Since necropsy study of the hearts with VSD has rarely been reported, information on morphological features of spontaneous VSD closure remains limited. In addition, the mechanisms for spontaneous VSD closure are not fully understood. Herein, we present a brief review of the incidence of spontaneous VSD closure, morphological characteristics of the closure, and the main mechanisms responsible for the closure.
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Affiliation(s)
- Jun Zhang
- Baylor Heart and Vascular Institute (Zhang, Ko, Roberts), the Department of Pathology (Guileyardo, Roberts), and the Division of Cardiology, Department of Internal Medicine (Roberts), Baylor University Medical Center at Dallas
| | - Jong Mi Ko
- Baylor Heart and Vascular Institute (Zhang, Ko, Roberts), the Department of Pathology (Guileyardo, Roberts), and the Division of Cardiology, Department of Internal Medicine (Roberts), Baylor University Medical Center at Dallas
| | - Joseph M Guileyardo
- Baylor Heart and Vascular Institute (Zhang, Ko, Roberts), the Department of Pathology (Guileyardo, Roberts), and the Division of Cardiology, Department of Internal Medicine (Roberts), Baylor University Medical Center at Dallas
| | - William C Roberts
- Baylor Heart and Vascular Institute (Zhang, Ko, Roberts), the Department of Pathology (Guileyardo, Roberts), and the Division of Cardiology, Department of Internal Medicine (Roberts), Baylor University Medical Center at Dallas
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25
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Mora A, Arroyo M, Gummelt KL, Colbert G, Ursales AL, Van Vrancken MJ, Snipes GJ, Guileyardo JM, Columbus C. West Nile virus and the 2012 outbreak: The Baylor University Medical Center experience. Proc (Bayl Univ Med Cent) 2015; 28:291-5. [PMID: 26130870 DOI: 10.1080/08998280.2015.11929253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
West Nile virus (WNV) has been responsible for multiple outbreaks and has shown evolution in its clinical manifestation. The Centers for Disease Control and Prevention has provided diagnostic criteria in classifying the variety of WNV infection; however, application of these criteria can prove challenging during outbreaks, and understanding the array of presentations and patient population is clinically important. In this article, we present the challenges encountered during the 2012 outbreak at one institution.
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Affiliation(s)
- Adan Mora
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Mariangeli Arroyo
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Kyle L Gummelt
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Gates Colbert
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Anna L Ursales
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Michael J Van Vrancken
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - George J Snipes
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Joseph M Guileyardo
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Cristie Columbus
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
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26
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Podduturi V, Guileyardo JM, Soto LR, Krause JR. A case series of clinically undiagnosed hematopoietic neoplasms discovered at autopsy. Am J Clin Pathol 2015; 143:854-60. [PMID: 25972327 DOI: 10.1309/ajcpay9zis1xepro] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES In the United States, autopsy rates have diminished to less than 5% during the last half of the 20th century and the beginning of the 21st century for a multitude of reasons. Many believe this results in unrecognized malignancies that could have explained a patient's death. METHODS We describe six deaths in which hematopoietic neoplasms were identified at autopsy but were not diagnosed clinically. RESULTS The six undiagnosed hematopoietic malignancy cases discovered at autopsy include four men and two women ranging from 50 to 78 years of age. One patient was African American and five patients were white, all with multiple comorbidities. The tumors included diffuse large B-cell lymphoma, activated B-cell type, intravascular large B-cell lymphoma, ALK-negative anaplastic large cell lymphoma arising in a setting of human immunodeficiency virus, and a myeloid sarcoma. CONCLUSIONS These cases illustrate the importance of the traditional postmortem examination in not only confirming clinical diagnoses but also identifying previously unknown diagnoses. Hematologic malignancies may present with nonspecific clinical manifestations, and this series of cases also emphasizes the necessity for widening the differential diagnosis in patients with unexplained lactic acidosis and hepatic failure to include hematopoietic malignancies since prompt treatment may be lifesaving.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology, Baylor University Medical Center, Dallas, TX
| | | | - Luis R. Soto
- Department of Pathology, Baylor University Medical Center, Dallas, TX
| | - John R. Krause
- Department of Pathology, Baylor University Medical Center, Dallas, TX
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27
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Abstract
Mixed epithelial and stromal tumors (MEST) of the kidney are uncommon neoplasms that were added to the World Health Organization's renal tumor classification in 2004. These entities are biphasic and contain both epithelial and mesenchymal components. MEST most commonly occur in women. Presented are two cases of MEST incidentally discovered at autopsy.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology, Baylor University Medical Center at Dallas
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28
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Podduturi V, Guileyardo JM. Sickle cell trait as a contributory cause of death in natural disease. J Forensic Sci 2015; 60:807-11. [PMID: 25653147 DOI: 10.1111/1556-4029.12713] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 11/05/2013] [Revised: 02/19/2014] [Accepted: 05/09/2014] [Indexed: 11/30/2022]
Abstract
Sickle cell trait (SCT) affects 300 million people globally, and awareness is growing that SCT is not an entirely benign condition; however, most reported cases have been non-natural deaths. Autopsy records from the Baylor University Medical Center (BUMC) in Dallas, Texas, contained seven natural deaths from January 2007 to October 2013 in which micro-occlusive sickling was identified at autopsy and SCT confirmed by postmortem hemoglobin fractionation. Sickle crisis was never diagnosed clinically. These cases illustrate the importance of red cell morphology in autopsy material. When sickling is suspected, hemoglobin fractionation should be performed. If confirmed, SCT should be listed as an autopsy finding and the severity and distribution of sickling documented. Extensive micro-occlusive sickling should be considered contributory to death; however, its relative importance depends on all facts of the case. Accurate reporting should facilitate further research and the development of evidence-based preventative and supportive strategies for these patients.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology, Baylor University Medical Center, Dallas, TX, 75246
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29
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Mazharuddin S, Podduturi V, Guileyardo JM, Cooper B. Hepatic angiosarcoma associated with disseminated intravascular coagulation. Proc (Bayl Univ Med Cent) 2015; 28:54-6. [PMID: 25552799 DOI: 10.1080/08998280.2015.11929186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We present a case of hepatic angiosarcoma that presented with disseminated intravascular coagulopathy to highlight the difficulty in diagnosing this disease due its aggressive clinical course, the overlapping features of various coagulopathies, and the nonspecific appearance of angiosarcomas on imaging.
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Affiliation(s)
- Samir Mazharuddin
- Departments of Internal Medicine (Mazharuddin), Pathology (Podduturi, Guileyardo), and Oncology (Cooper), Baylor University Medical Center at Dallas and the Baylor Charles A. Sammons Cancer Center, Dallas, Texas
| | - Varsha Podduturi
- Departments of Internal Medicine (Mazharuddin), Pathology (Podduturi, Guileyardo), and Oncology (Cooper), Baylor University Medical Center at Dallas and the Baylor Charles A. Sammons Cancer Center, Dallas, Texas
| | - Joseph M Guileyardo
- Departments of Internal Medicine (Mazharuddin), Pathology (Podduturi, Guileyardo), and Oncology (Cooper), Baylor University Medical Center at Dallas and the Baylor Charles A. Sammons Cancer Center, Dallas, Texas
| | - Barry Cooper
- Departments of Internal Medicine (Mazharuddin), Pathology (Podduturi, Guileyardo), and Oncology (Cooper), Baylor University Medical Center at Dallas and the Baylor Charles A. Sammons Cancer Center, Dallas, Texas
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31
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Roberts WC, Burks KH, Ko JM, Filardo G, Guileyardo JM. Commonalities of cardiac rupture (left ventricular free wall or ventricular septum or papillary muscle) during acute myocardial infarction secondary to atherosclerotic coronary artery disease. Am J Cardiol 2015; 115:125-40. [PMID: 25456862 DOI: 10.1016/j.amjcard.2014.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 11/29/2022]
Abstract
Although mortality rates during acute myocardial infarction (AMI) continue to drop, cardiac rupture (left ventricular free wall [LVFW] or ventricular septum [VS] or papillary muscle [PM] or combination) remains relatively common. The aim was to identify commonalities among patients with AMI complicated by cardiac rupture. During a 22-year period (1993-2014) 64 patients hospitalized for AMI were studied and clinical and morphologic variables in those with (25 patients) - vs - those without (39 patients) cardiac rupture were compared, and previous reports on this topic were reviewed. Compared to the non-rupture cases, the rupture group was significantly older (71 years - vs - 60 years); had a much higher frequency of huge deposits of adipose tissue in the heart (floated in formaldehyde) (88% - vs - 20%) but a lower mean body mass index (28.2 Kg/m(2) - vs - 33.2 Kg/m(2)); a much lower frequency of healed myocardial infarct (scar) (4% - vs - 28%); a lower frequency of diabetes mellitus (24% - vs - 47%), and a higher frequency of thrombolytic therapy during the fatal AMI (32% - vs - 10%). None of the rupture cases had evidence of dilated left ventricular cavities or evidence of heart failure before the AMI complicated by rupture. In conclusion, cardiac rupture appears to account for a high percent of deaths during a first AMI. It most commonly occurs in patients with extremely fatty hearts and in those without evidence of prior heart failure.
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Affiliation(s)
- William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Texas; Department of Internal Medicine (Division of Cardiology), Baylor University Medical Center at Dallas, Texas; Department of Pathology, Baylor University Medical Center at Dallas, Texas.
| | - Kendall H Burks
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Texas
| | - Jong Mi Ko
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Texas
| | - Giovanni Filardo
- Department of Epidemiology, Office of Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas
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Abstract
Intravascular large B-cell lymphoma (IVL) is rare and characterized by selective growth of neoplastic cells within the lumina of small blood vessels. We present the case of a 69-year-old woman who died of a widespread IVL with extravascular involvement of the lymph nodes, liver, bladder, and adrenal gland. This report discusses the unique features of IVL with concurrent extravascular components.
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Affiliation(s)
- Cody A Thomas
- Department of Pathology, Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
| | - Joseph M Guileyardo
- Department of Pathology, Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
| | - John R Krause
- Department of Pathology, Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
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Roberts CC, Snipes GJ, Ko JM, Roberts WC, Guileyardo JM. Nontraumatic intracerebral hemorrhage unassociated with arterial aneurysmal rupture as a cause of sudden unexpected death. Proc (Bayl Univ Med Cent) 2014; 27:331-3. [PMID: 25484501 DOI: 10.1080/08998280.2014.11929148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Sudden death from intracerebral hemorrhage was observed in two patients admitted to Baylor University Medical Center at Dallas in a single month. Each had been drinking alcohol at the time of onset of first symptoms. Intracerebral hemorrhage was diagnosed in one patient by computed tomography, but not in the second patient who clinically was diagnosed as having acute coronary syndrome. Both died within 24 hours of onset of symptoms, and autopsy in both disclosed intracerebral hemorrhage, an infrequent cause of sudden death. This report calls attention to intracerebral hemorrhage as a cause of sudden death.
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Affiliation(s)
- Carey Camille Roberts
- Baylor Heart and Vascular Institute (C. C. Roberts, Ko, W. C. Roberts), the Department of Pathology (Snipes, W. C. Roberts, Guileyardo), and the Division of Cardiology, Department of Internal Medicine (W. C. Roberts), Baylor University Medical Center at Dallas. C. C. Roberts is a second-year medical student at Georgetown University School of Medicine, Washington, DC
| | - George J Snipes
- Baylor Heart and Vascular Institute (C. C. Roberts, Ko, W. C. Roberts), the Department of Pathology (Snipes, W. C. Roberts, Guileyardo), and the Division of Cardiology, Department of Internal Medicine (W. C. Roberts), Baylor University Medical Center at Dallas. C. C. Roberts is a second-year medical student at Georgetown University School of Medicine, Washington, DC
| | - Jong Mi Ko
- Baylor Heart and Vascular Institute (C. C. Roberts, Ko, W. C. Roberts), the Department of Pathology (Snipes, W. C. Roberts, Guileyardo), and the Division of Cardiology, Department of Internal Medicine (W. C. Roberts), Baylor University Medical Center at Dallas. C. C. Roberts is a second-year medical student at Georgetown University School of Medicine, Washington, DC
| | - William Clifford Roberts
- Baylor Heart and Vascular Institute (C. C. Roberts, Ko, W. C. Roberts), the Department of Pathology (Snipes, W. C. Roberts, Guileyardo), and the Division of Cardiology, Department of Internal Medicine (W. C. Roberts), Baylor University Medical Center at Dallas. C. C. Roberts is a second-year medical student at Georgetown University School of Medicine, Washington, DC
| | - Joseph M Guileyardo
- Baylor Heart and Vascular Institute (C. C. Roberts, Ko, W. C. Roberts), the Department of Pathology (Snipes, W. C. Roberts, Guileyardo), and the Division of Cardiology, Department of Internal Medicine (W. C. Roberts), Baylor University Medical Center at Dallas. C. C. Roberts is a second-year medical student at Georgetown University School of Medicine, Washington, DC
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34
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Abstract
Clear cell carcinoma of the ovary (CCCO) is an uncommon, clinically aggressive neoplasm that has a propensity for the development of venous thrombosis and embolization, especially when compared to other subtypes of ovarian malignancies. We present a fatal case of a 59-year-old woman with a clinical course complicated by venous thrombosis and pulmonary thromboembolism that was attributed to CCCO discovered initially at autopsy.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology, Baylor University Medical Center at Dallas
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35
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Campa-Thompson MM, West JA, Guileyardo JM, Spak CW, Sloan LM, Beal SG. Clinical and morphologic findings in disseminated Scedosporium apiospermum infections in immunocompromised patients. Proc (Bayl Univ Med Cent) 2014; 27:253-6. [PMID: 24982580 DOI: 10.1080/08998280.2014.11929129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Scedosporium apiospermum is a ubiquitous, saprophytic, filamentous mold that may cause localized, subcutaneous infections in immunocompetent hosts, but disseminated infection in severely immunocompromised patients. This mold is often highly resistant to multiple commonly used antifungal drugs. Even with treatment, there is a high mortality rate. We present two patients with fatal disseminated S. apiospermum infections after bone marrow and lung transplantation. This infection can be rapidly fatal, and survival may be improved by early recognition.
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Affiliation(s)
- Molly M Campa-Thompson
- Departments of Pathology (Campa-Thompson, Guileyardo, Beal), Radiology (West), and Internal Medicine, Division of Infectious Diseases (Spak, Sloan), Baylor University Medical Center at Dallas; and med fusion Laboratory (Campa-Thompson, Beal), Lewisville, Texas
| | - James A West
- Departments of Pathology (Campa-Thompson, Guileyardo, Beal), Radiology (West), and Internal Medicine, Division of Infectious Diseases (Spak, Sloan), Baylor University Medical Center at Dallas; and med fusion Laboratory (Campa-Thompson, Beal), Lewisville, Texas
| | - Joseph M Guileyardo
- Departments of Pathology (Campa-Thompson, Guileyardo, Beal), Radiology (West), and Internal Medicine, Division of Infectious Diseases (Spak, Sloan), Baylor University Medical Center at Dallas; and med fusion Laboratory (Campa-Thompson, Beal), Lewisville, Texas
| | - Cedric W Spak
- Departments of Pathology (Campa-Thompson, Guileyardo, Beal), Radiology (West), and Internal Medicine, Division of Infectious Diseases (Spak, Sloan), Baylor University Medical Center at Dallas; and med fusion Laboratory (Campa-Thompson, Beal), Lewisville, Texas
| | - Louis M Sloan
- Departments of Pathology (Campa-Thompson, Guileyardo, Beal), Radiology (West), and Internal Medicine, Division of Infectious Diseases (Spak, Sloan), Baylor University Medical Center at Dallas; and med fusion Laboratory (Campa-Thompson, Beal), Lewisville, Texas
| | - Stacy G Beal
- Departments of Pathology (Campa-Thompson, Guileyardo, Beal), Radiology (West), and Internal Medicine, Division of Infectious Diseases (Spak, Sloan), Baylor University Medical Center at Dallas; and med fusion Laboratory (Campa-Thompson, Beal), Lewisville, Texas
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36
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Abstract
Malignant rhabdoid tumors (MRT) of the kidney are rare in children and even less common in adults, with only six previously reported adult cases. We present the case of a 60-year-old man with an MRT arising in the left kidney with extensive pulmonary micrometastases and thromboembolism resulting in thrombotic pulmonary microangiopathy (pulmonary tumor embolism syndrome). MRT is an extremely aggressive neoplasm with a short survival time.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
| | - Molly M Campa-Thompson
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
| | - Xin J Zhou
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
| | - Joseph M Guileyardo
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
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37
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Roberts WC, Rosenblatt RL, Ko JM, Grayburn PA, Kuiper JJ, Guileyardo JM. Cardiac restriction secondary to massive calcific deposits in the left ventricular cavity. Am J Cardiol 2014; 113:1442-6. [PMID: 24576543 DOI: 10.1016/j.amjcard.2013.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 12/26/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
Described herein are clinical and necropsy findings in a 61-year-old woman with fatal left ventricular diastolic failure secondary to massive calcific deposits primarily within the left ventricular cavity. At age 3, an isthmic aortic coarctation was resected, and at age 44, a stenotic congenitally bicuspid aortic valve was replaced. The cause of the intracavitary calcific deposits remains unclear, but surgical resection of the deposits has been an effective form of therapy.
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38
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Soto LR, Levine HR, Celinski SA, Guileyardo JM. Fatal abdominal hemorrhage associated with gallbladder perforation due to large gallstones. Proc (Bayl Univ Med Cent) 2014; 27:131-2. [PMID: 24688200 DOI: 10.1080/08998280.2014.11929086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Gallbladder perforation is a relatively uncommon complication of acute cholecystitis and may occur with or without gallstones. Prophylactic cholecystectomy has been recommended for patients with very large stones (>3 cm) due to an increased risk of gallbladder cancer. We present the case of a 68-year-old woman who died of hemorrhagic shock following gallbladder perforation due to very large gallstones. This case provides additional support for consideration of prophylactic cholecystectomy in patients with very large gallstones.
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Affiliation(s)
- Luis R Soto
- Departments of Pathology (Soto, Guileyardo), Radiology (Levine), and Surgery (Celinski), Baylor University Medical Center at Dallas
| | - Harold R Levine
- Departments of Pathology (Soto, Guileyardo), Radiology (Levine), and Surgery (Celinski), Baylor University Medical Center at Dallas
| | - Scott A Celinski
- Departments of Pathology (Soto, Guileyardo), Radiology (Levine), and Surgery (Celinski), Baylor University Medical Center at Dallas
| | - Joseph M Guileyardo
- Departments of Pathology (Soto, Guileyardo), Radiology (Levine), and Surgery (Celinski), Baylor University Medical Center at Dallas
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39
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology at Baylor University Medical Center in Dallas, TX
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40
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Abstract
Idiopathic spontaneous intraperitoneal hemorrhage (ISIH), or abdominal apoplexy, is due to nontraumatic, small vessel rupture; excluded by definition is hemorrhage associated with aortic aneurysm, gynecologic conditions (including ruptured ectopic pregnancy), and bleeding tumors. As defined, this condition is rare and etiologically complex. We report a case of ISIH associated with ruptured dissection of the gastroduodenal artery (GDA) which occurred following two paracentesis procedures for ascites due to cirrhosis. Severe acute inflammation of the vessel wall and resolving endocardial thrombosis suggest an infectious or “mycotic” etiology for this arterial dissection. Direct vascular injury during paracentesis was excluded as a cause of death. Small artery hemorrhage may be associated with aneurysmal rupture or other vasculopathies. Visceral small vessel aneurysms are rare, and GDA aneurysms are even less common. Although the regional vascular anatomy is complex and finding a bleeding point within a bloody field with no intravascular pressure may be impossible, careful dissection of the smaller vascular branches can be rewarding. Clinical management of ISIH is also challenging since findings may be nonspecific and limited to hemodynamic instability and atypical abdominal pain; however, immediate exploratory surgery is the treatment of choice, and the non-operative mortality approaches 100%.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology at Baylor University Medical Center in Dallas, TX
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41
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Podduturi V, Armstrong DR, Hitchcock MA, Roberts WC, Guileyardo JM. Isolated atrial amyloidosis and the importance of molecular classification. Proc (Bayl Univ Med Cent) 2013; 26:387-9. [PMID: 24082415 DOI: 10.1080/08998280.2013.11929013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Amyloid is identified microscopically as an amorphous extracellular hyaline material that exhibits "apple-green" birefringence with Congo red stains. Amyloid is not a chemically distinct entity, and currently available molecular methods are capable of identifying over 20 amyloidogenic precursor proteins. Some of the more common diseases associated with amyloidosis include plasma cell dyscrasias, chronic inflammatory disorders, hereditary-familial mutations involving transthyretin, Alzheimer's disease, and so-called "senile" or age-related amyloidosis. The amyloid deposits in these various diseases may be isolated to a single organ such as the heart or brain, or the amyloidosis may be systemic. The senile types of cardiac amyloidosis can result from overproduction of atrial natriuretic factor or from accumulation of otherwise normal or wild-type transthyretin. We present the case of an 83-year-old hospitalized woman with known atrial fibrillation and previous pacemaker implantation who had cardiac arrest unresponsive to attempted resuscitation. Autopsy disclosed prominent amyloidosis involving the left atrium, and subsequent molecular studies identified the amyloidogenic material as alpha atrial natriuretic factor. Since the clinical management and genetic implications of the various diseases associated with amyloidosis are markedly different, we stress the importance of molecular classification whenever possible.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology, Baylor University Medical Center at Dallas
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42
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Abstract
Pulmonary tumor embolism syndrome is a rare phenomenon that can occur in patients who have an occult neoplasm that metastasizes. We describe a case of an elderly woman with an undiagnosed colon cancer who suffered from respiratory distress and compromised pulmonary blood flow from micrometastasis in the pulmonary arteries.
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Affiliation(s)
- Robert Evans Heithaus
- Departments of Radiology (Heithaus) and Pathology (Hitchcock, Guileyardo), Baylor University Medical Center at Dallas
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43
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Roberts WC, Stoler RC, Grayburn PA, Hebeler RF, Ko JM, Brown DL, Brinkman WT, Mack MJ, Guileyardo JM. Necropsy findings early after transcatheter aortic valve implantation for aortic stenosis. Am J Cardiol 2013. [PMID: 23186601 DOI: 10.1016/j.amjcard.2012.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although transcatheter aortic valve implantation has been available for 10 years, reports of cardiovascular morphologic studies after the procedure are virtually nonexistent. The investigators describe such findings in 2 patients, both 86 years of age, who died early (hours or several days) after transcatheter aortic valve implantation. Although the prosthesis in each was seated well, and each of the 3 calcified cusps of the native aortic valves was well compressed to the wall of the aorta, thus providing a good bioprosthetic orifice, the ostium of the dominant right coronary artery in each was obliterated by the native right aortic valve cusp. Atherosclerotic plaques in the common iliac artery led to a major complication in 1 patient, who later died of hemorrhagic stroke. The other patient developed fatal cardiac tamponade secondary to perforation of the right ventricular wall by a pacemaker catheter.
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44
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Abstract
A 57-year-old woman, who had undergone Roux-en-Y gastric bypass surgery 9 years earlier, was admitted to the intensive care unit because of pneumonia. Despite antibiotic therapy, she died 40 days later, apparently because of sepsis and organ failure related to the pneumonia. However, the patient's family requested an autopsy, which revealed that her death was due to perforation of the Roux limb of her gastric bypass, which had resulted in severe peritonitis. The perforation was caused by a nasogastric tube inserted for enteral nutrition. We discuss ways nasogastric tubes might be inserted more safely after gastric bypass, the response of Baylor University Medical Center at Dallas to this complication, and the role of autopsy in improving the quality of hospital care.
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Affiliation(s)
- Thomas G Van Dinter
- Department of Internal Medicine (Van Dinter, John, Fordtran), and the Department of Pathology (Guileyardo), Baylor University Medical Center at Dallas. Dr. Van Dinter and Dr. John contributed equally to this paper
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45
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Abstract
Abdominal apoplexy, or idiopathic spontaneous intraperitoneal hemorrhage, is a rare and often fatal condition resulting from a variety of disease processes affecting the arterial and venous abdominal vasculature. Preoperative and intraoperative diagnosis and treatment of abdominal apoplexy are challenging. The source of bleeding may remain elusive even after careful autopsy dissection given the absence of intravascular pressure. Despite these challenges, early diagnosis and rapid treatment remain central to a successful outcome, as nonsurgical mortality has approached 100%. Presented here are two fatal cases of abdominal apoplexy, one involving a patient with arterial dissection of the gastroduodenal artery and one involving rupture of the superior mesenteric-portal venous system with perivascular pseudoaneurysm formation.
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Affiliation(s)
- Lori N Harbour
- Departments of Pathology (Harbour, Koch, Guileyardo) and Radiology (Louis, Fulmer), Baylor University Medical Center at Dallas
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46
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Guileyardo JM. Selected Quotes. Proc (Bayl Univ Med Cent) 2012. [DOI: 10.1080/08998280.2012.11928807] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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47
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Lim SH, Guileyardo JM, Graham R, Strong LR, Esler WV. ALK-negative anaplastic lymphoma after autologous stem cell transplant for relapsed diffuse large B-cell lymphoma. Leuk Res 2010; 35:e59-60. [PMID: 21146873 DOI: 10.1016/j.leukres.2010.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 10/22/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
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48
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Jolley TM, Guileyardo JM. Iatrogenic endocardial injury associated with preexisting atrial abnormalities. Am J Forensic Med Pathol 2009; 30:376-9. [PMID: 19901822 DOI: 10.1097/paf.0b013e318183f810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Considering the rising number of cardiac catheterization and pacemaker placement procedures being performed each year, it is likely that increasing numbers of deaths associated with complications from these procedures will require certification by the medical examiner. We report 2 cases of iatrogenic atrial injury related to pacemaker placement in which a preexisting cardiac abnormality increased the risk of such complications. One case was associated with an embryologic remnant known as Chiari's network, and the other case was associated with lipomatous hypertrophy of the interatrial septum. The identification of an anatomic abnormality, which results in a predisposition to iatrogenic injury may decrease the risk of costly or unnecessary litigation commonly associated with these deaths.
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Affiliation(s)
- Tracie M Jolley
- Department of Pathology, Baylor University Medical Center, Dallas, Tex 75219, USA
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49
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Abstract
Filicide is the killing of a child by his or her parent. Despite the disturbing nature of these crimes, a study of filicide classification can provide insight into their causes. Furthermore, a study of filicide classification provides information essential to accurate death certification. We report a rare case of familial filicide in which twin sisters both attempted to kill their respective children. We then suggest a detailed classification of filicide subtypes that provides a framework of motives and precipitating factors leading to filicide. We identify 16 subtypes of filicide, each of which is sufficiently characteristic to warrant a separate category. We describe in some detail the characteristic features of these subtypes. A knowledge of filicide subtypes contributes to interpretation of difficult cases. Furthermore, to protect potential child homicide victims, it is necessary to know how and why they are killed. Epidemiologic studies using filicide subtypes as their basis could provide information leading to strategies for prevention.
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Affiliation(s)
- J M Guileyardo
- Southwestern Institute of Forensic Sciences, Dallas 75235, USA
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50
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Abstract
The turnover of cholesterol in the brain is thought to occur via conversion of excess cholesterol into 24S-hydroxycholesterol, an oxysterol that is readily secreted from the central nervous system into the plasma. To gain molecular insight into this pathway of cholesterol metabolism, we used expression cloning to isolate cDNAs that encode murine and human cholesterol 24-hydroxylases. DNA sequence analysis indicates that both proteins are localized to the endoplasmic reticulum, share 95% identity, and represent a new cytochrome P450 subfamily (CYP46). When transfected into cultured cells, the cDNAs produce an enzymatic activity that converts cholesterol into 24S-hydroxycholesterol, and to a lesser extent, 25-hydroxycholesterol. The cholesterol 24-hydroxylase gene contains 15 exons and is located on human chromosome 14q32.1. Cholesterol 24-hydroxylase is expressed predominantly in the brain as judged by RNA and protein blotting. In situ mRNA hybridization and immunohistochemistry localize the expression of this P450 to neurons in multiple subregions of the brain. The concentrations of 24S-hydroxycholesterol in serum are low in newborn mice, reach a peak between postnatal days 12 and 15, and thereafter decline to baseline levels. In contrast, cholesterol 24-hydroxylase protein is first detected in the brain of mice at birth and continues to accumulate with age. We conclude that the cloned cDNAs encode cholesterol 24-hydroxylases that synthesize oxysterols in neurons of the brain and that secretion of 24S-hydroxycholesterol from this tissue in the mouse is developmentally regulated.
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Affiliation(s)
- E G Lund
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9046, USA
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