The Characteristics and Outcomes of Native Aortic Valve Thrombosis: A Systematic Review.

BACKGROUND: There is a lack of knowledge in the current medical literature about native aortic valve thrombosis. OBJECTIVES: The aim of this systematic review was to summarize the characteristics, presentations, underlying etiologies, and outcomes of native aortic valve thrombosis and to present a meta-analysis of the best available data. METHODS: The authors performed a literature search, identified published cases of patients with native aortic valve thrombosis, and pooled the data in this meta-analysis. The statistical analysis included calculations of the prevalence of the various presentations, underlying etiologies, aortic cusp involvement, as well as choices of diagnostic testing. They calculated the sensitivities of the various diagnostic testing as well as in-hospital mortality event rates and the univariate ORs of the risk factors for poor outcomes. RESULTS: The search strategy and screening process yielded 74 cases of native aortic valve thrombosis, which are included in this meta-analysis. The data revealed that the most common presentation was myocardial infarction in 36%, and the most common underlying etiology was hypercoagulable state in 30%. In-hospital clinical deterioration after presentation including recurrent embolism occurred in ∼38%, and in-hospital mortality rate was ∼20%. CONCLUSIONS: Native aortic valve thrombosis is clinically relevant, especially in patients presenting with embolic events. Awareness about native aortic valve or root thrombosis as well as its underlying etiologies, diagnostic work-up, and management is essential, because this condition can be associated with poor outcomes.

Cardiac tamponade as the first manifestation of systemic lupus erythematosus in children.

Systemic lupus erythematosus (SLE) is a serious chronic autoimmune disease with intense inflammatory response and damage in many target organs including joints, skin, kidneys, heart and nervous system. Cardiac tamponade is extremely rare as a cardinal presentation of SLE in children with only a few cases reported in the literature. We report two cases of a 9-year-old boy and an 11-year-old girl presenting with acute cardiac tamponade and later recognition of elevated anti-double-stranded DNA (anti-dsDNA) titre. We also present a literature review about similar cases in children and we stress on the importance of screening all cases of acute cardiac tamponade in children with antinuclear and anti-dsDNA antibodies to avoid any delay in SLE diagnosis and treatment.

Primary colorectal lymphoma.

This study aimed at investigating the incidence, presentation, patient and tumor characteristics, treatment, and outcome of primary colorectal lymphomas (PCL) at a tertiary care center in Lebanon over a 25-year period. The Dawson's criteria were used for selection of eligible cases. The medical records were reviewed for demographic variables, the presence of risk factors, presenting signs and symptoms, method of diagnosis, histologic type, type of therapy, and condition at last follow-up. Nine cases of PCL were identified (12.7% of gastrointestinal lymphomas and 0.1% of colorectal malignancies). The mean age at presentation was 44.2 years with male predominance noted. Abdominal pain was the most common presentation (77.8%). Colonoscopy was performed for eight patients with non-specific gross tumor characteristics. Three patients had Burkitt's and six had diffuse large B-Cell lymphomas. The most common site of involvement was the cecum (55.6%) with all cases presenting in stage I(E). Surgery was performed for six patients followed by chemotherapy except for one, and three patients had chemotherapy only. The median survival time was 25 months and the 2-year survival time was approximated at 60%. It is concluded that PCL is a rare malignancy with well-identified disease characteristics yet controversial ideal management plan.