Right heart failure due to benign metastasizing leiomyoma: a case report of this exceedingly rare condition and review of the literature.

BACKGROUND: Benign metastasizing leiomyoma (BML) is a smooth muscle tumour of genital origin occurring in women with a history of uterine or pelvic leiomyoma. Although histologically benign, it exhibits metastatic behaviour. Lungs are the most common site of metastasis. The heart is a rare site and metastasis at this location has been described in just few cases. CASE SUMMARY: A 42-year-old woman with a resected uterine leiomyoma and a subsequent and still not-resected left periovarian solid mass began complaining of shortness of breath 2 weeks before presentation. Echocardiography showed a mass located in the right ventricular cavity, enlargement of the right ventricle, and severe tricuspid regurgitation. Cardiac magnetic resonance revealed two masses suggestive of tumours in the right ventricle causing right ventricular outflow tract obstruction. Cardiac surgery was performed and, intraoperatively, a third small mass was detected on the tricuspid valve. The masses were resected, and tricuspid valve replacement was performed. Ten days later, the patient underwent an abdominal surgery for the pelvic mass resection. Immunohistochemical analysis of the cardiac and pelvic masses corroborated the diagnosis of benign leiomyomas. The patient was discharged in good clinical condition. DISCUSSION: Benign metastasizing leiomyoma to the heart is a rare condition. The pathogenesis remains controversial and includes: (i) vascular or lymphatic spread of myomatous tissue cells when leiomyoma resection or hysterectomy is performed and (ii) smooth muscle cell proliferation in multiple regions. The more usual locations of BML in the heart seem to be the tricuspid valve and the right face of the interventricular septum.

Prognostic Significance of Left Ventricular Noncompaction: Systematic Review and Meta-Analysis of Observational Studies.

BACKGROUND: Although left ventricular noncompaction (LVNC) has been associated with an increased risk of adverse cardiovascular events, the accurate incidence of cardiovascular morbidity and mortality is unknown. We, therefore, aimed to assess the incidence rate of LVNC-related cardiovascular events. METHODS: We systematically searched observational studies reporting the adverse outcomes related to LVNC. The primary end point was cardiovascular mortality. RESULTS: We identified 28 eligible studies enrolling 2501 LVNC patients (mean age, 46 years; male/female ratio, 1.7). After a median follow-up of 2.9 years, the pooled event rate for cardiovascular mortality was 1.92 (95% CI, 1.54-2.30) per 100 person-years. LVNC patients had a similar risk of cardiovascular mortality compared with a dilated cardiomyopathy control group (odds ratio, 1.10 [95% CI, 0.18-6.67]). The incidence rates of all-cause mortality, stroke and systemic emboli, heart failure admission, cardiac transplantation, ventricular arrhythmias, and cardiac device implantation were 2.16, 1.54, 3.53, 1.24, 2.17, and 2.66, respectively, per 100 person-years. Meta-regression and subgroup analyses revealed that left ventricular ejection fraction, not the extent of left ventricular trabeculation, had an important influence on the variability of incidence rates. The risks of thromboembolism and ventricular arrhythmias in LVNC patients were similar to dilated cardiomyopathy patients. However, LVNC patients had a higher incidence of heart failure hospitalization than dilated cardiomyopathy patients. CONCLUSIONS: Patients with LVNC carry a similar cardiovascular risk when compared with dilated cardiomyopathy patients. Left ventricular ejection fraction-a conventional indicator of heart failure severity, not the extent of trabeculation-appears to be an important determinant of adverse outcomes in LVNC patients. Registration: https://www.crd.york.ac.uk/PROSPERO/ Unique identifier: CRD42018096313.

Real-time measurement and audit of radiation dose to patients undergoing computed radiography.

A real-time patient dose monitoring system for auditing computed radiography is described. Technical data from each exposure and for every examination type are collected and sent by a network to a workstation, which calculates the moving average values of entrance skin dose and dose-area product from the 10 most recently examined patients. Comparison of averages with reference values generates warning messages if reference values are exceeded, prompting corrective action if necessary.

Mordida abierta hiperdivergente: una aproximación terapéutica conservadora / Hyperdivergent Open-bite: a conservative approach

Se presenta el caso clínico de una paciente adolescente con escaso crecimiento remanente y una maloclusión con mordida abierta hiperdivergente. Existen alteraciones esqueléticas y dentoalveolares en ambos maxilares y en los tres planos del espacio, con disminución de la altura facial posterior y aumento de la anterior, incremento de los ángulos goniaco y mandibular y de las alturas de los procesos dentoalveolares, compresión maxilar con oclusión cruzada, posterorrotación mandibular, resalte y mordida abierta anterior. El objetivo fundamental del tratamiento fue mejorar la proporción entre las alturas faciales posterior y anterior y conseguir una anterorrotación secundaria mandibular con el consecuente cierre de la mordida abierta anterior. El control vertical de las estructuras dentoalveolares posteriores se convierte, de esta forma, en el pilar fundamental sobre el que edificar el tratamiento. Se optó por una modalidad terapéutica conservadora, que incluyó la utilización de un dispositivo palatino de expansión rápida con bloques de acrílico y una mentonera de tiro occipital, barra transpalatina con botón de acrílico y aparatología fija multibrackets. El objetivo de toda la aparatología utilizada iba encaminada al control vertical de la maloclusión (AU)

The clinical case of a fifteen years-old patient with a hiperdivergent open- bite malocclusion is reported. This malocclusion is best characterized by three dimensional skeletal and dentoalveolar changes in both upper and lower maxillae, with a decreasing in the posterior facial height (PFH) and increased anterior facial height (AFH), large gonial and mandible planes, as well as the posterior dentoalveolar heights, narrow maxilla often associated with posterior cross-bite, mandible clockwise rotation and anterior open-bite. A combined orhopedic-orthodontic conservative approach was selected to correct skeletal, dentoalveolar and functional components of the malocclusion (AU)