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    Reveal LINQ Versus Reveal XT Implantable Loop Recorders: Intra- and Post-Procedural Comparison.
    J Pediatr 2017 May 22. Epub 2017 May 22.
    Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO. Electronic address:
    Objectives: To compare the procedure, recovery, hospitalization times, and costs along with patient/parent satisfaction after newer-generation cardiac implantable loop recorder (Reveal LINQ; Medtronic Inc, Minneapolis, Minnesota) and previous-generation implantable loop recorder (Reveal XT; Medtronic Inc).

    Study Design: A prospective study of patients undergoing LINQ implantations between April 2014 and October 2015 was performed. Retrospective chart review of patients undergoing XT implantations was performed for comparison. Read More

    Predictors of Mortality, Rehospitalization for Syncope and Cardiovascular Events in Patients With Cardiovascular Syncope.
    Circ J 2017 May 25. Epub 2017 May 25.
    Division of Cardiology, Department of Medicine, Showa University.
    Background: Predictors of poor outcomes remain unknown for cardiovascular syncope patients after discharge.Methods and Results:We reviewed the medical records of consecutive patients admitted to hospital with cardiovascular syncope. We then performed Cox stepwise logistic regression analysis to identify significant independent factors for death, rehospitalization for syncope, and cardiovascular events. Read More

    Whole‑exome sequencing identifies a novel mutation (R367G) in SCN5A to be associated with familial cardiac conduction disease.
    Mol Med Rep 2017 May 17. Epub 2017 May 17.
    Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China.
    Cardiac conduction disease is a primary cause of sudden cardiac death. Sodium voltage‑gated channel‑α subunit 5 (SCN5A) mutations have been reported to underlie a variety of inherited arrhythmias. Numerous disease‑causing mutations of SCN5A have been identified in patients with ≥10 different conditions, including type 3 long‑QT syndrome and Brugada syndrome. Read More

    A review of human neuroimaging investigations involved with central autonomic regulation of baroreflex-mediated cardiovascular control.
    Auton Neurosci 2017 May 15. Epub 2017 May 15.
    Human Cardiovascular and Exercise Physiology Laboratory, School of Health and Human Performance, Division of Kinesiology, Dalhousie University, Nova Scotia B3H 1T8, Canada. Electronic address:
    Effective regulation of central blood volume and arterial pressure is critical for optimal cardiovascular homeostasis. Inadequate regulation of mean arterial pressure has important pathophysiological implications including syncope, end organ damage, and stroke. Such regulation requires appropriate central integration of barosensory afferents and reflex autonomic control of the heart and blood vessels. Read More

    Surgical Management of Simultaneous Left Coronary Atresia and Anomalous Right Coronary Artery Origin.
    Ann Thorac Surg 2017 Jun;103(6):e513-e515
    University of Tennessee, LeBonheur Children's Hospital, Memphis, Tennessee. Electronic address:
    A 9-year-old child presented with syncope during exercise. He received a diagnosis of congenital atresia of the left main coronary artery by angiography. He underwent successful coronary artery bypass grafting. Read More

    Cost of Unnecessary Testing in the Evaluation of Pediatric Syncope.
    Pediatr Cardiol 2017 May 18. Epub 2017 May 18.
    The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
    Syncope is a common and a typically benign clinical problem in children and adolescents. The majority of tests ordered in otherwise healthy pediatric patients presenting with syncope have low diagnostic yield. This study quantifies testing and corresponding patient charges in a group of pediatric patients presenting for outpatient evaluation for syncope. Read More

    Discovery of a new mutation in the desmin gene in a young patient with cardiomyopathy and muscular weakness.
    Rom J Morphol Embryol 2017 ;58(1):225-230
    Department of Cardiology, "Prof. Dr. C. C. Iliescu" Institute of Emergency for Cardiovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;
    A 25-year-old woman with a five years history of syncope, mild left ventricular hypertrophy and moderately enlarged atria, was diagnosed with third degree atrioventricular heart block alternating with atrioventricular heart block 2:1, and received a dual chamber pacemaker. After three years of evolution, she developed atrial fibrillation, marked biatrial enlargement, severely depressed longitudinal myocardial velocities, associated with mild girdle weakness and slight increase in creatine kinase level. The diagnosis of restrictive cardiomyopathy with mild skeletal myopathy imposed the screening for a common etiology. Read More

    Multiple causes of syncope in the elderly: diagnostic outcomes of a Dutch multidisciplinary syncope pathway.
    Europace 2017 May 17. Epub 2017 May 17.
    Department of Geriatric Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
    Aims: To assess the diagnostic outcomes of a multidisciplinary pathway for elderly syncope patients.

    Methods And Results: Observational cohort study at a Fall and Syncope Clinic, including consecutive syncope patients aged ≥65 years between 2011 and 2014. Measurements: The sort, number, and accuracy of diagnoses resulting in syncope. Read More

    Diagnostic Yield of Routine Electroencephalography With Concurrent Video Recording in Detecting Interictal Epileptiform Discharges in Relation to Reasons for Request: A Prospective Study of 1,080 Video-Electroencephalograms.
    J Clin Neurophysiol 2017 May 16. Epub 2017 May 16.
    Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
    Purpose: The aim of this study was to prospectively analyze the sensitivity and specificity of routine electroencephalography with concurrent video recording (vEEG) in relation to the reasons for requesting the test and to investigate when routine vEEG should be requested.

    Methods: We prospectively analyzed 1,080 consecutive vEEGs performed between April 2015 and April 2016. The requests for vEEG were classified as requests with a low suspicion of epilepsy (syncope, confusion or delirium, suspicion of psychogenic nonepileptic seizures, and paroxysmal focal neurological deficit) or requests with a high suspicion of epilepsy (first clinical seizure, suspected status epilepticus, follow-up study of a patient with epilepsy, and acute symptomatic seizures). Read More

    Anomalous Origin of Right Coronary Artery From Left Coronary Sinus-13 Cases Treated With the Reimplantation Technique.
    World J Pediatr Congenit Heart Surg 2017 May;8(3):315-320
    1 Division of Cardiac Surgery, Cruces University Hospital, Barakaldo, Spain.
    Objectives: Anomalous aortic origin of a coronary artery is uncommon but potentially clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe our experience with surgical reimplantation and results at midterm follow-up. Read More

    Recurrent Stress Cardiomyopathy During COPD Exacerbation: Are Beta-adrenergic Agonists Only to Blame?
    Cureus 2017 Apr 14;9(4):e1166. Epub 2017 Apr 14.
    Cardiology, North Bronx Health Network Jacobi Medical Center.
    Takotsubo cardiomyopathy (TCM) is a variant of stress-induced cardiomyopathy, characterized by transient left ventricular dysfunction that may be associated with emotional or physical triggers. We present the case of a 51-year-old Caucasian female with severe chronic obstructive pulmonary disease (COPD) who presented with syncope and was found to have her second lifetime episode of stress-induced cardiomyopathy. Eight months prior, she had been admitted with a COPD exacerbation and was found to have left ventricular (LV) dysfunction with ejection fraction (EF) of 22% attributed to TCM with subsequent normalization of her left ventricular function. Read More

    Clinical Review: Loperamide Toxicity.
    Ann Emerg Med 2017 May 13. Epub 2017 May 13.
    Division of Clinical Pharmacology and Toxicology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical and Evaluative Sciences and Sunnybrook Research Institute, Toronto, Ontario, Canada.
    Loperamide is a nonprescription opioid widely used for the treatment of diarrhea. Although it is relatively safe at therapeutic doses, increasing reports describe its misuse and abuse at very high doses either for euphoric effects or to attenuate symptoms of opioid withdrawal. Life-threatening loperamide toxicity can result from the relatively new clinical syndrome of loperamide-induced cardiac toxicity. Read More

    Nitric oxide synthase inhibition restores orthostatic tolerance in young vasovagal syncope patients.
    Heart 2017 May 13. Epub 2017 May 13.
    Departments of Pediatrics, New York Medical College, Valhalla, New York, USA.
    Objective: Syncope is sudden transient loss of consciousness and postural tone with spontaneous recovery; the most common form is vasovagal syncope(VVS). We previously demonstrated impaired post-synaptic adrenergic responsiveness in young VVS patientswas reversed by blocking nitric oxide synthase(NOS). We hypothesised that nitric oxide may account for reduced orthostatic tolerance in young recurrent VVS patients. Read More

    Recurrent syncope in systemic lupus erythematosus: a hidden cause in abdomen.
    BMJ Case Rep 2017 May 12;2017. Epub 2017 May 12.
    Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India.
    Systemic inflammatory rheumatic diseases have shown an increase in frequency of internal malignancies, predominantly lymphoproliferative disorders. Occurrence of solid organ tumours is exceedingly rare. It is even rarer for it to manifest as recurrent syncope. Read More

    Implication of altered autonomic control for orthostatic tolerance in SCI.
    Auton Neurosci 2017 May 3. Epub 2017 May 3.
    James J Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Room 7A-13, Bronx, NY 10468, USA; Icahn School of Medicine, Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA. Electronic address:
    Neural output from the sympathetic and parasympathetic branches of the autonomic nervous system (ANS) are integrated to appropriately control cardiovascular responses during routine activities of daily living including orthostatic positioning. Sympathetic control of the upper extremity vasculature and the heart arises from the thoracic cord between T1 and T5, whereas splanchnic bed and lower extremity vasculature receive sympathetic neural input from the lower cord between segments T5 and L2. Although the vasculature is not directly innervated by the parasympathetic nervous system, the SA node is innervated by post-ganglionic vagal nerve fibers via cranial nerve X. Read More

    Brugada Syndrome:Risk Stratification And Management.
    J Atr Fibrillation 2016 Oct-Nov;9(3):1507. Epub 2016 Oct 31.
    Research and Development, Tachikawa Medical Center. Nagaoka, Japan.
    The Brugada syndrome (BrS) is an arrhythmogenic disease associated with an increased risk of ventricular fibrillation and sudden cardiac death. The risk stratification and management of BrS patients, particularly of asymptomatic ones, still remains challenging. A previous history of aborted sudden cardiac death or arrhythmic syncope in the presence of spontaneous type 1 ECG pattern of BrS phenotype appear to be the most reliable predictors of future arrhythmic events. Read More

    Idiopathic Paroxysmal Atrio-Ventricular Block. What is The Mechanism?
    J Atr Fibrillation 2016 Oct-Nov;9(3):1449. Epub 2016 Oct 31.
    University Hospital Virgen of Rocío (Seville), Spain.
    Idiopathic paroxysmal atrioventricular (AV) block poses a true diagnostic challenge. What is clear about this entity is the confusion about its definition and consequently about its etiology. According to certain sources, the diagnosis of this block requires the lack of a structural cardiac pathology that justifies the observed manifestations and an absence of electrocardiographic disorders prior to an episode. Read More

    Does Syncope Predict Mortality in Patients With Acute Pulmonary Embolism? A Retrospective Review.
    J Clin Med Res 2017 Jun 26;9(6):516-519. Epub 2017 Apr 26.
    Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA.
    Background: Acute pulmonary embolism (APE) is a potentially fatal disease with high mortality. Prior studies have shown an increased frequency of central localization of the clot, right ventricular dysfunction and elevated troponin in patients who present with syncope and APE. Existing evidence regarding mortality and length of hospital stay in these patients is unclear. Read More

    Pulmonary Embolism and Deep Venous Thrombosis in Patients Hospitalized With Syncope: A Multicenter Cross-sectional Study in Toronto, Ontario, Canada.
    JAMA Intern Med 2017 May 8. Epub 2017 May 8.
    Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario Canada.5Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.6Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. 7Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.

    Electrical Storm or Naxos Syndrome in an Adult Causing Recurrent Syncope.
    J Coll Physicians Surg Pak 2017 Apr;27(4):250-251
    Department of Cardiology, Punjab Institute of Cardiology, Lahore.
    Among the rare and well-known causes of sudden cardiac death by malignant arrthymias is a condition called arrhythmogenic right ventricular cardiomyopathy. It commonly presents with right ventricular dilatation, dysfunction and ventricular tachycardia of left bundle branch morphology due to fibro-fatty infiltration of right ventricle in second to fifth decade of life, making it an unrecognized and important cause of sudden cardiac death. Two rare variants of arrhythmogenic right ventricular cardiomyopathy are Carvajal syndrome and Naxos syndrome. Read More

    The clinical epidemiology of fatigue in newly diagnosed heart failure.
    BMC Cardiovasc Disord 2017 May 11;17(1):122. Epub 2017 May 11.
    Geisinger Health System, 100 N. Academy Avenue, Danville, PA, 17822, USA.
    Background: Fatigue is a common and distressing but poorly understood symptom among patients with heart failure (HF). This study sought to evaluate the prevalence, predictors, and prognostic value of clinically documented fatigue in newly diagnosed HF patients from the community.

    Methods: This retrospective cohort study consisted of 12,285 newly diagnosed HF patients receiving health care services through the Geisinger Health System, with passive data collection through electronic medical records (EMR). Read More

    Loss of consciousness, collapse and associated driving restrictions: a retrospective case note review - an important reminder regarding driving restrictions.
    Scott Med J 2017 Jan 1:36933017694779. Epub 2017 Jan 1.
    2 Consultant Physician and Clinical Pharmacologist, Department of Acute Medicine, Queen Elizabeth University Hospital, UK.
    Background and aims National guidelines outlining medical standards for fitness to drive are provided by The Driver and Vehicle Licensing Agency. We aimed to establish whether patients presenting with collapse or loss of consciousness received documented advice regarding driving restrictions, if appropriate for their working diagnosis. Methods and results A retrospective case note review was undertaken over a four-month period for emergency patients clinically coded as seizure/convulsion (R568) and collapse/syncope (R55X); 163 patients had a primary or working diagnosis on discharge that suggested driving status and restrictions could have been reviewed. Read More

    [Syncope; suspect pulmonary embolism, especially in the elderly].
    Ned Tijdschr Geneeskd 2017 ;161(0):D1365
    Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschap, Utrecht.
    Syncope can be caused by a pulmonary embolism. This applies in particular to elderly patients admitted with syncope; in the general population, however, syncope is far more frequently caused by a vasovagal response or orthostatic hypotension. Syncope can be the symptom of a pulmonary embolism, even in the absence of any clinical manifestations of this diagnosis; it is, therefore, important to exclude pulmonary embolism in any syncope patient in the accident and emergency department by applying the Wells clinical decision rule. Read More

    Surgical Repair of Subacute Right Ventricular Perforation after Pacemaker Implantation.
    Case Rep Cardiol 2017 6;2017:3242891. Epub 2017 Apr 6.
    Department of Cardiovascular Surgery, Omura Municipal Hospital, 133-22 Kogashima-machi, Omura, Nagasaki 856-8561, Japan.
    We report an 84-year-old woman who presented with right ventricular perforation 4 days after pacemaker implantation for syncope due to sick sinus syndrome. Median sternotomy revealed no pericardial effusion, but the pacing lead had penetrated the right ventricle and pericardium. When the pleura was opened, the tip of the lead was seen in the visceral pleura. Read More

    Disappearance of Electrocardiographic Abnormalities Associated with the Arrhythmic Pattern of a Barlow Disease After Surgical Mitral Valve Repair.
    Clin Pract 2017 Apr 20;7(2):946. Epub 2017 Apr 20.
    Department of Cardiology, IRCCS-Policlinico S. Matteo, Pavia, Italy.
    We describe the case of a 46-year old female with a Barlow's disease (MVP) characterized by systolic curling of posterior left ventricular (LV) wall + significant mitral annular disjunction + complex ventricular arrhythmias + syncope + inverted T waves in inferolateral leads in whom a successful surgical mitral valve rapair determined the disappearance not only of the echocardiographic but also the electrocar-diographic abnormalities (in particular the inferolateral T waves inversion on basal electrocardiogram and the complex basal arrhythmic pattern). This case demonstrates that electrocardiographic abnormalities may disappear after the surgical correction of the mechanical stretch imposed on the inferior LV free wall by the prolapsing mitral valve leaflets. Electrocardiographic changes remain an important and easy marker to recognize for the identification of a high-risk subgroup of MVP patients. Read More

    Fatal monomorphic ventricular tachycardia in a semi-urban setting in Cameroon: a case report.
    BMC Res Notes 2017 May 8;10(1):180. Epub 2017 May 8.
    Buea Regional Hospital, Buea, Cameroon.
    Background: Ventricular tachycardia is a life threatening cardiac arrhythmia. It needs management with defibrillation, without which, immediate death may occur.

    Case Presentation: A 66 year old black African patient with a 2 year history of hypertension was admitted to the emergency department of the Buea Regional hospital, a semi-urban setting in Cameroon, after presenting with syncope while in church. Read More

    Risk factors for sudden cardiac death in childhood hypertrophic cardiomyopathy: A systematic review and meta-analysis.
    Eur J Prev Cardiol 2017 Jan 1:2047487317702519. Epub 2017 Jan 1.
    1 Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK.
    Aims To perform a systematic literature review and meta-analysis of clinical risk factors for sudden cardiac death (SCD) in childhood hypertrophic cardiomyopathy. Methods Medline and PubMed databases were searched for original articles published in English from 1963 through to December 2015 that included patients under 18 years of age with a primary or secondary end-point of either SCD or SCD-equivalent events (aborted cardiac arrest or appropriate implantable cardioverter-defibrillator discharge) or cardiovascular death (CVD). Results Twenty-five studies (3394 patients) met the inclusion criteria. Read More

    Cardiac Papillary Fibroelastoma with Coronary Artery Anomaly: A Case Report.
    Heart Surg Forum 2017 Apr 28;20(2):E052-E054. Epub 2017 Apr 28.
    Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, China.
    Primary cardiac tumors are extremely rare with occurrence range of about 0.0017-0.28%. Read More

    Long Term Prognosis of Drug-Induced Brugada Syndrome.
    Heart Rhythm 2017 May 4. Epub 2017 May 4.
    Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
    Backround: Patients with a drug-induced Brugada syndrome (BS) are considered at a lower risk than those with the spontaneous type I pattern. Nevertheless, they can present arrhythmic events.

    Objective: The purpose of this study was to investigate their clinical characteristics, long-term prognosis and risk factors. Read More

    Cataplexy and Its Mimics: Clinical Recognition and Management.
    Curr Treat Options Neurol 2017 Jun;19(6):23
    Sleep Medicine Center Kempenhaeghe, P.O. Box 61, , 5590 AB, Heeze, The Netherlands.
    Opinion Statement: This review describes the diagnosis and management of cataplexy: attacks of bilateral loss of muscle tone, triggered by emotions and with preserved consciousness. Although cataplexy is rare, its recognition is important as in most cases, it leads to a diagnosis of narcolepsy, a disorder that still takes a median of 9 years to be diagnosed. The expression of cataplexy varies widely, from partial episodes affecting only the neck muscles to generalized attacks leading to falls. Read More

    Vestibular syncope: A disorder associated with drop attack in Ménière's disease.
    Auris Nasus Larynx 2017 May 3. Epub 2017 May 3.
    Department of Otolaryngology, University of Helsinki, Helsinki, Finland.
    Objective: Experiments in humans and animals indicate that vestibular influx through vestibular sympathetic reflex is an important and vital part of the regulatory system of circulation. The otolith organ adjusts the circulatory responses through the vestibular sympathetic reflex during an upright stance and may trigger a vasovagal attack of syncope. The aim of the present study was to evaluate the prevalence and association of syncope attacks among patients with Ménière's disease (MD). Read More

    Fainting episode in a pacemaker dependent patient with two implanted devices. Too much of a good thing!
    J Electrocardiol 2017 Apr 22. Epub 2017 Apr 22.
    Arrhythmology Unit, Ospedale S. Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy.
    A 73 year old man with CRT-D system and pacemaker dependence was admitted to the emergency department due to a syncopal episode. The device interrogation was performed. An RV ventricular sensing test was executed in VVI mode at 50 b/m. Read More

    DKA-Induced Takotsubo Cardiomyopathy in Patient with Known HOCM.
    Case Rep Crit Care 2017 3;2017:4287125. Epub 2017 Apr 3.
    Overlook Medical Center, Summit, NJ, USA.
    The first published case of Diabetic Ketoacidosis-induced Takotsubo cardiomyopathy was in 2009. Our patient is the 1st reported case of Diabetic Ketoacidosis- (DKA-) induced Takotsubo cardiomyopathy (TC) in a patient with known hypertrophic cardiomyopathy (HOCM) in the United States. In the literature, there are only two examples linking DKA to TC; however, this report focuses on the biochemical and physiological causes of TC in a patient with known HOCM and new-onset DKA. Read More

    Benefit of dual-chamber pacing with Closed Loop Stimulation in tilt-induced cardio-inhibitory reflex syncope (BIOSync trial): study protocol for a randomized controlled trial.
    Trials 2017 May 4;18(1):208. Epub 2017 May 4.
    BIOTRONIK Italia S.p.A., Vimodrone, Italy.
    Background: The efficacy of dual-chamber cardiac pacing in neuro-mediated reflex syncope with a cardio-inhibitory response to the Tilt-Table test (TT) has not been definitively assessed so far. The lack of reproducibility of results from previous studies may be partially explained by discrepancies in subject selection and some weaknesses in design and methods. The European Society of Cardiology (ESC) has set a class IIb indication to pacemaker implantation in this population recommending further research. Read More

    Clinical characteristics and outcomes of left ventricular pseudoaneurysm: A retrospective study in a single-center of China.
    Medicine (Baltimore) 2017 May;96(18):e6793
    aDepartment of Cardiology bDepartment of Traditional Chinese Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
    Left ventricular (LV) pseudoaneurysm is a fatal and rare condition with a high risk of rupture. The symptoms are nonspecific and diagnosis is often delayed. The purpose of this study is to analysis a series of cases in our institution. Read More

    Pulmonary Embolism and Intracardiac Type A Thrombus with an Unexpected Outcome.
    Case Rep Cardiol 2017 2;2017:9092576. Epub 2017 Apr 2.
    Cardiology Department, Hospital Senhora da Oliveira, Guimarães, Portugal.
    Detection of right heart thrombi (RHT) in the context of pulmonary thromboembolism (PE) is uncommon (4-18%) and increases the risk of mortality beyond the presence of PE alone. Type A thrombi are serpiginous and highly mobile and are thought to be originated from large veins and captured in-transit within the right heart. Optimal management of RHT is still uncertain. Read More

    Primary Cardiac Synovial Sarcoma: A Case Report.
    J Tehran Heart Cent 2017 Jan;12(1):32-34
    Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran.
    Primary cardiac sarcomas are rare clinical entities with an incidence rate of 0.0001% in collected autopsy series and are regarded as very aggressive tumors. We herein describe a 21-year-old woman presenting with syncope, dyspnea, and abdominal distention. Read More

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