Left atrial appendage (LAA) aneurysm is an extremely rare anomaly. So far, less than one hundred cases only have been reported worldwide. Revelation modes are dominated by complications such as arrhythmias and thromboembolic events. We herein report a pediatric case of huge congenital LAA aneurysm with an original revelation mode that has never been described before in medical literature.

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Mechanical heart valve thrombosis is not so rare in pregnant women because of the difficulties in managing anticoagulant treatment and the hypercoagulability state associated with pregnancy. Among the embolic complications of valve prosthetic thrombosis, the coronary embolism is rare, it requires an urgent pharmaco-invasive approach which must be adapted to this particular associated condition. We report the observation and the difficulties of managing antithrombotic therapy in a pregnant patient hospitalized for non-obstructive prosthetic valve thrombosis complicated by coronary embolism and resulting in ST elevation myocardial infarction.

Background: Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy. Early detection of HCC is extremely important in improving the survival of patients. Alpha-fetoprotein (AFP) was commonly used as a predictor for HCC, but it was associated with low sensitivity and specificity. Thioredoxin (TRX) is a ubiquitous protein that was suggested to be elevated in cases with HCC. Objective: To evaluate the value of serum thioredoxin as a diagnostic marker of HCC versus alpha-fetoprotein in cirrhotic HCV patients. Materials and methods: This study included 96 patients divided into; groups I included, patients with liver cirrhosis, and group II included, patients with HCC on top of a cirrhotic liver. Both groups were successfully undergoing treatment of HCV with direct-acting antiviral (DAAs). Basic data, clinical examination, and laboratory analysis were obtained from all the cases. Human thioredoxin detection was done using Human TRX kits. Results: There is statistically significant increased TRX, AFP, APRI, and FIB4 among hepatocellular carcinoma group versus cirrhotic group. The ROC curve analysis demonstrated that TRX at a cut-off value of 198.19 (IU/ml) has 85.4% sensitivity and 89.6% specificity for differentiating HCC cases from cirrhotic cases with 89.1% PPV, 86% NPV, and AUC equal to 0.841. Both, AFP at a cut-off of 24 (ng/ml) and combined AFP and TRX had 93.8% sensitivity and 97.9% specificity with AUC equal to 0.99 for differentiating HCC cases from cirrhotic cases. Conclusion:Thioredoxin is a novel biomarker that revealed good sensitivity in the prediction of HCC on top of liver cirrhosis especially if combined with AFP. Materials and methods Study settings and durationThis study was conducted in the Internal Medicine department, Specialized medical hospital, Mansoura University during the period from December 2018 to December 2019. PatientsThis study included 96 patients with chronic HCV infection, the patients were classified into two groups; group I included 48 patients with liver cirrhosis who successfully underwent treatment of HCV with directacting antiviral and group II included 48 patients with HCC on top of the cirrhotic liver who were successfully treated of HCV with DAAs.