scholarly journals Clinicopathological Features, Risk Factors and Predispositions, and Response to Treatment of Eosinophilic Oral Disease in 24 Dogs (2000-2016)

2019 ◽  
Vol 36 (1) ◽  
pp. 25-31
Author(s):  
Danielle Mendelsohn ◽  
John R. Lewis ◽  
Kristin Iglesias Scott ◽  
Dorothy C. Brown ◽  
Alexander M. Reiter
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Clinicopathological Features ◽  
Response To Therapy ◽  
Oral Disease ◽  
Response To Treatment ◽  
Inclusion Criteria ◽  
Lesion Location ◽  
Referral Practice

The objectives of this study were to retrospectively describe clinicopathological features of eosinophilic oral disease in dogs, to identify possible risk factors or predispositions to the condition, and to report overall treatment response. Canine medical records from a veterinary teaching hospital and private referral practice over a 17-year period were reviewed for a diagnosis of eosinophilic oral disease. Twenty-four dogs with 26 lesions met the inclusion criteria. Patient mean age and body weight were 6.8 (3.8) years and 13.4 kg, respectively. Fifteen breeds were represented including Cavalier King Charles spaniel (16.7%), Labrador retriever (12.5%), and West Highland white terrier (12.5%). Eosinophilic lesions were found in the palate (65.4%), tongue (26.9%), and other oral locations (7.7%). Median follow-up time was 5 months. Analysis revealed statistically significant associations between lesion location and body weight (palatal and tongue lesions were more likely in smaller dogs, whereas lesions in the other category [lip or mucosa] were more likely in larger dogs). There was a correlation in lesion location and resolution (all dogs with palatal lesions became asymptomatic at their last recheck), and resolution and the use of antibiotics plus prednisone (greater likelihood of resolution without the use of this combination). Seventy percent of asymptomatic dogs resolved without medication or with allergen therapy alone, suggesting that asymptomatic dogs may respond well to conservative management. No associations were found between lesion location and breed, signalment and response to therapy, lesion resolution and the use of glucocorticoids, or significance of peripheral eosinophilia.

scholarly journals Japan Scar Workshop (JSW) Scar Scale (JSS) for Assessing Keloids and Hypertrophic Scars

2020 ◽  
pp. 133-140
Author(s):  
Rei Ogawa
Keyword(s):  
Hypertrophic Scar ◽  
Assessment Tool ◽  
Treatment Method ◽  
Response To Therapy ◽  
Assessment Scale ◽  
Response To Treatment ◽  
Hypertrophic Scars ◽  
Scar Assessment ◽  
Appropriate Treatment

AbstractThe Vancouver scar scale, the Manchester scar scale, and the Patient and Observer Scar Assessment Scale (POSAS) are all very well-known scar evaluation methods. These tools are based on a number of scar variables, including color, height, and pliability. However, since all were mainly developed to evaluate burn scars, they are difficult to use in clinical practice for keloids and hypertrophic scars. This is because these pathological scars require both differential diagnosis and a way to evaluate their response to therapy. The Japan Scar Workshop (JSW) has sought to develop a scar assessment scale that meets these clinical needs. The first version of this scar assessment tool was named the JSW scar scale (JSS), and it was reported in 2011. In 2015, the revised second version was reported. The JSS consists of two tables. One is a scar classification table that is used to determine whether the scar is a normal mature scar, a hypertrophic scar, or a keloid. This grading system helps the user to select the most appropriate treatment method for the scar. The other table in the JSS is an evaluation table that is used to judge the response to treatment and for follow-up. Both tables contain sample images of each subjective keloid/hypertrophic scar item that allow the user to evaluate each item without hesitation.

scholarly journals P1795ASSOCIATION BETWEEN T CELL INFILTRATION IN BIOPSY PROVEN ACUTE T CELL MEDIATED REJECTION AND RESPONSE TO THERAPY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nooshin Dalili ◽  
Pedram Ahmadpoor ◽  
Behzad Einollahi ◽  
Hamed Azhdari Tehrani
Keyword(s):  
T Cell ◽  
Graft Function ◽  
Stable Condition ◽  
Response To Therapy ◽  
Response To Treatment ◽  
P Value ◽  
Organ Rejection ◽  
Graft Outcome ◽  
Significant Difference

Abstract Background and Aims Renal transplantation is considered as the best replacement therapy for advanced ESRD patients. An allograft rejection happens as a result of post transplant immune reactions, which change the outcome of the organ transplantation. Today a major challenge in the field of transplantation is the identification of easy, reliable and non-invasive markers or methods that being able to predict the probability of organ rejection. One of the possible methods is looking for type of infiltrated cells in tissue obtaining by biopsy stained with specific cellular markers and assesses the infiltration of these cells in different types of rejection. Here the severity of CD3, CD20, Th17 and FOXP3 infiltration in patients with biopsy proven acute cellular rejection was evaluated based on IHC staining, whether these specific infiltrations can show an association with graft outcome or not. Method 50 patients with biopsy proven Acute T Cell Mediated Rejection (ATCMR) recruited. Previous clinical data and 1 year clinical follow up collected. The entire specimen assessed for infiltration of CD3, CD20, FOXP3 Tregs and Th17 with IHC. Patients divided into subgroups: stable graft function versus impaired graft function based on serum creatinine course in one year follow up after rejection therapy and appropriate response to treatment versus failure to response, based on allograft function throughout the course of admission. Results In impaired graft function arm, FOXP3 (7.88 vs. 8.02 with P-value 0.96) and Th17 cells were higher (5.01 vs. 10.2 with P-value 0.24) but with non-significant values. FOXP3/Th17 ratio was higher in stable group (1.4 vs. 1.12 with P-value 0.22). In failure to response to therapy group both FOXP3 (9.95 vs. 6.63 with P-value 0.1) and Th17 (11.3 vs. 8.3 with P-value 0.15) cells were higher. FOXP3/Th17 ratio was higher in proper response group (1.19 vs. 1.15 with P-value 0.8). No significant difference was obtained between CD3 and CD20 infiltration in these two groups. Conclusion Final results showed that Th17 has more important role in predicting the graft outcome and response to treatment and FOXP3 infiltration had a minor part. This may be in controversial with previous facts about the role of FOXP3 cells, which drive the allograft into stable condition.

A Novel Grading System of Lower Gastrointestinal Acute Graft-Versus-Host Disease At Disease Onset Predicts Response to Therapy and Non-Relapse Mortality

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 153-153
Author(s):  
Andrew C. Harris ◽  
James L.M. Ferrara ◽  
Joel K. Greenson ◽  
Thomas M. Braun ◽  
Ernst Holler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Stage ◽  
Response To Therapy ◽  
Histologic Grade ◽  
Response To Treatment ◽  
Prognostic Information ◽  
Advanced Clinical Stage ◽  
Graft Versus Host ◽  
Risk Parameters ◽  
Conditioning Intensity

Abstract Abstract 153 We have recently described REG3α as a plasma biomarker of lower gastrointestinal (GI) graft-versus-host disease (GVHD), the target GVHD organ most associated with increased non-relapse mortality (NRM) following hematopoietic cell transplantation (HCT), that provides important diagnostic and prognostic information in 1014 HCT patients from 3 transplant centers (BBMT; 17: S163–164). Histologic and clinical severity of lower GI GVHD have not consistently correlated with transplant outcomes and thus there is no established system for risk stratification for patients at the onset of lower GI GVHD when stratification would be most beneficial. We hypothesized that incorporation of characteristics evaluable at the onset GVHD such as plasma REG3α and albumin concentrations and clinical and histologic severity could help identify patients at the time of GVHD diagnosis who are unlikely to respond to conventional therapy and thus are at greatest risk of NRM. Plasma REG3α concentrations, serum albumin concentrations, clinical stage, and histologic grade as defined by Lerner (Transplant Proc; 6: 367–71) were all available at GVHD diagnosis for 140 patients experiencing lower GI GVHD from 3 HCT centers (129 from the University of Michigan and 11 from Regensburg, Germany, and Kyushu, Japan). Patients with lower GI GVHD who did not respond to GVHD therapy at 4 weeks had REG3α concentrations over 3-fold higher at onset than those who experienced at least a partial response (p<0.001). Patients with lower GI GVHD who had onset plasma REG3α concentrations above the median (>151 ng/ml) had increased 1-year NRM compared to those who had concentrations below the median (≤151 ng/ml; 59% versus 34%, respectively; p<0.001; Figure 1A). NRM was modeled with cumulative incidence regression methods as described by Fine and Gray (J Am Stat Assoc; 94: 496–509); probability of response was modeled with logistic regression. We performed an independent model analysis and found all 4 risk factors independently predicted lack of response to GVHD therapy four weeks following treatment and predicted 1-year NRM after adjustment for known risk factors of donor type, degree of HLA match, conditioning intensity, age and baseline disease severity (odds ratios: 4.8, 3.9, 18.9, and 2.5, respectively; Table 1). When lack of response to therapy and NRM were modeled simultaneously on all four parameters, all but albumin remained statistically significant when adjusting for the aforementioned risk factors. High REG3α concentration and histologic grade displayed the highest odds ratios for no response to treatment (5.7 and 16.7, respectively), while advanced clinical stage and histologic grade provided the highest hazard ratio for NRM (3.1 and 2.9, respectively). When only advanced clinical stage and severe histologic grade were considered, NRM was 71% (Figure 1B), but the inclusion of high REG3α concentration produced a significantly greater NRM of 86% for patients with all three risk factors (p<0.001; Figure 1C). Patients with increasing numbers of high risk parameters had increasing rates of NRM. Thus all three high risk parameters provided important prognostic information prior to the initiation of therapy rather than at the time of maximum grade of GVHD. If the prognostic value of REG3α is confirmed in additional patients, we believe the integration of clinical stage, histologic grade and REG3α plasma concentrations into a single grading system will permit better risk stratification and rapid identification of those patients with severe GI damage in whom standard treatment is likely to be insufficient.Table 1.REG3α concentrations and characteristics at onset of GVHD diarrhea predict 4-week response to GVHD therapy and 1-year NRM.No response to treatment (at 4 weeks)IndependentSimultaneousOdds Ratiop-value*Odds Ratiop-value*REG3α (high vs. low)4.8<0.0015.70.001GVHD GI onset stage (2–4 vs. 1)3.90.0013.00.027Histologic grade (4 vs. 1–3)18.9<0.00116.7<0.001Albumin (low vs. high)2.50.021.40.5IndependentSimultaneous1-Year NRMHazard Ratiop-value*Hazard Ratiop-value*REG3α (high vs. low)2.20.0032.40.002GVHD GI onset stage (2–4 vs. 1)3.0<0.0013.1<0.001Histologic grade (4 vs. 1–3)3.6<0.0012.9<0.001Albumin (low vs. high)2.30.0041.60.2*Adjusted for age, donor type, HLA match, conditioning intensity and disease status at transplant. Disclosures: No relevant conflicts of interest to declare.

Stifle arthrodesis using a locking plate system in six dogs

2015 ◽  
Vol 28 (04) ◽  
pp. 288-293 ◽  
Author(s):  
T. Nicetto ◽  
M. Petazzoni
Keyword(s):  
Body Weight ◽  
Medical Records ◽  
Tibial Fracture ◽  
Locking Plate ◽  
Sagittal Plane ◽  
Inclusion Criteria ◽  
Radiographic Outcomes ◽  
Locking Plate System ◽  
Plate System

SummaryObjectives: To describe the use of the Fixin locking plate system for stifle arthrodesis in dogs and to retrospectively report the clinical and radiographic outcomes in six cases.[uni2028]Materials and methods: Medical records of dogs that had arthrodesis with the Fixin locking plate system were reviewed. For each patient, data pertaining to signalment and implant used were recorded. Plate series and thickness, number of screws placed, number of cortices engaged, and screw diameters were also recorded. The outcome was determined from clinical and radiographic followups. Radiographic outcomes assessed included the measurement of the postoperative femoral-tibial angle in the sagittal plane.Results: Six dogs met the inclusion criteria for the study. Mean body weight was 13 kg (range: 3 - 34 kg). Radiographic follow-up (mean: 32 weeks, range: 3 - 52 weeks) was available for all dogs. In one case, an intra-operative complication occurred. In another case, a tibial fracture occurred 20 days after surgery. All arthrodeses healed and no implant complication was detected although all cases had mechanical lameness.Clinical significance: Stifle arthrodesis can be performed successfully using a Fixin locking plate system.

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

2014 ◽  
Vol 21 (6) ◽  
pp. 994-1003 ◽  
Author(s):  
Justin S. Smith ◽  
Ellen Shaffrey ◽  
Eric Klineberg ◽  
Christopher I. Shaffrey ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Full Length ◽  
Consecutive Series ◽  
Inclusion Criteria ◽  
The Mean ◽  
Spine Radiographs ◽  
Rod Fracture

Object Improved understanding of rod fracture (RF) following adult spinal deformity (ASD) surgery could prove valuable for surgical planning, patient counseling, and implant design. The objective of this study was to prospectively assess the rates of and risk factors for RF following surgery for ASD. Methods This was a prospective, multicenter, consecutive series. Inclusion criteria were ASD, age > 18 years, ≥5 levels posterior instrumented fusion, baseline full-length standing spine radiographs, and either development of RF or full-length standing spine radiographs obtained at least 1 year after surgery that demonstrated lack of RF. ASD was defined as presence of at least one of the following: coronal Cobb angle ≥20°, sagittal vertical axis (SVA) ≥5 cm, pelvic tilt (PT) ≥25°, and thoracic kyphosis ≥60°. Results Of 287 patients who otherwise met inclusion criteria, 200 (70%) either demonstrated RF or had radiographic imaging obtained at a minimum of 1 year after surgery showing lack of RF. The patients' mean age was 54.8 ± 15.8 years; 81% were women; 10% were smokers; the mean body mass index (BMI) was 27.1 ± 6.5; the mean number of levels fused was 12.0 ± 3.8; and 50 patients (25%) had a pedicle subtraction osteotomy (PSO). The rod material was cobalt chromium (CC) in 53%, stainless steel (SS), in 26%, or titanium alloy (TA) in 21% of cases; the rod diameters were 5.5 mm (in 68% of cases), 6.0 mm (in 13%), or 6.35 mm (in 19%). RF occurred in 18 cases (9.0%) at a mean of 14.7 months (range 3–27 months); patients without RF had a mean follow-up of 19 months (range 12–24 months). Patients with RF were older (62.3 vs 54.1 years, p = 0.036), had greater BMI (30.6 vs 26.7, p = 0.019), had greater baseline sagittal malalignment (SVA 11.8 vs 5.0 cm, p = 0.001; PT 29.1° vs 21.9°, p = 0.016; and pelvic incidence [PI]–lumbar lordosis [LL] mismatch 29.6° vs 12.0°, p = 0.002), and had greater sagittal alignment correction following surgery (SVA reduction by 9.6 vs 2.8 cm, p < 0.001; and PI-LL mismatch reduction by 26.3° vs 10.9°, p = 0.003). RF occurred in 22.0% of patients with PSO (10 of the 11 fractures occurred adjacent to the PSO level), with rates ranging from 10.0% to 31.6% across centers. CC rods were used in 68% of PSO cases, including all with RF. Smoking, levels fused, and rod diameter did not differ significantly between patients with and without RF (p > 0.05). In cases including a PSO, the rate of RF was significantly higher with CC rods than with TA or SS rods (33% vs 0%, p = 0.010). On multivariate analysis, only PSO was associated with RF (p = 0.001, OR 5.76, 95% CI 2.01–15.8). Conclusions Rod fracture occurred in 9.0% of ASD patients and in 22.0% of PSO patients with a minimum of 1-year follow-up. With further follow-up these rates would likely be even higher. There was a substantial range in the rate of RF with PSO across centers, suggesting potential variations in technique that warrant future investigation. Due to higher rates of RF with PSO, alternative instrumentation strategies should be considered for these cases.

scholarly journals MON-662 Diabetes Risk for Non-Obese Subjects in a Japanese Population

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Yoshimi Tatsukawa ◽  
Hiroko Kitamura ◽  
Michiko Yamada ◽  
Waka Ohishi ◽  
Ayumi Hida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Risk Factor ◽  
Blood Glucose ◽  
Fatty Liver ◽  
Handgrip Strength ◽  
Fasting Blood Glucose ◽  
Significant Risk ◽  
Metabolic Abnormality

Abstract [Background] Obesity is a major risk factor of developing diabetes and cardiovascular diseases, though not all obese people develop these conditions and diseases. Because Asian populations have a lower frequency of obesity in comparison with populations in the United States and Europe, it is important to detect risk factors for developing diabetes in non-obese Japanese populations. [Objectives] To examine risk factors for diabetes, and to consider countermeasures against diabetes development in Japanese populations, especially non-obese individuals. [Methods] This study examined 1,794 individuals (514 males and 1,280 females) who participated in both Adult Health Study health examinations on A-bomb survivors and their controls in Hiroshima and Nagasaki between 1994–1996 (baseline) and 2008–2011. They were aged 48–79 years and had not been diagnosed with diabetes at baseline or cancer. Obesity was defined as a BMI of 23 kg/m2 or greater based on the WHO recommendation for Asians. In accordance with AHA/NHLBI criteria for diagnosis of metabolic syndrome, we defined a diagnosis of metabolic abnormality as having at least two of the criteria other than abdominal obesity. The diagnostic criteria for diabetes were a fasting blood glucose ≥126 mg/dL, a non-fasting blood glucose ≥200mg/dL, a self-report of a diabetes diagnosis, or the initiation of medical treatment for diabetes during the follow-up period. We compared presences of fatty liver and metabolic abnormality, BMI at baseline, and changes of body weight from baseline between the group that developed diabetes and the group did not over a 15-year follow-up. [Results] During the follow-up period until 2001, 66 (7.0%) individuals and 127 individuals (14.8%) from the non-obese and obese groups, respectively, developed diabetes. BMI at baseline and presences of fatty liver and metabolic abnormality were associated with developing diabetes in both non-obese and obese groups. Changes in body weight from baseline were not a significant risk factor of diabetes in this study. Furthermore, we analyzed the association between diabetes risk and appendicular lean mass/height2 (ALM/H2) and handgrip strength based on the diagnostic criteria for sarcopenia among 676 subjects with information of these measurements at baseline. Occurrences of low ALM/H2 were associated with developing diabetes, but an association between low handgrip strength and developing diabetes was not observed. [Conclusion] Regardless of whether obesity was observed or not, presences of metabolic abnormality and fatty liver were significant risk factors. Increased risk of developing diabetes was observed among non-obese individuals with suspected sarcopenia. This study suggests that maintenance of muscle mass may be an effective countermeasure to reduce the risk of developing diabetes.

Imaging findings of patients undergoing SBRT for HCC after prior TACE.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 252-252
Author(s):  
Aneliya Maleeva ◽  
Tarita Thomas ◽  
Joseph H Yacoub
Keyword(s):  
Stereotactic Body Radiation Therapy ◽  
Lesion Size ◽  
The Other ◽  
Response To Treatment ◽  
Imaging Findings ◽  
Inclusion Criteria ◽  
Before And After ◽  
Liver Sbrt ◽  
Pre Treatment

252 Background: Our purpose is to assess the treatment response using follow up MRI or CT in lesions treated with stereotactic body radiation therapy (SBRT) after transarterial chemoembolization (TACE). Methods: Twenty-six patients treated with liver SBRT at our institution in the period between 2015 and 2017. Of these we included patients who had lesions diagnosed as HCC (LR-5) or probable HCC (LR-4), and who had prior TACE with a residual/recurrent enhancing component on the pre SBRT images with adequate post SBRT imaging. One radiologist (5 year experience) evaluated all pre and post SBRT imaging and measured the lesion size and the size of the largest enhancing component. Lesion decrease or increased in size was assessed based on the mRECIST criteria. Explant pathology results were collected for patients who received transplant. Necrosis > 90% on explant was considered full response to treatment. AFP (alpha-fetoprotien) values before and after SBRT were collected. Results: Eight patients with 9 lesions meet our inclusion criteria, 3 of which were LR-5 and 6 LR-4 prior to the TACE. At 3 month, 2 lesions had no residual enhancing component, 2 lesions decreased in size, 2 lesions increased in size, 3 lesions remain unchanged. After maximum available follow-up (ranging from 3 to 8 months), 3 lesions had no residual enhancing component, 2 decreased, 2 lesions increased in size, 2 lesions remain unchanged. Of the 3 lesions that were definitive HCC (LR-5): 1 lesion decreased in size, 2 lesions increased in size. 4 of 8 patients (4 lesions) underwent transplant, 3 of them showed only 50% necrosis on explant. 1 of 3 lesions showed no change in size by imaging, the other 2 lesions had no residual enhancing component. Only 1 lesion had full response on the transplant. This lesion was unchanged on 3 and 6 months follow up. The AFP was not helpful since the majority of the patient had low pre-treatment AFP. Conclusions: Patient with viable disease on imaging after TACE subsequently treated with SBRT demonstrated variable behavior on imaging. Close to half demonstrated resolution of the enhancing component, however, in the few that had explant follow up there was no correlation between imaging findings and pathology.

Has the Incidence of Extramedullary Disease Changed with the New Therapeutic Approaches? Analysis of a Cohort of 965 Multiple Myeloma (MM) Patients (pts).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4749-4749
Author(s):  
Marzia Varettoni ◽  
Alessandro Corso ◽  
Gianmatteo Pica ◽  
Patrizia Zappasodi ◽  
Silvia Mangiacavalli ◽  
...  
Keyword(s):  
Overall Survival ◽  
Median Time ◽  
Response To Therapy ◽  
Response To Treatment ◽  
High Dose ◽  
Solitary Plasmacytoma ◽  
Therapeutic Approaches ◽  
New Therapeutic Approaches ◽  
Over Time

Abstract Extramedullary myeloma (EMM) at diagnosis or during the course of the disease is rare and often anecdotal. We reviewed the records of 965 consecutive MM pts diagnosed and followed from 1969 to July 2007 in order to evaluate: the overall incidence of EMMs and the changes over time clinical presentation, response to treatment and outcome of EMM pts divided into two subgroups according to the time of appearance, at diagnosis or during the course of the disease. We considered three periods: 1969–1989 (conventional chemotherapy, CCT); 1990–1999 (introduction of high-dose therapy, HDT); 2000–2007, (era of novel agents). The overall incidence of EMM was of 13% (129/965 pts), 87/42 M/F, median age 58 (31–80) years. A prior MGUS was present in 24 pts and a solitary plasmacytoma in 10 (8%). Characteristics at the time of EMM were: 77 pts IgG (60%), 23 IgA (18%), 2 IgM (2%), 16 light chain (12%), 11 not secretory (8%); 29 pts were in stage I, 14 in stage II, 86 in stage III; 30/129 pts (23%) were asymptomatic. More frequently involved sites were: paravertebral (40%), rib cage (32%), pelvis (10%). Multiple localizations were present in 27 pts (21%). A plasmacytic leukemia was observed during the follow-up in 9 pts (7%). The overall median follow-up was 24.4 (2.5–148) months. Seventy-three pts presented EMM at the time of diagnosis with different incidences in the 3 periods: 1969–1989 4.5%, 1990–99 4.3%, 2000–07 12.7%. These pts were treated with HDT in 43 cases (59%) and CCT in 30 (41%). Radiotherapy (RT) was associated in 38 pts (52%). A partial response (PR) was achieved in 49 pts (67%). Progression or relapse were observed in 46 pts (63%) and the median time to progression (TTP) and overall survival (OS) in this subgroup of pts were 17.3 and 21.5 months respectively. The other 56 pts showed an EMM during the course of the disease after a median time of 20 (2–144) months from diagnosis. EMM incidence varied as follows: 1969–1989 2.7%, 1990–99 7.2%, 2000–07 7.4%. Median number of previous lines of therapy was 1 (range: 1–7), including HDT in 22 pts (39%), thalidomide or lenalidomide in 18 (32%), bortezomib in 5 (9%). The median time from HDT to EMM was 17 (2–125) months. Treatment of these pts consisted of CCT in 36 cases (64%), thalidomide in 3 (5%) and bortezomib in 8 (14%). RT was given in 29 cases (52%). Response rate in this subgroup was low, only 30% of pts obtained a PR. The median TTP and OS from the time of appearance of EMM were 4.7 and 6.5 months respectively and the overall survival from the diagnosis was 29.9 months. The two groups of EMM pts were also compared for all the clinical characteristics, response to therapy and outcome. EMM pts at diagnosis showed higher levels of monoclonal component and haemoglobin, and lower bone marrow plasmacytosis with respect to the others. OS from diagnosis was similar in the two groups. In conclusion, our study shows an increased incidence of EMM over time. The more recent increase of EMM at diagnosis might be due to the wider use of more sensitive imaging techniques as CT scan and magnetic resonance, while during the course of the disease after 1990 could be related to the longer survival of pts thanks to the new therapeutic approaches. Anyway, the presence of EMM whether at diagnosis or at progression seems to negatively affect the outcome of pts since the OS is shorter than MM pts without EMM.

Determinants of Significant Out-Of-Hospital Bleeding in Patients Undergoing Percutaneous Coronary Intervention

2018 ◽  
Vol 118 (11) ◽  
pp. 1997-2005 ◽  
Author(s):  
Sabato Sorrentino ◽  
Usman Baber ◽  
Bimmer Claessen ◽  
Anton Camaj ◽  
Birgit Vogel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Inclusion Criteria ◽  
Post Discharge ◽  
Free Trial ◽  
Tertiary Centre ◽  
Percutaneous Coronary ◽  
One Year

Background Although several variables have been identified as bleeding determinants (BDs), their occurrence and predictive value in patients undergoing percutaneous coronary intervention (PCI) in the real world remain unclear. We aimed to characterize the rate of BDs in patients undergoing PCI with stent implantation in a large volume tertiary centre. Methods We included patients undergoing coronary stenting at our institution from January 2012 to December 2016, and defined post-discharge bleeding (PDB) as bleeding requiring hospitalization or transfusion. Several BDs, identified by the PARIS bleeding and PRECISE-DAPT scores and inclusion criteria of the LEADERS FREE trial, were analysed. Results In a population of 10,406 subjects who underwent PCI, 2,938 patients (28.2%) had 1, 2,367 (22.8%) had 2 and 2,913 (28.0%) had ≥3 pre-specified BD. Compared with patients without PDB, subjects who experienced PDB were older (70.43 ± 11.94 vs. 65.90 ± 11.54 years, p < 0.0001) with a higher prevalence of common cardiovascular risk factors. One-year PDB occurred in 177 patients (2.4%), and consistently increased according to the number of BDs involved (1.12, 2.11 and 4.35%, respectively; p < 0.0001). Analogously, 1-year rates of post-discharge myocardial infarction or stent thrombosis increased according to the number of BDs (2.44, 3.38 and 4.87%, respectively; p < 0.0001). Only 7 BDs remained independently associated with PDB at 1 year, with anaemia, oral anticoagulant at discharge and malignancy representing the strongest predictors of such risk. Conclusion Many risk factors predispose to PDB; they were often clustered together and conferred additive PDB risk at 1-year of follow-up.

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