Thrombosis associated with ventriculoatrial shunts

Object In this single-center study, the authors examined the clinical characteristics, risk factors, treatment strategies, and outcomes in patients with thrombosis associated with ventriculoatrial (VA) shunts. Methods Inpatient and outpatient charts of patients who underwent treatment and follow-up in the Hematology-Oncology Division at the authors' institution and in whom thrombosis developed secondary to a VA shunt placement were reviewed. A complete thrombophilia work-up was performed in each patient, and these records were also reviewed. Treatment including medical and surgical management was noted and outcome data were recorded. Results Resolution of thrombosis was seen after anticoagulation therapy in all patients; this may be an alternative to surgical therapy. Conclusions Patients with VA shunts represent a unique group at risk for thrombosis. The duration of anticoagulation therapy must be individualized. However, larger studies are needed to evaluate the efficacy of screening for asymptomatic thrombosis and to investigate the role of prophylactic anticoagulation.

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ECMO in COVID-19—prolonged therapy needed? A retrospective analysis of outcome and prognostic factors

Perfusion ◽

10.1177/0267659121995997 ◽

2021 ◽

pp. 026765912199599

Author(s):

Esther Dreier ◽

Maximilian Valentin Malfertheiner ◽

Thomas Dienemann ◽

Christoph Fisser ◽

Maik Foltan ◽

...

Keyword(s):

Lung Compliance ◽

Ecmo Support ◽

Short Term ◽

Single Center Study ◽

Venovenous Extracorporeal Membrane Oxygenation ◽

Baseline Characteristics ◽

Ecmo Therapy ◽

Vv Ecmo

Background: The role of venovenous extracorporeal membrane oxygenation (VV ECMO) in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) still remains unclear. Our aim was to investigate the clinical course and outcome of those patients and to identify factors associated with the need for prolonged ECMO therapy. Methods: A retrospective single-center study on patients with VV ECMO for COVID-19-associated ARDS was performed. Baseline characteristics, ventilatory and ECMO parameters, and laboratory and virological results were evaluated over time. Six months follow-up was assessed. Results: Eleven of 16 patients (68.8%) survived to 6 months follow-up with four patients requiring short-term (<28 days) and seven requiring prolonged (⩾28 days) ECMO support. Lung compliance before ECMO was higher in the prolonged than in the short-term group (28.1 (28.8–32.1) ml/cmH2O vs 18.7 (17.7–25.0) ml/cmH2O, p = 0.030). Mechanical ventilation before ECMO was longer (19 (16–23) days vs 5 (5–9) days, p = 0.002) and SOFA score was higher (12.0 (10.5–17.0) vs 10.0 (9.0–10.0), p = 0.002) in non-survivors compared to survivors. Low viral load during the first days on ECMO tended to indicate worse outcomes. Seroconversion against SARS-CoV-2 occurred in all patients, but did not affect outcome. Conclusions: VV ECMO support for COVID-19-induced ARDS is justified if initiated early and at an experienced ECMO center. Prolonged ECMO therapy might be required in those patients. Although no relevant predictive factors for the duration of ECMO support were found, the decision to stop therapy should not be made dependent of the length of ECMO treatment.

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SAT0267 ROLE OF AGGRESSIVE IMMUNOSUPPRESSION ON SUBGLOTTIC STENOSIS IN GRANULOMATOSIS WITH POLYANGIITIS: RETROSPECTIVE ANALYSIS OF A MONOCENTRIC COHORT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2582 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1076.1-1077

Author(s):

L. Moroni ◽

L. Giudice ◽

G. A. Ramirez ◽

S. Sartorelli ◽

A. Cariddi ◽

...

Keyword(s):

Medical Treatment ◽

Clinical Characteristics ◽

Granulomatosis With Polyangiitis ◽

Balloon Catheter ◽

Subglottic Stenosis ◽

Damage Accrual ◽

The Mean ◽

The One

Background:Subglottic stenosis (SGS) is defined as airway narrowing below the vocal cords and is a common and potentially life-threatening manifestation of Granulomatosis with Polyangiitis (GPA), with an estimated prevalence of 16-23% (1). Balloon catheter dilation is effective in GPA-related SGS, but relapses are frequent. Little is known about the role of immunosuppression in this setting.Objectives:to analyse the clinical characteristics of a monocentric GPA cohort, describe phenotype differences among patients with and without SGS and investigate the role of surgical and medical treatments on relapse risk and general outcome.Methods:Biopsy-proven patients with SGS were identified by review of medical charts among a cohort of patients with GPA, classified according to the algorithm of the European Medicine Agency (2). The clinical characteristics of patients with SGS were retrospectively collected over a median follow-up time of 15.9 years and compared to those of patients without SGS.Results:Fourteen patients with SGS-GPA were identified, with a female to male ratio of 1:1 and a prevalence of 29.2% among the cohort. The mean ± SD age at GPA onset was 30.8 ± 14.4 years, with a mean time from GPA diagnosis to SGS onset of 4.7 ± 4.2 years. ANCA were positive in 78.6% (54.0% anti-PR3, 18.1% anti-MPO and 27.9% IFI only). The mean Birmingham Vasculitis Activity Score (BVAS) at onset was 10.0 ± 5.6. The main clinical manifestations associated with SGS were crusty rhinitis (100%), sinusitis (78%), pulmonary disease (72.7%), otitis/mastoiditis (50%), glomerulonephritis (42.9%), orbital pseudotumor (28.6%). Six patients (42.9%) received medical treatment only, other six (42.9%) had one to three balloon dilations and two (14.2%) underwent four or more procedures. Eight patients had no SGS relapse (maximum one dilation) and they all received immunosuppression with rituximab (RTX), cyclophosphamide (CYC) or azathioprine (AZA). All patients who received no immunosuppression, methotrexate (MTX) or mycophenolate (MMF) had at least one relapse. Patients treated with MTX or MMF had a mean relapse-free survival of 13.1 months, which was comparable to the one of patients not receiving medical treatment (40.2 months; p=NS) and shorter than the one of patients receiving CYC or RTX (153.2 months; p=0.032). CYC use also inversely correlated with the number of surgical procedures (r=-0.691, p=0.006). Compared to patients without SGS (31 consecutive patients with at least 4 years of follow-up), patients with SGS-GPA had an earlier disease onset (mean age 30.8 vs 50.4 years; p<0.001), but with lower BVAS (mean 10.0 vs 15.3; p=0.013) and showed a higher prevalence of crusty rhinitis (100% vs 67.7%; p=0.019). No difference was observed in damage accrual over time between the two groups.Conclusion:Subglottic stenosis is highly prevalent in patients with GPA and may define a milder disease subset occurring more frequently in younger patients. MTX and MMF might be insufficient to prevent SGS relapses requiring balloon dilation. Aggressive immunosuppression (CYC or RTX) might have a non-redundant role in this setting and reduce the risk of relapses.References:[1]Quinn KA, et al. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology 2019; 58 (12), 2203-2211.[2]Watts R, et al. Development and validation of a consensus methodology for the classification of the ANCA associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007; 66: 222-7.Disclosure of Interests:Luca Moroni: None declared, Laura Giudice: None declared, Giuseppe Alvise Ramirez: None declared, Silvia Sartorelli: None declared, adriana cariddi: None declared, Angelo Carretta: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

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Imaging to Differentiate the Various Forms of Seronegative Arthritis

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0038-1639467 ◽

2018 ◽

Vol 22 (02) ◽

pp. 189-196

Author(s):

Kay-Geert Hermann ◽

Anna Zejden ◽

Iwona Sudoł-Szopińska ◽

Iris Eshed

Keyword(s):

Human Leukocyte ◽

Leukocyte Antigen ◽

Important Diagnostic Tool ◽

Inflammatory Bowel ◽

Diagnostic Work ◽

Factor Α ◽

Work Up ◽

Necrosis Factor

AbstractSpondyloarthritis (SpA) is a group of diseases characterized by back pain, spinal inflammation, human leukocyte antigen-B27 positivity, and peripheral findings such as dactylitis, enthesitis, and uveitis. It includes ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated SpA. The role of imaging in the diagnosis, management, and follow-up of patients with SpA has become dramatically more important with the introduction of new therapies such as tumor necrosis factor-α inhibitors. Although in many instances differentiating between the SpA entities is straightforward based on the clinical presentation, often such differentiation remains challenging, and categorization of an individual patient into a subset of SpA can be difficult. Imaging, mainly radiography and magnetic resonance imaging, serves as an important diagnostic tool. Diseases in the spondyloarthritis complex share common presentation but at the same time may have distinct radiographic phenotypes. We present these common and distinct imaging manifestations that may potentially help distinguish between the entities in the diagnostic work-up.

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Can EPS Development be Avoided with Early Interventions? The Potential Role of Tamoxifen—A Single-Center Study

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00286 ◽

2014 ◽

Vol 34 (6) ◽

pp. 582-593 ◽

Cited By ~ 18

Author(s):

Erika De Sousa–Amorim ◽

Gloria Del Peso ◽

M. Auxiliadora Bajo ◽

Laura Alvarez ◽

Marta Ossorio ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cumulative Number ◽

Randomized Controlled Studies ◽

Single Center Study ◽

Ultrafiltration Failure ◽

Life Threatening ◽

Severe Peritonitis ◽

Prompt Diagnosis

BackgroundEncapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD). Identification of patients at high risk for EPS (“EPS-prone”) and delivery of appropriate interventions might prevent its development. Our aim was to evaluate the clinical characteristics and outcomes of all EPS and EPS-prone patients diagnosed at our PD unit.MethodsFor a 30-year period representing our entire PD experience, we retrospectively identified all patients with EPS (diagnosed according to International Society for Peritoneal Dialysis criteria) and all patients defined as EPS-prone because they met at least 2 established criteria (severe peritonitis, PD vintage greater than 3 years, severe hemoperitoneum, overexposure to glucose, and acquired ultrafiltration failure).ResultsOf 679 PD patients, we identified 20 with EPS, for an overall prevalence of 2.9%. Mean age at diagnosis was 50.2 ± 16.4 years, with a median PD time of 77.96 months (range: 44.36 – 102.7 months) and a median follow-up of 30.91 months (range: 4.6 – 68.75 months). Of patients with EPS, 10 (50%) received tamoxifen, 10 (50%) received parenteral nutrition, and 2 (10%) underwent adhesiolysis, with 25% mortality related to EPS. Another 14 patients were identified as EPS-prone. Median follow-up was 54.05 months (range: 11.9 – 87.04 months). All received tamoxifen, and 5 (36%) received corticosteroids; none progressed to full EPS. We observed no differences in baseline data between the groups, but the group with EPS had been on PD longer (84 ± 53 months vs 39 ± 20 months, p = 0.002) and had a higher cumulative number of days of peritoneal inflammation from peritonitis (17.2 ± 11.1 days vs 9.8 ± 7.9 days, p = 0.015). Overall mortality was similar in the groups. The incidence of EPS declined during our three decades of experience (5.6%, 3.9%, and 0.3%).ConclusionsBeing a serious, life-threatening complication of PD, EPS requires high suspicion to allow for prompt diagnosis and treatment. Early detection of EPS-prone states and delivery of appropriate intervention might prevent EPS development. Tamoxifen seems to be a key strategy in prevention, but caution should be used in interpreting our results. Additional randomized controlled studies are needed.

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Imaging of pulmonary hypertension in adults: a position paper from the Fleischner Society

European Respiratory Journal ◽

10.1183/13993003.04455-2020 ◽

2021 ◽

Vol 57 (1) ◽

pp. 2004455

Author(s):

Martine Remy-Jardin ◽

Christopher J. Ryerson ◽

Mark L. Schiebler ◽

Ann N.C. Leung ◽

James M. Wild ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Working Group ◽

Position Paper ◽

Or Management ◽

Multidisciplinary Assessment ◽

Work Up ◽

Key Questions ◽

Pathophysiologic Mechanisms

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure greater than 20 mmHg and classified into five different groups sharing similar pathophysiologic mechanisms, haemodynamic characteristics, and therapeutic management. Radiologists play a key role in the multidisciplinary assessment and management of PH. A working group was formed from within the Fleischner Society based on expertise in the imaging and/or management of patients with PH, as well as experience with methodologies of systematic reviews. The working group identified key questions focusing on the utility of CT, MRI, and nuclear medicine in the evaluation of PH: a) Is noninvasive imaging capable of identifying PH? b) What is the role of imaging in establishing the cause of PH? c) How does imaging determine the severity and complications of PH? d) How should imaging be used to assess chronic thromboembolic PH before treatment? e) Should imaging be performed after treatment of PH? This systematic review and position paper highlights the key role of imaging in the recognition, work-up, treatment planning, and follow-up of PH.

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Feasibility of surgical management in patients with mammary tuberculosis-study of 100 cases.

TAJ Journal of Teachers Association ◽

10.3329/taj.v27i1.37614 ◽

2018 ◽

Vol 27 (1) ◽

pp. 44-49

Author(s):

RN Laila ◽

B Islam ◽

S Banu ◽

J Raihan

Keyword(s):

Surgical Intervention ◽

Treatment Strategies ◽

Diagnosis And Treatment ◽

Idiopathic Granulomatous Mastitis ◽

Breast Tuberculosis ◽

Chest Disease ◽

Disease Hospital ◽

Anti Tubercular Therapy

Tuberculous mastitis is a rare entity in patients with mammary disease even in countries where incidence of tuberculosis is high. In Bangladesh, TB is an endemic disease but breast tuberculosis is rarely reported. Its clinical patterns and treatment strategies are changing day by day. With this study, we aimed to analyze the role of surgery in diagnosis and treatment of hundred (100) cases received care for tuberculous mastitis at the Chest Disease Hospital, Rajshahi, from July’ 2012 to July’ 2016. This is a prospective nonrandomized descriptive study. Diagnosis was made in all patients initially by cytological examination from suspected lesions, which revealed typical tuberculous lesions. In all the patients the diagnosis was confirmed by biopsy of the lesion (open biopsy or core cut biopsy) with histological examination and detection of acid fast bacilli in discharge by Gene x-pert test and Z-N staining to exclude idiopathic granulomatous mastitis, malignancy and very rare concomitant malignancy. Medical therapy with anti-tubercular drugs (ATT) ranging from 9 to 12 months with follow up monthly was the mainstay of treatment. Surgical intervention reserved for selected refractory cases (36%). Extension of anti-tubercular therapy from 9 to 12 or 18 months required in fifty-eight(58) patients on the basis of slow clinical response. Complete resolution obtained in 92 patients but residual tiny mass in eight patients confirmed by repeated FNAC or biopsy to be fibrotic. Surgery play an essential role both in diagnosis and treatment of tubercular mastitis in addition with ATT but beware about unnecessary surgical intervention as majority of patients cured with only ATT.TAJ 2014; 27(1): 44-49

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Clinical characteristics and outcomes of patients with venous thromboembolism according to diagnosis on weekends versus weekdays: from the COMMAND VTE Registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.2280 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Yamashita ◽

T Morimoto ◽

T Makiyama ◽

K Ono ◽

T Kimura

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Clinical Outcomes ◽

Clinical Characteristics ◽

Anticoagulation Therapy ◽

Treatment Strategies ◽

Funding Source ◽

Medical Systems ◽

Severe Condition ◽

Entire Cohort

Abstract Background/Introduction The medical systems of hospitals often differs between on weekends and weekdays. These differences could lead different clinical outcomes for patients with acute medical conditions that require complex treatment strategies. However, the effect of the time of diagnosis on clinical outcomes in patients with acute venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is still controversial. Purpose We sought to evaluate the clinical characteristics and outcomes of patients with VTE comparing on weekends and weekdays in a large observational database of VTE in Japan. Methods The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic VTE objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. In the current analysis, diagnosis on weekends was defined as diagnosis during the period from 00:00 hours on Saturday to 24:00 on Sunday. All other times were defined as weekdays. We divided the entire cohort into 2 groups; diagnosis on weekends and diagnosis on weekdays groups, and we compared the clinical characteristics, management strategies and 30-day outcomes between the 2 groups. Results The current study population consisted of 337 patients diagnosed on weekends and 2690 patients diagnosed on weekdays. The median days from onset to diagnosis were shorter in the patients diagnosed on weekends than in those diagnosed on weekdays (2 days vs. 4 days, P<0.001). The patients diagnosed on weekends presented with PE more frequently (72% vs. 55%, P<0.001), and they showed more severe condition for PE with a higher simplified pulmonary embolism severity index score. The vast majority of PE patients were diagnosed by contrast-enhanced computed tomography in both groups (97% vs. 97%, P=0.67). The patients diagnosed on weekends more often received initial parenteral anticoagulation therapy and thrombolysis than those diagnosed on weekdays. The cumulative 30-day incidence of all-cause death was not significantly different between the 2 groups among PE patients (diagnosis on weekends: 6.2% vs. diagnosis on weekdays: 6.5%, P=0.87), as well as among DVT patients (0.0% vs. 1.5%, P=0.24) (Figure). After adjusting the confounders, the risk of diagnosis on weekends relative to diagnosis on weekdays for all-cause death among PE patients was still insignificant (adjusted HR: 0.76; 95% CI: 0.42–1.28). The most frequent cause of deaths was fatal PE in both groups among PE patients. The risks for recurrent VTE and major bleeding at 30 days were not significantly different between the 2 groups among PE patients nor DVT patients. Conclusions The VTE patients diagnosed on weekends presented with PE more frequently, and they showed more severe condition for PE, although the risks for short-term mortality were not significantly different between patients diagnosed on weekends and weekdays. Kaplan-Meier curves for all-cause death Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

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Outcome of leiomyosarcoma of bone: A single center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e21502 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e21502-e21502

Author(s):

Rajeev Rajendra ◽

Seth Pollack ◽

Eve T. Rodler ◽

Ernest U. Conrad ◽

Darin J Davidson ◽

...

Keyword(s):

Local Recurrence ◽

Neoadjuvant Chemotherapy ◽

Surgical Resection ◽

Treatment Strategies ◽

Recurrence Time ◽

Low Grade ◽

High Grade ◽

Response To Chemotherapy

e21502 Background: Leiomyosarcoma (LMS) of bone is a very rare sarcoma subtype. These tumors are managed akin to osteosarcoma, with neoadjuvant chemotherapy followed by surgery. The precise role of chemotherapy remains to be defined. Methods: Patients treated with primary bone LMS at the University of Washington between 2002 and 2012 were included. Patients with high grade tumors were treated with neoadjuvant chemotherapy and surgery; whereas those with low grade tumors were treated with surgical resection alone. Chemotherapy consisted of doxorubicin and ifosfamide x 2 cycles. Treatment details included: initial treatment (surgery versus chemo), surgical and pathological margins, and timing of chemotherapy. Follow-up data included: time to local recurrence, time to metastasis, time to last follow up if alive, or time to death. Results: Ten patients were identified, 4 male and 6 female. Median age at diagnosis: 52 years (range 29 - 91). The primary site was the distal femur in 5 patients, and the hemipelvis, acetabulum, proximal femur, distal clavicle and mid-shaft of femur in 1 patient each. Median tumor size at diagnosis was 8 cm. Five were high-grade tumors; 3 were intermediate and 2 were low grade. Four of 10 patients received neoadjuvant chemotherapy, with the following histological response; 70%, 30%, 15% and <5%. None of these patients had a dimensional radiological response to chemotherapy. Of the patients treated with surgery alone, one developed a local recurrence and another developed metastatic disease. Of the patients treated with chemotherapy and surgery, 1 died from an unrelated cause. Median follow-up was 9 months (range 0 - 83). Median DFS was 9 months (range 0 - 83). OS has not yet been reached. Conclusions: Surgical resection remains the mainstay of management of LMS of bone. The role of neoadjuvant chemotherapy requires further evaluation. Larger collaborative studies and biomarker analyses are essential to evaluate optimal treatment strategies for this rare disease.

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The Role of MRI in Prostate Cancer Active Surveillance

BioMed Research International ◽

10.1155/2014/203906 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 18

Author(s):

Linda M. Johnson ◽

Peter L. Choyke ◽

William D. Figg ◽

Baris Turkbey

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Treatment Strategies ◽

Low Grade ◽

Common Cancer ◽

High Incidence ◽

Aggressive Tumors ◽

Slow Growing

Prostate cancer is the most common cancer diagnosis in American men, excluding skin cancer. The clinical behavior of prostate cancer varies from low-grade, slow growing tumors to high-grade aggressive tumors that may ultimately progress to metastases and cause death. Given the high incidence of men diagnosed with prostate cancer, conservative treatment strategies such as active surveillance are critical in the management of prostate cancer to reduce therapeutic complications of radiation therapy or radical prostatectomy. In this review, we will review the role of multiparametric MRI in the selection and follow-up of patients on active surveillance.

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