scholarly journals A rare case of myelodysplastic syndrome with refractory thrombocytopenia

2015 ◽  
Vol 7 (3) ◽  
Author(s):  
Waqas Jehangir ◽  
John Webb ◽  
Shilpi Singh ◽  
Sabrina Arshed ◽  
Shuvendu Sen ◽  
...  
Keyword(s):  
Rare Case ◽  
Treatment Options ◽  
Gene Mutations ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Genetic Mutations ◽  
Specific Gene ◽  
High Morbidity ◽  
Risk Patients ◽  
Evidenced Based

Myelodysplastic syndromes (MDS) represent a variety of clonal abnormalities, possibly preleukemic and display numerous phenotypic manifestations. Specific mutations carry high morbidity and mortality rates due to cell line dysplasia. MDS commonly presents with symptoms related to anemia, and approximately two-thirds will develop thrombocytopenia, a rare, but potentially lethal complication that increases complexity in treatment and morbidity, and may be due to unique genetic mutations leading to refractory thrombocytopenia, ultimately leading to an overall reduction in survival. Careful identification and monitoring of this patient subdivision can significantly reduce morbidity and mortality, and potential identification of specific gene mutations and advances in treatment options will hopefully provide guidance on detecting at-risk patients in the future. We present a case of a man with MDS-U (karyotype 46, XY, del (20) (q11.2q13.3) (20) with no detected <em>JAK2</em> <em>V617F</em> mutation), who in despite of appropriate evidenced based treatment, continued to exhibit refractory thrombocytopenia.

scholarly journals Review: Research Toward Safer Resection of the Cirrhotic Liver

HPB Surgery ◽  
2000 ◽  
Vol 11 (5) ◽  
pp. 285-297 ◽  
Author(s):  
M. A. J. Moser ◽  
N. M. Kneteman ◽  
G. Y. Minuk
Keyword(s):  
Surgical Technique ◽  
Liver Function ◽  
Mortality Rates ◽  
Cirrhotic Liver ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Hepatic Surgery ◽  
Postoperative Course ◽  
Cirrhotic Patients ◽  
Surgery Resection

Despite recent advances in hepatic surgery, resection of the cirrhotic liver continues to be fraught with high morbidity and mortality rates. As a result, for many patients requiring resection of HCC the postoperative course is complicated and the probability of cure is diminished by coexisting cirrhosis. In this review, we discuss the characteristics of the cirrhotic liver which make it poorly tolerant of resection and the most common complications that follow such surgery. The main purpose of this paper is to review recent attempts to identify interventions that might be beneficial to cirrhotic patients undergoing resection. These interventions include assessment of liver reserve, advances in surgical technique, and improvement in liver function and regeneration.

scholarly journals Obturator Hernia: A Rare Case of Acute Mechanical Intestinal Obstruction

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Ibrahim Aydin ◽  
Ahmet Fikret Yucel ◽  
Ahmet Pergel ◽  
Dursun Ali Sahin
Keyword(s):  
Elderly Patients ◽  
Intestinal Obstruction ◽  
Rare Case ◽  
Mortality Rates ◽  
Obturator Hernia ◽  
Morbidity And Mortality ◽  
Common Symptom ◽  
Rare Type ◽  
Mechanical Intestinal Obstruction

Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common symptom is strangulation combined with mechanical intestinal obstruction.

scholarly journals Recent drug approvals for acute myeloid leukemia

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Catherine Lai ◽  
Kimberley Doucette ◽  
Kelly Norsworthy
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Treatment Options ◽  
Gene Mutations ◽  
Review Article ◽  
New Drugs ◽  
Specific Gene ◽  
New Agents ◽  
Survival Pathways ◽  
Acute Myeloid

Abstract Acute myeloid leukemia (AML) is the most common form of acute leukemia in adults, with an incidence that increases with age, and a generally poor prognosis. The disease is clinically and genetically heterogeneous, and recent advances have improved our understanding of the cytogenetic abnormalities and molecular mutations, aiding in prognostication and risk stratification. Until recently, however, therapeutic options were mostly limited to cytotoxic chemotherapy. Since 2017, there has been an explosion of newly approved treatment options both nationally and internationally, with the majority of new drugs targeting specific gene mutations and/or pivotal cell survival pathways. In this review article, we will discuss these new agents approved for the treatment of AML within the last 2 years, and will outline the mechanistic features and clinical trials that led to their approvals.

Management of Esophageal Perforation: 28-Year Experience in a Major Referral Center

2018 ◽  
Vol 84 (5) ◽  
pp. 684-689 ◽  
Author(s):  
Ana Puertavicente ◽  
Pablo Priego JimÉNez ◽  
María Ángeles Cornejo López ◽  
Francisca GarcÍA-Moreno Nisa ◽  
Gloria RodrÍGuez Velasco ◽  
...  
Keyword(s):  
Esophageal Perforation ◽  
Severe Disease ◽  
Treatment Options ◽  
Delayed Diagnosis ◽  
Mortality Rates ◽  
Endoscopic Management ◽  
High Morbidity ◽  
Septic Complications ◽  
Delay In Diagnosis ◽  
Individualized Approach

Esophageal perforation constitutes a surgical emergency. Despite its gravity, no single strategy has been described as sufficient to deal with most situations to date. The aim of this study was to assess the etiology, management, and outcome of esophageal perforation over a 28-year period, to characterize optimal treatment options in this severe disease. A retrospective clinical review of all patients treated for esophageal perforation at Ramón y Cajal Hospital between January 1987 and December 2015 was performed (n = 57). Iatrogenic injury was the most frequent cause of esophageal perforation (n = 32). Abdominal esophagus was the main location (23 patients; 40.4%). Eight patients (14%) were managed with antibiotics and parenteral nutrition. In seven patients (12.3%), an endoscopic stent was implanted. Surgical therapy was performed in 38 patients (66.7%). Morbidity and 90-day mortality rates were 61.4 and 28 per cent, respectively. Five patients were reoperated (8.8%). Median hospital stay was 23.5 days. The mortality rate was higher among patients with spontaneous and tumoral perforation (54.5 and 100%; P = 0.009), delayed diagnosis (>24 hours; P = 0.0001), and abdominal/thoracic location (37.5%; P = 0.05). No statistical differences were found between surgical and conservative/endoscopic management (31% vs 20%; P = 0.205) although hospital staying was longer in surgical group (36.30 days vs 15.63 days; P = 0.029). Esophageal perforation was associated with high morbidity and mortality rates. Global outcomes depend on etiology, site of perforation, and delay in diagnosis. An individualized approach for each patient should be chosen to prevent septic complications of this potentially fatal disease.

Emergent Right Hemicolectomies

2005 ◽  
Vol 71 (8) ◽  
pp. 653-657 ◽  
Author(s):  
Amy D. Wyrzykowski ◽  
David V. Feliciano ◽  
Timothy A. George ◽  
Lorraine N. Tremblay ◽  
Grace S. Rozycki ◽  
...  
Keyword(s):  
Damage Control ◽  
Primary Anastomosis ◽  
Bowel Perforation ◽  
Demographic Data ◽  
Wound Dehiscence ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Trauma Patients ◽  
Abdominal Abscess

Emergent right hemicolectomies have historically been associated with surprisingly high morbidity and mortality rates. A retrospective review of emergent right hemicolectomies over a 7-year period was performed to assess current morbidity and mortality. Emergent right hemicolectomy was defined as a procedure performed for an acute abdomen with no formal preoperative cleansing of the colon. Demographic data, diagnostic evaluation, length of stay and outcomes were evaluated. Over the study period, 122 emergent right hemicolectomies were performed on both general surgery and trauma patients. The average patient was 52.9 ± 18.5 years old, and the majority of patients (66.4%) were male. The indications for the procedures performed were bowel perforation (51), hemorrhage (25), cancer (16), benign obstruction (14), phlegmon (8), ischemia (6), or other (2). Resection with primary anastomosis was performed in 98 patients, 16 had an end ileostomy, and 8 underwent damage control procedures in which gastrointestinal continuity was not reestablished at the time of the original operation. Postoperative complications developed in 48 patients (39.3%). The majority of the complications (83.3%) were related to infection including intra-abdominal abscess (21 patients), sepsis (16), and wound infection (5). Other complications included anastomotic leak (5), wound dehiscence (3), stoma-related (3) and postoperative bowel obstruction (2). The patients who developed complications did not differ from those who had an uneventful postoperative course in terms of age, indication for procedure, or presence of intra-abdominal abscess or gross contamination at the time of the original procedure. The overall mortality rate was 13 per cent. Patients who died were older than those who lived (63 ± 19 vs 52 ± 18; P = 0.03) and were significantly more likely to have evidence of shock on presentation ( P = 0.0013). Emergent right hemicolectomies continue to be associated with high morbidity and mortality rates. The most common complications are related to infection. Age and manifestations of shock at the time of admission are strong predictors of mortality.

Thirty-day morbidity and mortality rates for carotid artery intervention by surgeons who perform both carotid endarterectomy and carotid artery angioplasty and stent placement

2007 ◽  
Vol 106 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Robert D. Ecker ◽  
Tsz Lau ◽  
Elad I. Levy ◽  
L. Nelson Hopkins
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Carotid Revascularization ◽  
Symptomatic Carotid ◽  
Risk Patients ◽  
Related Group ◽  
The University

Object There is no known standard 30-day morbidity and mortality rate for high-risk patients undergoing carotid artery (CA) angioplasty and stent (CAS) placement. The high-risk registries and the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy, Carotid Revascularization using Endarterectomy or Stenting Systems, and European Long-term Carotid Artery Stenting trials report different rates of morbidity and mortality, and each high-risk cohort has a different risk profile. The applicability of carotid endarterectomy (CEA) results from North American Symptomatic Carotid Endarterectomy Trial/Asymptomatic Carotid Atherosclerosis Study (NASCET/ACAS) remains uncertain, as most clinical CAS placement series reported to date typically included patients who would not have qualified for those studies. At the University at Buffalo, the same neurosurgeons perform triage in patients with CA disease and perform both CEA and CAS insertion. The authors review morbidity and mortality rates in this practice model. Methods Diagnosis-related group codes were used to search the authors’ practice database for patients who had undergone a completed CA intervention solely for the indication of atherosclerotic disease. One hundred twenty patients (129 vessels) treated with CAS surgery and 95 patients (100 vessels) treated with CEA met these criteria. In the CAS placement group, 78% of the patients would not have met NASCET/ACAS inclusion criteria. Demographic and clinical data for both groups were recorded on a spreadsheet for analysis. At 30 days, one patient in the CEA group and two in the CAS group had died. Stroke occurred in one patient in the CAS group and none in the CEA group. Myocardial infarction (MI) occurred in one patient who underwent CAS surgery compared with three undergoing CEA. Composite incidence of stroke/death/MI was 3.3% in the CAS group and 3.2% in the CEA group. Conclusions In a practice in which surgeons perform both CEA and CAS surgery, the event rates for the CAS surgery equivalent to NASCET and ACAS rates for CEA can be achieved, even in high-risk NASCET/ACAS-ineligible patients in 78% of the CAS cases.

An Immersed Porous Boundary Method for Computational Fluid Dynamics of Blood Flow in Aneurysms With Flow Diverters

2012 ◽  
Author(s):  
Viorel Mihalef ◽  
Puneet Sharma ◽  
Ali Kamen ◽  
Thomas Redel
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Flow Diverters

Intracranial aneurysms are pathological dilatations of a cerebral artery that may suffer rupture and lead to subarachnoid hemorrhage. Such a condition presents high morbidity and mortality rates for the patients concerned.

scholarly journals Morbidity and Mortality Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy at a Single Institution in Japan

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Akiyoshi Mizumoto ◽  
Emel Canbay ◽  
Masamitsu Hirano ◽  
Nobuyuki Takao ◽  
Takayuki Matsuda ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Single Institution ◽  
Crs And Hipec

Background. Even though cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are associated with a high morbidity and mortality rates, it has been reported that CRS and HIPEC improved survival of selected patients with peritoneal carcinomatosis. We aimed to report morbidity and mortality results of CRS and HIPEC from a single institution in Japan.Methods and Results. Total of 284 procedures of CRS were performed on patients with pseudomyxoma peritonei, peritoneal carcinomatosis (PC) from colon cancer and gastric cancer between 2007 and 2011 in our institution. The morbidity rate was 49% of all procedure, and grades I/II and grades III/IV complications were 28% and 17%, respectively. Most frequent complication was surgical site infections including intraabdominal abscess. The mortality rate was 3.5%, and reoperation was needed in 11% of all procedures. Univariate and multivariate analysis showed peritoneal carcinomatosis index (PCI) greater than 20 was the only significant factor for occurrence of postoperative complications (P<0.01). In contrast, HIPEC significantly reduced postoperative complications (P<0.05).Conclusions. The morbidity and mortality rates of our institution are comparable with previous reports that are in acceptable rates. Optimal patient selection such as patients with PCI less than 20 seems to be of paramount importance to CRS and HIPEC.

scholarly journals Fungal Biofilms 2020

2021 ◽  
Vol 7 (8) ◽  
pp. 603
Author(s):  
Célia F. Rodrigues ◽  
Jesus A. Romo
Keyword(s):  
Healthcare Costs ◽  
Fungal Infections ◽  
Mortality Rates ◽  
Multidrug Resistant ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Effective Response ◽  
Multidrug Resistant Pathogens ◽  
Global Threat

Fungal infections are an important and increasing global threat, carrying not only high morbidity and mortality rates, but also extraordinary healthcare costs. Without an effective response, it is predicted that 10 million people will die per year because of multidrug-resistant pathogens. [...]

scholarly journals Recurrent Glioblastoma: From Molecular Landscape to New Treatment Perspectives

Cancers ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 47
Author(s):  
Cristina Birzu ◽  
Pim French ◽  
Mario Caccese ◽  
Giulia Cerretti ◽  
Ahmed Idbaih ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Kinase Inhibitors ◽  
Treatment Options ◽  
Gene Mutations ◽  
Genetic Alterations ◽  
Recurrent Glioblastoma ◽  
Molecular Characteristics ◽  
Specific Gene ◽  
Primary Tumors ◽  
First Line Therapy

Glioblastoma is the most frequent and aggressive form among malignant central nervous system primary tumors in adults. Standard treatment for newly diagnosed glioblastoma consists in maximal safe resection, if feasible, followed by radiochemotherapy and adjuvant chemotherapy with temozolomide; despite this multimodal treatment, virtually all glioblastomas relapse. Once tumors progress after first-line therapy, treatment options are limited and management of recurrent glioblastoma remains challenging. Loco-regional therapy with re-surgery or re-irradiation may be evaluated in selected cases, while traditional systemic therapy with nitrosoureas and temozolomide rechallenge showed limited efficacy. In recent years, new clinical trials using, for example, regorafenib or a combination of tyrosine kinase inhibitors and immunotherapy were performed with promising results. In particular, molecular targeted therapy could show efficacy in selected patients with specific gene mutations. Nonetheless, some molecular characteristics and genetic alterations could change during tumor progression, thus affecting the efficacy of precision medicine. We therefore reviewed the molecular and genomic landscape of recurrent glioblastoma, the strategy for clinical management and the major phase I-III clinical trials analyzing recent drugs and combination regimens in these patients.

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