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Refractory hypertension

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https://www.readbyqxmd.com/read/28635560/sorafenib-in-japanese-patients-with-locally-advanced-or-metastatic-medullary-thyroid-carcinoma-and-anaplastic-thyroid-carcinoma
#1
Yasuhiro Ito, Naoyoshi Onoda, Ken-Ichi Ito, Iwao Sugitani, Shunji Takahashi, Iku Yamaguchi, Koki Kabu, Katsuya Tsukada
BACKGROUND: Therapeutic options for treating advanced or metastatic medullary thyroid carcinoma (MTC) and anaplastic thyroid carcinoma (ATC) are still limited in Japan even though vandetanib for MTC, and lenvatinib for MTC and ATC have been approved. Sorafenib is an oral multikinase inhibitor approved for the treatment of patients with radioactive iodine-refractory (RAI-R) differentiated thyroid cancer (DTC). We conducted an uncontrolled, open-label, multicenter, single-arm, phase 2 clinical study to evaluate the safety and efficacy of sorafenib in Japanese patients with MTC and ATC...
June 21, 2017: Thyroid: Official Journal of the American Thyroid Association
https://www.readbyqxmd.com/read/28633365/phase-ii-study-of-copanlisib-a-pi3k-inhibitor-in-relapsed-or-refractory-indolent-or-aggressive-lymphoma
#2
M Dreyling, F Morschhauser, K Bouabdallah, D Bron, D Cunningham, S E Assouline, G Verhoef, K Linton, C Thieblemont, U Vitolo, F Hiemeyer, M Giurescu, J Garcia-Vargas, I Gorbatchevsky, L Liu, K Koechert, C Peña, M Neves, B H Childs, P L Zinzani
Background: Copanlisib is a pan-class I phosphatidylinositol 3-kinase (PI3K) inhibitor with predominant activity against the α- and δ- isoforms. Patients and methods: This phase II study evaluated the response rate of copanlisib administered intravenously on days 1, 8, and 15 of a 28-day cycle, in patients with indolent or aggressive malignant lymphoma. Archival tumor tissues were used for immunohistochemistry, gene-expression profiling, and mutation analysis...
June 14, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/28623993/management-of-refractory-chylous-ascites-with-peritoneovenous-shunts
#3
Ying Huang, Peter Gloviczki, Audra A Duncan, Mark D Fleming, David J Driscoll, Manju Kalra, Gustavo S Oderich, Thomas C Bower
OBJECTIVE: The purpose of this study was to define outcome of treatments of refractory chylous ascites using peritoneovenous shunts (PVSs). METHODS: Clinical data of patients with refractory chylous ascites treated with PVSs between 1992 and 2015 were retrospectively reviewed. The primary end point was clinical benefit, defined as cured, improved, or poor results; secondary end points were complications and reinterventions. RESULTS: Seventeen patients (eight female [47%]; median age, 47 years [range, 19-78 years]) with refractory chylous ascites were studied...
July 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28620841/device-based-approaches-for-the-treatment-of-arterial-hypertension
#4
REVIEW
Jens Jordan
Device-based antihypertensive treatments have primarily been developed and clinically tested for patients with hypertension refractory to pharmacological treatment. Most but not all device-based treatments target the sympathetic nervous system and provided important new insight in the mechanisms of human hypertension. This review provides an overview on the scientific rational and clinical data on recent device-based antihypertensive treatment approaches. Device-based treatments targeting the sympathetic nervous system include catheter-based renal nerve ablation, electrical carotid sinus stimulation, modulation of baroreflex transduction through a dedicated carotid stent, carotid body denervation, and deep brain stimulation...
July 2017: Current Hypertension Reports
https://www.readbyqxmd.com/read/28620552/refractory-lactic-acidosis-in-small-cell-carcinoma-of-the-lung
#5
Daniel J Oh, Ellen Dinerman, Andrew H Matthews, Abraham W Aron, Katherine M Berg
BACKGROUND: Elevated lactate levels in critically ill patients are most often thought to be indicative of relative tissue hypoxia or type A lactic acidosis. Shock, severe anemia, and thromboembolic events can all cause elevated lactate due to tissue hypoperfusion, as well as the mitochondrial dysfunction thought to occur in sepsis and other critically ill states. Malignancy can also lead to elevation in lactate, a phenomenon described as type B lactic acidosis, which is much less commonly encountered in the critically ill...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28602971/new-developments-in-hepatorenal-syndrome
#6
Ayse L Mindikoglu, Stephen C Pappas
Hepatorenal Syndrome (HRS) continues to be one of the major complications of decompensated cirrhosis leading to death in the absence of liver transplantation. Challenges in precisely evaluating renal function in the patient with cirrhosis remain due to the limitations of serum creatinine (Cr) alone in estimating glomerular filtration rate (GFR); current GFR estimating models appear to underestimate renal function. Newer models incorporating renal biomarkers, such as the Cr-Cystatin C GFR Equation for Cirrhosis appear to more accurately estimate true GFR...
June 7, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28595464/the-effects-of-baroreflex-activation-therapy-on-blood-pressure-and-sympathetic-function-in-patients-with-refractory-hypertension-the-rationale-and-design-of-the-nordic-bat-study
#7
Daniel Gordin, Fadl Elmula M Fadl Elmula, Bert Andersson, Anders Gottsäter, Johan Elf, Thomas Kahan, Kent Lodberg Christensen, Pirkka Vikatmaa, Leena Vikatmaa, Thomas Bastholm Olesen, Per-Henrik Groop, Michael Hecht Olsen, Ilkka Tikkanen
OBJECTIVE: To explore the effects of baroreflex activation therapy (BAT) on hypertension in patients with treatment resistant or refractory hypertension. METHODS: This investigator-initiated randomized, double-blind, 1:1 parallel-design clinical trial will include 100 patients with refractory hypertension from 6 tertiary referral hypertension centers in the Nordic countries. A Barostim Neo System will be implanted and after 1 month patients will be randomized to either BAT for 16 months or continuous pharmacotherapy (BAT off) for 8 months followed by BAT for 8 months...
June 8, 2017: Blood Pressure
https://www.readbyqxmd.com/read/28593148/endovascular-repair-in-acute-complicated-type-b-aortic-dissection-3-year-results-from-the-valiant-us-investigational-device-exemption-study
#8
REVIEW
Chang Young Lim
Acute complicated type B aortic dissection (TBAD) is a potentially catastrophic, life-threatening condition. If left untreated, there is a high risk of aortic rupture, irreversible organ or limb damage, or death. Several risk factors have been associated with acute complicated TBAD, including age and refractory hypertension. In the acute phase, even uncomplicated patients are more prone to develop complications if hypertension and pain are left medically untreated. Innovations in stent graft technologies have incrementally improved outcomes since their first use for this condition in 1999, though improvement is needed in mitigating periprocedural complications, adverse events, and mortality...
June 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28591324/case-2-2017-56-year-old-male-with-refractory-heart-failure-systemic-arterial-hypertension-and-aortic-valve-stenosis-that-led-to-heart-transplantation
#9
Desidério Favarato, Paulo Sampaio Gutierrez
No abstract text is available yet for this article.
May 2017: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/28590564/-beta-blockers-in-patients-with-advanced-liver-disease-has-the-dust-settled
#10
REVIEW
Carlos Moctezuma-Velazquez, Sylvia Kalainy, Juan G Abraldes
Non-selective beta blockers (NSBBs) have been the backbone for the treatment of portal hypertension in cirrhosis for the last three decades. A publication in 2010 of a prospective observational study suggested that NSBBs could increase mortality in patients with refractory ascites. This opened a controversy about the safety and efficacy of NSBBs in patients with advanced liver disease and led to the publication of a large corpus of observational data assessing the safety of NSBBs in patients with advanced cirrhosis...
June 7, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28583558/successful-treatment-of-a-patient-with-diffuse-portosplenomesenteric-thrombosis-using-a-pericholedochal-varix-for-portal-flow-reconstruction-during-deceased-donor-liver-transplantation-a-case-report
#11
Y-D Yu, D-S Kim, J-H Han, Y-I Yoon
Portal vein thrombosis remains a challenging issue in liver transplantation. When thrombectomy is not feasible due to diffuse portosplenomesenteric thrombosis, other modalities are adapted such as the use of a jump graft or portal tributaries or even multivisceral transplantation. For patients with diffuse thrombosis of the splanchnic venous system, a large pericholedochal varix can be a useful vessel for providing splanchnic blood flow to the graft and for relieving portal hypertension. We report our experience of successfully treating a patient with diffuse portosplenomesenteric thrombosis using a pericholedochal varix for portal flow reconstruction during deceased donor liver transplantation and eventually preventing unnecessary multivisceral transplantation...
June 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28583542/splenectomy-for-severe-intestinal-bleeding-caused-by-portal-hypertensive-enteropathy-after-pediatric-living-donor-liver-transplantation-a-report-of-three-cases
#12
K Tokodai, N Kawagishi, S Miyagi, C Nakanishi, Y Hara, W Nakanishi, T Kamei, N Ohuchi
BACKGROUND: The incidence of portal vein thrombosis after pediatric living-donor liver transplantation (LDLT) is reported to be higher than that after deceased-donor or adult liver transplantation. Portal vein thrombosis can cause portal hypertension and related complications, including portal hypertensive gastropathy or portal hypertensive enteropathy (PHE). PHE, in particular, can lead to severe intestinal bleeding, which is extremely difficult to treat. However, the pathogenesis of and appropriate treatment for PHE are not clearly defined, especially after pediatric LDLT...
June 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28566595/gastroesophageal-variceal-bleeding-successfully-controlled-by-partial-splenic-embolization
#13
Takayuki Kogure, Jun Inoue, Eiji Kakazu, Masashi Ninomiya, Tooru Shimosegawa
A 53-year-old male patient with a history of hepatocellular carcinoma developed gastroesophageal varices refractory to endoscopic injection sclerotherapy (EIS). He required EIS six times in 2 years for recurring variceal bleeding. After hepatic resection, he developed massive splenomegaly. Partial splenic embolization (PSE) was performed to reduce the portal pressure. Varices and variceal bleeding were not detected during 13-year follow up, until the patient died of hepatocellular carcinoma. This is a unique case of gastroesophageal varices controlled by PSE and improved portal hypertension...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28562736/bariatric-surgery-as-a-treatment-for-pseudotumor-cerebri-case-study-and-narrative-review-of-the-literature
#14
Everton Cazzo, Martinho Antonio Gestic, Murillo Pimentel Utrini, Felipe David Mendonça Chaim, Fábio Henrique Mendonça Chaim, Elaine Cristina Cândido, Luciana Bueno da Silveira Jarolavsky, Ana Maria Neder de Almeida, José Carlos Pareja, Elinton Adami Chaim
CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of child-bearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema...
May 29, 2017: São Paulo Medical Journal, Revista Paulista de Medicina
https://www.readbyqxmd.com/read/28559663/consecutive-sessions-of-rescue-balloon-atrial-septostomy-for-an-idiopathic-pulmonary-arterial-hypertension-patient-with-refractory-right-heart-failure-usefulness-of-intracardiac-echocardiography-guidance
#15
Yu-Wei Chen, Hung-Chih Pan, Kuo-Yang Wang, Kae-Woei Liang
For idiopathic pulmonary artery hypertension (PAH) patients with end-stage right heart failure who received maximal medical therapy, balloon atrial septostomy (BAS) is recommended by most guidelines as a palliative therapy or a bridging treatment before lung transplantation. In this report, we described a 32-year-old woman with idiopathic PAH, who received maximal PAH-specific medical treatment, including intravenous prostacyclin, but still suffered from refractory right heart failure. The markedly enlarged right atrium (RA), high mean RA pressure of 23 mmHg, low systemic arterial oxygen saturation of 86% and concomitant pancytopenia all increased the patient's risk for BAS...
May 2017: Acta Cardiologica Sinica
https://www.readbyqxmd.com/read/28543980/multicenter-analysis-of-the-use-of-transjugular-intrahepatic-portosystemic-shunt-tips-for-management-of-mpn-associated-portal-hypertension
#16
Christopher R Reilly, Daria V Babushok, Karlyn Martin, Jerry L Spivak, Michael Streiff, Ranjeeta Bahirwani, Jeffrey Mondschein, Brady Stein, Alison Moliterno, Elizabeth O Hexner
BCR-ABL1-negative myeloproliferative neoplasms (MPNs) are clonal stem cell disorders defined by proliferation of one or more myeloid lineages, and carry an increased risk of vascular events and progression to myelofibrosis and leukemia. Portal hypertension (pHTN) occurs in 7-18% of MPN patients via both thrombotic and nonthrombotic mechanisms and portends a poor prognosis. Transjugular intrahepatic portosystemic shunt (TIPS) has been used in the management of MPN-associated pHTN; however, data on long-term outcomes of TIPS in this setting is limited and the optimal management of medically refractory MPN-associated pHTN is not known...
May 24, 2017: American Journal of Hematology
https://www.readbyqxmd.com/read/28543165/recognition-of-early-mortality-in-multiple-myeloma-by-a-prediction-matrix
#17
Howard Terebelo, Shankar Srinivasan, Mohit Narang, Rafat Abonour, Cristina Gasparetto, Kathleen Toomey, James W Hardin, Gail Larkins, Amani Kitali, Robert M Rifkin, Jatin J Shah
Early mortality (EM; death ≤ 6 months from diagnosis) has been reported in several newly diagnosed multiple myeloma (NDMM) trials. Before the era of novel agents, the incidence was 10%-14%. Causes of death included infections/pneumonia, renal failure, refractory disease, and cardiac events. Staging systems, such as the revised International Staging System (r-ISS), and prognostic factors including cytogenetics, lactate dehydrogenase levels, and myeloma-specific factors, are useful to assess overall prognosis; however, they cannot predict EM...
May 24, 2017: American Journal of Hematology
https://www.readbyqxmd.com/read/28535940/-postpartum-hemorrhage-and-pregnancy-induced-hypertension-during-emergency-lower-segment-cesarean-section-dexmedetomidine-to-our-rescue
#18
Uma Hariharan
Dexmedetomidine is a highly selective α-2 agonist which has recently revolutionized our anesthesia and intensive care practice. An obstetric patient presented for emergency cesarean delivery under general anesthesia, with pre-eclampsia and postpartum hemorrhage. In carefully selected cases with refractory hypertension and postpartum hemorrhage, dexmedetomidine can be used for improving overall patient outcome. It was beneficial in controlling both the blood pressure and uterine bleeding during cesarean section in our patient...
May 20, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28533908/ascites-refractory-ascites-and-hyponatremia-in-cirrhosis
#19
Brett Fortune, Andres Cardenas
Ascites is the most common complication related to cirrhosis and is associated with increased morbidity and mortality. Ascites is a consequence of the loss of compensatory mechanisms to maintain the overall effective arterial blood volume due to worsening splanchnic arterial vasodilation as a result of clinically significant portal hypertension. In order to maintain effective arterial blood volume, vasoconstrictor and antinatriuretic pathways are activated, which increase overall sodium and fluid retention...
May 2017: Gastroenterology Report
https://www.readbyqxmd.com/read/28528859/efficacy-side-effects-and-monitoring-of-oral-cyclosporine-in-interstitial-cystitis-bladder-pain-syndrome
#20
Iryna M Crescenze, Barbara Tucky, Jianbo Li, Courtenay Moore, Daniel Shoskes
OBJECTIVE: To evaluate the efficacy of oral Cyclosporine A (CyA) in treatment of refractory interstitial cystitis/bladder pain syndrome (IC/BPS) and assess safety using drug level and renal function monitoring. METHODS: Patients with IC/BPS who failed at least 2 prior treatments were enrolled in an open-label study of oral CyA. Medication was started at 3 mg/kg divided twice daily for 3 months. Dose was adjusted based on side effects and drug level measured 2 hours after the morning dose (C2)...
May 18, 2017: Urology
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