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G F Pierce, A Haffar, G Ampartzidis, F Peyvandi, S Diop, M El-Ekiaby, H M van den Berg
INTRODUCTION: The gaps in haemophilia treatment around the world are enormous; approximately 60% of an estimated 475 000 individuals are not identified. Of the 187 000 diagnosed, 30% (57 000) access clotting factor replacement therapy. Since 1996, humanitarian aid distributed by the World Federation of Hemophilia (WFH) has played a minor, yet vital role providing life-saving clotting factor to countries in emergency situations. Donated amounts have been small and sporadic, often salvaging short-dated products, providing little opportunity to leverage donations with governments...
March 14, 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
María Victoria Alvarez-Sánchez, O B Luna, I Oria, K Marchut, F Fumex, G Singier, A Salgado, B Napoléon
BACKGROUND: It has been suggested that EUS-BD may be a feasible and safer alternative to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in patients with ascites. To date, no study has specifically evaluated the performance of EUS-BD in this context. METHODS: Retrospective analysis was done for patients with and without ascites who underwent EUS-BD for malignant biliary obstruction after failed ERCP between July 2010 and September 2014. Complications and technical and clinical successes between the two groups were compared...
March 12, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Craig I Coleman, Alexander G G Turpie, Thomas J Bunz, Jan Beyer-Westendorf
PURPOSE: Frailty predicts poorer outcomes in patients receiving anticoagulation. We sought to assess the effectiveness and safety of rivaroxaban versus warfarin in frail patients experiencing venous thromboembolism in routine practice. METHODS: Using United States MarketScan claims data from 1/2012-12/2016, we identified frail patients (using the Johns Hopkins Claims-Based Frailty Indicator score) who had ≥1 primary hospitalization/emergency department visit discharge diagnosis code for venous thromboembolism (index event), received rivaroxaban or warfarin as their first outpatient oral anticoagulant (OAC) within 30-days of the index event and had ≥12-month of insurance coverage prior the index venous thromboembolism (baseline)...
March 8, 2018: American Journal of Medicine
Ewa Zabrocka, Marek Z Wojtukiewicz, Ewa Sierko
Advanced cancer patients in hospice are at notably increased risk of venous thromboembolism (VTE) due to age, local and distal advancement of the malignancy and bed confinement, among other factors. Asymptomatic VTE prevalence among palliative care patients has been found to reach 50%, whereas the clinically overt form occurs in 10%. Hospice patients are frequently given medications increasing VTE risk, for instance megestrol which is a drug commonly used in cancer cachexia. Many of the available guidelines encourage the implementation of thromboprophylaxis (TPX) in cancer patients, e...
February 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
V Piloni, M Bergamasco, G Melara, P Garavello
BACKGROUND: The aim of the present study was to assess the relationship between symptoms of obstructed defecation and findings on magnetic resonance (MR) defecography in males with obstructed defecation syndrome (ODS). METHODS: Thirty-six males with ODS who underwent MR defecography at our institution between March 2013 and February 2016 were asked in a telephone interview about their symptoms and subsequent treatment, either medical or surgical. Patients were divided into 2 groups, one with anismus (Group 1) and one with prolapse without anismus (Group 2)...
March 6, 2018: Techniques in Coloproctology
Robert H G Schwinger
Elderly people show increased probability to develop atherosclerotic diseases; in consequence heart failure - most often following coronary heart disease - as well as atrial fibrillation is more common. Following guidelines may lead to polypharmacy, i. e. use of more than 5 drugs daily. Thus, drug interactions as well as side effects become more likely; especially in elderly patients reduced kidney function has to be taken into account. Only drugs which have shown to prolong life or to reduce symptoms in controlled clinical trials should be used...
February 2018: Deutsche Medizinische Wochenschrift
D Sharma, G Singh
AIM: This retrospective observational study was done to analyze age, gender, site of primary tumor and histological characterstics in patients of colorectal carcinoma in the first two decades of life. MATERIAL AND METHOD: A total of 373 patients of colorectal patients were registered in the Department of Radiation Oncology from January 2010 to December 2015. Patients who were <20 years of age were analyzed for clinicopathological characteristic. RESULTS: In our study, a total of 29 out of 373 patients (7...
April 2017: Indian Journal of Cancer
Lizandra M Paravidine Sasaki, Keitty R C Andrade, Ana Claudia Morais Godoy Figueiredo, Miriam da S Wanderley, Maurício G Pereira
The objective of our study was to estimate the frequency of pre-malignant and malignant lesions in endometrial polyps and to evaluate associated clinical and demographic factors. A literature search was performed in major databases and the gray literature using the terms polyps OR endometrial polyp AND endometrial neoplasms OR endometrial cancer OR endometrial hyperplasia OR malignan*. Studies describing the frequency of pre-malignant and malignant lesions in endometrial polyps and any clinical or demographic factors associated with malignant lesions extracted using hysteroscopy were considered eligible...
February 14, 2018: Journal of Minimally Invasive Gynecology
G Naldini, A Sturiale, B Fabiani, I Giani, C Menconi
BACKGROUND: The aim of the present study was to evaluate the safety and efficacy of autologous, micro-fragmented and minimally manipulated adipose tissue injection associated closure of the internal opening in promoting healing of complex anal fistula. METHODS: A pilot study was conducted on patients referred to our center with anal fistula, from April 2015-December 2016. Inclusion criteria were age over 16 years old and a diagnosis of complex anal fistula according to the American Gastroenterological Association classification The patients were divided into 2 groups; the "first time group" (Group I) in which micro-fragmented adipose tissue injection with closure of the internal opening was the first sphincter-saving procedure, and the "recurrent group" (Group II) consisting of patients who had failed prior sphincter-saving procedures...
February 16, 2018: Techniques in Coloproctology
Amit P Amin, Patricia Crimmins-Reda, Samantha Miller, Brandon Rahn, Mary Caruso, Andrew Pierce, Brandy Dennis, Marissa Pendegraft, Katrine Sorensen, Howard I Kurz, John M Lasala, Alan Zajarias, Richard G Bach, Hemant Kulkarni, Jasvindar Singh
BACKGROUND: Same-day discharge (SDD) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low-risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a "patient-centered" protocol based on risk of complications at Barnes-Jewish Hospital. METHODS AND RESULTS: Our objectives were as follows: (1) to evaluate time trends in SDD; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD (NSDD); and (3) to compare SDD eligibility by our patient-centered approach versus Society for Cardiovascular Angiography and Interventions guidelines...
February 15, 2018: Journal of the American Heart Association
Timothy Mott, Kelly Latimer, Chad Edwards
Many Americans between 45 and 65 years of age experience hemorrhoids. Hemorrhoidal size, thrombosis, and location (i.e., proximal or distal to the dentate line) determine the extent of pain or discomfort. The history and physical examination must assess for risk factors and clinical signs indicating more concerning disease processes. Internal hemorrhoids are traditionally graded from I to IV based on the extent of prolapse. Other factors such as degree of discomfort, bleeding, comorbidities, and patient preference should help determine the order in which treatments are pursued...
February 1, 2018: American Family Physician
H C A M Hazendonk, I van Moort, R A A Mathôt, K Fijnvandraat, F W G Leebeek, P W Collins, M H Cnossen
Replacement therapy with clotting factor concentrates (CFC) is the mainstay of treatment in hemophilia. Its widespread application has led to a dramatic decrease in morbidity and mortality in patients, with concomitant improvement of quality of life. However, dosing is challenging and costs are high. This review discusses benefits and limitations of pharmacokinetic (PK)-guided dosing of replacement therapy as an alternative for current dosing regimens. Dosing of CFC is now primarily based on body weight and based on its in vivo recovery (IVR)...
January 31, 2018: Blood Reviews
Yutaka Tomizawa, Akiko Tanaka, Hiroto Kitahara, Atsushi Sakuraba, Nir Uriel, Valluvan Jeevanandam, Takeyoshi Ota
BACKGROUND: Large scale data on preoperative risk stratification for gastrointestinal bleeding (GIB) following continuous-flow left ventricular assist device (CF-LVAD) implantation are scarce. AIMS: To identify independent predictors for GIB following CF-LVAD implantation. METHODS: We conducted a retrospective cohort study of consecutive 243 patients who underwent CF-LVAD implantation (HeartMateII) from January 2009 to March 2015 at the University of Chicago Medical Center...
February 8, 2018: Digestive Diseases and Sciences
Craig I Coleman, Alexander G G Turpie, Thomas J Bunz, William L Baker, Jan Beyer-Westendorf
INTRODUCTION: Screening for primary hypercoagulable states (PHSs) in venous thromboembolism (VTE) patients was not mandated in the EINSTEIN trials; and therefore, few patients with a known PHS were available for analysis. We sought to assess the effectiveness and safety of rivaroxaban versus warfarin for treatment of VTE in patients with a known PHS. METHODS: Using MarketScan claims data from 1/2012-9/2015, we identified adults with a primary diagnosis of VTE during a hospitalization/emergency department visit (the index event), with ≥180-days of continuous insurance coverage prior to the index event, a documented diagnosis for a PHS and newly-initiated as an outpatient on rivaroxaban or warfarin within 30-days of the index VTE...
January 31, 2018: Thrombosis Research
Yi Zeng, Haibo Si, Canfeng Li, Yuangang Wu, Bin Shen
PURPOSE: The aim of this study was to demonstrate the association between tranexamic acid (TXA)-combined application and knee flexion in the first 24 hour post-operatively that could reduce total blood loss and transfusion need in patients undergoing total knee arthroplasty (TKA), without sacrificing safety. METHODS: Ninety TKA patients were divided into three groups randomly: the flexion group: the knee was in 90° flexion position for the first 12 hour post-surgery and kept at 60°for the next 12 hour, combined with 1 g TXA topical and 1 g TXA intravenous application...
February 2, 2018: International Orthopaedics
J Gebhart, S Hofer, S Panzer, P Quehenberger, R Sunder-Plassmann, G Hoermann, E Eigenbauer, H Haslacher, S Kepa, P A Kyrle, S Eichinger, P Knöbl, L Eischer, C Mannhalter, C Ay, I Pabinger
INTRODUCTION: Data on clinical characteristics and the prevalence of underlying coagulopathies in patients with mild-to-moderate bleeding disorders (MBDs) are scarce. AIM: We established the Vienna Bleeding Biobank (VIBB) to characterize and thoroughly investigate Austrian patients with MBDs. RESULTS: Four hundred eighteen patients (female = 345, 82.5%) were included. A platelet function defect (PFD) was diagnosed in 26 (6.2%) and a possible PFD in 30 (7...
February 1, 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
Jorinde H van Laanen, Tom Cornelis, Barend M Mees, Elisabeth Litjens, Magda M van Loon, Jan H Tordoir, Arnoud G Peppelenbosch
OBJECTIVE: To determine the best operation technique, open versus laparoscopic, for insertion of a peritoneal dialysis (PD) catheter with regard to clinical success. Clinical success was defined as an adequate function of the catheter 2 - 4 weeks after insertion. METHODS: All patients with end-stage renal disease who were suitable for PD and gave informed consent were randomized for either open surgery or laparoscopic surgery. A previous laparotomy was not considered an exclusion criterion...
January 31, 2018: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Martin Broberg, James Doonan, Filip Mundt, Sandra Denman, James E McDonald
BACKGROUND: Britain's native oak species are currently under threat from acute oak decline (AOD), a decline-disease where stem bleeds overlying necrotic lesions in the inner bark and larval galleries of the bark-boring beetle, Agrilus biguttatus, represent the primary symptoms. It is known that complex interactions between the plant host and its microbiome, i.e. the holobiont, significantly influence the health status of the plant. In AOD, necrotic lesions are caused by a microbiome shift to a pathobiome consisting predominantly of Brenneria goodwinii, Gibbsiella quercinecans, Rahnella victoriana and potentially other bacteria...
January 30, 2018: Microbiome
A G Beburishvili, S I Panin, E N Zyubina
AIM: To obtain new data for diagnosis and treatment of patients with perforated cholecystitis. MATERIAL AND METHODS: It was analyzed the variants of original classification of perforated cholecystitis by Fedorov S.P. - Neimeier O.W. (1934). Moreover, we have assessed treatment of 292 patients with gallbladder perforation (own material of Faculty Surgery Clinic). RESULTS: According to continuous 20-year follow-up perforated cholecystitis was observed in 2...
2018: Khirurgiia
J Waskowski, J C Schefold, F Stueber
BACKGROUND: Minimising perioperative bleeding is a key goal of "patient blood management" programs. One component of respective strategies includes preventive inhibition of fibrinolysis using protease inhibitors, such as tranexamic acid (TXA). TXA inhibits plasminogen activation and plasmin-induced fibrin degradation. OBJECTIVES: The present article provides an overview of the existing literature and TXA applications in the prophylaxis of perioperative bleeding...
January 24, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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