Cardiotoxicity and cardiomyopathy in children and young adult survivors of hematopoietic stem cell transplant.

Cardiomyopathy is common in long-term survivors of pediatric hematopoietic stem cell transplant (HSCT). Events occurring before and after HSCT when combined with specific insults during HSCT likely contribute to long-term risk. Strategies for detecting subclinical cardiomyopathy prior to patients developing overt heart failure are under investigation. Changes in HSCT preparative regimens and cardioprotective medications administered during chemotherapy may alter the risk for cardiomyopathy. Interventions in long-term survivors such as lifestyle modification and cardioactive medications are of increasing importance. Herein we review the causes of cardiac injury, discuss strategies for detection of cardiomyopathy, and evaluate therapeutic options for long-term HSCT survivors.

More is Less: Image Enhancement Technology Reduces Radiation Exposure During Anterior Lumber Interbody Fusion.

BACKGROUND CONTEXT: Fluoroscopy and radiation exposure occur during anterior lumbar interbody fusion (ALIF). Image enhancement technology is available that can potentially reduce radiation exposure. PURPOSE: The purpose of this study is to evaluate radiation exposure and fluoroscopy times comparing standard fluoroscopy (FL) with a low dose image enhancement platform (LD). STUDY DESIGN: Retrospective review of prospectively maintained database PATIENT SAMPLE: Consecutive patients undergoing ALIF with either standard fluoroscopy or low dose image enhancement technology OUTCOME MEASURES: Radiation dispersion and fluoroscopy times in ALIF patients with standard fluoroscopy and low dose image enhancement technology METHODS: A retrospective review of a prospective database on consecutive patients who have undergone ALIF, stratified into two groups: subjects with standard fluoroscopy (FL), and low dose fluoroscopy with image enhancement technology (LD). RESULTS: A total of 487 ALIF patients were included (FL: 372 vs LD: 115). LD patients were significantly older (66 vs 60 years), with more deformity cases (28% vs 12%), and less degenerative cases (71% vs 87%), all p<0.05; no differences in sex, BMI, or the number of levels operated on between groups. Fluoroscopy time (sec) was significantly higher in LD (51.4 vs 45.5), with a statistically significant reduction in radiation (mGy) compared to FL (23.3 vs 48.2), both p<0.05. Furthermore, the results showed that radiation dispersion is increasingly reduced as fluoroscopy time increases in LD compared to FL (12%, 56%, and 65% reduction in radiation dispersion for fluoroscopy time < 30 sec, between 30 to 60 sec, and > 60 sec, respectively). CONCLUSIONS: The use of low dose fluoroscopy with image enhancement technology significantly reduces the cumulative dose of radiation during ALIF compared to standard dose fluoroscopy. Also, radiation dispersion increasingly decreases as fluoroscopy time increases using low dose image enhancement technology. Low dose image enhancement technology improves the safety profile of ALIF for patients and operating room staff.

Gastrocardiac Fistula as a Complication of Prior Bariatric Surgery.

Gastrocardiac fistula is a rare, typically fatal, diagnosis which has been reported infrequently in post-esophagectomy patients and, to a much lesser extent, patients with history of Roux-en-Y gastric bypass. This case describes a patient with a history of an eroded adjustable gastric band and subsequent removal with conversion to Roux-en-Y gastric bypass that initially presented with an upper gastrointestinal bleed. She was found to have a transdiaphragmatic fistula between the gastric lumen and left ventricle.

Gastrocardiac Fistula as a Complication of Prior Bariatric Surgery.

Gastrocardiac fistula is a rare, typically fatal, diagnosis which has been reported infrequently in post-esophagectomy patients and, to a much lesser extent, patients with history of Roux-en-Y gastric bypass. This case describes a patient with a history of an eroded adjustable gastric band and subsequent removal with conversion to Roux-en-Y gastric bypass that initially presented with an upper gastrointestinal bleed. She was found to have a transdiaphragmatic fistula between the gastric lumen and left ventricle.