Successful management of refractory immune-mediated thrombotic thrombocytopenic purpura during pregnancy and delivery using the anti-VWF nanobody caplacizumab.

Pregnancy is a potential trigger of acute thrombotic thrombocytopenic purpura (TTP). The management of pregnancy-associated immune-mediated TTP (iTTP) can be challenging, especially when it is refractory to standard treatment. Caplacizumab, a nanobody to von Willebrand factor (VWF) blocking its A1 domain, is a valuable new therapeutic option. Its use is, however, not approved during pregnancy and breastfeeding. We describe the successful off-label administration of caplacizumab during pregnancy and delivery in a patient with refractory iTTP. The favourable outcome without significant thrombotic or haemorrhagic complications indicates that caplacizumab may be an effective and safe treatment option in refractory iTTP during pregnancy.

Clinical comparison between wall defects surgery using conventional and low-adhesion mesh materials Preliminary results.

PURPOSE: The use of prosthetic materials for hernia repair has become a standard procedure. Still the optimal material has not yet been found. Primitive hernia with loss of substance and big incisional hernia repair requires a prosthetic material which not induce, especially in the area of visceral peritoneal contact, chronic inflammation and fibrosis. The aim of this study is to clinically compare two different mesh materials: uncoated monofilament polypropylene and polypropylene- polyurethane double surface mesh. METHODS: Forty eight primitive hernia and incisional hernia affected patients were included in the study. They were randomly allocated in two groups. In each group a different type of mesh was utilized, respectively uncoated monofilament polypropylene mesh and polypropylene-polyurethane double surface synthetic mesh. Lichtenstein and Rives surgical techniques were utilized. Intra-operative, early and late post-operative complications were clinically evaluated. RESULTS: Uncoated monofilament polypropylene meshes treated patients showed higher abdominal pain, inflammatory diseases and hernia recurrence incidence than polypropylene-polyurethane double surface meshes. Abdominal wall hypo-mobility, discomfort and atypical sensation were the same in the two groups of treated patients. CONCLUSIONS: Given the limited number of our patient's set, from our preliminary results is possible to assert that polypropylene-polyurethane double surface meshes have revealed superior bio-functional and bio-compatible efficacy.