Desmopressin as a hemostatic and blood sparing agent in bleeding disorders.

Intranasal, subcutaneous, or intravenous desmopressin can be utilized to release von Willebrand Factor and Factor VIII into circulation, enhance platelet adhesion and shorten bleeding time. Due to these properties, desmopressin can be effective in controlling bleeding in mild hemophilia A, certain subtypes of von Willebrand disease and in acute bleeding from uremia, end stage renal disease, and liver disease. Its use, however, can be complicated by hyponatremia and rarely arterial thrombotic events. While desmopressin has also been used as a prophylactic blood sparing agent in orthopedic, renal, and hepatic procedures, clinical studies have shown limited benefit in these settings. The purpose of this article is to review the evidence for desmopressin in primary hematologic disorders, discuss its mechanism of action and evaluate its utility as a hemostatic and blood sparing product in various bleeding conditions.

Quantitative DCE-MRI prediction of breast cancer recurrence following neoadjuvant chemotherapy: a preliminary study.

INTRODUCTION: Breast cancer patients treated with neoadjuvant chemotherapy (NACT) are at risk of recurrence depending on clinicopathological characteristics. This preliminary study aimed to investigate the predictive performances of quantitative dynamic contrast-enhanced (DCE) MRI parameters, alone and in combination with clinicopathological variables, for prediction of recurrence in patients treated with NACT. METHODS: Forty-seven patients underwent pre- and post-NACT MRI exams including high spatiotemporal resolution DCE-MRI. The Shutter-Speed model was employed to perform pharmacokinetic analysis of the DCE-MRI data and estimate the Ktrans, ve, kep, and τi parameters. Univariable logistic regression was used to assess predictive accuracy for recurrence for each MRI metric, while Firth logistic regression was used to evaluate predictive performances for models with multi-clinicopathological variables and in combination with a single MRI metric or the first principal components of all MRI metrics. RESULTS: Pre- and post-NACT DCE-MRI parameters performed better than tumor size measurement in prediction of recurrence, whether alone or in combination with clinicopathological variables. Combining post-NACT Ktrans with residual cancer burden and age showed the best improvement in predictive performance with ROC AUC = 0.965. CONCLUSION: Accurate prediction of recurrence pre- and/or post-NACT through integration of imaging markers and clinicopathological variables may help improve clinical decision making in adjusting NACT and/or adjuvant treatment regimens to reduce the risk of recurrence and improve survival outcome.

Clinical predictors for thrombus progression in cirrhotic patients with untreated splanchnic vein thrombosis.

INTRODUCTION: Splanchnic vein thrombosis (SVT) occurs in a heterogenous group of patients secondary to a variety of risk factors including liver disease. Minimal data regarding natural history and outcomes of SVT exists to inform management decisions. As such, there is equipoise regarding the utility of anticoagulation in cirrhotic patients with SVT. We sought to identify clinical factors predictive of new or progressive thrombosis in a cohort of patients with untreated SVT. METHODS: We conducted a retrospective cohort study of cirrhotic patients over 18 years of age diagnosed with SVT at the Oregon Health & Science University from 2015 to 2020, excluding those initially treated with anticoagulation. The primary study endpoint was a composite of the following: imaging-confirmed progression of SVT, development of cavernous transformation, intestinal ischemia, portal cholangiopathy or new venous or arterial thrombosis. RESULTS: 261 patients were included in the analysis (median age 61 years, 68% male, 32% female). Forty percent of all patients experienced the primary composite endpoint. Multivariable logistic regression found that only the presence of pancreatitis or abdominal infection at diagnosis was associated with an increased likelihood of experiencing thrombus progression in patients with untreated SVT (OR 3.61, P = 0.02). There was a statistically significant overall survival difference between patients that did and did not experience the primary composite endpoint after controlling for confounding variables. (p = 0.0068). CONCLUSIONS: Overall, only the presence of pancreatitis or intrabdominal infection were found to be significantly associated with thrombotic progression, with varices identified as marginally non-significant risk factor. Notably, thrombotic progression was associated with a significant reduction in overall survival.

Early Surface Ablation on Aborted LASIK Flaps.

PURPOSE: To report the outcomes of a series of 16 patients who had secondary surface ablation within 4 weeks of an aborted femtosecond laser-assisted in situ keratomileusis (FS-LASIK) procedure. METHODS: A retrospective chart review of electronic medical record data from 2011 to 2015 was performed to identify eyes of patients who had an aborted FS-LASIK procedure followed by secondary surface ablation (photorefractive keratectomy or laser epithelial keratomileusis) within 4 weeks of the primary procedure. Patients were required to have at least three postoperative visits to be included in the study. RESULTS: The review identified 20 aborted FS-LASIK procedures of 7,142 eyes (0.003%), of which 16 met the inclusion criteria. The most common reasons for abortion were incomplete (10) and decentered (3) flaps. Thirteen of 16 eyes were treated within 2 weeks. A total of 11 of 16 eyes achieved uncorrected distance visual acuity (UDVA) of 20/20, 13 of 16 achieved UDVA of 20/25 or better, and 15 of 16 had a corrected distance visual acuity (CDVA) of 20/20. There were no intraoperative complications during the second procedure and there were no cases of diffuse lamellar keratitis. One patient developed postoperative haze with a CDVA of 20/25 and was lost to follow-up. CONCLUSIONS: This case series indicates that early surface ablation (within 4 weeks) after an aborted FS-LASIK procedure may be performed with good visual outcomes. [J Refract Surg. 2019;35(2):121-125.].