Aspirin resistance among patients with new and recurrent ischemic heart disease episodes in Qassim region, Saudi Arabia.

OBJECTIVE: Aspirin resistance is described as the failure of aspirin to decrease the production of thromboxane A2 by platelets, which is the mechanism by which aspirin decreases platelet activation and aggregation. This study was performed to assess the prevalence of aspirin resistance among cardiovascular patients in al-Qassim, Saudi Arabia. PATIENTS AND METHODS: The study used a survey of patients with first and recurrent attacks of ischemic heart disease (IHD) and available data from blood samples processed using a VerifyNow® kit, which measures aspirin reaction units (ARUs). RESULTS: A total of 119 patients were included: 45 with their first IHD episodes and 74 with recurrent episodes. Of the surveyed patients, 40% with a first episode were younger than 50 years old, and 75.6% of them have been diagnosed with IHD during the previous 5 years. Of the patients with recurrent attacks, 45.9% were older than 60 years, and 54.1% of them have been diagnosed more than 5 years before. The group with first episodes of IHD had 133.2 ARUs, whereas the group with recurrent episodes had 168.5 ARUs (p=0.105). In the recurrent-episode group, 77% had diabetes; in the first-episode group, only 37.8% had diabetes (p≤0.001). Overall, 46.2% were overweight, 54.6% were nonsmokers, and 82.4% underwent percutaneous coronary intervention. CONCLUSIONS: The study participants in both the new and recurrent IHD groups showed no sign of aspirin resistance. The presence of cardiovascular risk factors increased the likelihood of episode recurrence.

Radioembolization using yttrium-90 microspheres as bridging and downstaging treatment for unresectable hepatocellular carcinoma before liver transplantation: initial single-center experience.

INTRODUCTION: HCC is the sixth most common malignancy worldwide and is the third most common cause of cancer related mortality. Moreover, the incidence of HCC is increasing. Surgical treatments for HCC including resection and/or transplantation provide the best curative outcomes in early stages. Unfortunately, many patients present at an advanced stage. Currently, locoregional therapies have an emerging role in the management of HCC for bridging to liver transplantation and for downstaging the disease to within transplant criteria. Radioembolization is among commonly used locoregional therapies. OBJECTIVE: To describe our initial experience with the use of Therasphere® as bridging or downstaging modality before liver transplantation, including our institutional indications, technique and outcome. MATERIALS AND METHODS: We retrospectively examined our database for liver transplantation after the use of Therasphere®. Nine patients were identified and reported. RESULTS: They were 5 females and 4 males. Their current age range is 40-72 years with a mean of 53.8 ± 9.5 years. Three patients had Therasphere® as downstaging treatment to our institutional transplantation criteria. Our institution is using UCSF criteria as a cut off limit for liver transplantation as primary treatment modality. The other 6 patients had Therasphere® as bridging for liver transplantation especially when other modalities are not possible. None of these lesions were treated by any other locoregional treatment before or after Therasphere®. Follow-up after liver transplantation ranged between 3.7 and 60.1 months (mean of 15.8 ± 17.7 months). All patients are still living, no retransplantation was done and none of them showed evidence of disease recurrence (100% graft, patient and disease free survival). CONCLUSION: Our initial experience showed that Therasphere® is a promising therapeutic tool for both downstaging and bridging of HCC before liver transplant.

Use of yttrium-90 microsphere radioembolization of hepatocellular carcinoma as downstaging and bridge before liver transplantation: a case report.

BACKGROUND AND OBJECTIVE: Yttrium-90 microspheres radioembolization (Y90-RE) has been recently introduced as promising modality of treatment in patients with hepatocellular carcinoma (HCC) who are not otherwise candidates for local ablation, surgical resection, or liver transplantation (OLT). However, its use in downstaging HCC or as a bridge for OLT is still unclear. Herein, we have presented a case where Y90-RE was used to both downstage and to serve as a bridge for OLT. CASE REPORT: We report a 54-year-old lady who was known to have hepatitis B virus cirrhosis in addition to two focal hepatic lesions in segments 5 and 8, measuring 1.5 and 7.5 cm, respectfully. Extrahepatic spread was thoroughly ruled out. This tumor was clearly beyond both the Milans and University of California San Francisco criteria for OLT in HCC patients; therefore, we offered the patient Y90-RE in an attempt to downstage the tumor and as a bridge for OLT. Y90-RE was performed targeting the large lesion; the patient underwent cadaveric OLT 2 months thereafter. Gross examination of the explant showed necrotic tumor with obvious signs of irradiation-induced damage. Microscopic examination of the explant showed Y90 microspheres trapped in the large tumor with near-complete tumor necrosis. This patient completed 1-year post-OLT follow-up with no signs of tumor recurrence. CONCLUSIONS: The use Y90-RE in HCC may be useful for downstaging or as a bridge to liver transplantation.

Pancreatic pseudocyst in paediatric systemic lupus erythematosus.

Pancreatitis is a rare complication of paediatric systemic lupus erythematosus (SLE). We describe a child with severe form of SLE who initially developed acute pancreatitis, subsequently complicated by extensive pancreatic pseudocyst. The treatment and outcome are discussed.