Management of gynecologic surgery in the patient with factor XI deficiency: a review of the literature.

UNLABELLED: Factor XI deficiency is a rare bleeding disorder that is more commonly found in Ashkenazi Jews. Bleeding manifestations of this disorder are varied and poorly correlate with factor XI levels. Spontaneous bleeding is uncommon, whereas delayed postoperative bleeding is often the presentation of factor XI deficiency. To date, there are no standard recommendations for prophylactic treatment in women undergoing gynecologic surgery. Here, we review published cases of gynecological surgery in women with factor XI deficiency and discuss the risks and benefits of various therapeutic options. TARGET AUDIENCE: Obstetricians And Gynecologists. LEARNING OBJECTIVES: After participating in this activity, physicians should be better able to identify the pathophysiology of factor XI deficiency. Compare previous outcomes of prophylactic treatment in patients with factor XI deficiency undergoing gynecological surgery. Implement possible prophylactic therapies for patients with factor XI deficiency undergoing gynecological surgery.

Screening for distress in patients with brain cancer using the NCCN's rapid screening measure.

GOALS OF WORK: Patients with brain cancer are at a risk of experiencing elevated levels of distress due to the severe functional, neurocognitive, and neuropsychological sequelae of the disease. Using the National Comprehensive Cancer Network's Distress Thermometer, we evaluated the extent and sources of distress within a population of patients with brain cancer. PATIENTS AND METHODS: Participants were asked to complete the Distress Thermometer, a single-item rapid screening tool for distress. The Distress Thermometer is a visual analog scale on which participants rate their level of distress from '0' (none) to '10' (extreme). Participants were also asked to designate which items from a 34-item list constitute sources of distress. MAIN RESULTS: Fifty-two percent of participants met the > or =4 cut-off score for distress. The scores were positively correlated with patient-reported emotional sources of distress (r = 0.444, p < 0.001), physical sources of stress (r = 0.231, p < 0.05), and total number of concerns (r = 0.368, p < 0.001). On average, brain tumor patients reported 5.8 cancer-related items of concern. CONCLUSION: Brain cancer patients are likely to experience distress at some point during their disease trajectory. Patient-reported emotional sources of distress should be targeted and interventions should be designed to address sources of distress such as worry, sadness, and depression.

Enhanced ability of the progenipoietin-1 to suppress apoptosis in human hematopoietic cells.

Repopulating hematopoietic cell compartments after myeloablative chemotherapy remains a key factor in a successful chemotherapy program. Modified and chimeric cytokines have been developed to help reduce inflammation, fever and hospitalization time for patients. A chimeric cytokine, progenipoietin-1 (ProGP-1), containing the G-CSF and FL receptor agonists binds both the G-CSF receptor and FLT-3. It also stimulates the growth of dendritic cells, which play an important role in immunotherapy. While in vivo effects of ProGP-1 are well described, the mechanisms by which it stimulates growth are not well understood. We have investigated the effects of ProGP-1 on prevention of apoptosis in the human hematopoietic cell line OCI-AML.5. ProGP-1 promoted cellular proliferation better than G-CSF or FL separately but stimulated proliferation similar to their co-addition as demonstrated by growth curves and [3H]-thymidine incorporation. ProGP-1 prevented apoptosis to a greater degree than G-CSF or FL alone as determined by annexin V/propidium iodide binding and TUNEL assays. ProGP-1 promoted maintenance of the mitochondrial membrane potential better than G-CSF or FL alone. In addition, Pro-GP promoted a lower redox potential as higher levels of free radicals were detected after cytokine treatment than in cytokine-deprived cells implying increased respiration. These data indicate that ProGP-1 promotes the proliferation and prevents the apoptosis of human hematopoietic cells better than FL or G-CSF alone, and to a similar extent as their co-addition. Thus, ProGP-1 can be used to repopulate certain hematopoietic cells as a single entity rather than the introduction of two different cytokines.