1,721,197 research outputs found
Thrombophilic screening in young patients (
No full textThromb Res. 2011 Feb;127(2):85-90. Epub 2010 Dec 18.
Thrombophilic screening in young patients (< 40 years) with idiopathic ischemic
stroke: a controlled study.
Dragoni F, Chiarotti F, Rosano G, Simioni P, Tormene D, Mazzucconi MG, Cafolla A,
Avvisati G.
Thrombosis Center, Department of Biotecnologie Cellulari ed Ematologia,
University Sapienza, Rome, Italy. [email protected]
INTRODUCTION: Despite extensive clinical and laboratory investigations, the
etiology of ischemic stroke remains unknown in approximately one third of
patients.
MATERIALS AND METHODS: Thirty-four consecutive patients less than 40 years old
(Males 13, Females 21, mean age 26.6 years, range 2-39) with documented ischemic
stroke underwent, one year after the acute event, laboratory evaluation of
antithrombin, protein C, free and total protein S, activated protein C
resistance, fibrinogen, factor VII:C, homocysteine levels and antiphospholipid
antibodies (APA). Moreover, prevalence of F5 R506Q, F2 G2021A and homozygosis for
thermolabile variant C677T of the methylenetetrahydrofolate reductase (MTHFR)
were also evaluated and compared to the results obtained in 120 normal controls.
RESULTS: Antithrombin and protein C levels resulted normal in all cases. One
patient (2.9%) showed free protein S deficiency and 3 patients (8.8%) had
activated protein C resistance. Homocysteine levels above 15 μmol/L were found in
one patient (2.9%). APA were found in 21 patients (61.7%) and in only 2 out of
120 (1.66%) controls (OR=95.31; 95% C.I.: 18.22-667.81). The multivariate
analysis selected that the presence of APA was significantly associated with an
increased risk of stroke (OR=156.60; 95% C.I.: 25.99-943.47) in this cohort of
patients. The combination between APA and cardiovascular risk factors determined
a risk of 29-fold (OR=29.31; 95% CI: 3.28-261.69).
DISCUSSION: Our data suggest that the presence of APA is associated with an
increased risk of idiopathic ischemic stroke in young patients. Furthermore, also
the combination of APA and cardiovascular risk factors is significantly
associated with development of idiopathic ischemic stroke.
Copyright © 2010 Elsevier Ltd. All rights reserved.
PMID: 21172722 [PubMed - indexed for MEDLINE
Fibrin glue for endoscopic gastrointestinal bleeding in patients with impaired haemostasis.
No full textNo abstract availabl
Recurrent thrombophlebitis in a colon cancer patient with C677T heterozygous genotype for MTHFR treated with 5-fluorouracil-based adjuvant chemotherapy
No full textIntraventricular thrombosis during all-trans retinoic acid treatment in acute promyelocytic leukemia.
No full textAcute promyelocytic leukemia: a curable disease
No full textThe Second International Symposium on Acute Promyelocytic Leukemia (APL) was held in Rome in 12-14 November 1997. Clinical and basic investigators had the opportunity to discuss in this meeting the important advances in the biology and treatment of this disease achieved in the last 4 years, since the First Roman Symposium was held in 1993. The first part of the meeting was dedicated to relevant aspects of laboratory research, and included the following topics: molecular mechanisms of leukemogenesis and of response/resistance to retinoids, biologic and therapeutic effects of new agents such as arsenicals and novel synthetic retinoids; characterization of APL heterogeneity at the morphological, cytogenetic and immunophenotypic level. The updated results of large cooperative clinical trials using variable combinations of all-trans retinoic acid (ATRA) and chemotherapy were presented by the respective group chairmen, and formed the 'core' part of the meeting. These studies, which in most cases integrated the molecular assessment of response to treatment, provided a stimulating framework for an intense debate on the most appropriate frontline treatment options to be adopted in the future. The last day was dedicated to special entities such as APL in the elderly and in the child, as well as the role of bone marrow transplantation. The prognostic value of molecular monitoring studies was also discussed in the final session of the meeting. In this article, we review the major advances and controversial issues in APL biology and treatment discussed in this symposium and emerging from very recent publications. We would like to credit the successful outcome of this meeting to the active and generous input of all invited speakers and to participants from all over the world who provided constructive and fruitful discussions
Enoxiparin effects depend on body-weight and current doses my be inadequate in obese patients
No full textAcute promyelocytic leukemia: clinical and morphologic features and prognostic factors
No full textThe most impressive clinical feature of acute promyelocytic leukemia (APL) at diagnosis is the presence in 80% to 90% of patients of a severe hemorrhagic syndrome. Recent data favor a fibrinolytic/proteolytic process rather than a disseminated intravascular coagulation as the mechanism mainly responsible for the hemorrhagic diathesis in APL. Morphologically, two main cytologic variants have been Identified: the classical hypergranular APL (M3), which represents the great majority of all APL, and the microgranular variant (M3v), which accounts for about 15% to 20% of all APL. A rare basophilic variant has also been described. With regard to prognosis, it has markedly changed from that of a rapidly fatal acute leukemia to that of a highly curable disease. This revolutionary progress was mainly due to the introduction during the 1990s of all-trans retinoic acid (ATRA) for the treatment of this disease. After the introduction of ATRA, in addition to clinical features such as hyperleukocytosis (white blood cell count > 10 x 10(9)/L) or thrombocytopenia (platelet count < 10 x 10(3)/L) at presentation, immunophenotype markers and polymerase chain reaction status for promyelocytic leukemia/retinoic acid receptor-alpha during follow-up also had an impact on prognosis
Advances in the understanding and management of acute promyelocytic leukemia
No full textConsiderable progress has been made over the past decade in the understanding and management of acute promyelocytic leukemia (APL). At the laboratory level, molecular mechanisms underlying the arrest of differentiation that typically features in this malignancy, have been clarified and currently provide important models for addressing future investigation aimed at releasing the maturation block in other malignancies. In the clinic, advances in the management of APL have converted this rapidly fatal disease into the most frequently curable leukemia in adults. Use of retinoids in combinatorial protocols with anthracycline-based chemotherapy for front line treatment currently results in long-term survival and potential cure in at least 60% of newly diagnosed patients. Even after relapse, the disease is still curable in a high percentage of cases by various approaches including combinations of chemotherapy, retinoids, arsenic trioxide, stem cell transplantation and antibody-targeted chemotherapy. Genetic testing for identification of the disease-specific gene rearrangement and monitoring of residual disease have proved critical in establishing correct diagnosis and better evaluate the response to therapy at the molecular level. Current 'hot' issues for clinical investigation include: (i) better understanding and management of the severe coagulopathy present at diagnosis in most patients; (ii) the definition of risk categories to improve identification of patients at highest risk of relapse and (iii) the translation of successful differentiation therapy to other leukemia subsets
- …
