Therapeutic Anticoagulation in Patients with Primary Brain Tumors or Secondary Brain Metastasis
AbstractPatients with primary or metastatic brain tumors are at increased risk of developing venous thromboses. However, the potential benefit of therapeutic anticoagulation in these patients must be weighed against the deadly complication of intracranial hemorrhage. In this review, we summarize available evidence and recent studies of intracranial bleeding risks in primary and metastatic tumors and the impact of therapeutic anticoagulation. We find that for the majority of primary and treated metastatic brain tumors, the risk of spontaneous bleeding is acceptable and not further increased by careful therapeutic anticoagulation with low molecular weight heparin or direct oral anticoagulants, although thrombocytopenia (platelet count less than 50,000/μL) and other coagulopathies are relative contraindications. Patients with brain metastasis from melanoma, renal cell carcinoma, choriocarcinoma, thyroid carcinoma, and hepatocellular carcinoma have a higher tendency to bleed spontaneously than noted in patients with other malignancies, and thus warrant routine brain imaging and alternative strategies such as inferior vena cava filter placement in the acute setting of venous thromboembolism before consideration of therapeutic anticoagulation.Implications for Practice.Malignant gliomas are associated with increased risks of both venous thromboses and intracranial hemorrhage, but the additional bleeding risk associated with therapeutic anticoagulation appears acceptable, especial...
Worldwide use of pneumococcal conjugate vaccines (PCVs) had reduced the incidence of pneumonia and invasive pneumococcal disease (IPD) in children.1,2 Despite increasing vaccine coverage and a reduction in the prevalence of IPD, Streptococcus pneumoniae remains a significant cause of non-Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (HUS) in children.3 HUS is characterized by the presence of the clinical triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury.
Uterine fibroids (leiomyoma) are benign monoclonal neoplasms of the myometrium and represent the most common tumors in women worldwide. Tumors occur in ∼77% of women overall and are clinically manifest in ∼25% by age 45 years. Although benign, these tumors are nonetheless associated with significant morbidity; they are the primary indication for hysterectomy, and a major source of gynecologic and reproductive dysfunction, ranging from profuse m enstrual bleeding and pelvic pain to infertility, recurrent miscarriage, and preterm labor.
Authors: Bilkhu R, Billè A Abstract The coronavirus 2019 (COVID-19) pandemic has caused significant mortality around the world and the focus has been on reducing the number of infections. In order not to compromise treatment of oncology patients, reducing the number of patients with COVID-19 undergoing treatment is mandatory. We reviewed the experience of the National Institute of Cancer in Milan and compared it with our experience. PMID: 32462984 [PubMed - as supplied by publisher]
Conclusion: Adding a BM-TT to FIT-screening considerably reduces colonoscopy burden, but could also decrease screening effectiveness. Combining FIT15 with a high polyp sensitivity BM-TT seems most promising. PMID: 32462913 [PubMed - as supplied by publisher]
Publication date: Available online 29 May 2020Source: International Journal of Surgery Case ReportsAuthor(s): María José Gómez-Jurado, Anna Curell, Rocío Martín, Amador García Ruiz-de-Gordejuela, Manel Armengol Carrasco
SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA
This issue of the Surgical Oncology Clinics of North America is devoted to covering the important topic of melanoma. The incidence of primary cutaneous melanoma continues to increase each year. While melanoma accounts for the majority of skin cancer –related deaths, surgical treatment of early disease can be curative. Over the last decade, there have been marked changes in the surgical and systemic treatment of melanoma. For example, within the surgical field, there have been multiple prospective randomized clinical trials to define the exten t of surgery with important changes to how the nodal basin should be managed and staged.
The management of melanoma has undergone a radical transformation over the past decade. Beginning with the publication of the Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1) in 2006 and most recently with the results of the MSLT-2 trial in 2017, the surgical management of patients with this disease has evolved at a remarkable pace. In addition, substantial improvements in systemic therapy have prompted an exploration of neoadjuvant approaches, combination therapy, and many other attractive therapeutic endeavors.
With the universal adoption of immune checkpoint blockade and agents targeting BRAF-mutated melanomas in the metastatic setting, numerous clinical trials have evaluated these agents in the neoadjuvant setting. These smaller trials have shown promising results with high pathologic response rates and acceptable safety. Larger prospective randomized trials are under way to determine if all patients with resectable metastatic disease should be receiving neoadjuvant therapy.
We describe lesions ranging from the potentially benign to the likely malignant. Correctly identifying features associated with higher-risk lesions has proven challenging given the overall good prognosis and low rate of events. An appropriate treatment plan generally requires discussion between the surgeon and an experienced dermatopathologist. When clinically indicated, additional testing may be used to further support or refute a diagnosis of melanoma. The indications for these techniques, the data to support their use, and the strengths and weakness of each are reviewed.
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