ABSTRACT
BACKGROUND: Endoscopic band ligation (EBL) is used for primary (PP) and secondary prophylaxis (SP) of variceal bleeding. Current guidelines recommend combined use of non-selective beta-blockers (NSBBs) and EBL for SP, while in PP either NSBB or EBL should be used. AIM: To assess (re-)bleeding rates and mortality in cirrhotic patients receiving EBL for PP or SP for variceal bleeding. METHODS: (Re-)bleeding rates and mortality were retrospectively assessed with and without concomitant NSBB therapy after first EBL in PP and SP. RESULTS: Seven hundred and sixty-six patients with oesophageal varices underwent EBL from 01/2005 to 06/2015. Among the 284 patients undergoing EBL for PP, n = 101 (35.6%) received EBL only, while n = 180 (63.4%) received EBL + NSBBs. In 482 patients on SP, n = 163 (33.8%) received EBL only, while n = 299 (62%) received EBL + NSBBs. In PP, concomitant NSBB therapy neither decreased bleeding rates (log-rank: P = 0.353) nor mortality (log-rank: P = 0.497) as compared to EBL alone. In SP, similar re-bleeding rates were documented in EBL + NSBB vs EBL alone (log-rank: P = 0.247). However, EBL + NSBB resulted in a significantly lower mortality rate (log-rank: P<0.001). A decreased risk of death with EBL + NSBB in SP (hazard ratio, HR: 0.50; P<0.001) but not of rebleeding, transplantation or further decompensation was confirmed by competing risk analysis. Overall NSBB intake reduced 6-months mortality (HR: 0.53, P = 0.008) in SP, which was most pronounced in patients without severe/refractory ascites (HR: 0.37; P = 0.001) but not observed in patients with severe/refractory ascites (HR: 0.80; P = 0.567). CONCLUSIONS: EBL alone seems sufficient for PP of variceal bleeding. In SP, the addition of NSBB to EBL was associated with an improved survival within the first 6 months after EBL.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Endoscopy, Gastrointestinal/methods , Esophageal and Gastric Varices/mortality , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/mortality , Gastrointestinal Hemorrhage/therapy , Adult , Aged , Chemoprevention/methods , Combined Modality Therapy , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/drug therapy , Female , Gastrointestinal Hemorrhage/drug therapy , Gastrointestinal Hemorrhage/etiology , Humans , Ligation , Liver Cirrhosis/drug therapy , Middle Aged , Primary Prevention/methods , Retrospective Studies , Secondary Prevention/methods , Survival Analysis , Treatment OutcomeABSTRACT
Umbilical vessel catheterization is common practice for infants in the neonatal intensive care unit (NICU). Umbilical venous catheters (UVC) although very useful as a means of obtaining vascular access, do not come without risks. Here we will describe three separate cases of infants in the NICU who, during their course of treatment, were found to have hepatic masses attributed to UVC misplacement. Two of the cases presented incidentally and one presented acutely. We believe liver hematomas may be a more common complication of malpositioned UVCs than previously believed. An appreciation of the complications of malpositioned UVCs should alert clinicians to screen for potential complications and to ensure ideal line placement.
Subject(s)
Catheterization/adverse effects , Catheters, Indwelling/adverse effects , Hematoma/diagnostic imaging , Hepatomegaly/diagnostic imaging , Liver/injuries , Umbilical Veins/diagnostic imaging , Abdomen/diagnostic imaging , Catheterization/standards , Clinical Competence , Female , Hematoma/etiology , Hematoma/prevention & control , Hepatomegaly/etiology , Humans , Infant, Newborn , Intensive Care, Neonatal , Liver/diagnostic imaging , Male , Practice Guidelines as Topic , Ultrasonography , Umbilical Veins/injuriesABSTRACT
BACKGROUND: Patients with metastatic breast cancer (MBC) overexpressing HER2 (human epidermal growth factor receptor 2) are currently selected for treatment with trastuzumab, but not all patients respond. PATIENTS AND METHODS: Using a novel assay, HER2 protein expression (H2T) was measured in formalin-fixed, paraffin-embedded primary breast tumors from 98 women treated with trastuzumab-based therapy for MBC. Using subpopulation treatment effect pattern plots, the population was divided into H2T low (H2T < 13.8), H2T high (H2T ≥ 68.5), and H2T intermediate (13.8 ≤ H2T < 68.5) subgroups. Kaplan-Meier (KM) analyses were carried out comparing the groups for time to progression (TTP) and overall survival (OS). Cox multivariate analyses were carried out to identify correlates of clinical outcome. Bootstrapping analyses were carried out to test the robustness of the results. RESULTS: TTP improved with increasing H2T until, at the highest levels of H2T, an abrupt decrease in the TTP was observed. KM analyses demonstrated that patients with H2T low tumors [median TTP 4.2 months, hazard ratio (HR) = 3.7, P < 0.0001] or H2T high tumors (median TTP 4.6 months, HR = 2.7, P = 0.008) had significantly shorter TTP than patients whose tumors were H2T intermediate (median TTP 12 months). OS analyses yielded similar results. CONCLUSIONS: MBC patients with very high levels of H2T may represent a subgroup with de novo resistance to trastuzumab. These results are preliminary and require confirmation in larger controlled clinical cohorts.
