ABSTRACT
BACKGROUND: Patients with cancer who have thrombocytopenia may experience acute coronary syndromes (ACS), and the use of aspirin (ASA) poses an increased risk of bleeding. The purpose of this study was to test the hypothesis that the benefit of ASA therapy in the treatment of ACS would extend to cancer patients with thrombocytopenia and outweigh the risks of severe bleeding. METHODS: The records of all cancer patients diagnosed with an ACS in 2001 and referred for cardiology consultation were reviewed. Patients were divided into 2 groups on the basis of platelet count, >100 cells k/microL and < or = 100 cells k/microL. Data were collected on the use of ASA therapy, bleeding complications, and survival rates. The authors assessed group differences by using the Wilcoxon rank sum test or 2-tailed Fisher exact test, as appropriate. Univariate and multivariate logistic regression models were used to assess factors potentially associated with 7-day survival. RESULTS: In cancer patients with ACS and thrombocytopenia, those who did not receive ASA had a 7-day survival rate of 6% compared with 90% in those who did receive ASA (P < .0001). There were no severe bleeding complications. Patients with a platelet count (>100 cells k/microL) who received ASA had a 7-day survival rate of 88% compared with 45% in those who did not receive ASA (P = .0096). CONCLUSIONS: Therapy with ASA was associated with a significantly improved 7-day survival after ACS in cancer patients, with or without thrombocytopenia, and not associated with more severe bleeding.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Aspirin/therapeutic use , Coronary Disease/prevention & control , Myocardial Infarction/prevention & control , Neoplasms/complications , Thrombocytopenia/prevention & control , Acute Disease , Aged , Coronary Disease/drug therapy , Coronary Disease/etiology , Female , Hemorrhage/complications , Humans , Male , Medical Records , Myocardial Infarction/drug therapy , Myocardial Infarction/etiology , Outcome Assessment, Health Care , Platelet Count , Retrospective Studies , Survival Rate , Thrombocytopenia/drug therapy , Thrombocytopenia/etiologyABSTRACT
Changes in the expression of glial glutamate transporters (GLAST and GLT-1) were examined in the spinal cord of rats with chemotherapy (taxol)-induced mechanical hyperalgesia. Immunohistochemical studies show that the expression of both GLAST and GLT-1 in the L4-L5 spinal dorsal horn is decreased by 24% (P<0.001) and 23% (P<0.001), respectively, in rats with taxol-induced hyperalgesia as compared with those in control rats. These changes were further confirmed using an enzyme-linked immunosorbent assay that confirmed downregulation of GLAST by 36% (P<0.05) and GLT-1 by 18% (P<0.05) in the L4-L5 spinal cord of taxol-treated rats. These data indicate that downregulation of glutamate transporters may contribute to the development of hyperalgesia induced by taxol and suggest that glutamate transporters may be a new target for treatment of pain.
Subject(s)
Amino Acid Transport System X-AG/metabolism , Excitatory Amino Acid Transporter 2/metabolism , Hyperalgesia/metabolism , Paclitaxel , Peripheral Nervous System Diseases/metabolism , Posterior Horn Cells/metabolism , Symporters/metabolism , Amino Acid Transport System X-AG/drug effects , Animals , Antineoplastic Agents, Phytogenic , Cell Communication/drug effects , Cell Communication/physiology , Disease Models, Animal , Down-Regulation/drug effects , Down-Regulation/physiology , Excitatory Amino Acid Transporter 1 , Excitatory Amino Acid Transporter 2/drug effects , Glutamate Plasma Membrane Transport Proteins , Glutamic Acid/metabolism , Hyperalgesia/chemically induced , Hyperalgesia/physiopathology , Male , Neuroglia/drug effects , Neuroglia/metabolism , Nociceptors/drug effects , Nociceptors/metabolism , Peripheral Nervous System Diseases/chemically induced , Peripheral Nervous System Diseases/physiopathology , Posterior Horn Cells/drug effects , Presynaptic Terminals/drug effects , Presynaptic Terminals/metabolism , Rats , Rats, Sprague-Dawley , Symporters/drug effects , Synaptic Transmission/drug effects , Synaptic Transmission/physiologyABSTRACT
Most ICU patients have a significant number of risk factors for VTE. The high incidence of DVT in the ICU population and the recognition of a high incidence of PE at autopsy confirm this. We have alluded to the difficulty of clinical diagnosis of VTE and the need for diagnostic investigations. We have reviewed currently available diagnostic investigations with regard to their sensitivity and specificity and their practicability in ICU patients, and have formulated recommended diagnostic algorithms (Figs. 4 and 5). The most important factor in the management of VTE is prevention. In the ICU, all patients are at high risk for VTE, and therefore, at a minimum should receive subcutaneous prophylactic heparin unless it is contraindicated. Alternative methods of prophylaxis are available, and should be considered for patients who have contraindications to heparin.
Subject(s)
Anticoagulants/therapeutic use , Critical Care , Intensive Care Units , Venous Thrombosis , Humans , Risk Factors , Venous Thrombosis/drug therapy , Venous Thrombosis/physiopathology , Venous Thrombosis/prevention & controlABSTRACT
OBJECTIVE: To review outcome and cardiovascular and respiratory function after initiation of differential lung ventilation for acute severe native lung hyperinflation in patients who have had a single-lung transplant for end-stage emphysema. DESIGN: Retrospective review. SETTING: Cardiothoracic tertiary referral center. PARTICIPANTS: Thirteen patients who had differential lung ventilation for acute severe native lung hyperinflation, of a total of 132 patients who had a single-lung transplant for end-stage emphysema between 1988 and the end of 2000. INTERVENTIONS: None. measurements and main results: Thirteen patients had differential lung ventilation for acute severe native lung hyperinflation; 7 survived to 1 year after transplant. There was a highly significant (p = 0.0006) improvement in mean PaO(2) from 8.23 (95% confidence interval [CI], 6.15 to 10.3) to 16.6 (95% CI, 12.84 to 20.45) 1 hour after start of differential lung ventilation. The average ratio of estimated dynamic compliance in the native lung compared with the transplanted (donor) lung was 2.69 (95% CI, 1.75 to 3.62). CONCLUSION: In addition to previous case reports, this series shows that differential lung ventilation is an appropriate treatment for acute severe native lung hyperinflation. A difference in estimated effective dynamic compliance of > or = 2.69 between native and transplanted lung may require differential lung ventilation.