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Rosenkilde Wyatt posted an update 6 months, 1 week ago
Liver and kidney are strictly connected in a reciprocal manner, in both the physiological and pathological condition. The Italian Association for the Study of Liver, in collaboration with the Italian Society of Nephrology, with this position paper aims to provide an up-to-date overview on the principal relationships between these two important organs. A panel of well-recognized international expert hepatologists and nephrologists identified five relevant topics 1) The diagnosis of kidney damage in patients with chronic liver disease; 2) Acute kidney injury in liver cirrhosis; 3) Association between chronic liver disease and chronic kidney disease; 4) Kidney damage according to different etiology of liver disease; 5) Polycystic kidney and liver disease. The discussion process started with a review of the literature relating to each of the five major topics and clinical questions and related statements were subsequently formulated. The quality of evidence and strength of recommendations were graded according to the GRADE system. The statements presented here highlight the importance of strong collaboration between hepatologists and nephrologists for the management of critically ill patients, such as those with combined liver and kidney impairment.Facial nerve iatrogenic injuries are serious and can negatively affect the quality of life of the patients. Due to the properties of the nerve, the complications are devastating involving the aesthetic appearance and the function of the face. Moreover, the multiple branches of the nerve increase the risk of an iatrogenic injury making the detailed knowledge of the anatomical correlations around them critical. In this review, a meticulous analysis was performed including the surgical procedures posing the greater risk of an iatrogenic injury as well as the full description of all the reported anatomical landmarks involving the extracranial course of the facial nerve.Surgical treatment of small renal masses (RMs) is still characterized by a non-negligible rate of benign histology, ultimately resulting in overtreatment. Since the risk of kidney cancer increases with age and the risk of malignancy usually increases with tumor size, we created a model based on patient age, RM size, and their interaction for predicting malignant histology. As male sex is associated with a higher risk of renal malignancy, we also stratified our analyses by sex. We used data for 2252 patients with cT1N0M0 disease (1551 male , 701 female ). On logistic regression, both age and RM size were predictors of malignant histology. For males, the odds ratio (OR) was 1.82 (95% confidence interval 1.78-2.80) for age and 2.04 (95% CI 1.69-2.47) for RM size; for females, the OR was 1.82 (95% CI 1.78-2.80) for age and 2.04 (95% CI 1.69-2.47) for RM size (all p ≤ 0.007), with a significant continuous-by-continuous interaction between them (p less then 0.001) in both models. On decision curve analysis, the model demonstrated clinical utility for predicting malignancy at a probability of less then 55% for males and less then 60% for females. Individuals with lower probability should be considered for renal biopsy and those with higher probability for upfront surgery. The model was also more informative than RM size alone in predicting malignancy, which currently represents the only absolute criterion for active surveillance eligibility. PATIENT SUMMARY In this study we analyzed the correlation between age and tumor size for predicting tumor malignancy. The aim in management is to balance the utility of performing a biopsy and the appropriateness of upfront surgery against the ultimate goal of decreasing overtreatment.
Thrombocytopenia is a common perioperative clinical problem and preoperative platelet transfusion prior to surgery is standard practice. Recent platelet trials and literature reviews have found no association between platelet count and bleeding incidence except when platelet count is extremely low. Amcenestrant order Our aim was to evaluate the bleeding risk and the overall platelet transfusion management among pediatric patients with severe thrombocytopenia based on whether they were preoperatively transfused versus transfused at time of incision.
This is a retrospective analysis of pediatric patients with a platelet count ≤50×10
/L in the 12h prior to surgery at a single tertiary pediatric hospital from 2011 to 2016. Eligible patients were ≤21 years old. Patients with necrotizing enterocolitis and neonates were excluded. The primary outcome was postoperative bleeding complications. Additional outcomes were preoperative platelet change and weight adjusted transfusion volumes.
A total of 37 patients were included in this analysis of which 29 (78%) received preoperative platelet transfusions within 12h prior to surgery. No postoperative bleeding complications occurred 30 days after operation, regardless of preoperative transfusion status. There was no significant difference in platelet change by preoperative transfusion status and preoperative transfusion volume was a poor predictor of change in preoperative platelet count (crude r
=0.19, age/gender adjusted r
=0.48).
Patients transfused at time of surgical procedure did not have an increased risk of bleeding over those preoperatively transfused. This finding is in agreement with previous studies in adult populations, supporting the safety of deferring platelet transfusions until the time of incision for thrombocytopenic pediatric surgical patients.
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Prasugrel inhibits platelet aggregation more potently than clopidogrel. In the global phase III trial, prasugrel reduced the incidence of ischemic events but involved a higher risk of hemorrhage than clopidogrel in patients with acute coronary syndromes who were scheduled to undergo percutaneous coronary intervention (PCI). In the Japanese phase III trial for similar patients wherein the prasugrel dose regimen was adjusted (LD/MD, 20/3.75 mg), the efficacy of prasugrel and clopidogrel were comparable to that in the global trial; however, the safety could not be determined due to limited power. Given the strict enrollment criteria, the results of the Japanese phase III trial may not be applicable to routine clinical practice. We compared the safety and effectiveness of prasugrel and clopidogrel in the real-world setting in Japanese patients.
With an analysis of a large claims database prepared during the post-marketing stages in Japan, we identified patients undergoing PCI and compared the incidence of bleeding and ischemic coronary events between patients who received prasugrel and those receiving clopidogrel.
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