Expert Consensus on the Incorporation of Anti-CD38 Monoclonal Antibody Therapy Into the Management of Newly Diagnosed Multiple Myeloma.

Introduction: Multiple myeloma is a hematologic malignancy that is typically associated with recurrent relapses. There are numerous frontline treatment regimens that are highly effective for individual patients. The introduction of anti-CD38 monoclonal antibody therapy has shifted treatment decision-making in this setting, with many centers now considering the use of daratumumab as part of initial therapy regardless of patient eligibility for autologous stem cell transplantation (ASCT).

Muscular responses to testosterone replacement vary by administration route: a systematic review and meta-analysis.

Background: Inconsistent fat-free mass (FFM) and muscle strength responses have been reported in randomized clinical trials (RCTs) administering testosterone replacement therapy (TRT) to middle-aged and older men. Our objective was to conduct a meta-analysis to determine whether TRT improves FFM and muscle strength in middle-aged and older men and whether the muscular responses vary by TRT administration route.

Methods: Systematic literature searches of MEDLINE/PubMed and the Cochrane Library were conducted from inception through 31 March 2017 to identify double-blind RCTs that compared intramuscular or transdermal TRT vs.

Practice gaps and barriers to optimal care of hematologic malignancies in the United States.

Background: Treating patients with hematologic malignancies can be challenging for physicians because of the rapidly evolving standards of care and relatively low incidence of these diseases.

Objective: To identify clinical challenges among hematologists and medical oncologists regarding the provision of care to patients with chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), or B-cell lymphomas. Methods Hematologists and medical oncologists in active practice in the United States and who have a case load of ≥ 1 patient a year with CML, ALL, or B-cell lymphoma were recruited.

Impact of an Interactive On-line Tool on Therapeutic Decision-Making for Patients with Advanced Non-Small-Cell Lung Cancer.

Background: Treatment guidelines provide recommendations but cannot account for the wide variability in patient-tumor characteristics in individual patients. We developed an on-line interactive decision tool to provide expert recommendations for specific patient scenarios in the first-line and maintenance settings for advanced non-small-cell lung cancer. We sought to determine how providing expert feedback would influence clinical decision-making.

Practice challenges affecting optimal care as identifed by US medical oncologists who treat renal cell carcinomas.

Background: Approval of new agents provides alternative treatment options for medical oncologists and their patients with renal cell carcinoma (RCC). Treatment decisions remain challenging in the absence of clear evidence supporting optimal selection and sequencing of treatment for different patient or tumor characteristics.

Objective: To assess the clinical practice gaps of medical oncologists treating patients with RCC.

Superficial venous aneurysms of the small saphenous vein.

Historically, superficial venous aneurysms of the lower extremities are considered rare. However, owing to the increased use of duplex ultrasound imaging, these entities are being recognized more frequently. The clinical significance of superficial aneurysms is poorly defined; yet, pulmonary emboli arising from superficial aneurysms have been reported.

Development and implementation of endovascular capabilities in wartime.

Background: Endovascular techniques are widespread in the management of civilian trauma and provide standard treatment for select injuries. Despite the commonality of this less invasive technology, there have been no reports on its use in wartime. The objective of this study was to describe the implementation of endovascular capability at a level III surgical facility in Iraq and illustrate the effectiveness of catheter-based techniques.

Penetrating femoropopliteal injury during modern warfare: experience of the Balad Vascular Registry.

Objective: Wounding patterns, methods of repair, and outcomes from femoropopliteal injury have been documented in recent civilian literature. In Operation Iraqi Freedom, as in past conflicts, these injuries continue to be a therapeutic challenge. Therefore, the objective of the current study is to document the pattern of femoropopliteal injuries, methods of repair, and early outcomes during the current military campaign in Iraq.

The complete management of extremity vascular injury in a local population: a wartime report from the 332nd Expeditionary Medical Group/Air Force Theater Hospital, Balad Air Base, Iraq.

Background: Although the management of vascular injury in coalition forces during Operation Iraqi Freedom has been described, there are no reports on the in-theater treatment of wartime vascular injury in the local population. This study reports the complete management of extremity vascular injury in a local wartime population and illustrates the unique aspects of this cohort and management strategy.

Methods: From September 1, 2004, to August 31, 2006, all vascular injuries treated at the Air Force Theater Hospital (AFTH) in Balad, Iraq, were registered.

In-theater management of vascular injury: 2 years of the Balad Vascular Registry.

Background: Wartime vascular injury management has traditionally advanced vascular surgery. Despite past military experience, and recent civilian publications, there are no reports detailing current in-theater treatment. The objective of this analysis is to describe the management of vascular injury at the central echelon III surgical facility in Iraq, and to place this experience in perspective with past conflicts.

Limb ischemia associated with persistent sciatic artery aneurysms-a report of 2 cases.

Persistent sciatic artery (PSA) is a rare developmental anomaly, usually associated with iliofemoral hypoplasia and dependence on the sciatic artery as the dominant inflow to the lower extremity. Although rare, this anomaly is associated with a very high rate of aneurysm formation and frequent thromboembolic complications presenting as lower extremity ischemia, and requires familiarity on the part of the vascular surgeon to properly diagnose the disorder and plan therapy. The authors present 2 cases of PSA presenting with lower extremity ischemia and review the pathophysiology, diagnosis, and treatment of this rare but important anomaly.

Critical appraisal of cardiac risk stratification before elective vascular surgery.

This study was undertaken to evaluate the efficacy of the cardiac risk stratification protocol proposed by the American College of Cardiology/American Heart Association (ACC/AHA) in predicting cardiac morbidity and mortality associated with elective, major arterial surgery. Cardiac risk stratification using ACC/AHA guidelines was done on 425 consecutive patients before 481 elective cerebrovascular (n = 146), aortic/inflow (n = 166), or infrainguinal (n = 169) procedures at an academic Veterans Affairs Medical Center. Cardiac risk was stratified as low, intermediate, or high based on clinical risk factors, such as, Eagle criteria, history of cardiac intervention, patient functional status, results of noninvasive cardiac stress testing, and coronary angiography with coronary revascularization performed when appropriate.

The effects of dichloroacetate in a rabbit model of acute hind-limb ischemia and reperfusion.

Background: Dichloroacetate (DCA) is a drug that allows pyruvate dehydrogenase to remain active under anaerobic conditions by inhibiting the inactivating enzyme, pyruvate dehydrogenase kinase. We hypothesize that the administration of DCA during acute limb ischemia may have a beneficial effect by reducing the severity of anaerobic metabolism and lessening the irreversible injury.

Study Design: We studied a rabbit model using unilateral ligation of the iliac artery or femoral artery to evaluate two degrees of ischemia.

Outcome of carotid stent-assisted angioplasty versus open surgical repair of recurrent carotid stenosis.

Purpose: We compared outcome and durability of carotid stent-assisted angioplasty (CAS) with open surgical repair (ie, repeat carotid endarterectomy [CEA]) to treat recurrent carotid stenosis (RCS).

Methods: A retrospective review of anatomic and neurologic outcomes was carried out after 27 repeat CEA procedures (1993-2002) and 52 CAS procedures (1997-2002) performed to treat high-grade internal carotid artery (ICA) RCS after CEA. The incidence of intervention because of symptomatic RCS was similar (repeat CEA, 63%; CAS, 60%), but the interval from primary CEA to repeat intervention was greater (P <.

Successful management of long-term general anesthesia in rabbits used as an animal model of human disease.

The rabbit represents a popular animal model for basic science research, but projects requiring anesthesia and endotracheal intubation represent a technical challenge because of the difficulty in accessing the animal's airway and sensitivity to common anesthetic agents. We hypothesized that transoral intubation under direct visualization with guidewire assistance would improve airway access success and reduce perioperative mortality in the rabbit. Of the 39 New Zealand White rabbits that had passive inhalation anesthesia and were intubated using wire-guided assistance under direct laryngeal visualization, 33 were intubated using a flexible wire after the rigid guide had resulted in airway injury in three of the first six rabbits.

Patency of infrarenal aortic side branches determines early aneurysm sac behavior after endovascular repair.

In this study we sought to determine whether initial abdominal aortic aneurysm (AAA) sac anatomy, morphology, and side branch patency influence changes in aneurysm size and development of endoleak following endovascular repair. A blinded, retrospective review of preintervention CT scans and angiograms was conducted on 70 consecutive patients treated for infrarenal AAA (mean size 6.0 +/- 0.

Duplex selection facilitates single point-of-service endovascular and surgical management of aortoiliac occlusive disease.

We attempted to optimize management of aortoiliac occlusive disease by using duplex imaging to aid in selection of favorable lesions for percutaneous transluminal angioplasty (PTA)/stenting, by avoiding nontherapeutic arteriography, and by providing single point-of-service care in which endovascular and open surgical reconstruction were combined. One-hundred consecutive patients with symptomatic (91 claudication, 9 limb threat) inflow occlusive disease based on clinical examination and physiologic testing underwent physician-directed duplex scanning of the infrarenal aorta through the femoral bifurcation. Iliac lesions suited to endovascular intervention were defined as focal (length <5 CM), high-grade stenoses with a peak velocity >300 cm/sec and velocity ratio >2 by duplex and were differentiated from unfavorable (diffuse/long iliac stenosis, occlusions, aneurysms, femoral occlusive disease) inflow lesions.