Prevalence and prognostic value of D-dimer elevation in patients with AL amyloidosis.

Light chain (AL) amyloidosis is a protein folding disorder that can affect many different organ systems, in addition to the coagulation pathway. D-dimer, a measurement of fibrin degradation, is commonly elevated in hematologic malignancies, but the prevalence and significance of D-dimer elevation in AL amyloidosis is unknown. We conducted an analysis of 921 patients with AL amyloidosis that presented to the Boston University Amyloidosis Center.

Evaluation of a new continuous mononuclear cell collection procedure in a single transplant center cohort enriched for AL amyloidosis patients.

Background: The Spectra Optia continuous mononuclear cell (CMNC) program is newly available, and herein validated in a single-center cohort enriched with AL amyloidosis patients to collect a target CD34+ yield of 2.5 × 10 cells/kg within 2 days.

Methods: Consecutive autologous transplant patients in 2016 are included.

Intermittent Dosing of Dabrafenib and Trametinib in Metastatic BRAF Mutated Papillary Thyroid Cancer: Two Case Reports.

Background: A multi-institutional, randomized phase II trial of continuous dosing of dabrafenib with or without trametinib is ongoing in metastatic thyroid cancer. Preclinical evidence and emerging clinical experience in other cancers support evaluating intermittent dosing of these two agents to achieve more durable response, while being better tolerated and more cost effective.

Patients: Two consecutive patients with symptomatic, metastatic radioactive iodine-resistant BRAF mutated papillary thyroid cancer and poor performance status were treated initially with dabrafenib 150 mg twice daily plus trametinib 2 mg once daily, first in continuous daily dosing, then in a five-week-on and three-week-off schedule.

A Woman in Her 40s With Headache and New-Onset Seizures.

A woman in her 40s with a history of plasma cell leukemia presented with 1 month of intermittent headaches followed by a seizure. Results from laboratory studies were notable for a cerebrospinal fluid opening pressure of 28 mm H2O and 8 white blood cells, including 1 atypical plasma cell. Imaging studies revealed confluent bifrontal white matter fluid-attenuated inversion recovery hyperintensities, as well as a contrast-enhancing sellar lesion.

Management of anticoagulants in the periprocedural period for patients with cancer.

Patients with cancer undergo surgeries and procedures for various purposes, including prophylaxis, diagnosis, staging, cure, debulking, palliation, and reconstruction. The diagnosis of cancer itself, along with the well-established complication of venous thromboembolism (VTE), places these patients at risk for perioperative thromboembolism. It is also well-established that continuing patients on oral anticoagulation therapy during the periprocedural period is associated with an increased risk of bleeding.

A new paradigm shift in antithrombotic therapy.

Decades after the introduction of oral anti-coagulants namely the vitamin K antagonist (VKA) Warfarin and antiplatelet agents such as Aspirin and Plavix, new classes of direct, small molecule, novel oral anti-coagulant medications and antiplatelet P2Y12 receptor inhibitors have recently become available. For the novel oral anticoagulants (NOAC), these agents can be separated by direct thrombin inhibitors such as Dabigatran and direct Factor Xa inhibitors such as Rivaroxaban and Apixaban. For next generation antiplatelet agents such as Ticagrelor and Prasugrel, these new P2Y12 receptor inhibitors form the cornerstone of therapy for patients with acute coronary syndrome (ACS) or undergoing percutaneous interventions.

Risk factors and comorbidities associated with obesity in children and adolescents after the arterial switch operation and Ross procedure.

Background: Over 25% of patients with congenital heart disease are obese (OB) or overweight (OW). Unique factors such as activity restriction and early feeding practices may play a role. We evaluated a high-risk cohort predisposed to early coronary artery disease due to past surgery involving coronary artery reimplantation.

Accuracy of intraoperative transesophageal echocardiography in the prediction of future neo-aortic valve function after the Ross procedure in children and young adults.

Objective: Neo-aortic insufficiency (neo-AI) has been noted following the Ross procedure. The purpose of this study was to evaluate the ability of intraoperative transesophageal echocardiography (TEE) to predict future neo-AI in pediatric patients undergoing the Ross from January 1995 to December 2003, who had an intraoperative TEE, and discharge and follow-up transthoracic (TTE) echocardiograms.

Design: Retrospective case series.