Citations

Objective: To review the benefits of adapting the complex techniques of formal lymphedema therapy to the more generalized forms of edema often seen in the chronic disease and palliative care settings. Data Sources: Peer-reviewed literature and clinical practice. Conclusion: Lymphedema treatment modalities have much to offer beyond their well-characterized benefit in classical lymphedema. In modified forms, they may improve and lessen the burden of refractory edema originating from a diverse range of causes. Thoughtful planning and practice, however, are essential as an inadequate adaptation may result in unnecessary effort, injury for the patient, or an unsatisfactory outcome.

ObjectivesTo evaluate risk factors associated with iatrogenic splenectomy during nephrectomy and to assess outcomes among patients undergoing nephrectomy for renal tumors.MethodsOf 4323 patients who underwent nephrectomy at Mayo Clinic between 1992 and 2008, 33 (0.8%) had an iatrogenic/unplanned splenectomy. In a case–control study design, controls without splenectomy were matched 1:3 based on age, sex, surgical date, side of the renal tumor, surgical approach and surgeon. Perioperative features and survival were evaluated using conditional logistic and Cox regression.ResultsAmong the 33 iatrogenic splenectomy patients, the majority (94%) underwent radical, open and left‐sided nephrectomy. Primary tumor classification ≥T3 was the only clinicopathological risk factor significantly associated with splenectomy (odds ratio 3.4; P = 0.02). Compared with controls, patients with an iatrogenic splenectomy were more likely to have longer operative time (205 vs 171 min; P = 0.02), higher estimated blood loss (1.3 vs 0.3 L; P = 0.001), longer length of stay (median 7 vs 5 days; P = 0.03) and a higher likelihood for postoperative complications (odds ratio 5.3; P = 0.002). With a median of 9.8 years of follow up, splenectomy patients tended to have greater all‐cause mortality (hazard ratio 1.6; P = 0.07), although this difference approached statistical significance.ConclusionsIatrogenic splenectomy is a rare complication during nephrectomy and is associated with locally advanced tumors (≥pT3). It also carries prognostic significance for adverse perioperative outcomes and possibly diminished survival, although this warrants further study.

The literature on the use of therapeutic apheresis is often criticized for the preponderance of low to very low quality evidence. Shehata et al. examined the apheresis literature published between 1976 and 1999 and found a lack of randomized controlled trials with those identified demonstrating significant limitations. To determine if this has improved, MEDLINE was searched for randomized controlled therapeutic apheresis trials. In addition, the Clinicaltrials.gov database was also searched for actively recruiting randomized controlled therapeutic apheresis trials. The results revealed that the total and average number of publications per year examining therapeutic apheresis has increased substantially in the period 2000–2012 compared to 1976–1999. This was associated with a small increase in the average number of randomized controlled trials reported each year, but these trials represented a smaller percentage of the therapeutic apheresis literature published compared to the 1976–1999 time range. The reported trials continued to have very small numbers of enrolled patients raising questions about their ability to determine whether apheresis represents an effective therapy. Finally, according to the Clinicaltrials.gov database, a small number of randomized controlled trials of therapeutic apheresis are enrolling patients. Despite an increasing emphasis on evidence‐based medicine and the need for quality randomized controlled clinical trials, there is still a lack of such trials when it comes to therapeutic apheresis. There continues to be a need for more and better designed randomized trials in therapeutic apheresis. J. Clin. Apheresis 28:48–55, 2013. © 2013 Wiley Periodicals, Inc.

BackgroundPrevalence and risk factors for focal hemosiderin deposits are important considerations when planning amyloid‐modifying trials for treatment and prevention of Alzheimer's disease (AD).MethodsSubjects were cognitively normal (n = 171), early‐mild cognitive impairment (MCI) (n = 240), late‐MCI (n = 111), and AD (n = 40) from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Microhemorrhages and superficial siderosis were assessed at baseline and on all available MRIs at 3, 6, and 12 months. β‐amyloid load was assessed with 18F‐florbetapir positron emission tomography.ResultsPrevalence of superficial siderosis was 1% and prevalence of microhemorrhages was 25% increasing with age (P < .001) and β‐amyloid load (P < .001). Topographic densities of microhemorrhages were highest in the occipital lobes and lowest in the deep/infratentorial regions. A greater number of microhemorrhages at baseline was associated with a greater annualized rate of additional microhemorrhages by last follow‐up (rank correlation = 0.49; P < .001).ConclusionsFocal hemosiderin deposits are relatively common in the ADNI cohort and are associated with β‐amyloid load.